PubMed Health⌕ Search

Biomedical subjects

Robert M Hamm

Publications and source records attributed to Robert M Hamm.

12 recordsLinked to original sources
PubMed2006

Does secondary smoke exposure increase the incidence and/or severity of asthma in children?

Pediatric asthma is a significant health problem in the United States. Up to 26,000 new asthma cases are identified every year. Seventeen percent of all pediatric emergency department visits are attributable to asthma. There are no universally agreed upon diagnostic criteria for asthma. Because no single agent has been identified as causing asthma and because no pathologic feature is entirely unique to asthma, the disease can more easily be described than defined. Asthma is diagnosed clinically based upon recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night in the absence of other causes. Asthma is considered a chronic inflammatory disorder associated with airflow obstruction, which is often reversible either spontaneously or with treatment. This inflammation exacerbates bronchial hyper-responsiveness to a variety of environmental stimuli including allergens and irritants. Due to inconsistency of diagnostic criteria for asthma, it is easier to measure asthma severity or to study events such as hospitalizations or deaths, rather than to measure incidence. Since a randomized controlled trial of the effect of cigarette exposure on asthma would be unethical, we must rely on either randomized trials of reduction of cigarette exposure or epidemiological studies to determine associations between secondary exposure to cigarette smoke and asthma.

Adolescent↗
PubMed2005

Exploring beliefs about prostate cancer and early detection in men and women of three ethnic groups.

OBJECTIVES: Practice guidelines support informed or shared decision-making about prostate cancer screening. To compare beliefs across three racial/ethnic categories concerning prostate cancer etiology and risk, screening routines, and shared decision-making, we conducted 12 focus groups. METHODS: Participants were recruited in primary care settings and included 33 African Americans, 35 Hispanics, and 22 non-Hispanic Whites. Of the 90 participants, 53% were male. RESULTS: Groups identified heredity, age, race, sexual activity, and other lifestyle influences as risk factors. Few were aware that prostate cancer is asymptomatic in early stages. Confidence in knowledge of screening routines was high, but included misconceptions supporting initiation of screening at earlier ages and at shorter intervals than professional recommendations. Females encouraged screening of male relatives to protect their health. DISCUSSION AND CONCLUSION: While racial/ethnic groups had similar views and knowledge about screening, African Americans wanted to organize to address the threat of prostate cancer in their communities. Hispanics had awakening awareness of the health risks of prostate cancer. Non-Hispanic Whites were aware of the health threat of prostate cancer, but their approach to health protection was more individual and less community focused than that of African Americans. Participants were not aware of controversy about screening. PRACTICE IMPLICATIONS: Developers of educational materials to support informed or shared decision-making should be aware that initial views of prostate cancer screening are positive.

Adult↗
PubMed2004

Acute bacterial rhinosinusitis in adults: part I. Evaluation.

Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory practice. Although often caused by viruses, it sometimes is caused by bacteria, a condition that is called acute bacterial rhinosinusitis. The signs and symptoms of acute bacterial rhinosinusitis and prolonged viral upper respiratory infection are similar, which makes accurate clinical diagnosis difficult. Because two thirds of patients with acute bacterial rhinosinusitis improve without antibiotic treatment and most patients with viral upper respiratory infection improve within seven d antibiotic therapy should be reserved for use in patients who have had symptoms for more than seven days and meet clinical criteria. Four signs and symptoms are the most helpful in predicting acute bacterial rhinosinusitis: purulent nasal discharge, maxillary tooth or facial pain (especially unilateral), unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement. Sinus radiography and ultrasonography are not recommended in the diagnosis of uncomplicated acute bacterial rhinosinusitis, although computed tomography has a role in the care of patients with recurrent or chronic symptoms.

Acute Disease↗
PubMed2004

Acute bacterial rhinosinusitis in adults: part II. Treatment.

