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Biomedical subjects

M J Bass

Publications and source records attributed to M J Bass.

At least 19 recordsLinked to original sources
PubMed1995

Factors associated with location of death (home or hospital) of patients referred to a palliative care team.

OBJECTIVE: To identify factors associated with the location of death (home or hospital) of patients referred to a palliative care home support team. DESIGN: Retrospective case-control chart review. SETTING: Palliative care inpatient unit with a home support team in a large chronic care hospital. SUBJECTS: All 75 patients receiving services from the home support team who died at home between June 1988 and January 1990 and 75 randomly selected patients receiving the same services who died in hospital. OUTCOME MEASURES: Place of death (home or hospital). RESULTS: Of the 267 patients referred to the palliative care home support team during the study period 75 (28.1%) died at home. Factors significantly associated with dying at home were the patient's preference for dying at home recorded at the time of the initial assessment (p < 0.001), a family member other than the spouse involved in the patient's care (p = 0.021) and the use of private shift nursing (p < 0.001). The patients who died in hospital were more likely than the other patients to have had no home visits from the palliative care team after the initial assessment (p = 0.04). The patient's preference for dying at home was not met if the caregiver could not cope or if symptoms were uncontrolled. The patient's preference for dying in hospital was not met if his or her condition deteriorated rapidly or if the patient died suddenly. CONCLUSIONS: Patients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients' dying at home. The determination of these factors should be part of every palliative care assessment. Patients and their families should be informed about available home support services.

Adult↗
PubMed1995

Who provides follow-up care for patients with early breast cancer?

OBJECTIVE: To assess how often family physicians are involved in posttreatment care of their stage I breast cancer patients and to identify factors associated with family physicians providing follow-up care. DESIGN: A retrospective cohort study with a 5-year follow up by chart review. PARTICIPANTS: All cases of breast cancer seen at the London Regional Cancer Centre between 1982 and 1987 were reviewed to identify 183 stage I cancer patients alive at 5 years. MAIN OUTCOME MEASURES: Whether a physician (other than an oncologist) was involved in the follow-up care of patients, and whether the physician was a family physician or a surgeon. RESULTS: Follow-up care during the 5-year postoperative period was provided in most cases by oncologists alone (66.7%); family physicians and surgeons were involved in 17.5% and 15.8% of cases, respectively. Surgeons became involved in follow-up care much earlier (12 months) than family physicians did (23 months) (P = 0.01) and were more likely to provide care for patients who received radiation treatment (P = 0.04) and for patients who lived in London (P = 0.004). Most malignant breast lesions (77.5%) were discovered by patients themselves (P = 0.0001). CONCLUSIONS: Currently, family physicians are infrequently involved in follow-up care of their patients with early breast cancer.

Adult↗
PubMed1994

Evaluation of a palliative care service: problems and pitfalls.

OBJECTIVE: To evaluate a palliative care home support team based on an inpatient unit. DESIGN: Randomised controlled trial with waiting list. Patients in the study group received the service immediately, those in the control group received it after one month. Main comparison point was at one month. SETTING: A city of 300,000 people with a publicly funded home care service and about 200 general practitioners, most of whom provide home care. MAIN OUTCOME MEASURES: Pain and nausea levels were measured at entry to trial and at one month, as were quality of life for patients and care givers' health. RESULTS: Because of early deaths, problems with recruitment, and a low compliance rate for completion of questionnaires, the required sample size was not attained. CONCLUSION: In designing evaluations of palliative care services, investigators should be prepared to deal with the following issues: attrition due to early death, opposition to randomisation by patients and referral sources, ethical problems raised by randomisation of dying patients, the appropriate timing of comparison points, and difficulties of collecting data from sick or exhausted patients and care givers. Investigators may choose to evaluate a service from various perspectives using different methods: controlled trials, qualitative studies, surveys, and audits. Randomised trials may prove to be impracticable for evaluation of palliative care.

Canada↗
PubMed1992

Risk language preferred by mothers in considering a hypothetical new vaccine for their children.

OBJECTIVES: To determine the type of risk language preferred by mothers considering the use of hypothetical new vaccine for their children and to compare their choice with what their physicians perceived they would prefer. DESIGN: Mail survey. SETTING: Thirteen family practices in southwestern Ontario. PARTICIPANTS: Women with at least one child between the ages of 6 months and 5 years and their physicians. MAIN OUTCOME MEASURES: Preferred risk language and physicians' predictions about patient preference. RESULTS: Of the 226 women sent the questionnaire 208 (92%) responded. Of the 192 who indicated their risk language preference 118 (61%) chose a numeric statement. Of the 11 physicians who answered the question 8 (73%) predicted that their parents would prefer non-numeric statements. Although the women in the study were more likely to be married, were better educated and had higher family incomes than women of the same age in the Ontario population, risk language preference was not found to be related to any of those demographic characteristics. CONCLUSION: Physicians must be prepared to outline the risks associated with vaccination in both quantitative and qualitative terms.

Adult↗
PubMed1992

Determinants of maternal tolerance of vaccine-related risks.

In a time when informed consent requires knowledge of the risks and benefits of medical care and technology to be communicated to the public, perceptions of benefits and risks of these techniques and procedures take on special importance. The purpose of the present study was to examine the determinants of maternal tolerance of vaccine-related side-effects in their children. A questionnaire was sent to 226 mothers of young children in southwestern Ontario seeking their opinion of the benefits and risks of selected medical procedures. It asked them to identify the risk of serious reactions they would tolerate for a new vaccine with benefits similar to that of pertussis vaccine. The response rate to the questionnaire was 92%. This group of young, well-educated mothers had high regard for some of the most common procedures and treatments used in family practice. The less common and more invasive procedures (heart surgery, brain surgery) were viewed as carrying almost as much risk as benefit. Abortion was perceived as involving more risk than benefit. Levels of acceptable risk with respect to a hypothetical new childhood vaccine were determined. A risk level of 1 in 1 million was the most popular level of acceptable risk, chosen by 25% of the respondents. The next most frequently chosen risk level was 1 in 100,000, chosen by 22%. Tolerance of possible vaccine side-effects did not differ with maternal age, education or prior experience with adverse vaccine or drug reactions. A summary net benefit score was derived for four technologies commonly used in family practice (antibiotics, vaccinations, birth control pills and X-rays).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Assessing functional status in family practice.

