==================================HSR28================================== 28. Recommendations for physical examinations; including frequency, including Pap smears, gynecological exams, chest X-rays, EKG's, sigmoidoscopy. 1 UI - 87101803 AU - Wells PN TI - The prudent use of diagnostic ultrasound. British Institute of Radiology presidential address 1986. AB - Progress in diagnostic ultrasound is driven by the development of new technology. The place of new techniques in diagnostic algorithms has to be determined jointly by radiologists and clinicians and appropriate arrangements have to be made for training. About 30 million pounds per year is currently spent on diagnostic ultrasound in the UK. Diagnostic ultrasound depends on the information obtained as a result of ultrasonic irradiation of the patient. Biological effects, some of which are undesirable, can be produced by ultrasound but there is no evidence that the exposures used in diagnosis carry any risk. In judging whether ultrasonic scanning is appropriate in any particular situation, it is necessary to consider benefits, costs and available resources. The costs include not only the costs of the test but also the cost of any hypothetical ultrasonic hazard and the cost of misdiagnosis. The most prudent use of ultrasound is that which maximises the benefit-total-cost ratio and although this cannot presently be quantified, some of the concepts involved can be understood in terms of the health increment and the health decrement, the latter apparently being equal to zero when the diagnosis is correctly made using contemporary equipment. This approach can be extended to introduce the idea of profit arising from the test. As an example, obstetric ultrasound is considered to be appropriate when there is a medical indication for it. Although routine scanning at 16 weeks of pregnancy has been shown to result in a very large profit, there is still conflicting guidance about its advisability on the grounds of safety and existing accounting systems may restrict access to the profit. In discussing the desirability of ultrasonic scanning, patients can be informed that there is no reason to believe that there are any risks related to ultrasonic exposure. The imminent availability of inexpensive ultrasonic scanners for the layman is a worrying prospect to which the medical profession should now try to develop a prudent response. MH - Cost Benefit Analysis ; Human ; Patient Acceptance of Health Care ; Risk ; Technology, Radiologic/TRENDS ; Ultrasonic Diagnosis/ADVERSE EFFECTS/ *ECONOMICS SO - Br J Radiol 1986 Dec;59(708):1143-51 2 UI - 87080619 AU - Pham QT ; Mur JM ; Teculescu D ; Chau N ; Gabiano M ; Gaertner M ; Henquel JC TI - A longitudinal study of symptoms and respiratory function tests in iron miners. AB - A first survey has been conducted on 1179 iron-ore mine workers, 35-55 years old, who were randomly selected from 5900 at work with normal chest roentgenograms. Five years later, 871 of them were re-examined. Both surveys included a standard respiratory symptoms questionnaire (British MRC), a physical examination of the chest, and measurement of pulmonary function (vital capacity - VC; forced expiratory volume during 1 s - FEV1.0; residual volume - R.V. by helium dilution: carbon monoxide uptake - FuCO by the steady-state method). Both surveys were done by the same research team under identical conditions, using the same equipment. The mine technical services determined the dust and noxious gas concentrations at work places. No evidence of worsening of respiratory health status was observed overall. Symptoms of chronic bronchitis and asthma were recorded with a similar prevalence in both surveys; the decline in lung function was minimal for the total sample. However, our aim was to compare changes that were observed in groups differing by work place (surface or underground) or by activity (active or retired). Analysis showed that development of respiratory symptoms was more frequent and decline in lung function accelerated in the 5-year interval among underground workers who were still active as compared to those retired. In all subgroups (surface or underground workers, active or retired), decline of lung function values was more marked in smokers compared to non-smokers. MH - Adult ; Asthma/PHYSIOPATHOLOGY ; Bronchitis/PHYSIOPATHOLOGY ; Carbon Monoxide/METABOLISM ; Chronic Disease ; Comparative Study ; France ; *Health Status ; *Health ; Human ; *Iron ; Longitudinal Studies ; Male ; Middle Age ; *Mining ; Questionnaires ; *Respiratory Function Tests ; Retirement ; Smoking ; Support, Non-U.S. Gov't ; Work SO - Eur J Respir Dis 1986 Nov;69(5):346-54 3 UI - 87037006 AU - Culkin DJ ; Wheeler JS Jr ; Nemchausky BA ; Fruin RC ; Canning JR TI - Percutaneous nephrolithotomy in the spinal cord injury population. AB - We evaluated 23 male spinal cord injury patients who underwent percutaneous nephrolithotomy for the success rate of stone removal and the incidence of operative complications. There were 18 quadriplegic and 5 paraplegic patients, and 5 had bilateral procedures. Of the kidneys 7 had staghorn calculi, 8 had pelvic and caliceal combinations, 6 had large multiple caliceal stones, 4 had large (more than 2.5 cm.) pelvic stones and 3 had pelvic stones less than 2.5 cm. Placement of a nephrostomy tube and stone extraction were performed as a single procedure with the use of general anesthesia in all but 4 patients. Our results showed that 19 of 21 compliant patients (90.4 per cent) were free of stone, with an average of 2.04 procedures per patient. A total of 47 procedures was performed, with an average operative time of 1 hour 45 minutes. Major complications were associated with 4 of the 47 procedures (8.5 per cent), and consisted of a respiratory arrest, 2 perirenal abscesses and a hydrothorax. Minor complications included fever (more than 101.5F) in 64.3 per cent and retained stones in 14.3 per cent of the kidneys operated upon, dislodged nephrostomy tubes in 12.6 per cent of the procedures (21.4 per cent of the kidneys operated upon), and anemia requiring transfusion in 17.0 per cent (8 of 47) of the procedures (27.8 per cent of the kidneys operated upon). The presence of infected stones, prior operative procedures and medical complexity of these patients make complications more frequent. Nevertheless, percutaneous nephrolithotomy is a safe and effective procedure for the spinal cord injury population. MH - Adult ; Aged ; Human ; Kidney Calculi/COMPLICATIONS/*SURGERY ; Male ; Middle Age ; *Nephrostomy, Percutaneous/ADVERSE EFFECTS ; Patient Acceptance of Health Care ; Spinal Cord Injuries/*COMPLICATIONS SO - J Urol 1986 Dec;136(6):1181-3 4 UI - 87036049 AU - Goldenberg K TI - Periodic health examination: comparison of residency programs and national recommendations. AB - Health maintenance and disease prevention guidelines of primary care internal medicine residency (PCIM) programs were investigated and compared with recommendations of major national organizations. Preventive screening data were requested from 134 PCIM programs; 120 (90%) responded. Methods included seminars/lectures by 73 (61%), health maintenance flow sheets by 58 (48%), and a variety of other formats by 25 (21%) programs. A comparison of recommended flow sheet items (n = 33) from five major studies and 48 PCIM programs showed concordances (+/- SE) of 62% (+/- 5) with high-priority items (n = 15) and 33% (+/- 4) with low-priority items (n = 18). When an item's frequency or age range was examined, however, concordances were much lower. From our analysis, fewer than half the programs routinely used prompting systems, such as flow sheets, in their ambulatory clinics, and there was little uniformity in the frequencies and age ranges for those items employed. The data suggest that major study recommendations were underused and underemphasized. MH - Comparative Study ; Data Collection ; Human ; Internal Medicine/ *EDUCATION ; *Internship and Residency ; *Physical Examination ; Preventive Health Services/*UTILIZATION ; Support, U.S. Gov't, P.H.S. ; United States SO - J Gen Intern Med 1986 Sep-Oct;1(5):282-6 5 UI - 87017848 AU - Brailey LJ TI - Effects of health teaching in the workplace on women's knowledge, beliefs, and practices regarding breast self-examination. AB - This study had two primary purposes: to examine the effects of group and individual teaching by nurses in the workplace on 140 female office employees' health knowledge, beliefs, and practices regarding breast self-examination and to identify factors associated with frequency of practice. Skill in technique, confidence in the skill, and frequency of breast self-examination increased significantly with both teaching formats, but there were areas of technique that needed further improvement. Perceived susceptibility to breast cancer and perceived benefits of breast self-examination increased