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Biomedical subjects

J Froom

Publications and source records attributed to J Froom.

At least 19 recordsLinked to original sources
PubMed1992

Selection bias in using data from one population to another: common pitfalls in the interpretation of medical literature.

The prevalence, course and prognosis of diseases in patients referred to tertiary medical centers frequently differ from those treated in primary care settings. Extrapolation of findings from one population to another may therefore be unwarranted. Other factors that contribute to misinterpretation of medical literature include failure to distinguish statistical from clinical significance and advocacy of medical interventions prior to adequate clinical trials.

Epidemiology↗
PubMed1991

Selections from current literature: hormone therapy in postmenopausal women.

The articles reviewed for this issue of 'Selections' concern potential therapies to prevent osteoporosis and cardiovascular disease in postmenopausal women. Each therapy is controversial and provokes more questions than answers. The most benign intervention is the administration of calcium to postmenopausal women whose daily calcium intake is less than 400 mg. Although there have been reports that calcium administration failed to demonstrate benefit in this group, the treatment is unlikely to do harm. Etidronate can increase bone mineralization in women with osteoporosis, but will it be useful for prophylaxis? Oestrogens can prevent bone loss, but is the increased risk of breast cancer sufficient to preclude their use? Do oestrogens increase or decrease the risk of cardiovascular disease? A combination of oestrogen and progesterone may avoid the increased risk of uterine cancer but what are the effects of long term administration? Do the potential benefits of hormone therapy justify the costs and treatment of large numbers of women who without therapy would never have developed complications attributable to oestrogen lack? (Herman J: Fam Phys 1990; 18: 39-40) Given these uncertainties, is postmenopausal administration of hormones reasonable or prudent? The current literature does not provide adequate answers to these questions. Uncertainty, however, is not new for clinicians, who will weigh the evidence, evaluate the multiple variables in the individual patient that influence therapy, and with their patients decide whether the risks outweigh the benefits.

Calcium, Dietary↗
PubMed1991

The long pull.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Otitis media in day-care children. A report from the International Primary Care Network.

The relationship between day care and acute otitis media and its adverse consequences was analyzed as part of a collaborative multinational study. Data from primary care research networks in eight countries were collected on 1335 children, aged 0 to 60 months, at the time of initial visits to their primary care physicians for acute otitis media. A history of recurrent acute otitis media, poor hearing, and tonsillectomy or adenoidectomy were all more frequent in day-care children aged 25 to 60 months, compared with those cared for at home. Day-care children were brought to their physicians more promptly after the onset of symptoms and received more referrals to otolaryngologists at the time of the index visit for acute otitis media. Day care may pose a significant risk for otitis media and its adverse consequences.

Acute Disease↗
PubMed1990

Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network.

STUDY OBJECTIVE: The relation between a history of disorders suggestive of acute otitis media, symptoms, and findings of an examination of the tympanic membrane and doctors' certainty of diagnosis. Also, to examine differences in prescribing habits for acute otitis media among doctors from different countries. DESIGN: Questionnaires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media. SETTING: General practices in Australia, Belgium, Great Britain, Israel, The Netherlands, New Zealand, Canada, Switzerland, and the United States. PATIENTS: 3660 Children divided into the three age groups 0-12 months, 13-30 months, and greater than or equal to 31 months. MAIN OUTCOME MEASURES: General practitioners' responses to questions on their diagnostic certainty and resolution of patients' symptoms after two months. RESULTS: The diagnostic certainty in patients aged 0-12 months was 58.0%. This increased to 66.0% in those aged 13-30 months and 73.3% in those aged greater than or equal to 31 months. In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging. Redness of the membrane and pain were also associated with certainty in patients aged 13-30 months, and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months. The proportion of patients prescribed antibiotics varied greatly among the countries, from 31.2% in The Netherlands to 98.2% in both Australia and New Zealand, as did the duration of treatment. Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic. CONCLUSIONS: Doctors' certainty of diagnosis of acute otitis media was linked to patient's age. Improved criteria or techniques for diagnosing acute otitis media, especially in very young children, need to be developed. Antibiotic treatment did not improve the rate of recovery of patients in this study.

Acute Disease↗
PubMed1990

Glycemic control in elderly people with diabetes.

Hyperglycemia is only one of several metabolic derangements that are prevalent in diabetes mellitus. Of these, hyperlipidemia, obesity, and co-existent hypertension may make more important contributions to complications than persistently elevated blood sugars. The role of hyperglycemia in the genesis of diabetic complications is uncertain and there is little evidence from prospective randomized controlled studies to support rigorous hypoglycemic treatment. Adverse consequences of pharmacologic therapy can be severe, including death, and are most frequent in the elderly. The group of elderly diabetic ambulatory patients is markedly heterogeneous and individualization of therapy is required. Obese persons require dietary therapy, and additional dietary manipulations are needed for patients with the complications of hyperlipidemia, hypertension, and nephropathy. Pharmacologic hypoglycemic therapy may be required to control symptoms, but its use in asymptomatic diabetic persons is for the most part unwarranted.

Age Factors↗
PubMed1989

Selections from current literature: the cholesterol controversy.

This issue of 'Selections' focuses on studies of cholesterol reduction in asymptomatic adults. Treatment of persons with coronary heart disease involves other issues and the need to consider additional evidence from other studies. Elevated blood cholesterol levels are associated with increased coronary heart disease in young adults. The real question is whether or not lowering cholesterol levels with diet and drugs is possible and if possible, whether it reduces the risk of morbidity and mortality. Even if the relative risk can be reduced it is necessary to consider the absolute risk reduction. Reduction of the risk of fatal myocardial infarction from 2.0% to 1.6% over a seven year period while at the same time increasing the risk for gallbladder surgery from 1.3% to 1.9% may not be an attractive gamble. There is little evidence that elevated cholesterol levels are a risk factor in adults over the age of 60 years. Intervention trials have not been conducted in women or in the aged, and overall mortality has not been reduced in any of the studies. The Department of Health and Human Services of the United States recommends an approach that if implemented could have initial costs that exceed 10 billion dollars. Yearly costs are likely to exceed the initial cost. In a recent editorial Professor Joseph Herman expresses concern that the Israel Society for Research on Atherosclerosis and the European Atherosclerosis Society have adopted similar recommendations to those recently announced in the United States. He also points to large variations reported from 5000 laboratories given standard samples to be tested for total cholesterol. Currently blood cholesterol levels are available to shoppers at a supermarket in Florida (New York Times 1989, January 3). The end of this controversy is not yet in sight.

Adult↗
PubMed1978

Practice profiles in evaluating the clinical experience of family medicine trainees.

A practice profile is a compilation of information allowing definition and evaluation of any of several parameters of health-care delivery. Prerequisites for development of profiles presented in this report include: suitable classification of health problems; patient demographic data; identification of individual and groups of health-care providers; and definition of the practice or study population. Details are given for two profiles: the assigned patient and the diagnostic workload profiles. Single profiles are purely descriptive but, when evaluated by appropriate peer comparison, may form the basis for a more dynamic process--that of improvement and change. Possible applications of practice profiles are discussed.

Ambulatory Care↗
PubMed1977

A conversion code from the RCGP to the ICHPPC classification system.

Faculty members from four family medicine training programs participated in the production of a definitive conversion of the Royal College of General Practitioners Classification of Diseases as modified for use with problem-oriented medical records (RCGP) to the International Classification of Health Problems for Primary Care (ICHPPC). The method used to produce the conversion and the several problems encountered are described. A detailed translation with the appropriate ICHPPC equivalent for each RCGP diagnostic title and code number is provided.

Disease↗