Family physicians need functional assessment skills to care effectively for elderly patients. Self-assessment instruments, such as the COOP charts, offer promise. Educators must give priority to functional assessment and develop specific materials for residency training.

Activities of Daily Living↗
PubMed1991

Ambulatory blood pressure monitoring and the primary care physician.

The primary care physician welcomes technology that will reduce overlabelling and overtreatment of hypertension. Three concerns with respect to ambulatory blood pressure monitoring are: the clear identification of those patients who will benefit from monitoring; the potential for labelling patients prematurely as having technical abnormalities (i.e., 'hypervariability'), which may have little clinical significance; and the inaccessibility of ambulatory monitoring. To determine patient acceptance of ambulatory monitoring, a follow-up survey of 37 patients who used the Spacelab 5200 device was conducted. Twenty-four percent said they would not be agreeable to further monitoring. While newer devices may be less disruptive, the point is made that it is important to include patient assessments in the evaluation of these devices. A comparison is undertaken between ambulatory monitors and the more accessible self-monitoring devices which involve the patient to a greater degree in his/her own care.

Blood Pressure Determination↗
PubMed1989

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.

Adult↗
PubMed1989

Recruiting family physicians as participants in research.

Obtaining the voluntary participation of family physicians in quality of care research is a major problem in family practice research. An innovative approach was therefore required to recruit 120 randomly selected family physicians in southern Ontario in a quality of care study by the College of Family Physicians of Canada. A network of physician recruiters oriented to the study was organized for each district. This recruitment method resulted in an 84.5% participation rate. The relationship of these physician recruiters to the candidate and the method of approach were important factors in the enrolment process: the highest participation rate (95%) was obtained when the recruiters were friends of the candidate and when a personal meeting was arranged (91%). Recruiters were given an information package to help them in the recruitment process and rated the most useful items as follows: a policy statement about confidentiality, a description of the study and reprints of a published feasibility study. These results illustrate that cooperation in research in family physicians' offices can become a reality.

Confidentiality↗
PubMed1989

The impact of discussion of non-medical problems in the physician's office.

To determine the impact of discussion of non-medical problems with the physician, patients with at least one chronic illness who were taking medication were interviewed in their family doctor's office. Of 149 patients interviewed, 90.6% reported at least one non-medical problem. Half (51%) of those patients with a problem had discussed it with their doctor. More than half (55%) of those patients discussing a problem reported that the discussion was helpful. Patient compliance and satisfaction were positively associated with 'helpful' discussion, but not with discussion per se. In particular, the two aspects of doctor-patient communication which were significantly associated with feeling helped were: 'Doctor tells me all I want to know about my illness' and 'Doctor gives me a chance to say what is really on my mind'. Both factors reflect care which is oriented to patient concerns. The study results provide support for a patient-centred approach to care.

Adult↗
PubMed1988

Study of relation of continuing medical education to quality of family physicians' care.

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Certification↗
PubMed1988

Abdominal pregnancy after in vitro fertilization and embryo transfer.

Ectopic pregnancy continues to be a major complication of in vitro fertilization (IVF) and embryo transfer. We report the first abdominal pregnancy occurring after this therapeutic approach. The patient, a 35-year-old female, presented a frozen pelvis with a history of severe endometriosis and a left salpingectomy. After the transfer of four concepti in her second IVF/embryo transfer attempt, she became pregnant. Unfortunately, ultrasound evaluation five weeks later showed an ectopic pregnancy in the cul-de-sac. During laparotomy, it was noticed that implantation had taken place near the mesentery of the sigmoid and rectosigmoid. A right cornual tubal ligation was performed. Although the benefit of IVF/embryo transfer far outweighs the risk of an ectopic pregnancy, it is imperative that physicians who care for patients after IVF/embryo transfer be fully aware of the possibility of this complication in this high-risk population.

Adult↗
PubMed1988

Is population mobility an obstacle to continuity of care? Attrition rates over five years in 17 Ontario practices.

The University of Western Ontario Hypertension Study provided an opportunity to study attrition rates over a five-year period in the population of 17 family practices in southwestern Ontario. The baseline population consisted of all patients between the ages of 20 and 65 years who were active in the practices in 1978. During the five years of the study, a medical assistant in each practice recorded data on morbidity, mortality, and patients leaving the practice. The follow-up of nonresponders to a demographic questionnaire provided additional data on patient moves. The overall five-year move rate was 13.2 percent for men and 16.6 percent for women. Those in the 20- to 29-year age group had the highest rates, and those in the 30- to 39-year age group had the next highest. The rates for men stabilized after the age of 40 years to between 8 and 10 percent, and for women after 40 years to between 11 and 13 percent. The move rates were higher in urban than in rural practices. Ninety percent of hypertensive patients received continuous care over the five-year period. In southwestern Ontario, population mobility does not appear to be a major barrier to continuing care.

Adult↗
PubMed1987

Detecting changes in functional ability in women with premenstrual syndrome.

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.

Adult↗
PubMed1987

The effect of an on-site radiology facility on radiologic utilization in family practice.

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.

Community Health Centers↗