Jane G. Zapka

Bio: Jane G. Zapka is an academic researcher from Medical University of South Carolina. The author has contributed to research in topics: Health care & Breast cancer screening. The author has an hindex of 53, co-authored 187 publications receiving 9367 citations. Previous affiliations of Jane G. Zapka include University of Connecticut Health Center & Kaiser Permanente.

Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial.

Abstract: ContextDelayed access to medical care in patients with acute myocardial infarction (AMI) is common and increases myocardial damage and mortality.ObjectiveTo evaluate a community intervention to reduce patient delay from symptom onset to hospital presentation and increase emergency medical service (EMS) use.Design and SettingThe Rapid Early Action for Coronary Treatment Trial, a randomized trial conducted from 1995 to 1997 in 20 US cities (10 matched pairs; population range, 55,777-238,912) in 10 states.ParticipantsA total of 59,944 adults aged 30 years or older presenting to hospital emergency departments (EDs) with chest pain, of whom 20,364 met the primary population criteria of suspected acute coronary heart disease on admission and were discharged with a coronary heart disease–related diagnosis.InterventionOne city in each pair was randomly assigned to an 18-month intervention that targeted mass media, community organizations, and professional, public, and patient education to increase appropriate patient actions for AMI symptoms (primary population, n=10,563). The other city in each pair was randomly assigned to reference status (primary population, n=9801).Main Outcome MeasuresTime from symptom onset to ED arrival and EMS use, compared between intervention and reference city pairs.ResultsGeneral population surveys provided evidence of increased public awareness and knowledge of program messages. Patient delay from symptom onset to hospital arrival at baseline (median, 140 minutes) was identical in the intervention and reference communities. Delay time decreased in intervention communities by −4.7% per year (95% confidence interval [CI], −8.6% to −0.6%), but the change did not differ significantly from that observed in reference communities (−6.8% per year; 95% CI, −14.5% to 1.6%; P=.54). EMS use by the primary study population increased significantly in intervention communities compared with reference communities, with a net effect of 20% (95% CI, 7%-34%; P<.005). Total numbers of ED presentations for chest pain and patients with chest pain discharged from the ED, as well as EMS use among patients with chest pain released from the ED, did not change significantly.ConclusionsIn this study, despite an 18-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI.

Screening mammography: A missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies

Abstract: Data from seven studies sponsored by the National Cancer Institute (NCI) were used to determine current rates of breast cancer screening and to identify the characteristics of and reasons for women not being screened. All seven studies were population-based surveys of women aged 50 to 74 years without breast cancer. While over 90% of non-Hispanic white respondents had regular sources of medical care, 46% to 76% had had a clinical breast examination within the previous year, and only 25% to 41% had had a mammogram. Less educated and poorer women had had fewer mammograms. The two most common reasons women gave for never having had a mammogram were that they did not know they needed it and that their physician had not recommended it. Many physicians may have overlooked the opportunity to recommend mammography for older women when performing a clinical breast examination and to educate their patients about the benefit of screening mammography.

Introduction: Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum

Abstract: Health care in the United States is notoriously expensive while often failing to deliver the care recommended in published guidelines There is, therefore, a need to consider our approach to health-care delivery Cancer care is a good example for consideration because it spans the continuum of health-care issues from primary prevention through long-term survival and end-of-life care In this monograph, we emphasize that health-care delivery occurs in a multilevel system that includes organizations, teams, and individuals To achieve health-care delivery consistent with the Institute of Medicine's six quality aims (safety, effectiveness, timeliness, efficiency, patient-centeredness, and equity), we must influence multiple levels of that multilevel system The notion that multiple levels of contextual influence affect behaviors through interdependent interactions is a well-established ecological view This view has been used to analyze health-care delivery and health disparities However, experience considering multilevel interventions in health care is much less robust This monograph includes 13 chapters relevant to expanding the foundation of research for multilevel interventions in health-care delivery Subjects include clinical cases of multilevel thinking in health-care delivery, the state of knowledge regarding multilevel interventions, study design and measurement considerations, methods for combining interventions, time as a consideration in the evaluation of effects, measurement of effects, simulations, application of multilevel thinking to health-care systems and disparities, and implementation of the Affordable Care Act of 2010 Our goal is to outline an agenda to proceed with multilevel intervention research, not because it guarantees improvement in our current approach to health care, but because ignoring the complexity of the multilevel environment in which care occurs has not achieved the desired improvements in care quality outlined by the Institute of Medicine at the turn of the millennium

Breast cancer screening by mammography: utilization and associated factors.

Abstract: The status of mammography screening experience and factors related to utilization were examined in six towns serviced by physician staffs at five hospitals. Data were collected via random digit dial telephone interview of a probability sample of 1184 women, aged 45-75 years. The results showed that 55% of the women reported ever having had a mammogram. Of those who had ever had a mammogram, 21% reported that the mammogram in the past year was their first one. Of those women who are over 50 and had ever had a mammogram, 57% reported one in the past year. Analyses demonstrated that a combination of demographic factors, certain beliefs and knowledge, having a regular physician, social interaction and media exposure are independently related to ever having a mammogram, and to having one in the past year. Despite anecdotal and empirical evidence that the proportion of women ever having had a mammogram has substantially increased in the past several years, increasing utilization among older and lower-income wom...

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

Abstract: Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists.[1–3][1][][2][][3] The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients

ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation

Abstract: ACE : angiotensin-converting enzyme ACS : acute coronary syndrome ADP : adenosine diphosphate AF : atrial fibrillation AMI : acute myocardial infarction AV : atrioventricular AIDA-4 : Abciximab Intracoronary vs. intravenously Drug Application APACHE II : Acute Physiology Aand Chronic

Medscape

Abstract: Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?