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Biomedical subjects

J Froom

Publications and source records attributed to J Froom.

At least 19 recordsLinked to original sources
PubMed2001

Low job satisfaction predicts delayed return to work after laparoscopic cholecystectomy.

We studied 102 consecutive employed patients treated by elective laparoscopic cholecystectomy to determine job characteristics and psychological factors that predict delay in return to work after their procedure. Median sick leave was 13 days, and five variables significantly added to a model predicting sick leave of at least 20 days (31.4% of the workers): low job satisfaction (odds ratio [OR], 12.56; 95% confidence interval [CI], 3.34 to 47.2); physical effort at work (OR, 4.99; 95% CI, 1.46 to 17.04); pain at 7 days (OR, 5.55; 95% CI, 1.56 to 19.76); patient's expectation of slow recovery (> 7 days) (OR, 6.12; 95% CI, 1.82 to 20.55); and patient's expectation of no financial loss (OR, 3.85; 95% CI, 1.14 to 12.50). The model was excellent (area under the receiver operating characteristic curve, 89.6%). We conclude that low job satisfaction is a major predictor of delayed return to work.

Adult↗
PubMed2000

Reducing antihypertensive medication use in nursing home patients.

Of the 1.5 million nursing home residents, about 40% are aged 85 years or older, and a similar percentage have hypertension. The rates of incorrect diagnoses from the "white coat" effect and from errors in blood pressure evaluation are as frequent in older persons as in younger persons. The benefits of antihypertensive treatment and the risks of lowering blood pressures in the very old (> or = 85 years) are uncertain. Elderly patients experience adverse effects from drug treatment that are unique to their age group and that complicate management problems associated with polypharmacy and multiple comorbid conditions. Trials to withdraw or lower the dosage of antihypertensive medications have been successful in up to 40% of elderly persons when combined with salt restriction and weight loss, but such studies are lacking in nursing home patients. The management of hypertension should be reevaluated in nursing home patients.

Aged↗
PubMed2000

Tympanometry interpretation by primary care physicians. A report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN).

BACKGROUND: The accuracy of data gathered by primary care clinicians in practice-based research networks (PBRNs) has been questioned. Tympanometry, recently recommended as a means of improving accuracy of diagnosing acute otitis media, was included as an objective diagnostic measure in an international PBRN study. We report the level of agreement of interpretations of tympanograms between primary care physicians in PBRNs and experts. METHODS: Primary care physicians in PBRNs in the Netherlands, United Kingdom, United States, and Canada enrolled 1773 children aged 6 to 180 months who contributed 6358 tympanograms during 3179 visits. The physicians were trained in the use and interpretation of tympanometry using the Modified Jerger Classification. We determined the level of agreement between physicians and experts for interpretation of tympanograms. One comparison used the 6358 individual ear tracings. A second comparison used the 3179 office visits by children as the unit of analysis. RESULTS: The distribution of expert interpretation of all tympanograms was: 35.8% A, 30% B, 15.5% C1, 12% C2, and 6.8% uninterpretable; for visits, 37.8% were normal (A or C1), 55.6% abnormal (B or C2), and 6.6% could not be classified. There was a high degree of agreement in the interpretation of tympanograms between experts and primary care physicians across networks (kappa=0.70-0.77), age groups of children (kappa=0.69-0.73), and types of visits (kappa=0.66-0.77). This high degree of agreement was also found when children were used as a unit of analysis. CONCLUSIONS: Interpretations of tympanograms by primary care physicians using the Modified Jerger Classification can be used with confidence. These results provide further evidence that practicing primary care physicians can provide high-quality data for research purposes.

Acoustic Impedance Tests↗
PubMed1998

Hypertension in nursing home patients.

