Biomedical subjects

John L Dorland

Publications and source records attributed to John L Dorland.

4 recordsLinked to original sources

PubMed2004

Simulation modeling of change to breast cancer detection age eligibility recommendations in Ontario, 2002-2021.

PURPOSE: The purpose of this project was to demonstrate the development and use of a decision support tool based on simulation modeling of breast cancer screening to evaluate the implications for the provision of health services and the economic impact of extending routine radiographic screening for breast cancer to women in the 40-49 age group between 2002 and 2021. METHODS: The main method was computer simulation with a Markov model that used published estimates of population size by age group, breast cancer prevalence and incidence, screening program participation rate, sensitivity and specificity of the screening test and diagnostic test, stage transition probabilities, directed diagnosis rates and costs. FINDINGS: The model predicted that changes to age eligibility requirements would result in the detection of an additional 6610 women with breast cancer in Ontario requiring treatment, at an additional cost of 795 Canadian per case. These costs include those related to screening, diagnosis and initial treatment and apply to the 20-year period. CONCLUSIONS: The model provided a useful decision support tool for those planning and implementing breast cancer screening programs.

Age Factors↗

PubMed2003

Economic burden of agricultural machinery injuries in Ontario, 1985 to 1996.

CONTEXT: Agricultural injuries are an important and understudied category of occupational injuries. PURPOSE: This study estimated the economic burden of agricultural machinery injuries that occurred in Ontario, Canada's largest province, between 1985 and 1996. METHODS: Conventional methodology for estimating economic burden, as embodied in a computer program previously developed for this purpose, was applied to hospitalized, nonhospitalized, and fatal agricultural machinery injuries. FINDINGS: The total economic burden of these injuries over the 12-year study period was estimated to be 228.1 million dollars, or 19.0 million dollars annually (1995 Canadian dollars, 3.0% discount rate). By extrapolation, the economic burden of all farm injuries in Canada is estimated to be between 200 and 300 million dollars annually. CONCLUSIONS: Costing information about agricultural injuries provides support for the prioritization and development of injury-control initiatives.

Adolescent↗

PubMedDate not supplied

A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services.

OBJECTIVES: To determine whether the outcomes of routine home visiting by public health nurses (PHN) after early obstetrical discharge differ from those of a screening telephone call designed to identify mothers who need further intervention. METHODS: Primiparas delivering a singleton infant and eligible for postpartum follow-up were randomized to a home visit or screening telephone call. Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario. Outcomes included maternal confidence at two weeks, health problems of the infants between discharge and four weeks postpartum, breastfeeding rates at six months and costs of the two models. RESULTS: Differences between the samples at the two sites necessitated stratified analyses. No differences were detected between the groups in maternal confidence (p = 0.96), health problems of infants (p = 0.87), or rates of breastfeeding at six months (p = 0.22). However, at both sites the cost of routine home visits was found to be higher than that of screening by telephone. CONCLUSION: Although universal access to postpartum support is important, the results suggest that a routine home visit is not always necessary to identify the women who need it. These results can be generalized only to low-risk women and infants.

Adult↗

PubMedDate not supplied

An epidemiologically-based needs assessment for stroke services.

Stroke is amenable to the entire spectrum of health services, ranging from prevention of its risk factors, to the treatment of acute stroke and rehabilitation and palliation of stroke. The aim of this study was to determine the number of persons with the capacity to benefit from evidence-based effective stroke services. Population-based survey and registry data along with published, evidence-based recommendations for services were used to determine the number of persons in Eastern Ontario with stroke (including risk factors, acute stroke and chronic stroke) and their related need for services (including prevention programs, diagnostic services, treatment of acute stroke and rehabilitation). These estimates were then compared to the actual provision of these services. Estimates of the need for effective services exceeded the provision of all services with the exception of pharmacologic treatment for diabetes mellitus and carotid endarterectomy for acute stroke. The approach was able to identify both the under-provision and over-provision of evidence-based effective services for stroke. This study has shown that an epidemiologically-based needs assessment could be a useful basis for the planning of health services.

Adult↗