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The ATAC (Arimidex, Tamoxifen, Alone or in Combination) adjuvant breast cancer trial in postmenopausal patients: factors influencing the success of patient recruitment.

The ATAC ('Arimidex', Tamoxifen, Alone or in Combination) trial is a randomised, double-blind, double-dummy trial, evaluating anastrozole alone or in combination with tamoxifen compared with tamoxifen alone, as a 5-year adjuvant treatment for postmenopausal patients with early breast cancer. The rapid rate of recruitment into this trial was a major achievement, as frequently encountered differences between projected and actual recruitment rates can threaten the successful completion of clinical trials. A questionnaire designed in order to highlight possible factors influencing the success of patient recruitment was completed by 62% of the ATAC trialists. This included 11 statements rated for their level of importance on a three-point scale. The top three motives for recruiting patients were: (1) the attractive scientific rationale of the trial (84%); (2) a design that was easy to explain to patients (79%); and (3) a pragmatic trial design in line with standard practice (76%). A new questionnaire will solicit opinion from the participating patients.

Anastrozole↗

Variables influencing perceptions of the communicative competence of an adult augmentative and alternative communication system user.

The effects of aided message length, partner reauditorization, and observer background on perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Two groups of subjects participated: naive adults with minimal exposure to nonspeaking persons, and speech-language pathologists currently working with AAC users. Four scripted videotaped conversational conditions involving an AAC user and a normally speaking partner were employed to manipulate aided message length and partner reauditorization. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC user. Results indicated a significant interaction effect involving subject group and aided message length. The speech-language pathologists were affected by aided message length. Furthermore, significant differences between subject groups were found in specific conditions. Future research directions are discussed.

Adult↗

The effect of an interactive experience on music majors' perceptions of music for deaf students.

The purpose of this study was to examine the effect of an interactive experience on music majors' perceptions of music experiences for deaf students. Twenty-three members of a pre-existing college brass ensemble served as subjects, and a 1-hour interactive concert/presentation for 10 deaf elementary children served as the independent variable. The interactive experience was designed to provide social, musical, and educational interactions between the college musicians and the deaf children. A pretest-posttest design was utilized, and the dependent variable was a questionnaire designed to examine the subjects' perceptions regarding music for deaf students, including how prepared, comfortable, and willing they felt to provide music experiences for deaf students. Results reveal that this single interactive experience had a significant effect on the subjects' perceptions of the value of music in the education of deaf children (p <.05). Although the pretest and posttest scores indicate that the subjects felt apprehensive about their preparedness to work with deaf students, the subjects felt significantly more positive about their preparedness following the interaction (p <.001). An analysis of open comments indicates that the subjects perceived the experience as (a) very positive, (b) increasing their knowledge and perception of music for deaf students, (c) helping them better relate to the deaf population, (d) promoting interest in similar experiences and in gaining more information, and (e) eliciting a feeling that future teachers should have similar experiences. Quotes from the subjects are given, and implications for teacher training/music therapy programs are discussed.

Adult↗

Practical use of a disability index in the routine management of acne.

We describe a brief questionnaire designed to assess the disability caused by acne. The questionnaire adds a patient-orientated dimension to medical records, high-lights patients with unusually high levels of disability, and increases the relevant information on which we base therapeutic decisions.

Acne Vulgaris↗

Responsiveness of the Roland-Morris Disability Questionnaire: consequences of using different external criteria.

OBJECTIVE: To determine the consequences of using different external criteria on responsiveness of the Roland-Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain. DESIGN: Questionnaire measures before and after rehabilitation treatment. SETTING: Rehabilitation centre. SUBJECTS: Patients with nonspecific chronic low back pain, referred for treatment. MAIN MEASURES: The RMDQ was used to assess self-reported functional status. The used external criteria were: (1) global perceived effect of change in complaints; (2) global perceived effect of change in ability to take care of oneself; (3) change in rating of pain intensity; (4) smallest real difference. Standardized response means, pooled effect sizes and receiver operating curves were calculated to determine responsiveness and to enable comparison of effect sizes with the thresholds of Cohen. RESULTS: Standardized response means ranged from 1.33 to 3.45, pooled effect sizes ranged from 1.50 to 2.81, and areas under curves ranged from 0.76 to 1.00, dependent on the used external criterion. CONCLUSIONS: All pooled effect sizes were well above 0.80, and all other statistics were high, indicating good responsiveness of the RMDQ. However, considerable differences were found in responsiveness, when using different external criteria in a same study population. Therefore, it can be concluded that the magnitude of the responsiveness statistic depends on the used external criteria.

Activities of Daily Living↗

Preparation of parents for the ICU experience: what are we missing?

This study examined the stress experienced by parents of children hospitalized in an intensive care unit (ICU) and explored the degree to which parents are prepared for specific aspects of the ICU environment. Twenty-two mothers and 6 fathers of 22 children hospitalized in a pediatric ICU were interviewed using the Parental Stressor Scale: Pediatric Intensive Care Unit, the Parent Preparation questionnaire designed for this study, and a personal-situational questionnaire. A majority of parents (82%) responded that they had been prepared in some manner and considered the preparation adequate. The dimensions of the ICU that were perceived by parents as most stressful were the child's behavior and the child's emotional response, and parental role alterations. The dimensions of the ICU environment that parents were least likely to have been prepared for or receive help with were these same dimensions. When parents were prepared for or helped with aspects of the ICU, they perceived the adequacy of that help as high. The results of this study suggested that an important focus in parental education and support should be on the parent-child relationship, the most stressful aspect of a child's ICU admission for parents.

