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Biomedical subjects

M E Wheat

Publications and source records attributed to M E Wheat.

7 recordsLinked to original sources
PubMed1992

Breast cancer screening for elderly women with and without comorbid conditions. A decision analysis model.

OBJECTIVE: To determine whether breast cancer screening extends life for women aged 65 years or more with and without comorbid medical conditions. SETTING: A provider-patient encounter. DESIGN: A decision analysis of the utility of screening for breast cancer. MEASUREMENTS: Clinical examination and mammography among four groups of women aged 65 to 85 or more years: average health, mild hypertension, congestive heart failure, and average-health black women. The effects of screening were estimated using the best quality data available. RESULTS: Screening saved life at all ages among patients studied. Savings were highest for black women and decreased with increasing age and comorbidity. Screening all average-health women aged 65 or more saved 67,912 years of life. For women who had cancer, screening extended life by 617 days for average-health women between 65 and 69 years of age and 178 days for those aged 85 years or more. Perioperative mortality and test characteristics had little effect on the results. The risks equaled the benefits of screening only when operative mortality was between 27% and 62%. The marginal costs of screening during a routine office visit were $138 and increased with advancing age and decreasing test specificity. Benefits persisted after adjustment for changes in long-term quality of life; however, for women aged 85 years and older (with and without comorbidities), the short-term morbidity of anxiety or discomfort associated with screening may have outweighed the benefits. CONCLUSION: No inherent reason exists to impose an upper-age limit for breast cancer screening; however, more data are needed on women's preferences for screening strategies.

Age Factors↗
PubMed1991

Hypertension in women: what is really known? The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine.

PURPOSE: To determine whether there is sufficient information in the medical literature to guide appropriate treatment of hypertensive women. DATA IDENTIFICATION: Epidemiologic surveys of hypertension, clinical trials of antihypertensive therapy, and studies of selected adverse effects of antihypertensive agents were identified through a computerized search using MEDLINE and by identifying all studies cited in current medical textbooks as supporting evidence for the guidelines for the treatment of hypertensive individuals. All epidemiologic studies selected were cross-sectional or longitudinal, multicenter, population-based surveys. All clinical trials were large, randomized studies comparing one or more antihypertensive agents with a placebo or nonplacebo control group. Epidemiologic studies and clinical trials were reviewed to assess the quantity and quality of information available regarding important aspects of hypertension in women. Data pertaining to epidemiology, natural history, results of treatment, and two significant side effects of antihypertensive treatment were examined. RESULTS OF DATA ANALYSIS: The prevalence of hypertension is greater in black women than in black men and is about equal in white women and men. Because women outnumber men in the population, there are more hypertensive women than men. The attributable risk percent (the proportion of end points that could be eliminated by removing hypertension) for cardiovascular complications of hypertension is higher for women than men. Clinical trials show clear benefit of therapy for black women but no clear benefit for white women; some studies suggest that treatment of white women is harmful. Lipid profiles and their relation to ischemic heart disease differ for women and men; there is currently no information on the effects of antihypertensive agents on serum lipids in women. Few data have been published on the frequency of sexual dysfunction in treated hypertensive women. CONCLUSIONS: Hypertension in women and its related cardiovascular outcomes are a major public health problem. Clinical trials of antihypertensive therapy do not fully support current guidelines for the treatment of hypertensive women. Research concerning adverse effects of antihypertensive agents has largely excluded women from consideration; further studies are required to guide appropriate treatment.

Black or African American↗
PubMed1988

Recovery of function after hip fracture. The role of social supports.

Previous studies have found that social support may reduce mortality after myocardial infarction and reduce overall mortality among the elderly. To determine whether social support also influences the recovery of function among patients who have had hip fractures and to describe other potential predictors of recovery after hip fracture, 111 patients with hip fractures were interviewed and examined before discharge from the hospital. The functional status of surviving patients was assessed again 6 months later. Patients who had a greater number of social supports had more complete recovery of their prefracture level of function (r = .21; P = .04). This association was strongest for patients over 60 years old (r = .31; P = .006); among these patients, this association remained statistically significant after adjustment for other significant (P less than .05) predictors of recovery: arm strength, mental status, and serum albumin. Additional studies should be done to test whether interventions to increase social supports can improve the recovery of function among elderly patients with hip fractures and other illnesses. In the meantime, health professionals should counsel elderly patients about the potential rehabilitative and preventive benefits of social supports.

Activities of Daily Living↗
PubMed1988

Pap smear screening in women 65 and older.

Pap smear screening in women 65 years of age and older is controversial. To assess the need to offer screening in this group, we examined Pap results of women 65 and older whose charts were reviewed as part of a cancer screening study in two San Francisco hospitals. Two hundred thirty women (41%) were 65 years of age or older (mean age, 73). Compared with younger women, they were less likely to have had a Pap smear during the past 3 years (61% versus 72%), less likely to have seen a gynecologist (24% versus 34%), and were more likely to have refused Pap screening (11% versus 5%). Of the 140 women who had Paps, five showed atypia (class II). None exhibited dysplasia or carcinoma in situ. Those with atypia were all nonwhite. One had had a hysterectomy; two had a history of previously abnormal Paps. Overall, women with a history of abnormal Paps were far more likely to be screened (91% versus 58%). Those who had had a hysterectomy were significantly less likely to be screened (51% versus 68%). These results showed a low rate of cervical dysplasia/carcinoma in older, low-income women. Although our sample was small, the low rate of abnormals may reflect the relatively high rate of prior screening in this population. Because older women are not likely to see gynecologists, primary care physicians should continue Pap screening in older women (including those with a history of hysterectomy) until a history of repeated, technically adequate, normal Pap smears is documented.

Age Factors↗
PubMed1983

Aspects of medical care of Soviet Jewish Emigrés.

Soviet Jewish emigrés are a recently arrived refugee group in San Francisco and in other cities in the United States. They have frequently been perceived as a demanding and complaining population, particularly the elderly, often chronically ill members. These behaviors can also be seen as positive survival mechanisms that have evolved in response to the Soviet health care system and cultural background. An understanding of that background and system, together with time, greatly improves the interaction between Soviet Jewish patients and American physicians.

Aged↗
PubMedDate not supplied

Cancer screening in women: a study of house staff behavior.

To explore physician, patient, and provider factors associated with house staff performance of cancer screening in women, we reviewed 565 randomly selected charts of 58 medical residents in two San Francisco teaching hospitals, H1 and H2. We assessed performance of Pap smear, breast exam, mammography, rectal exam, and stool occult blood testing, and administered questionnaires to all residents to ascertain screening beliefs and attitudes and individual screening criteria. The main finding was a significant difference in screening between the two hospitals. Four of five tests (Pap smear, breast exam, mammography, rectal exam) were performed more frequently at H2. Neither provider nor patient factors could explain this. Organizational differences between the sites included more frequent flow sheet recommendations for mammography and rectal exams at H2. Increased gynecological referral at H2 was also associated with more frequent Pap smears, breast exams, and rectal exams. White women did receive more frequent rectal exams, and mammography was increased among those who agreed with American Cancer Society screening recommendations, but no other provider or patient characteristics were associated with difference in screening. Results of further study of the effect of the learning environment and referral strategies on cancer screening, including assessment of patient acceptability and cost, can be used to improve cancer screening behaviors of medical house staff.

Adult↗