significantly only with individual teaching; knowledge was not increased with either teaching format. MH - Adult ; Attitude to Health ; Breast Neoplasms/DIAGNOSIS ; *Breast ; Comparative Study ; Disease Susceptibility ; Female ; Health Education/ *METHODS ; Human ; Middle Age ; *Occupational Health Services ; *Palpation ; Practice (Psychology) ; Self Care ; Teaching/METHODS SO - Res Nurs Health 1986 Sep;9(3):223-31 6 UI - 87016798 AU - Weisman CS ; Celentano DD ; Hill MN ; Teitelbaum MA TI - Pap testing: opinion and practice among young obstetrician-gynecologists. AB - Since 1976, contradictory recommendations by a number of groups (including the American Cancer Society, the National Cancer Institute, a National Institutes of Health Consensus Development Conference, the Canadian Task Force on Cervical Cancer Screening Programs, and the American College of Obstetricians and Gynecologists) on the timing of Pap testing--including age to begin testing, appropriate frequency of testing, and age to discontinue testing--have been communicated to both physicians and consumers. The opinions and practices of a U.S. national sample of recently trained obstetrician-gynecologists, whose professional association continues to endorse annual Pap tests, were investigated and compared with key points from the various recommendations. The appropriateness of the recommendations themselves is not addressed. Findings show that respondents are aware of recommendations for less frequent Pap testing, but they believe that women should generally receive annual Pap tests and that regular Pap testing should not be discontinued among the elderly. While the intensity of Pap testing services varies by type of practice arrangement, such variation does not occur for opinions regarding Pap testing, with one exception: Those practicing in multispecialty groups (including health maintenance organizations) are more likely to endorse routine Pap testing for elderly women if they see elderly women in their practices. Thus, the physicians in this study are not adhering to recommendations for Pap testing on a less-than-annual basis or for discontinuance in the elderly. MH - Adolescence ; Adult ; Age Factors ; Aged ; Attitude to Health ; Female ; *Gynecology ; Human ; Male ; Middle Age ; *Obstetrics ; Societies, Medical ; Support, U.S. Gov't, P.H.S. ; Time Factors ; United States ; *Vaginal Smears SO - Prev Med 1986 Jul;15(4):342-51 7 UI - 87011209 AU - Cash TF ; Green GK TI - Body weight and body image among college women: perception, cognition, and affect. AB - This study examined the relations between body weight and multiple parameters of body image in a nonclinical sample. Thirty-six female undergraduate students with stable body weights served as subjects; 12 were underweight, 12 were normal weight, and 12 were overweight, as determined using recent normative tables. Each subject responded to a general weight information questionnaire and to the Body-Self Relations Questionnaire, a standardized instrument assessing affective, cognitive, and behavioral components of appearance-related body image. A newly developed apparatus and procedure for estimating body size, the Body Image Detection Device, was utilized for perceptual and cognitive measures of body image. Each subject estimated and also subjectively appraised the width of her own body at five points and that of a realistic female mannequin. A caliper was used to record actual widths, and a standard laboratory scale and rule measured weight and height. The general finding of the study was that the perceptual, affective, and cognitive components of body image differed as a function of body weight, but the nature of the differences varied with the measure employed. The pattern of results for the perceptual measure suggest a cautious view of its reliability and validity. The multidimensional approach of our study, in marked contrast to earlier fractionated studies, offers a more integrated perspective on body image and provides new directions for future research. MH - Adult ; *Affect ; Attitude ; *Body Image ; *Body Weight ; *Cognition ; Female ; Human ; Obesity/PSYCHOLOGY ; Personality Tests ; Psychometrics SO - J Pers Assess 1986 Summer;50(2):290-301 8 UI - 86217608 AU - Johnson R ; Ananth J TI - Physically ill and mentally ill. AB - Undetected physical illnesses in psychiatric patients are common. Why do so many physical illnesses go undetected? These disorders are