Browsing by Subject "Primary Care"
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Item Adaptation of the Genetic Risk Prediction Model BRCAPRO for Primary Care Settings(2017-05-01) Atienza, Philamer M.; Sumihiro Suzuki; Swati Biswas; Karan P. SinghIdentifying women at high risks of carrying the breast cancer susceptibility genes is crucial for providing timely surveillance and necessary health management interventions. BRCAPRO is one of the most widely used statistical models for breast cancer risk prediction in genetic counseling. It provides carrier probabilities of BRCA1/2 mutations and calculates the risks of developing breast and ovarian cancers. This calculation requires extensive personal and family history information, which makes it difficult to use in primary care where a wider population could be reached. Thus, we developed a two-stage approach for the genetic risk prediction of BRCA1/2 mutation. In the first stage, limited information on the counselee and her family history of cancer are used in simplified versions of BRCAPRO. If the risk at this stage is found to be high, the full BRCAPRO model utilizing the complete family history is implemented in the second stage. We aimed to balance the tradeoff between the amount of information used and the accuracy of the predictions. We explored several first stage tools. BRCAPROLYTE uses information on the affected relatives up to the second degree only. BRCAPROLYTE-Plus additionally includes unaffected relatives by imputing their ages. BRCAPROLYTE-Simple eliminates the need to collect information on the numbers and types of unaffected relatives and imputes them and their ages instead. The study cohorts include 1,917 families mostly at high risk from the Cancer Genetics Network, 796 high-risk families from MD Anderson Cancer Center, and 1,344 population-based families from Newton-Wellesley Hospital. To evaluate the models, we used sensitivity, specificity, area under the curve, and observed versus expected number of carriers. We also considered clinical criteria of number of referrals made by each model. We found the proposed two-stage approach (with BRCAPROLYTE, BRCAPROLYTE-Plus, and BRCAPROLYTE-Simple at the first stage) has very limited loss of discrimination and comparable calibration with BRCAPRO. It identifies a similar number of carriers without requiring a full family history evaluation on all probands. Thus, our two-stage approach allows for practical large-scale genetic risk assessment in primary care.Item An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly(1999-05-01) Johs, Jennifer L.Johs, Jennifer L. An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly. Master of Public Health (Biomedical Sciences), May, 1999, 57 pp., 4 tables, references, 66 titles. The current study compared utilization markers of 87 frail elderly homebound patients prior to and subsequent to enrollment in an interdisciplinary, physician-led house calls program, as well as measured efforts to increase documentation of advance directives. After enrollment in the program the number of hospital admissions (p=0.047) and emergency department visits (p=0.030) were significantly decreased. The number of admissions to skilled nursing facilities (p=0.023) was also reduced, as was length of stay in skilled nursing facilities (p=0.018). The prevalence of advance directives increased from 26% to 74% (p [less than] 0.001) subsequent to enrollment. Patients who died were more likely to die at home (19) than in the hospital (6). All patients who died at home had documented advance directives.Item Burnett, John H., D.O. and Burnett, Mary M., D.O.(1989-08-31) Burnett, John H.; Burnett, Mary M.; Stokes, C. RayThe Burnett’s are a husband and wife team of Dallas general practitioners. A past president of the American Osteopathic Association and the Texas Osteopathic Medical Association, John was a member of TCOM’s initial board of directors and served on its executive committee as chairman of house and grounds. Mary also has been active in the profession, having served as president of the American College of General Practitioners in Osteopathic Medicine and Surgery. Interviewed by C. Ray Stokes, August 31, 1989.Item Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas(2006-08-01) Lancaster, Scott Bradley; Kristine Lykens; Russell Gamber; Jeffrey TalbertLancaster, Scott