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Biomedical subjects

J C Shank

Publications and source records attributed to J C Shank.

18 recordsLinked to original sources
PubMed1992

Adherence to screening flexible sigmoidoscopy in asymptomatic patients.

The purpose of this study was to assess patient adherence to physician-recommended screening flexible sigmoidoscopy. In the setting of a family practice residency program, adherence rates in asymptomatic patients (N = 333, age > or = 50 years) were compared among a Usual Care Group; an Intervention Group that received educational materials and a phone reminder; and a Continuity Group, which had longstanding continuity with a single physician. Data from mailed questionnaires (N = 180) were used to examine the associations of demographic factors and attitudes with adherence. Adherence was 30.3% overall, with a nonsignificant increase in the Intervention Group compared with the Usual Care Group. In a pooled analysis of the Usual Care and Continuity Groups, the half of the sample with the highest continuity had a significantly higher adherence rate than the rest of the sample (45%; P < 0.001). In a discriminant analysis (78% correct classification, P < 0.001) two history variables (family history of cancer; family history of colon problems), one measure of continuity (number of physician visits), one demographic variable (lower household income), and two attitudinal factors (perception of how painful flexible sigmoidoscopy would be; perception of how well the physician explained its importance) made statistically significant contributions to the prediction of adherence. Results of the study show that screening flexible sigmoidoscopy is acceptable to asymptomatic patients, and that continuity is likely to have a positive impact on adherence. Because attitudes offer the potential for modification, we suggest that physicians reassure patients that flexible sigmoidoscopy is not unduly painful and discuss with patients individually its importance to their health.

Aged↗
PubMed1992

Physician agreement with US Preventive Services Task Force recommendations.

BACKGROUND: No large-scale work has yet assessed the reactions of physicians to the report of the US Preventive Services Task Force (USPSTF), despite its potential for fostering a consensus among practitioners. This study undertook a survey of family physicians to assess their agreement with the recommendations of the Task Force. METHODS: A survey containing the verbatim summary recommendations of the USPSTF was mailed to all 1784 active members of the Ohio Academy of Family Physicians. RESULTS: No evidence of selection bias was found among the 898 responding physicians. The average physician agreed with 88% of the recommendations. For a number of recommendations, however, particularly those in which the Task Force differed with the American Cancer Society, there was a high level of disagreement. Physician disagreement with the recommendations was associated with older age, not having completed a residency, male sex, less prior exposure to the USPSTF guidelines, and greater perception of the impracticality of applying them. CONCLUSIONS: The high level of agreement with most USPSTF recommendations implies that they represent an emerging consensus about which preventive services should be delivered. Attempts at USPSTF guideline dissemination should focus on recommendations with high agreement. Additional research is needed to assess the reasons for disagreement.

Age Factors↗
PubMed1991

Patient preferences regarding educational pamphlets in the family practice center.

Educational pamphlets are widely used in family practice offices despite few studies on patient attitudes toward this educational technique. The purpose of this study was to: 1) determine how frequently patients perceive that pamphlets are used and how often they are desired; 2) determine what is usually done with pamphlets; and 3) determine patient preferences regarding requesting pamphlets, location of unsolicited pamphlets, techniques of getting pamphlets, and style of pamphlets. In this survey of 360 patients, 90% reported wanting a pamphlet at some or all of their office visits. Overall, 67% reported reading or looking through and saving pamphlets received, 30% read or looked through them and then threw them away, and only 2% threw them away without review. Only 11% of males and 26% of females reported ever asking a doctor for pamphlets. Some conclusions are that: 1) more patients desire pamphlets than are receiving them; 2) most patients do save pamphlets; and 3) patients need encouragement and permission to ask for pamphlets.

Adolescent↗
PubMed1989

Fine-needle breast aspiration biopsy.

Fine-needle aspiration biopsy of breast lesions is a safe, accurate, well-tolerated procedure that can easily be done in the family physician's office. It has a specificity and positive predictive value of virtually 100 percent, a sensitivity of 53 to 99 percent (median of 89 percent), and a negative predictive value of 80 to 99 percent (median of 93 percent). It is limited by the nature of the lesion, which must be easily palpable, the physician's technical ability, and the availability of a reference cytopathologist. Complications are rare and usually very benign, such as local hematoma. With proper training and understanding of the procedure, many family physicians could easily introduce the procedure into their office practice.

Biopsy, Needle↗
PubMed1988

Health screening examinations: the patient's perspective.

Periodic preventive screening programs will require patient cooperation if they are to be successful. To determine the level of patient interest on a broad scale, 1,788 adult patients were surveyed in 47 family physicians' offices over a statewide area. Seventy percent said they had participated in a screening health checkup in the preceding two years. Nine percent of these patients reported discovering a previously unknown condition as a result of their recent screening examination. The majority of surveyed patients said they would agree to be screened or treated with the complete list of eight suggested procedures for men and ten procedures for women. Rates of patient acceptance of specific health maintenance recommendations ranged from a low of 54 percent for influenza immunization to a high of 91 percent for a blood pressure check. Listing typical costs did not alter the selection rates of patients with insurance coverage compared with those without it. The geriatric age group was the least willing to be screened. Seventy-two percent of patients indicated that they wanted to discuss at least one wellness topic with their physician. Overall, most patients are willing to participate in the concept of a periodic health maintenance examination as recommended to them by their physician.