Although most cases of acute rhinosinusitis are caused by viruses, acute bacterial rhinosinusitis is a fairly common complication. Even though most patients with acute rhinosinusitis recover promptly without it, antibiotic therapy should be considered in patients with prolonged or more severe symptoms. To avoid the emergence and spread of antibiotic-resistant bacteria, narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days. In patients with mild disease who have beta-lactam allergy, trimethoprim/sulfamethoxazole or doxycycline are options. Second-line antibiotics should be considered if the patient has moderate disease, recent antibiotic use (past six weeks), or no response to treatment within 72 hours. Amoxicillin-clavulanate potassium and fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae. In patients with beta-lactam hypersensitivity who have moderate disease, a fluoroquinolone should be prescribed. The evidence supporting the use of ancillary treatments is limited. Decongestants often are recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion. Topical ipratropium and the sedating antihistamines have anticholinergic effects that maybe beneficial, but there are no clinical studies supporting this possibility. Nasal irrigation with hypertonic and normal saline has been beneficial in chronic sinusitis and has no serious adverse effects. Nasal corticosteroids also may be beneficial in treating chronic sinusitis. Mist, zinc salt lozenges, echinacea extract, and vitamin C have no proven benefit in the treatment of acute bacterial rhinosinusitis.

Acute Disease↗
PubMed2004

Reimbursement for pediatric diabetes intensive case management: a model for chronic diseases?

OBJECTIVE: Current reimbursement policies serve as potent disincentives for physicians who provide evaluation and management services exclusively. Such policies threaten nationwide availability of care for personnel-intensive services such as pediatric diabetes. This report describes an approach to improving reimbursement for highly specialized, comprehensive pediatric diabetes management through prospective contracting for services. The objective of this study was to determine whether pediatric diabetes intensive case management services are cost-effective to the payer, the patient, and a pediatric diabetes program. METHODS: A contract with a third-party payer was created to reimburse for 3 key pediatric diabetes intensive case management components: specialty education, 24/7 telephone access to an educator (and board-certified pediatric endocrinologist as needed), and quarterly educator assessments of self-management skills. Data were collected and analyzed for 15 months after signing the contract. Within the first 15 months after the contract was signed, 22 hospital admissions for diabetic ketoacidosis (DKA) occurred in 16 different patients. After hospitalizations for DKA, all 16 patients were offered participation in the program. All were followed during the subsequent 1 to 15 months of observation. Ten patients elected to participate, and 6 refused participation. Frequency of rehospitalization, emergency department visits, and costs were compared between the 2 groups. RESULTS: Among the 10 participating patients, there was only 1 subsequent DKA admission, whereas among the 6 who refused participation, 5 were rehospitalized for DKA on at least 1 occasion. The 10 patients who participated in the program had greater telephone contact with the team compared with those who did not (16 crisis-management calls vs 0). Costs (education, hospitalization, and emergency department visits) per participating patient were approximately 1350 dollars less than those for nonparticipating patients. Differences between participating and nonparticipating groups included age (participants were of younger age), double-parent households (participants were more likely to be from double parent households), and number of medical visits kept (participants kept more follow-up visits). No differences in duration of diabetes, months followed in the program, sex, or ethnicity were observed. CONCLUSIONS: Contracting with third-party payers for pediatric diabetes intensive case management services reduces costs by reducing emergency department and inpatient hospital utilizations, likely a result of intensive education and immediate access to the diabetes health care team for crisis management. Such strategies may prove to be cost saving not only for diabetes management but also for managing other costly and personnel-intensive chronic diseases.

Adolescent↗
PubMed2003

Interpretation of prostate cancer screening events and outcomes: a focus group study.

Professional guidelines call for physicians to provide patients with information to permit informed decision making. We conducted focus groups to obtain reactions to numerical information about events and outcomes related to prostate cancer screening (prevalence, natural history, accuracy of screening, and treatment outcomes). The focus groups were used to help develop a balance sheet, a decision aid that explicitly compares likelihood and value of outcomes. In all, 90 persons participated in 12 focus groups homogeneous in ethnicity (African American, White, Hispanic) and gender. Discussions were transcribed and analyzed using qualitative methods. The view of screening derived by participants from the numerical information was less positive than initial opinions based on the media and confidence in medicine. Participants suggested shorter screening intervals, regular screening, and different treatment methods. No single topic was seen as sufficient for the screening decision. The balance sheet should cover prevalence and outcomes of screening and treatment.