difficult to detect and need an elaborate consultatory process. Some of the problems may be related to the fact that psychiatrists do not do physical examinations. Clues suggesting an organic etiology may be attributed to psychodynamic issues by many physicians. In this paper, seven case reports are presented to illustrate the following: perform your own physical examination; do not attribute physical signs to dynamic issues; all physical signs should be explained; be alert to atypical presentations; conduct relevant laboratory workup; avoid bias against unattractive patients; and pose specific questions to consultants. MH - Attitude of Health Personnel ; *Diagnostic Errors ; Human ; Mental Disorders/*DIAGNOSIS ; Patients/PSYCHOLOGY ; Physical Examination ; Physicians/PSYCHOLOGY ; Psychiatry/*STANDARDS ; Referral and Consultation SO - Can J Psychiatry 1986 Apr;31(3):197-201 9 UI - 86212304 AU - Tinetti ME ; Schmidt A ; Baum J TI - Use of the erythrocyte sedimentation rate in chronically ill, elderly patients with a decline in health status. AB - A decline in health status in a chronically ill, elderly patient could mean the progression of a known disease, depression, or the development of a new disease. The value of the erythrocyte sedimentation rate in selecting patients in whom the likelihood of a new disease is high enough to warrant a diagnostic evaluation was studied. Subjects included long-term residents of a chronic-care hospital over age 65 in whom the erythrocyte sedimentation rate was determined because of a nonspecific, subacute change in health status (n = 98) or new, unexplained musculoskeletal complaints (n = 44). The target erythrocyte sedimentation rate-elevating diseases included infections, connective tissue diseases, and malignancies. Among the group with subacute deterioration, post-test probabilities (incorporating clinical data with test results) of a new disease ranged from 7 percent in those with an erythrocyte sedimentation rate below 20 mm per hour to 66 percent in those with a rate of 50 mm per hour or more. The comparable probabilities among the group with musculoskeletal complaints were 3 percent and 57 percent. The erythrocyte sedimentation rate, an inexpensive test, although nonspecific, appears useful in deciding when to pursue expensive, and sometimes uncomfortable or hazardous, diagnostic evaluations. The erythrocyte sedimentation rate is most useful among patients in whom the probability of disease is moderate (neither very high nor very low) following initial history-taking and examination. MH - Aged ; *Blood Sedimentation ; *Chronic Disease ; Comparative Study ; Diagnosis, Differential ; Female ; *Health ; *Health Status ; Hospital Bed Capacity, 500 and over ; Human ; Long Term Care ; Male ; Probability ; Support, Non-U.S. Gov't SO - Am J Med 1986 May;80(5):844-8 10 UI - 86185039 AU - Tape TG ; Mushlin AI TI - The utility of routine chest radiographs. AB - Although admission and preoperative chest radiography has been done for many years in various settings, existing data do not support its utility in enhancing patient care. Calculations based on estimates of the accuracy of chest radiographs and the likelihood of disease suggest that routine chest radiography may result in many more misleading than helpful results. Patients in whom chest radiographs are likely to improve outcome are best identified by a careful history and physical examination. We recommend that the practice of doing routine chest radiographs on admission and preoperatively be stopped and that the procedure be reserved for patients with clinical evidence of chest disease and patients having intrathoracic surgery. MH - Adult ; *Diagnostic Tests, Routine ; False Negative Reactions ; False Positive Reactions ; Hospitalization ; Human ; *Mass Chest X-Ray ; Patient Care Planning ; Preoperative Care ; Review ; Support, Non-U.S. Gov't ; Thoracic Radiography ; United States SO - Ann Intern Med 1986 May;104(5):663-70 11 UI - 86175786 AU - Joseph JG ; Simpson JS ; MacDonald CE ; Unsworth CL ; Carpenter LM TI - Breast self-examination in an urban population: estimates of prevalence and quality of performance. AB - Interview data from 434 women (aged greater than or equal to 20 years) in two Wellington suburban areas were used to estimate the prevalence and quality of performance of breast self-examination. Although 98% of women were familiar with breast self-examination, and 73% had performed