Adult↗
PubMed1979

Chronic and acute disease problems in rural nursing home patients.

The patients of a rural nursing home in Iowa were surveyed according to age and sex, plus chronic and acute disease problems. With the use of the International Classification of Health Problems in Primary Care, the diagnoses were organized by major disease category and by specific diagnosis. Of the 66 patients, 76 percent were age 75 or older. Women comprised 61 percent of the group, and men 39 percent. Overall, the mean age was 79.1 years. Senility was the most common diagnosis for chronic diseases, and genitourinary infections for acute diseases. Circulatory system disorders comprised the largest category of chronic diseases, whereas genitourinary comprised the largest category of acute diseases. Overall, there were 4.2 chronic disorders per patient. Although the data compare favorably with those in the National Health Survey of nursing homes, more research is needed to prepare medical personnel for the problems associated with a rapidly expanding population of elderly patients.

Acute Disease↗
PubMed1979

Emergency room misuse by medical assistance patients in a family practice residency.

Four hundred individual Emergency Room records were retrospectively reviewed. Demographic data, complaint, diagnosis, and treatment were tabulated and analyzed by computer assistance. Judgment was not made regarding the necessity of physician consultation, but whether an Emergency Room visit was warranted considering the duration of the presenting complaint. During a time period when 29 percent of the total outpatient visits to the Family Practice Center Model Office were made by recipients of Medical Assistance, the same population accounted for 53 percent of the Emergency Room visits reviewed. Twenty-five percent of the 400 visits were judged to be unnecessary according to the pre-established criteria. Sixty-four percent of the unnecessary visits were by Medical Assistance patients. Of 304 total families represented, 73 were responsible for multiple visits. Thirty-one percent of these visits were unnecessary, whereas 21 percent of the visits made by families with single visits were unnecessary. In this family practice setting, it is concluded that Medical Assistance patients have a greater tendency toward inappropriate use of the Emergency Room when compared to non-Assistance patients.

Adolescent↗
PubMed1979

Comparative content of three family practice residency programs.

A method of collecting physician-patient encounter data is described and applied to the comparison of the clinical content of residents' experiences in the family practice office. Comparisons were made of over 1,000 consecutive unselected encounters in each of the three family practice residency programs. Considerable differences between the patients encountered by the three programs were observed and between program patients and patients attending family physicians in Iowa. It is important to monitor the demography and diagnostic status of patients attending family practice residency programs to ensure the authenticity of the residents' experience.

Arizona↗
PubMed1978

Pleural effusion.

Pleural effusion unassociated with other radiologic evidence of disease is a challenging diagnostic problem. With small effusion, only silhouetting of the diaphragm may be noted. A lateral decubitus view will often be helpful. After a careful history, physical examination and selected hematologic studies, diagnostic thoracentesis is indicated. The following determinations on the fluid may be useful: color, character, protein, lactic dehydrogenase (LDH), glucose, amylase and cytology. Pleural biopsy may be helpful with tuberculosis and malignancy.

Adult↗
PubMed1978

Hospital problems cared for by one family physician.

Most family physicians provide regular care in the community hospital setting. The North American literature is quite deficient in documenting this aspect of family practice. The purpose of this paper is to present the content of problems cared for in a small community hospital. The study population consisted of all inpatients care for principally by the author during the first year in practice. The hospital is a 100-bed facility in a representative midwestern community of 15,000. Data analyzed included age, sex, discharge diagnoses, and outcome. Diagnoses were coded and organized according to the ICHPPC code. During the one-year study period, 509 hospital problems were cared for. Primary responsibility for 235 hospitalizations was assumed, for an average of 19.6 patients hospitalized per month. The age/sex profile, when corrected for newborns and obstetric patients, showed peaks in the 75+ age category for both sexes. By major ICHPPC category, circulatory system diseases ranked first and respiratory diseases ranked second. Most frequent specific diagnoses were: (1) newborn care, (2) vaginal delivery, (3) congestive heart failure, (4) diabetes, and (5) chronic lung disease. There were eight deaths of 3.4 percent of the hospitalizations.

Adolescent↗
PubMed1977

Streptococcal infection and the chronic carrier state.

Group A beta-hemolytic streptococcal pharyngitis is an extremely common problem for the family physician. Clinical signs are not reliable in making the diagnosis. Infections with few or no symptoms are common. Throat culture is the best aid to diagnosis. One-quarter or more of family contacts harbor the organism. Good mamagement includes accurate bacteriologic diagnosis, adequate use of the appropriate penicillin preparation, repeat cultures, treatment of family members, if indicated, and recognition of the chronic carrier state.

Adolescent↗
PubMed1977

The content of family practice: a family medicine resident's 2 1/2-year experience with the E-book.

