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Biomedical subjects

O Szafran

Publications and source records attributed to O Szafran.

9 recordsLinked to original sources
PubMed1998

Admissions and transfers from a rural emergency department.

OBJECTIVE: To examine the characteristics of patients transferred from a rural hospital emergency department, to compare them with patients admitted on an emergency basis, and to use this information to help plan physician education. DESIGN: Descriptive study using records for the period January 1, 1991, to June 30, 1992. SETTING: The emergency department at Bonnyville Health Centre, an acute care rural hospital located 240 km northeast of Edmonton, serving a catchment population of approximately 10,000. PARTICIPANTS: One thousand fifty-five patients seen in the emergency department who were either transferred to another centre or admitted to the Bonnyville Health Centre on an emergency basis. MAIN OUTCOME MEASURES: For the transferred group, main diagnosis, category of transfer, and reason for transfer. For the admitted group, main diagnosis, length of stay, type of discharge. RESULTS: Of the 1055 patients ill enough to be either admitted or transferred, 114 (10.8%) were transferred. Those transferred were predominantly men, the elderly, and people with orthopedic injuries or neurologic diseases. Those admitted presented primarily with internal, respiratory, gynecologic, or pediatric disorders. Reason for transfer was mainly lack of specialized services or equipment at the rural hospital. CONCLUSIONS: Patients transferred out of the emergency department differed from those admitted in diagnoses and sex. Most transfers were considered "mandatory." Results of this analysis supported incorporating a formal rotation in orthopedics and adding 4 weeks to the existing emergency medicine rotation in our family medicine residency program.

Adolescent↗
PubMed1995

Continuity of care. Opportunity for residents to see repeat patients.

OBJECTIVE: To examine the opportunity for first-year family medicine residents to experience continuity of care during family medicine block time and half-day returns. DESIGN: Retrospective analysis of patient encounter data during the 1987-1988 and 1991-1992 academic years to determine how much contact residents had with repeat patients. SETTING: Two family medicine teaching centres in Edmonton. PARTICIPANTS: First-year family medicine residents: 24 residents during 1987-1988 and 24 during 1991-1992. MAIN OUTCOME MEASURES: Number of patient-resident contacts and number of repeat contacts. RESULTS: During the 4-month block time and half-day return, residents had repeat contact with 25.9% and 20.3% of the patients seen. These patients provided 48.3% and 37.7% of all visits at Centres A and B, respectively. CONCLUSION: Increasing block time from 2 to 4 months resulted in only a slight increase in repeat contact with patients. Half-day returns did not appear to enhance the opportunity for continuity of care.

Alberta↗
PubMed1994

Putting prevention into practice.

In primary medical care settings, disease prevention services are delivered at lower rates than recommended. Furthermore, practitioners tend to overestimate the rate at which they perform them. There are essentially two steps in delivering evidence-based preventive services: (1) knowing what the evidence is for performing various detection and intervention manoeuvres, and (2) integrating the preventive services into daily practice. The first is a scientific process and is carried out in Canada by the Canadian Task Force on the Periodic Health Examination. However, after a decade of experience with evidence-based guidelines, we now know that guidelines are not enough. Integrating clinical prevention into busy practices is a political and logistical process. This truth is best captured by the quip, "An ounce of prevention requires a pound of office system change". A number of studies have demonstrated that continuing medical education (CME) courses and workshops for physicians are not enough to ensure that clinical preventive services are incorporated into practice. According to Lomas, the traditional CME educational approaches need to be complemented by strategies from such paradigms as the social influence model, the diffusion of innovation model and the adult learning model. Battista, in "From Science to Practice," points out the complexity of the communication process required for the diffusion of innovation into practice. Walsh's Systems Model of Clinical Preventive care best captures the interacting factors that mediate between practitioners' intentions and their actions when it comes to delivering clinical prevention services. This paper reports on a practical example of helping family practitioners develop a "sustaining office system in prevention" that minimizes barriers, focuses energy and integrates clinical prevention into office routines. The key components are (i) a practice coordinator for prevention, (ii) clear clinical prevention-related job descriptions for all persons who deal with patients, (iii) an information management system that reinforces prevention, and (iv) a practice feedback and problem solving strategy.

Aged↗
PubMed1985

Response to treatment and its influence on survival in metastatic breast cancer.

The clinical response to first systemic therapy of 381 patients with metastatic breast cancer was assessed; the influence of the category of this first response on eventual survival from diagnosis of first distant metastasis was analyzed. Survival from diagnosis of first distant metastasis was found to be similar whether the patient had a complete response, a partial response, or stable disease; only when progressive disease occurred with first systemic treatment was survival significantly shortened. This similarity in survival whatever the category of response from diagnosis of first distant metastases was found whether the patient received chemotherapy or hormone therapy as first systemic treatment, and whether the patient was premenopausal or postmenopausal; there was some suggestion on analysis of premenopausal patients treated with hormone therapy as first systemic therapy that a complete response conferred a survival advantage, but the numbers were small in this group. When complete responders to first systemic therapy as well as any other subsequent systemic therapy were analyzed for survival from diagnosis of first distant metastasis, again, no survival advantage could be found compared to the other response categories, but the complete response rate was low owing to the unselected nature of this group of study patients. It is concluded that the categories of complete, partial, or stable response to therapy have no great significance in terms of survival; the category of progressive disease to first systemic therapy is, however, associated with a shorter survival in all the analyses performed. We suggest that assessment of a treatment's worth should be based as much on the patient's subjective feeling of well-being as on the magnitude of the tumor response, since with currently available therapies, provided some form of response is obtained, the magnitude of the response does not appear to translate into any major survival advantage. This study points up the disparity between research-oriented criteria of response (survival, response rate, and its magnitude) and patient care criteria of response (survival and quality of life).

Adult↗
PubMed1982

Brain metastases in breast cancer patients receiving adjuvant chemotherapy.

A retrospective analysis was performed comparing the incidence of brain metastases as a site of first recurrence in patients receiving adjuvant chemotherapy during the period from 1973--1979 for node-positive operable carcinoma of the breast, compared to a matched control group of patients presenting during the same period treated by local measures only. Five of 115 patients (4.3%) receiving adjuvant chemotherapy have had brain metastases as first site of distant recurrence compared to zero of 115 (0%) in the control group. This comprised 12.8% of first distant recurrences in the adjuvant group. The authors suggest that this increased incidence of brain metastases, as site of first recurrence, reflects prolonged suppression of systemic disease by adjuvant chemotherapy with less effect in controlling metastases in the brain.

Adult↗
PubMed1981

Effect of chemotherapy on survival in metastatic breast cancer.

In order to assess the impact of modern combination chemotherapy on overall survival of metastatic breast cancer patients, we retrospectively analysed survival data of those patients who presented with breast cancer and developed metastases at our clinic from 1971-78 inclusive. Our results indicate a trend towards improved survival from onset of first distant metastasis after 1975. Assessment of survival by treatment modality revealed significantly longer survival from first metastasis for those patients receiving predominantly endocrine treatment compared to chemotherapy, median survival being 32.5 versus 23 months for endocrine therapy and chemotherapy respectively. Patients receiving adriamycin in combination with other drugs, had longer survival from first metastasis than those patients receiving chemotherapy without adriamycin (median survival being 25 versus 18.5 months respectively). These differences are most probably due to patient selection. On the basis of these results it would appear that chemotherapy may be improving short-term survival in some patients, but is making no major impact on long-term survival.

Antineoplastic Agents↗