Biomedical subjects

S A Fontana

Publications and source records attributed to S A Fontana.

10 recordsLinked to original sources

PubMed2001

A computerized system for tracking practice and prescriptive patterns of family nurse practitioner students.

Decisions about the fit between advanced practice nursing curricula and the real world of primary care practice should be based on data and not on intuition. The purpose of this article is to describe a computerized database system that can be used to: 1) track practice (including prescribing) patterns of nurse practitioner (NP) students; 2) address data issues that commonly arise; and 3) describe NP students' practice during their education to prospective employers. The database system uses both the Family Nurse Practitioners Log (FNPLOG), a faculty-developed software program, and Epi Info, a companion public domain software program. Variables are categorized as being related to sociodemographic, diagnostic, or prescriptive components of primary care. The system provides a simple, efficient, and feasible way of computerizing, analyzing, and evaluating students' clinical experience and practice patterns. The implications for advanced practice nursing education will be illustrated along with other potential uses of the database system.

Data Collection↗

PubMed2000

Nurse practitioner student prescriptive patterns.

As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15-month period in 1997 and 1998. Numbers of over-the-counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and sociodemographic information. Individual student data were aggregated and analyzed using Epi Info (Epidemiology Program Office of the Centers for Disease Control) and SPSS-PC. Results identified that: 1) the majority of patient visits involved the prescription of 1-2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti-microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.

Adolescent↗

PubMed1997

The delivery of preventive services in primary care practices according to chronic disease status.

OBJECTIVES: The current study examined the relationship between chronic disease status and the receipt of cancer preventive services over a 3-year period. METHODS: Adults (n = 4320) cared for by 167 nonacademic physicians in 42 primary care group practices were studied. Medical records were audited for each patient, as were patient responses to two questionnaires assessing health and sociodemographic characteristics. RESULTS: While the odds of having received counseling to obtain regular checkups were increased for men (1.56) and women (1.46) with hypertension, the odds were reduced (range = 0.32 to 0.81) for having received a sigmoidoscopy (women with diabetes or hypertension, men with hypertension or heart disease), fecal occult blood test (men with diabetes or heart disease, women with heart disease), mammogram or counseling about smoking (women with diabetes), clinical breast exam (women with heart disease), and Pap test (women with diabetes or heart disease). CONCLUSIONS: The presence of common chronic health problems in older adults is associated with lower levels of cancer screening services.

Adult↗

PubMed1996

The simultaneous analysis of patient, physician and group practice influences on annual mammography performance.

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Aged↗

PubMed1993

Frequency and determinants of screening for breast cancer in primary care group practice.

BACKGROUND: Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. METHODS: To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. RESULTS: Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. CONCLUSIONS: In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Breast Neoplasms↗

PubMed1993

Marketing health promotion: hitting or missing the target in occupational health.

1. Occupational health nurses can use marketing strategies to plan, offer, and manage health promotion programs; and to conduct research aimed at better understanding the health needs of workers. 2. By applying a social marketing orientation to health promotion planning, occupational health nurses can tailor programs to fit employees' needs, and deliver health messages that are readily understandable to worker groups. 3. A priority in implementing any occupational health program or service is learning about the needs, desires, and health habits of employees. 4. Greater benefits to employee health may occur by targeting change in structures and systems at the workplace rather than solely focusing on lifestyle issues.

Health Promotion↗

PubMed1991

Applying marketing concepts to promote health in vulnerable groups.

Public health nurses must have a valid marketing orientation. Two marketing concepts, exchange relationships and channels of distribution and their application for public health nursing practice, have relevance in this context. In spite of the complexities inherent in applying them, they can be used to promote health in at-risk populations. By incorporating these concepts in planning and delivering public health nursing services, it is hoped that the health goals of a larger number of vulnerable individuals can be achieved.

Health Behavior↗

PubMed1988

Blood cadmium level as affected by hypertension, smoking, occupation, and body mass.

Cadmium can induce persistent hypertension in rats, yet, studies involving humans have been limited by the lack of controlling for confounding variables. The purpose of this study was to determine which lifestyle, health, and other factors are significantly related to predicting blood cadmium level. Thirty-two black female hypertensives 50-75 years of age were selected for comparison with 30 normotensives. Questionnaires were used to gather data on health and other factors. Blood cadmium levels were determined from venous blood samples using atomic absorption spectrophotometry. Smoking status, blood pressure status, and body mass were the only variables significantly related (P less than .05) to blood cadmium level. In the future, studies involving a larger sample size could further clarify a possible relationship between blood cadmium level and hypertension.

Aged↗

PubMed1988

Update on high blood pressure: highlights from the 1988 national report.

This article summarizes the highlights of the 1988 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. In addition, it examines the implications for practice relative to caring for individuals with elevated blood pressure, including individuals with coexisting medical conditions and those from special populations (e.g., young, elderly, pregnant). This article outlines an insightful approach to the definitive clinical recommendations issued in the report. The ways in which nurse practitioners can facilitate greater patient involvement in drug and non-drug therapy as well as in reducing other cardiovascular risk factors are presented. The article addresses the quality of life aspects relative to implementing the treatment guidelines and their importance in clinical decision-making.

Aged↗

PubMed1986

Lifestyle/environmental factors and blood cadmium levels in hypertensive and normotensive individuals.

Cadmium is a non-essential trace metal presently found at environmental concentration far exceeding its natural occurrence, to which human populations are exposed form diverse sources. Animals exposed chronically to subtoxic cadmium levels develop hypertension, yet human studies are inconclusive. In the present study, the relationship between lifestyle/environment factors and blood cadmium levels was investigated. Black females aged 50-75 years were chosen from university clinics and community settings (30 normotensives and 32 hypertensives). Questionnaires giving environmental, lifestyle and other date were collected. Cadmium blood levels were determined by atomic absorption spectophotometry; and results indicated a high degree of precision and accuracy for the cadmium analytical technique which was used. No significant differences were found in cadmium blood levels between groups.

Aged↗