The purpose of this paper is to present the content of office family practice problems seen over a 2 1/2-year residency period and to afford comparison with the well-known Virginia Study. It illustrates the usefulness of the diagnostic E-Book, with which all the data were collected and preserved. Over a 2 1/2-year period, the author cared for 592 patients in the family practice office. The ratio of one physician to 592 patients compares to the Virginia Study's one physician to approximately 745 patients. A total of 1,640 problems were coded in the E-Book. In this study 55 problems/physician/month were seen, whereas in the Virginia Study approximately 177 problems/physician/month were noted. Respiratory illnesses were the most common diagnostic category in both studies. Among specific problems, obesity ranked first at Hershey, with afebrile colds second, hypertension and Beta streptococcal pharyngitis third, and smoking fourth. Obesity and smoking were ranked considerably lower in the Virginia Study, whereas "health maintenance examinations" were ranked number one. Finally, for age-sex practice profiles, the present data revealed two peak age groups for both sexes, whereas the Virginia work noted only one peak age range.

Acute Disease↗
PubMed1976

A study of thyroid disease in family practice.

Thyroid disease is relatively common in family practice, yet is often undiagnosed or poorly managed. This study examines several aspects of thyroid disease in a large, semirural family practice setting and exemplifies the type of practical clinical research that can be done in family medicine. An overall prevalence of approximately one percent was determined for thyroid disease in this practice. In a series of 85 patients, the ratio of hypothyroidism:hyperthyroidism:euthyroid goiter was 9:2:1 respectively. Initial signs and symptoms recorded for these patients conformed closely to the findings in other large series. Eighty percent of the patients with idiopathic hypothyroidism never had enlarged glands, whereas 100 percent of the patients with hypothyroidism associated with Hashimoto's thyroiditis had enlarged glands. Laboratory aids such as serum thyroid stimulating hormone (TSH), anti-thyroid antibodies, and radioactive iodine uptake (RAIU) and scans were inadequately utilized. Medical and/or surgical consultation was obtained in 17.5 percent of patients with hypothyroidism, 80 percent of patients with hyperthyroidism, and 63 percent of those with euthyroid goiter. Currently 95 percent of the hypothyroid patients and 100 percent of the hyperthyroid patients are euthyroid.

Adolescent↗
PubMedDate not supplied

An assessment of the effect of "DOC talk" on school children in rural Iowa.

The effectiveness of family physicians as health educators through a community health organization (Doctors Ought To Care/DOC) was studied. Seventh-grade students in a rural school system received a series of uniquely prepared slide presentations (DOC talks) on smoking, alcohol, drug use, and venereal disease to study the effect of such talks on knowledge gain and behavior change. The presentations were made during the semester in which the students were also taking a required health education course. A second group of seventh graders in the same school system did not receive the presentations but had the same health education course and served as the control group. Both groups showed similar gains in knowledge during their semester of health education. However, only the group which received the DOC talks showed a continuation of knowledge gains on a follow-up questionnaire. Also, only the group which saw the presentations showed positive behavior changes including decreased substance use. While aware of the study's methodologic limitations, we believe the results support the value of the community physician presenting DOC talks to supplement the usual school health curriculum.

Adolescent↗
PubMedDate not supplied

A five-year demonstration project associated with improvement in physician health maintenance behavior.

The purpose of this demonstration project was to evaluate the effect of a sustained preventive medicine emphasis in a community hospital based family practice residency. A simplified, visually tolerable, and prominent "health maintenance guide" served as the cornerstone of the overall residency educational effort. Screening interventions and intervals were based on the major published recommendations at the initiation of the project. An audit of 100 random adult patient charts was done at baseline and yearly for five years. Physicians received both group and individual feedback regarding screening compliance on a regular basis. Overall physician compliance with screening for six basic parameters improved from 71% to 85% (P less than .0005). Physicians behavior improved significantly in recording or recommending blood pressure, physician breast exam, personal life change, tetanus/diphtheria immunization, mammography, breast self-examination, testicular self-examination, and a prudent diet. Physician use of the guide as a recording device steadily increased.

Adult↗
PubMedDate not supplied

The association of psychosocial factors with the resolution of abdominal pain.

Although abdominal pain is a common presenting complaint in the family practice setting, its natural history and psychosocial associations have not been clearly described. A prospective study was conducted of 92 patients who presented with abdominal pain to the University of Iowa and Cedar Rapids Family Practice Centers between September 1982 and March 1983. Patients were given a self-administered questionnaire for measuring stress, family functioning, and psychological symptoms. All patients were followed for at least six weeks. Resolution of the pain was documented by chart audit, telephone, or mail follow-up. Two-thirds of the patients experienced resolution of their pain within six to eight weeks. The scores on the Hopkins Psychological Symptom Checklist, Family APGAR, and the Daily Hassles Stress Scale did not predict resolution of pain. Age, sex, education, occupation, and final diagnosis also did not predict resolution of pain. Marital status was not associated with pain resolution, though widowed and separated individuals more often had pain at follow-up.

Abdomen↗