There have been few studies of hypertension in nursing home patients. To assess the prevalence, demographic characteristics, comorbidity and drug therapy in hypertensive nursing home patients compared with those who are normotensive, we reviewed all medical charts of patients in three nursing home facilities. Of the 804 patients, 355 (44.2%) have hypertension. Calcium channel blockers were the most frequently prescribed anti-hypertensive (30.3%) and together with diuretics (28.4%) and ACE inhibitors (27.7%) account for more than 85%. Hypertensive patients take more cardiac, hypoglycaemic, and analgesic drugs (P = <0.001, <0.001, and 0.004, respectively) than those who are normotensive. Overall patients take an average of 8.68 medications daily. In hypertensive patients, the average number of comorbid conditions (excluding hypertension) is 5.02 compared with 3.23 in normotensive patients. Hypertension is significantly associated with diabetes, heart disease, cerebrovascular disease, neoplasms, endocrine disorders, gastrointestinal diseases, psychiatric disorders, dementia, other central nervous system diseases, skin problems, blood diseases and inversely with hip fracture. Blood pressure control (<140/90 mm Hg) is achieved in 88.8%, is not related to age and is significantly more frequent in males than females (91.8% vs 82.6% P = 0.025). The problem of hypertension in nursing home patients is complex and has received insufficient study. Since studies demonstrating benefit from anti-hypertensive therapy in the elderly excluded the very elderly and those with significant comorbid conditions, additional research is needed.

Aged↗
PubMed1997

Asymptomatic microscopic hematuria--is investigation necessary?

Microscopic hematuria is common in asymptomatic adults, but the benefit of screening the general population for blood in the urine has not been established. On the other hand, most studies of referred patients with putatively asymptomatic microscopic hematuria have reported a 2-11% prevalence of urothelial malignancies, leading to the recommendation that all patients with microscopic hematuria be thoroughly investigated. Urinalysis is inexpensive and highly acceptable to the general population, but is neither a sensitive, nor specific test, and has poor predictive value for urothelial malignancies, and nephrological diseases. Furthermore the benefits of early detection of such diseases has not been established. We conclude that screening urinalysis cannot be recommended. Studies are needed to determine which constellation of findings primary physicians use to select patients for referral to centers with urological and nephrological expertise.

Adult↗
PubMed1996

Classification of severity of health problems in family/general practice: an international field trial.

BACKGROUND: A methodology is needed for classification of health problems by severity. OBJECTIVES: We aimed to test the Duke Severity of Illness Checklist (DUSOI) for feasibility and usefulness. METHOD: The DUSOI was field tested internationally by 22 family/general practitioners in 9 countries. RESULTS: The DUSOI was found to be feasible for rating severity of illness of health problems in family/general practice. The measure was shown to be clinically useful in older patients and those with chronic and more severe health problems. Variability of severity ratings was less within the same rater than between different raters (i.e. higher intrarater than interrater reliability). Clinical face validity was supported by the finding that DUSOI ratings classified patients with the same diagnosis and those with different diagnoses according to the severity differences that would be expected clinically. CONCLUSIONS: Although research is needed to improve reliability and to test validity further, the DUSOI was shown in the present study to be a methodology that is reasonable for consideration as an international classification of health problems by their severity in primary care patients.

Adolescent↗
PubMed1996

Age, seasonality and health.

Seasonal effects on mood and other components of functional status have been demonstrated in large segments of the general population but have received little attention in primary care patients. In the present study on adult members of a communal settlement (kibbutz) in Israel, seasonality and functional status were measured in both the winter and summer seasons in the same patients. Patients under age 65 had better overall health ratings than those 65 and over in both winter and summer. Overall health ratings were better in summer for those under 65 but were unchanged in the older group. Summer and winter seasonality scores were more constant in the younger group than in the older patients. We conclude that both age and seasonality need to be considered when measuring functional status in primary care patients.

Aged↗
PubMed1995

Depressive disorders in three primary care populations: United States, Israel, Japan.

Primary care patients in the United States, Israel and Japan received the Inventory to Diagnose Depression and the Dartmouth COOP Functional Status Charts modified for international use. Patients were classified as having major depressive disorder or minor depression. Although demographic characteristics varied by country, the rank order and frequency of the depressive symptoms were similar for both major and minor depression. Functional impairment was most severe in patients with major depression, less severe in those with minor depression and was least impaired in those not depressed. The results suggest that depressive disorders have similar presentations in the three countries studied, although the separate cultures confer different consequences on patients receiving these diagnoses.

Adolescent↗
PubMed1994

Minor depression and functional impairment.

