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Biomedical subjects

S W Vernon

Publications and source records attributed to S W Vernon.

At least 55 records · Page 3Linked to original sources
PubMed1992

Productivity of radiologists in the United States by imaging technique: a 16-year analysis based upon relative value units.

Professional Relative Value Units (RVUs) quantifying productivity of radiologists in the United States were used to study trends from 1973 to 1989 in the distribution of productivity among the various imaging techniques. Data from a 1989 survey were used to estimate the distribution of radiology examinations among techniques for 1989. A difficulty index (RVUs per examination) was calculated for each technique weighted by actual CPT-code occurrences reported in that survey. An RVU workload was estimated for each technique by multiplying the occurrences of the technique by its corresponding difficulty index. This analysis was applied first to the 1989 data, and second, retrospectively, to data from the literature that gave the distribution by technique of estimated national procedures for 1973 and 1980. The number of studies and RVUs in all techniques has increased from 1973 to 1989 with a relatively greater increase in the percentage of mammography and of sectional imaging examinations. Differences in difficulty index between the techniques leverage the changes in occurrence, causing a dramatic increase in the percentage of RVU workload represented by sectional imaging. The percentage of procedures and RVUs represented by vascular/interventional has remained relatively constant. The overall difficulty index has risen by 18% from 1973 to 1989. These trends should influence the allocation of space, equipment, and human resources in radiology department planning and management.

Diagnostic Imaging↗
PubMed1992

Diabetes and disability among Mexican Americans: the effect of different measures of diabetes on its association with disability.

The association of non-insulin-dependent diabetes mellitus and disability was evaluated in a population of Mexican Americans from the southwest U.S. using data from the Hispanic Health and Nutrition Examination Survey. Among the total sample of persons who completed a clinical examination, 14.6% reported a limitation of job performance, the inability to complete housework, or the inability to perform activities of daily living. Among the subsample who completed the clinical examination and reported having diabetes, 31.6% claimed similar disability. In those respondents who also completed an oral glucose tolerance test (OGTT) or who were currently receiving insulin, the prevalence of disability was 25% in persons with an abnormal OGTT and 40.2% in those who were receiving insulin compared with 14.9% in those with a normal OGTT. Self-reported diabetes was positively associated with functional impairment in the examined population after adjusting for demographic variables and comorbidity; however, diabetes confirmed by OGTT was not significantly associated with disability after adjustment for other factors. Differences in pre-existing health status between persons who completed the OGTT and those who did not are discussed in relation to these results.

Activities of Daily Living↗
PubMed1991

Productivity of radiologists: estimates based on analysis of relative value units.

Analysis of relative value units (RVUs) was used to quantify patient-care productivity of radiologists in 19 multispecialty group practices and to determine how productivity is affected by certain characteristics of the practices. The RVUs used in this study are the professional component RVUs developed by the American College of Radiology and the Health Care Financing Administration and published as the Radiology Relative Value Scale. An RVU workload was calculated by multiplying the number of times each procedure was performed by the procedure's corresponding RVU; the sum of these products gave the overall professional RVU workload. Five productivity indexes were calculated. The physician index denotes the ratio of the total number of physicians in the clinics to the total number of radiologists. The availability index denotes the fraction of radiologists who are available to perform clinical work after deductions are made for time away from clinical work. The difficulty index measures, in RVUs per examination, the level of complexity of the overall examination mix. The examination index measures examinations per available radiologist, and the RVU index measures RVUs per available radiologist. Altogether, the 19 clinics reported 3,234,451 examinations performed by 299 radiologists. The computed overall indexes were as follows: physician index = 20 physicians per radiologist; availability index = 0.77; difficulty index = 2.27 RVUs per examination; examination index = 14,098 examinations per year per available radiologist; RVU index = 32,065 RVUs per year per available radiologist. When the clinics were grouped according to characteristics of the practices, the RVU index was higher for single-site practices, high-prepaid practices, outpatient-only practices, and practices without radiology training programs. Fifty-two percent of the RVUs were in general radiology, 37% in sectional imaging, and 10% in special procedures. The concept of RVU workload is timely because it undoubtedly will be used to compare workloads across medical subspecialties, and these workloads are likely to be related by third-party payers to compensation.

Ambulatory Care↗
PubMed1991

Physicians' management of health effects related to industrial exposures: two case reports.

Although physicians play a vital role in diagnosing and treating health effects related to industrial exposures, most physicians have limited training in occupational and environmental medicine. Two cases of industrial exposure, one affecting an individual and the other, a community, are described to illustrate the need for physicians' awareness of such exposure and their need to know how to manage potential health effects. Resources to assist in identifying and managing these exposures and their related conditions are discussed.

Accidents, Occupational↗
PubMed1990

Mammographic screening of women with increased risk of breast cancer.