it at least once, only 39% did so at least monthly. Its practice was significantly more common in the middle years (30-59), among Europeans, and in women with tertiary education. Thoroughness or quality of performance was assessed by comparison with Cancer Society recommendations. Scores for examination technique were generally high (mean = 73%) compared with those assessing timing (mean = 47.5%) and conditions under which breast self-examination was performed (mean = 43.3%). Results from this study were compared with 1975-76 New Zealand survey data which produced lower estimates of the prevalence of monthly breast self-examination. Both studies found that more than a quarter of women have never practiced it. Future research and intervention efforts should be directed toward this group of women. MH - Adult ; Attitude to Health ; *Breast ; Ethnic Groups ; Female ; Health Education ; Human ; Interviews ; Middle Age ; New Zealand ; *Palpation ; Support, Non-U.S. Gov't ; Urban Population SO - NZ Med J 1986 Mar 12;99(797):156-9 12 UI - 86174443 AU - Mir MA ; Marshall RJ ; Evans RW ; Hall R ; Duthie HL TI - Teaching medical history-taking: a comparison between the use of audio- and videotapes. AB - The efficacy of audiotape was compared with that of videotape as a way of teaching students the essentials of the medical interview. Two consultants--a general physician and a neurologist--were videotaped as they took histories from two patients. The neurologist described his methods and summarized his findings, but his interview was conducted conventionally without interruptions (continuous interview). In a contrasting style, the general physician frequently explained his methods and findings in steps, interrupting his interview to do this (discontinuous interview). Fifty students starting their main medical term were divided into two groups (A and B). Group A was shown the videotape of the discontinuous interview while group B was played an audiotape of that interview. Groups A and B were then crossed over, but this time group A was allowed only to hear the audiotape of the continuous interview, while the videotape of it was played to group B. After each tape the students were tested on its content. There was no significant difference between the mean scores of Group A and Group B when tested on the discontinuous interview and both groups scored well. For the continuous interview the group who saw the videotape scored significantly better than the group who only heard this tape. Both groups scored significantly better in the test based on the discontinuous interview than they did in the test based on the continuous interview. The results indicate that videotapes are a good medium for teaching history-taking, but also suggest that audiotape recordings of medical history-taking can be effective teaching aids if the interview is explained in stages. MH - Attitude of Health Personnel ; Comparative Study ; *Education, Medical, Undergraduate ; Human ; *Medical History Taking ; *Tape Recording ; *Videotape Recording ; Wales SO - Med Educ 1986 Mar;20(2):102-8 13 UI - 86167704 AU - Cavanaugh RM Jr TI - Obtaining a personal and confidential history from adolescents. An opportunity for prevention. AB - Fifty adolescent girls ages 12-18 years (mean 14.9 years) were asked to complete a confidential questionnaire exploring many important issues of adolescence. The responses included the following: 38 (76%) girls did not wear seatbelts while riding in a car, 23 (46%) had used alcoholic beverages (10 at age less than or equal to 13 years), 17 (34%) had experience with marijuana, four (8%) had used other psychoactive drugs, and 14 (28%) were having sexual intercourse, while only eight were using contraception. Of the 16 (32%) girls who smoked cigarettes ten did not want to quit. Twenty-two (44%) girls had dysmenorrhea but only four had sought medical attention for the problem. This study suggests the usefulness of a questionnaire to identify individual health care needs for which preventive counseling may be offered. MH - Adolescence ; *Adolescent Behavior ; Alcohol Drinking ; Child ; *Confidentiality ; Contraception ; Female ; Human ; *Medical History Taking ; Patient Education ; Questionnaires ; Self Disclosure ; Sex Behavior ; Smoking ; Street Drugs/ADMINISTRATION & DOSAGE SO - J Adolesc Health Care 1986 Mar;7(2):118-22 14 UI - 86143514 AU - Lorenz RP ; Willard D ; Botti JJ TI - Role of prenatal genetic counseling