OBJECTIVE: To describe a method of assessing minor depression and its effects on functional status, medical co-morbidity, seasonality, and demographic variables. DESIGN: A survey administered to a nonrandom sample of 302 patients. SETTING: A university-based family practice outpatient center. PATIENTS: Patients who were seen for routine ambulatory care were asked to complete the Inventory to Diagnose Depression scale and a modified version of the Dartmouth COOP Functional Assessment Charts, including a measure of seasonality. MAIN OUTCOME MEASURES: Six categories of functional impairment were examined across two categories of depression (major and minor) and the nondepressed. Major depression is defined strictly by criteria in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Minor depression is defined as depressed mood or anhedonia and one other of the nine depression symptoms. RESULTS: Forty-seven patients (15.6%) had minor depression. Using chi 2 analysis, significant differences were found among the three levels of depression for each functional status category. Logistic regression analysis showed patients with minor depression to have greater odds of more impairment in feelings (odds ratio [OR], 4.01; 95% confidence interval [CI], 1.75 to 9.19), pain (OR, 2.58; 95% CI, 1.18 to 5.63), and social activities (OR, 2.48; 95% CI, 1.19 to 5.17) compared with the nondepressed patient. The cluster of impairment distinguishing minor from major depression differed somewhat, with more impairment in daily activities (OR, 19.6; 95% CI, 3.45 to 112.00) and feelings (OR, 24.4; 95% CI, 1.78 to 333.00) and greater lung disease (OR, 13.7; 95% CI, 2.19 to 80.00) and seasonality (OR, 5.9; 95% CI, 1.10 to 32.1 for highest seasonality) in patients with major depression. CONCLUSIONS: There appears to be significant functional disability associated with the presence of minor depression. Seasonality was also present in those with minor depression, although it was of greater importance among those with major depression. Despite lack of national consensus on the definition of minor depression, limitations owing to sampling method, and statistical modeling, there is evidence that patients with minor depression reveal a different constellation of impairment than do those with major depressive disorder.

Activities of Daily Living↗
PubMed1994

Primary health care in Japan and the United States.

Japan has universal health insurance and its total health expenditure as a percentage of the gross domestic product is almost 50% less than that of the United States where 15% of persons under age 65 are uninsured. The health of the Japanese population as judged by neonatal, postnatal, and total infant mortality, percent of infants born with birth weights below 2500 g, and life expectancy at birth and ages 20 and 65 is superior to the health of Americans. Primary care, however, as an academic discipline and primary care training programs are absent in Japan. Physician training, incongruent with need, combined with government controlled low professional medical fees contribute to an extraordinarily high annual ambulatory patient contact rate (14 compared with 2.8 for Americans) and excessive use of diagnostic testing. Although primary care training is better developed in the U.S.A., interest in receiving, such training among medical school graduates is declining. Several factors that contribute to quality of care are examined. Comparisons between countries, however, must be viewed with caution because of the multitude of demographic, genetic, historical, economic and cultural variables that influence how health care is delivered and received. Both countries face major challenges. The projected rapid increase in the relative ratio of the elderly to total population in Japan will severely strain its ability to contain health care costs. Interest in primary care training in Japan dates back to 1978 but its implementation has been largely unsuccessful. The challenges in the U.S.A. are far more formidable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Depressive disorders in Japanese primary care patients.

In a sample of 276 Japanese adult patient attenders at two primary care clinics affiliated with the Department of Hygiene and Preventive Medicine at the Okayama University Medical School major depression was diagnosed in 5.8% and minor depression in 7.2% of patients studied. Functional impairment was significantly more severe in patients with either major or minor depression than in those not affected. None of the 36 patients with major or minor depression had received a diagnosis of depression or had been given antidepressant therapy. Possible explanations for the marked underdiagnosis of depression and lack of specific antidepressant therapy in these patients include severe stigma associated with a diagnosis of mental disorders, focus of the mental health system on hospitalization with consequent trivialization of mental problems in ambulatory patients, and the extraordinarily high work load of primary care doctors.

Activities of Daily Living↗
PubMed1993

Effect of patient characteristics and disease manifestations on the outcome of acute otitis media at 2 months.