Bradley, Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas, 2005. Master of Public Health (Health Management and Policy), May 2006, 63 pp., 13 tables, bibliography, 59 titles. Primary care physician demographics were examined to determine if subgroups differed in choice of practice location in urban and rural Medically Underserved Areas (MUAs) in Texas. Compared with the overall proportion of physicians practicing in rural MUAs (8.8%), subgroups that significantly differed were Dos (13.5%), males (10.6%), general practitioners (19.4%), family physicians (12.4%), and graduates of medical school prior to or during 1960 (18.8%) and from 1961-1970 (11.2%). Compared with the overall proportion of physicians practicing in urban MUAs (23.2%), subgroups that significantly differed were females (25%), Blacks (29.7%), and Latinos (38.7). Binary logistic regression showed that Asian ethnicity, general practice specialty, and graduate year of 1961-1970 predicted MUA practice location. The statistically significant differences observed underscore the importance of further study to examine potential differences between rural and urban MUAs. Public policy that provides incentives for more equitable physician distribution should be based on sound research.Item Clearfield, Michael, D.O.(1994-02-22) Clearfield, Michael; Hailey, BlakeDr. Clearfield, Chairman of the Department of Medicine, began at TCOM in 1979. He discusses his long career with TCOM, his research and his thoughts on the school's future. Interviewed by Blake Hailey, February 22, 1994Item Cohen, Benjamin L., D.O.(1993-12-20) Cohen, Benjamin L.; Hailey, BlakeDr. Cohen, Executive Dean and Vice President of Heath Administration, discusses the school's progress and plans for the future. Interviewed by Blake Hailey, December 20, 1993Item Coy, Marion E., D.O.(1981-01-01) Coy, Marion E.; Stokes, C. RayThe founding president of TCOM, Dr. Coy came to TCOM in March 1972 as dean and chief administrative officer. He graduated from Kirksville College of Osteopathic Medicine in 1938 and then served as a general practitioner in Jackson, Tenn., for the next 33 years. A past president of the American Osteopathic Association, Dr. Coy headed the college until it became a state-supported institution in September 1975. From 1975 until his retirement in 1983, he served as professor of osteopathic philosophy, principles, and practice. Interviewed by C. Ray Stokes, Spring and Summer 1981.Item Effects of Cardiorespiratory Fitness on Serum Ferritin Concentration and Type 2 Diabetes: Evidence from the Aerobics Center Longitudinal Study (ACLS)(2008-05-01) Le, Tuan D.; Sejong Bae; Karan Singh; Steven BlairLe, Tuan D., Effects of Cardiorespiratory Fitness on Serum Ferritin Concentration and Type 2 Diabetes: Evidence from the Aerobics Center Longitudinal Student (ACLS). Doctor of Public Health (Clinical Research). May 2008, 114 pp., 12 tables, 8 figures, bibliography, 68 titles. Recent studies suggest that an elevated serum ferritin concentration is considered an independent factor associated with increased risk of type 2 diabetes and cardiorespiratory fitness (CRF) is inversely associated with diabetes. Using secondary data from Aerobics Center Longitudinal Study at the Cooper Institute, Dallas, Texas, the author explored the association between serum ferritin levels and diabetes, CRF and diabetes, and the effect of CRF on the association between serum ferritin levels and diabetes. A cross-sectional study and a longitudinal cohort study were used. In the cross-sectional study, an increased CRF level found to be associated with a decreased serum ferritin concentration and a lowered prevalence of type 2 diabetes. Participants with high ferritin levels and high triglyceride levels were 1.89 and 1.57 times more likely to have diabetes respectively. Overweight or obese individuals were 1.35 to 1.40 times more likely to have diabetes. Participants with a family history of diabetes were 3.69 times more likely to have diabetes. Participants in the highest CRF quintile levels were 40% and 15% less likely to have type 2 diabetes among persons with normal and high blood glucose, respectively. In the prospective cohort study, it was found that serum ferritin might predict the development of type 2 diabetes in males and high serum ferritin concentration levels. The incidence rate among males increased with serum ferritin quartile (ptrend [less than] 0.05). A reduction of serum ferritin concentration was associated with a reduction of diabetes risk in those participating in physical activity. It suggests physicians might use patients' serum ferritin concentrations as a marker for predicting risk for new-onset diabetes and patients should be encouraged to participate in physical activities.Item Grainger, H. George, D.O.