Attitude to Health↗
PubMed2002

Measuring academic production.

BACKGROUND: The entire academic medical community is under increasing pressure to define and measure its activities. Previous relative value-based systems to measure research, teaching, administration, and patient care share several features that threaten their acceptability and validity. Using a bottom-up approach, our academic family medicine department attempted to develop a measurement system that avoided some of the flaws of the earlier systems. METHODS: The system was developed in two phases. In the first phase, faculty members were invited to submit lists of all their professional activities. In the second phase, the faculty rated the relative value of a comprehensive list of academic activities using an unbounded ratio scale and indicated how many times a year they did each activity. RESULTS: Phase One resulted in a list of 96 academic activities. The activity rated in Phase Two as having the greatest relative value was principal investigator of a funded grant (relative value=30.23), followed by sole author of a book (relative value=28.25). The activity with the smallest relative value was attending a faculty meeting (relative value=.36). A half-day clinic session had a relative value of 1.08. The department's annual production, measured in relative value units, was 5,764 units of administration, 5,702 units of clinical activities, 5,480 units of teaching, and 4,401 units of scholarly activities. CONCLUSIONS: Overall, the process efficiently produced relative value measures for a large number of faculty activities using a process in which most of the faculty participated. Problems with internal coherence, face validity, and inconsistencies in estimation suggest it would be premature to use such estimates of relative value to quantify individuals 'productivity as a basis for budgetary decisions.

Academic Medical Centers↗
PubMedDate not supplied

Do perceptions of risk and quality of life affect use of hormone replacement therapy by postmenopausal women?

BACKGROUND: Although the understanding of the health impact of hormone replacement therapy (HRT) is incomplete, even less is known about the attitudes, perceptions, and motivations of women faced with the decision to use HRT. The purpose of this study was to evaluate the relation between HRT use and women's perceptions of the risk and benefits associated with HRT use. METHODS: A written questionnaire was administered to 387 women, aged 45 years and older, responding to a health plan invitation for free bone mineral density screening. Women were asked to estimate the lifetime probability of developing breast cancer, uterine cancer, osteoporosis, and myocardial infarction when taking HRT and when not taking HRT. Women rated their quality of life in their current state of health, with breast cancer, with uterine cancer, with osteoporosis, and after myocardial infarction. RESULTS: HRT users perceived a greater risk reduction using HRT compared with HRT nonusers for osteoporosis (-34.9% vs -17.8%, P <.001) and myocardial infarction (-20.7% vs -8.4%, P <.001). HRT nonusers perceived a greater risk increase using HRT compared with HRT nonusers for breast cancer (16.5% vs 3.3%, P <.001) and uterine cancer (9.2% vs 0.6%, P =.004). HRT users estimated a greater quality-of-life reduction compared with HRT nonusers for osteoporosis (-31.0 vs -24.5, P =.006). CONCLUSIONS: Regardless of whether they used HRT, women in this study overestimated their risk for all four diseases. HRT users perceived greater benefit and less risk using HRT than nonusers. The results of our study show that continuing efforts are needed to help women understand the risks and benefits of HRT.

Aged↗
PubMedDate not supplied

The relationships among constructs in the health belief model and the transtheoretical model among African-American college women for physical activity.

PURPOSE: Health Belief Model (HBM) and Transtheoretical Model concepts were used to investigate possible differences in perceptions of physical activity among African-American college women categorized by their stage of physical activity behavior METHODS: A survey was administered to 233 participants to assess their stage of physical activity behavior and HBM perceptions. Analysis of variance was used to investigate possible differences among HBM constructs for each behavior stage. RESULTS: Perceived barriers were significantly higher (p < .05), and perceived severity, cues to action, and self-efficacy were significantly lower in the inactive group than in the active group. For example, perceived barriers were significantly higher in the inactive (mean = 2.3) stage than in the preparation (mean = 2.1), action (mean = 1.9), and maintenance (mean = 1.7) stages of physical activity behavior. DISCUSSION: The results suggest that many perceptions of physical activity differ significantly among stages of behavior in this sample of African-American college women. A limitation was that some scales were modified specifically for this population and were not validated.

Adolescent↗