BACKGROUND: Optimal therapy for acute otitis media (AOM) is controversial and there is no consensus regarding which antibiotic to use, how long to administer it, or whether antibiotics are effective at all. Knowledge of the effects of patient characteristics and disease manifestations is needed to individualize treatment and to evaluate large-scale trials. METHODS: Data originated from 2251 patients with AOM, aged newborn to 15 years, who participated in a prospective primary care study in eight countries. At the initial visit, medical history, symptoms, physical findings, and treatment data were recorded. Follow-up 2 months later identified changes in treatment and outcome. RESULTS: Patients younger than 13 months were less likely to have recovered than those aged 13 months to 15 years (P = .05). Using univariate analysis for infants aged 12 months or younger, male sex, prior episodes of AOM, and serous otitis media were associated with poor outcome. For older patients, poor outcome was associated with initial history of ear tubes, prophylactic antibiotic use, ear discharge, decreased hearing, serous otitis media; and past episodes of AOM; the symptom of decreased hearing; and the finding of pus exuding from the tympanic membrane. Using multivariate analysis for infants aged 12 months or younger, a history of serous otitis media (odds ratio [OR], 2.3; 95% confidence interval [CI], 0.95-5.7), past episodes of AOM (OR, 1.9; 95% CI, 0.82-4.5), and male sex (OR, 1.7; 95% CI, 1.0-3.0) made independent contributions to poor outcome. For children aged 13 months to 15 years, significant variables included pus drainage (OR, 2.2; 95% CI, 1.5-3.3), a history of ear tubes (OR, 2.3; 95% CI, 1.5-3.6), past episodes of AOM (OR, 1.8; 95% CI, 1.3-2.34), and a history of serous otitis media (OR, 1.4; 95% CI, 1.0-1.9). CONCLUSIONS: Patient characteristics and disease manifestations are significant determinants of AOM outcome.

Acute Disease↗
PubMed1993

Marital status and timing of coronary artery surgery.

Women undergoing surgery for coronary artery disease are older and have greater impairment of functional status than their male counterparts, suggesting either gender differences or gender bias. Reduced willingness to accept risks of surgery and reduced reliability of non-invasive tests in women have been proposed as possible explanations of surgical intervention delay. Since women survive their husbands by 7 years, their role as a terminal caretaker may impede acceptance of recommended surgery. In a record review of 145 women who underwent coronary artery bypass surgery, widows, as compared with the general population, were over-represented in each of the 3 decades from age 45-74. A prospective study to assess the several variables contributing to poorer surgical outcome in women is warranted.

Aged↗
PubMed1993

Deficiencies in structured medical abstracts.

This study was carried out to determine if the content of structured abstracts conforms with recommendations of the Ad Hoc Working Group for the critical appraisal of the medical literature as adopted by the Annals of Internal Medicine. The study design was a survey. All articles published in Annals of Internal Medicine in 1991, excluding editorials, case-reports, literature reviews, decision analysis, studies in medical education, descriptive studies of clinical and basic phenomena, and papers lacking a structured abstract, were studied. Of a total of 150 articles, 20 were excluded. The abstract and text of each article were assessed for the presence of the following items; patient selection criteria, statements concerning extrapolation of findings, need for further study, and whether or not the information should be used now. Number of refusers, drop outs and reason(s) for drop outs were assessed for intervention and prospective cohort studies only. Deficiencies of assessed items were noted in both abstracts and texts. For abstracts, patient selection criteria, numbers of refusers, number of drop outs and reason(s) for drop outs were reported in 44.6% (58/130), 3.1% (4/130), 16.9% (14/83) and 2.4% (2/83) respectively. These items were reported more frequently in the texts 87.7% (114/130), 9.2% (12/130), 60.2% (50/83) and 37.3% (31/83) respectively (p < 0.05). Statements concerning extrapolation of findings, need for further study and use of information now were also more frequent in texts than abstracts (p < 0.0001). A large number of structured abstracts published in the Annals of Internal Medicine in 1991, lack information recommended by the Ad Hoc Working Group. Our findings should not be extrapolated to other journals requiring structured abstracts.

Abstracting and Indexing↗