(1984-02-24) Grainger, H. George; Stokes, C. RayA member of the TCOM Board of Directors from 1969 until 1975, Dr. Grainger describes his career from1929 until the present, including serving as a general practitioner in Tyler, Texas, for more than 50 years. Interviewed by C. Ray Stokes, February 24, 1984.Item Healthcare Provider Barriers to Family Health History Clinical Decision Support Tools(2015-05-01) Baria, Victoria R.; Deanna Cross; Patricia A. Gwirtz; Bobby L. LaRueFamily Health History (FHH) is a useful method of identifying patients who are at risk of developing hereditary diseases. This process is conducted by a primary care provider and should be used to assist in the treatment of the patient; however, this does not always occur. Three barriers related to FHH acquisition include: 1) a lack of training among providers and failure to recognize inherited diseases; 2) limited time or resources; and 3) a lack of patient knowledge regarding his/her FHH.[3,4] In an attempt to reduce these barriers, MeTree, an FHH and Clinical Decision Support (CDS) tool, was developed. The University of North Texas Health Science Center (UNTHSC) is currently conducting a clinical research trial investigating MeTree implementation in UNTHSC Family Medicine clinics. The significance of such a project is that with the adoption of FHH self-collection tools, FHH collection will improve, and at-risk populations will be identified more accurately, improving patient outcomes. This study aims to accomplish three goals: to determine 1) the barriers to MeTree implementation, 2) the MeTree risk stratification format preferences, and 3) the best method for recruiting healthcare providers to implementation studies. To satisfy the three study aims, qualitative and quantitative data was obtained from providers through group discussion, in-person interviews, and by obtaining consent from Family Medicine providers within UNTHSC. Three barriers to provider enrollment were identified and included issues with patient recruitment, possible MeTree software limitations, and provider involvement and liability. Electronic Medical Record (EMR) integration of the risk report was determined to be the main preference among providers.Item Hurley, Alfred F., Ph.D.(1994-02-16) Hurley, Alfred F.; Hailey, BlakeDr. Hurley, President of UNT and Chancellor at the UNTHSC, served as VP for Administrative Affairs at North Texas and was involved in the development of the TCOM physical plant. Interviewed by Blake Hailey, February 16, 1994Item Jennings, Virgil L., D.O.(1988-12-01) Jennings, Virgil L.; Stokes, C. RayDr. Jennings, a GP in the Fort Worth area since 1946, now specializes in preventative medicine, and is a founder of the International Academy of Preventative Medicine. Dr. Jennings, a founding staff member of Fort Worth Osteopathic Hospital, built and operated Hurst General Hospital (now Northeast Community Hospital) in Hurst, Texas, from 1959 until 1981. Interviewed by C. Ray Stokes, December 1, 1988.Item Kinzie, Earl C., D.O.(1984-02-22) Kinzie, Earl C.; Stokes, C. RayA pioneer country doctor, Dr. Kinzie has practiced more than four decades in East Texas, delivering more than 2,000 babies, including football star Earl Campbell. He shares the highlights of his long and exciting career. Interviewed by C. Ray Stokes, February 22, 1984.Item Knebl, Janice, D.O.(1994-04-15) Knebl, Janice; Hailey, BlakeDr. Knebl is Associate Professor of Medicine for the Department of Medicine and Chief for the Geriatrics Division. She discusses her current and future work with the Health Science Center. Interviewed by Blake Hailey, April 15, 1994Item Menopause Clinical Education Aid(2008-01-01)Item NorTex Fall 2013 Newsletter(2013-10-01)Item NorTex Fall 2014 Newsletter(2014-10-01)Item NorTex Fall 2015 Newsletter(2015-10-01)Item NorTex Fall 2016 Newsletter(2016-10-01)
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