before amniocentesis. A survey of genetics centers. AB - Although prenatal genetic amniocentesis is an accepted procedure for certain high-risk pregnancies, there is no standard approach to prenatal counseling, timing of counseling, materials used and location of the procedure. This survey of 126 genetics centers offering prenatal genetic amniocentesis reviewed aspects of 48,502 counseling events and a total of 61,174 samples processed in 1982. Eighty-three percent of the samples were obtained after counseling at the centers. Of the patients counseled, 88.5% chose amniocentesis, but the utilization rates varied widely between the centers. The choice of amniocentesis varied measurably with the educational materials used but not with the center size. Educational materials, written or audiovisual, were used by genetics centers in counseling 82% of the patients. There was a wide variation in center size, counseling methods used, the timing and use of counseling, and patient responses in the survey population. MH - *Amniocentesis ; Female ; *Genetic Counseling ; Human ; Patient Education ; Pregnancy ; Prenatal Care ; Questionnaires SO - J Reprod Med 1986 Jan;31(1):1-3 15 UI - 86114557 AU - Seymore C ; DuRant RH ; Jay MS ; Freeman D ; Gomez L ; Sharp C ; Linder CW TI - Influence of position during examination, and sex of examiner on patient anxiety during pelvic examination. AB - It has been reported that adult women prefer the semi-sitting position over the supine position for the pelvic examination. We determined the effect of the pelvic examination position and the examiner's gender on adolescent anxiety with the pelvic examination. Adolescent girls (n = 112) aged 12 to 19 years were randomly assigned to a semi-sitting or supine position and to a male or female physician. Before and after the examination questionnaires containing the Spielberger State-Trait Anxiety Inventory and other scales were administered. There were no differences between the groups in pre-examination anxiety or concern. Patients in the semi-sitting group reported fewer negative responses during the examination when examined by a male physician (P less than or equal to 0.009); those in the supine group reported fewer negative responses when examined by a female physician. These findings persisted after controlling for previous pelvic examinations, frequency of sexual activity, and Tanner stage. Patients who had previously had a pelvic examination and were examined in the semi-sitting position by a male physician reported the lowest levels of post-examination anxiety (P less than or equal to 0.02). Patients who had never had a pelvic examination expressed less anxiety if they were examined in the semi-sitting position by a female physician. These data suggest that the patient's previous history of pelvic examinations and the gender of the examiner should be considered when selecting the pelvic examination position. MH - Adolescence ; *Anxiety ; Attitude ; Child ; Female ; *Gynecology ; Human ; Patients/*PSYCHOLOGY ; *Physical Examination ; *Physician-Patient Relations ; *Posture ; Random Allocation SO - J Pediatr 1986 Feb;108(2):312-7 16 UI - 86113930 AU - Norman RM ; Tudiver F TI - Predictors of breast self-examination among family practice patients. AB - The predictors of breast self-examination (BSE) and knowledge of BSE technique were examined among patients of a family practice group. There was found to be little relationship between the frequency with which women practiced BSE and their knowledge of effective BSE technique. The most important predictors of frequency of BSE were patients' perception of the social support for BSE and the extent to which they found BSE to be distasteful. Perceived health benefits of BSE were of less importance in predicting behavior. Knowledge of BSE technique was unrelated to any of these predictors. Women's self-reported confidence in their knowledge of BSE technique was only weakly related to their assessed knowledge. Further analysis showed that formal instruction in BSE was associated with a higher frequency of self-examination and greater knowledge of technique. The implication of the findings for family practice are discussed. MH - Adolescence ; Adult ; Attitude to Health ; *Breast ; Family Practice ; Female ; Health Promotion ; Human ; *Palpation ; Patient Education ; Patients/*PSYCHOLOGY ; Perception ; Probability ; Questionnaires SO - J Fam Pract 1986 Feb;22(2):149-53