Five hundred one women from Dallas County, Texas who participated in the American Cancer Society 1987 Texas Breast Screening Project were selected because of a self-reported family history of breast cancer (cases). They were matched with 501 randomly selected women from the same county with no family history (controls). Although there was a statistically significant trend with age for an increasing proportion of women to report having undergone mammography, there was no significant difference when comparing mammographic histories of cases with controls after controlling for age (31.5% versus 35.1%, P = 0.33). Significantly more cases (79%) perceived their risk for breast cancer to be moderate or greater compared with controls (54%, P less than 0.0001), but mammographic histories were not different when controlling for perceived risk. Both cases and controls cited lack of physician referral and cost as their reasons for not having undergone mammography. Women at increased risk for breast cancer (because of their family history) are not undergoing regular mammographic screening despite their self-awareness of the increase in their risk.

Adult↗
PubMed1990

Using the CES-D scale to screen for depression and anxiety: effects of language and ethnic status.

The purpose of this report is to present data on the effects of language (English/Spanish) and ethnic status (white/non-Hispanic or Mexican origin) on the ability of the Center for Epidemiologic Studies Depression (CES-D) scale to detect cases of clinical depression and generalized anxiety identified using the Diagnostic Interview Schedule (DIS) in psychiatric treatment settings. The agreement between the CES-D scale and the DIS diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) was poor, especially among Mexican-origin patients interviewed in Spanish. Multiple regression analysis revealed that the CES-D scale was positively associated with MDD in all groups. In addition, GAD also was associated with the CES-D scale in Anglos and English-speaking Mexican-Americans but not in Spanish-speaking Mexican-Americans.

Anxiety Disorders↗
PubMed1990

Participation in breast screening programs: a review.

Despite recommendations by the American Cancer Society and other organizations for use of screening mammography, data on reported utilization of this procedure by American women show that these guidelines are not being met. We reviewed published studies that reported participation rates or that examined factors associated with participation in selected breast screening programs. In general, women at high risk due to age and family or personal history of breast disease were not more likely to participate in breast screening programs than women without those risk factors. The one group of variables that was fairly consistently associated with participation was the practice of other preventive health behaviors. Women who expressed more concern about their health and who were more knowledgeable about breast cancer screening and its benefits also were more likely to complete mammography. Approaches to increasing participation are discussed in the context of the literature on this subject.

Attitude to Health↗
PubMed1990

Reasons for participation and nonparticipation in a colorectal cancer screening program for a cohort of high risk polypropylene workers.

Little is known about reasons for participation in occupational colorectal cancer screening programs using flexible sigmoidoscopy and barium enema. To assess this issue, telephone interviews were conducted with a sample of participants and nonparticipants in such a program. This study was a follow-up of a previous assessment of factors that affected screening participation among a cohort found to have elevated rates of colorectal cancer. The major finding of this survey was that the absence of symptoms was the major reason for nonparticipation, although both participants and nonparticipants expressed the view that early detection was important and that colorectal cancer could be cured if treated at an early stage. Based on the results of this study and of other surveys, educational messages to workers explaining the asymptomatic development of colorectal cancer should be tried as a way of increasing participation.

Aged↗
PubMed1989

Effects of language and ethnic status on reliability and validity of the Center for Epidemiologic Studies-Depression Scale with psychiatric patients.

Data from 562 psychiatric patients were analyzed to assess the effects of ethnic status (Anglo/Mexican origin) and language (English/Spanish) on the reliability and validity of the Center for Epidemiologic Studies-Depression Scale. The results indicate no systematic variation in either reliability (test-retest, internal consistency), dimensionality, or ability of the CES-D Scale to detect clinical depression among Anglos or persons of Mexican origin classified according to language use as Spanish dominant, English dominant, or bilingual. However, the data indicate that this particular screening instrument does not adequately discriminate between patients with clinical depression and those without depression. These results corroborate several recent studies that question the utility of the CES-D Scale as a depression screening instrument. Taken together, the available evidence suggests that the ability of the CES-D Scale to detect major depression is so limited that further use of the instrument as a screening scale would seem unwarranted, at least in treatment settings.

Analysis of Variance↗
PubMed1989

Stage at diagnosis of breast cancer. Comparison in a fee-for-service and health maintenance organization practice.

