Counseling: implementing our knowledge in a hurried and complex world.
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Adolescent↗
Biomedical subjects
P T Hagen
Publications and source records attributed to P T Hagen.
Colorectal cancer screening: a community case-control study of proctosigmoidoscopy, barium enema radiography, and fecal occult blood test efficacy.
OBJECTIVE: To examine the effectiveness of screening proctosigmoidoscopy, barium enema radiography, and the fecal occult blood test (FOBT) in decreasing colorectal cancer mortality in a community setting. PATIENTS AND METHODS: In this population-based case-control study, cases comprised 218 Rochester, Minn, residents who died of colorectal cancer between 1970 and 1993. Controls were 435 age- and sex-matched residents who did not have a diagnosis of colorectal cancer. Screening proctosigmoidoscopy, barium enema radiography, and FOBT results were documented for the 10 years prior to and including the date of diagnosis of fatal colorectal cancer in cases and for the same period in matched controls. History of general medical examinations and hospitalizations was also recorded. RESULTS: Within the 10 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening proctosigmoidoscopy were 23 (10.6%) of 218 cases vs 43 (9.9%) of 435 controls; at least 1 screening barium enema radiographic study was done in 12 (5.5%) of 218 vs 25 (5.7%) of 435. Within 3 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening FOBT were 27 (12.4%) of 218 vs 44 (10.1%) of 435. Adjusted odds ratios were 1.04 (95% confidence interval [CI], 0.21-5.13) for proctosigmoidoscopy (distal rectosigmoid cancers only), 0.67 (95% CI, 0.31-1.48) for barium enema radiography, and 0.83 (95% CI, 0.45-1.52) for FOBT over the above time periods. CONCLUSION: In this case-control study within a community setting, a colorectal cancer-specific mortality benefit could not be demonstrated for screening by FOBT, proctosigmoidoscopy, or barium enema radiography. Screening frequency was low, which may have contributed to the lack of measurable effects.
Aged↗
Implementing an EMR: paper's last hurrah.
The implementation of an electronic medical record system in any large organization is as complex a task as the design of the system. During implementation, it is necessary that health care providers using the electronic system are able to communicate with colleagues who are continuing to work with the paper record. The Mayo Clinic in Rochester, Minnesota, is well along the path to implementing an electronic medical record system. One of the key issues addressed has been the need for the electronic system to integrate with the paper record. This need to function in the dual electronic/paper environment has placed new demands on printers, required revision of some paper forms, and required the electronic system to create facsimilies of paper record forms. In addition, new security issues have been raised. Dual paper/electronic environment issues are an important challenge in the implementation of an electronic medical record.
Computer Systems↗
Age-related changes in normal human hearts during the first 10 decades of life. Part I (Growth): A quantitative anatomic study of 200 specimens from subjects from birth to 19 years old.
Heart weight, ventricular wall thicknesses, and valve circumferences were measured in 200 autopsy specimens of normal hearts from persons who ranged from birth to 19 years old. During this period of body growth, all cardiac measurements increased progressively and correlated with both age and body size (height, weight, and surface area). For most measurements, the mean predicted values were greater in male than in female subjects. Heart weight correlated better with body weight and body surface area than with body height or age of patients. In contrast, ventricular wall thicknesses and valve circumferences correlated better with age of the patients than with measurements of body size. In both sexes at all ages, the thickness of the left ventricle was greater than that of the right ventricle and was generally less than that of the ventricular septum. The circumference of the tricuspid valve usually exceeded that of the mitral valve, but aortic and pulmonary valve circumferences were similar. On the basis of these data, equations were derived and reference tables were constructed to predict normal values for heart weight, ventricular wall thicknesses, and valve circumferences.
Adolescent↗
Age-related changes in normal human hearts during the first 10 decades of life. Part II (Maturity): A quantitative anatomic study of 765 specimens from subjects 20 to 99 years old.
Heart weights, ventricular wall thicknesses, and valve circumferences were measured in 765 autopsy specimens from normal hearts from persons 20 to 99 years old. Body weight was a better predictor of normal heart weight than was body surface area or height, and mean heart weights were greater in men than in women at all ages. When heart weights were indexed (divided by body surface area), the mean values per decade increased significantly in women between the 3rd and 10th decades of life (P less than 0.01) but remained relatively constant with time in men. We found no significant differences in ventricular wall thicknesses between men and women. Although indexed mean values for left and right ventricular wall thicknesses remained relatively constant in all decades, ventricular septal thickness increased significantly between the 3rd and 10th decades of life (P less than 0.001). Beyond the seventh decade of life, the mean ratio of septal to left ventricular free wall thicknesses exceeded 1.20, and the upper 95% confidence limit exceeded 1.50--an important consideration in evaluation of hypertrophic cardiomyopathy in elderly patients. Mean valve circumferences were usually greater in men than in women, but the opposite pertained when values were indexed by body surface area. In both sexes, all indexed mean valve circumferences increased progressively throughout adult life, although this trend was greater for semilunar than for atrioventricular valves. The mean circumference of the aortic valve surpassed that of the pulmonary valve in the 4th decade and approached that of the mitral valve by the 10th decade of life. Thus, in evaluation of annuloaortic ectasia, investigators should take into account the normal age-related changes in aortic valve dimensions.
Adult↗
Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts.
The incidence and size of the patent foramen ovale were studied in 965 autopsy specimens of human hearts, which were from subjects who were evenly distributed by sex and age. Neither incidence nor size of the defect was significantly different between male and female subjects. The overall incidence was 27.3%, but it progressively declined with increasing age from 34.3% during the first three decades of life to 25.4% during the 4th through 8th decades and to 20.2% during the 9th and 10th decades. Among the 263 specimens that exhibited patency in our study, the foramen ovale ranged from 1 to 19 mm in maximal potential diameter (mean, 4.9 mm). In 98% of these cases, the foramen ovale was 1 to 10 mm in diameter. The size tended to increase with increasing age, from a mean of 3.4 mm in the first decade to 5.8 mm in the 10th decade of life.
Adolescent↗