This study assessed the effectiveness of two types of health plans in the diagnosis of female breast cancer by comparing the clinical stage at final diagnosis. Data on 202 cases diagnosed over a 4-year period from May 1983 to May 1987 were abstracted from medical records. Of these, 133 (65.8%) used fee-for-service (FFS) and 69 (34.2%) used health maintenance organization (HMO) plans. The two groups differed significantly on age and employment status; the HMO cases were younger than the FFS cases and were more likely to be employed. HMO cases also were more likely to have had some tests and procedures, but the test results were similar. Other demographic, risk factor, behavioral, clinical, and laboratory findings did not differ significantly by health plan, suggesting a uniformity of characteristics and of service availability. Overall, there was no difference between the groups in clinical stage of breast cancer at final diagnosis. On age-specific tests, however, the 45 to 55 year age group showed a significant difference in the stage of breast cancer at diagnosis with a higher proportion of HMO cases diagnosed at stage 1 than FFS cases. In contrast, in the 20 to 44 year age group, there was a nonsignificant trend for more FFS than HMO cases to be diagnosed at stage 1. Results from this study suggest that when offered by one medical practice, both FFS and HMO plans may be equally effective in the detection of breast cancer.

Adult↗
PubMed1989

Comparison of participants and nonparticipants in a work site cancer awareness and screening program.

In 1985, Pennzoil Company offered a company-paid cancer awareness and screening program focusing on breast and colorectal cancers for its employees. Following a lecture/slide presentation, employees filled out a risk assessment questionnaire. Those at risk for breast and/or colorectal cancers were invited for consultation, mammography, and/or short colonoscopy. Overall completion rates were 49% for mammography, 20% for the fecal occult blood test, and 31% for short colon oscopy, but these rates varied by risk status. Moreover, the same demographic and risk factors were not consistently associated with completion of the same screening procedure across risk groups. Based on these findings, we suggest that different interventions may need to be developed depending on the risk characteristics of subgroups within the target population.

Adult↗
PubMed1989

Factors associated with participation in an occupational program for colorectal cancer screening.

This study reports factors associated with participation in a colorectal cancer screening program for a cohort of workers on a polypropylene manufacturing unit. The impetus for the screening program was the discovery of a colorectal cancer cluster among workers on this unit. The program included a life-style/risk factor questionnaire, fecal occult blood test, a 60-cm colonoscopy, and an air-contrast barium enema. Overall, 52.5% of the 406 men who were offered screening participated in the program. Of those screened, only 40% attended a briefing, but over 80% of those who attended a briefing came for screening. Factors associated with completion of screening are analyzed and discussed in the context of the literature on participation in colorectal screening programs. The implications for colorectal cancer screening of occupational groups believed to be at high risk are considered.

Adult↗
PubMed1987

Problems in estimating the prevalence of physical activity from national surveys.

Health policy in the United States has paid scant notice to physical activity until recently. This current policy focus on physical activity has revealed not only that there is less than adequate data about it but also that the single survey questions used for the purpose of measuring its prevalence should be interpreted carefully. A case in point is the example presented in this article, which gives estimates of physical activity prevalence levels for women of child-bearing ages from several National Center for Health Statistics (NCHS) surveys. The amount of physical activity reported, and thus the proportion of women at risk for various diseases due to limited activity, depends on how the question is asked and the type of responses offered as options. Various questions used in three different NCHS surveys produced prevalence estimates of limited physical activity levels ranging from 3.9 to 39.1%. These findings have important implications for survey assessments of physical activity at all policy levels.

Adult↗
PubMed1986

Marital status, delay in seeking treatment and survival from breast cancer.

This study examined 10-year survival following a breast cancer diagnosis among 910 married and 351 widowed white women after adjusting for the effects of age, socio-economic status (SES), stage of disease and delay in seeking treatment for symptoms. All breast cancer patients were treated at M.D. Anderson Hospital and Tumor Institute in Houston, Texas between 1949 and 1968. Marital status, age, SES, delay and stage were all univariate predictors of survival. Widowed patients were less likely to survive than married patients. Multivariate analyses using a Cox regression technique did not detect an effect of delay on survival when stage and the other variables were included. However, marital status differences in survival remained when all the other variables were included in the model. These data suggest that marital status differences in survival cannot be accounted for by patient delay in seeking treatment for breast cancer symptoms.

Adult↗
PubMed1985

Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer.

This study examined differences in 10-year survival rates from breast cancer among white, black, and Hispanic women controlling for the effects of age, socioeconomic status (SES), stage of disease, and delay in seeking treatment for symptoms. Breast cancer patients (n = 1983) treated at M. D. Anderson Hospital and Tumor Institute in Houston, Texas between 1949 and 1968, were followed for 10 years. Ethnicity, SES, stage of disease, and delay were all found to affect survival when considered separately. Black patients were less likely to survive than either white or Hispanic patients whose survival experience appeared to be similar. Multivariate analysis that used a Cox regression technique showed that ethnic differences remained when age, SES, stage, and delay were included in the model. In contrast, the authors could not detect an effect of delay on survival when ethnicity and all other variables were included. These data suggest that ethnic differences in breast cancer survival are not mediated by differences in delay in seeking treatment for breast cancer symptoms.

Black or African American↗