Adult↗

Identifying and assessing depression in prelingually deaf people: a literature review.

IDENTIFYING AND ASSESSING DEPRESSION is essential to ensuring access to appropriate treatment and services. Unfortunately, limited literature exists on identifying and assessing depression in prelingually deaf people. In a literature review, the authors critically examined relevant published studies. The earliest reported information on depression in deaf people was found in historical studies that descriptively evaluated specialist psychiatric services for deaf people. These studies did not accurately reflect the prevalence of depression; reasons for this are discussed. Issues regarding assessment of depression in deaf people, such as communication, use of interpreters, and use of standardized assessments, are examined. Studies that have attempted to overcome these challenges are reviewed, including studies using modified versions of written questionnaires designed for hearing people and studies in which standardized questionnaires were translated and administered in sign. Advantages and disadvantages of different methods are highlighted; recommendations for future research are made.

Activities of Daily Living↗

Attitudes of nursing students toward patients with AIDS.

Nursing students (N = 124) voluntarily completed a questionnaire designed to measure attitudes towards patients with AIDS. The questionnaire included one of two vignettes, a prejudicial evaluation scale, and the Index of Homophobia. Results indicate that nursing students expressed a significantly more negative attitude toward the homosexual patients with AIDS. Homophobia accounted for a substantial amount of variation in the difference in expressed attitude between heterosexual and homosexual AIDS patients. The researchers recommend that nursing students and other prospective health care workers be provided educational programs dealing with AIDS which include study of homophobia and homosexuality.

Acquired Immunodeficiency Syndrome↗

Role conflict and role ambiguity among respiratory care managers.

UNLABELLED: The health occupations and management literature does not specifically address role stress among technical directors of respiratory care departments. We undertook an analysis of role conflict, role ambiguity, and job satisfaction among technical directors of respiratory care departments in Texas. METHODS & MATERIALS: We distributed a questionnaire designed to measure role conflict and ambiguity and a questionnaire to elicit demographic and organization data to 283 technical directors in all Texas hospitals with more than 75 beds. Organization characteristics and demographic factors were studied as moderators. RESULTS: Analysis of the 199 responses received revealed that both role conflict (mean [SD] 3.86 [0.97] on 7.0 scale) and role ambiguity (2.64 [0.93] on 7.0 scale) scores were low compared to the neutral point of measure. Role overload, a component of role conflict, was found to be above the neutral point (4.64 [1.85]). One-way analysis of variance revealed no significant differences between the role conflict or the role ambiguity measures based on age, race, gender, number of employees supervised, size of institution, and position to which the respondent reported. Role conflict and role overload were each found to have significant negative correlations with job satisfaction (p less than 0.01). CONCLUSION: We are encouraged by the low role-conflict and ambiguity scores observed but concerned about the elevated role-overload scores. We believe that an in-depth study of role overload among respiratory care managers is warranted.

Adult↗

The effects of hair loss in European men: a survey in four countries.

Despite the high prevalence and the accepted psychological aspects of male pattern hair loss, few have characterized the effects of hair loss in representative samples of men in different countries. A representative sample of households in 4 European countries (France, Germany, Italy and the United Kingdom) was contacted by an interviewer and resident males 18-40 years of age (n = 1,717) completed a questionnaire designed specifically to evaluate attitudes to hair loss. The questionnaire was comprised of 78 questions translated and pilot-tested using standard methodology into each local language. Questionnaires queried about self-rated hair loss, satisfaction with hair appearance, noticeability of hair loss to others, and bother, concerns and perceptions about hair loss, as well as general physical health (the SF-12 questionnaire) plus three additional questions about mental health. The self-reported degree of hair loss in men was statistically significantly associated (p < 0.001) with all hair-loss specific effects measured, except "limiting job opportunities". The impact of hair loss was generally consistent in the four countries surveyed, although less pronounced in the United Kingdom. Age was significantly correlated with hair loss (rs = 0.34, p < 0.001). Men with greater hair loss were more bothered, more concerned about looking older due to their hair loss, and less satisfied with their hair appearance. Male pattern hair loss has significant negative effects on hair-loss specific measures in men 18 to 40 years of age in France, Italy, Germany and the UK. The degree that hair loss is perceived as noticeable to others appears to be a significant contributor to these negative effects.

Adolescent↗

The emotional and psychological impact of mass casualty incidents on forensic odontologists.

Motivated by the findings of a previous research project, 38 forensic odontologists with known occupational experience of mass casualty incidents completed a questionnaire designed to elicit both quantitative and qualitative data. The questionnaire sought to provide an insight into the psychological and emotional impact of conducting work of this nature. Two psychometric scales were included in the questionnaire, The Positive and Negative Affect scale (PANAS) and the Impact of Events Scale (IOE). In addition, a number of open-ended questions relating to the personal experiences of the respondent during the mass casualty incident were also included. Quantitative findings indicate that on the whole mass casualty incidents resulted in a positive experience for the respondents, although over a third reported being distressed, upset or irritable at some time during the event. Sense of achievement and camaraderie were among the qualitative themes elicited that help explain the positive reactions. Working conditions, politics and the ictims were cited as sources of negativity.

Canada↗

Characteristics, importance, and implications of comprehensive drug therapy management.

Ideas and opinions about comprehensive drug therapy management (CDTM) were gathered from an expert panel representing health care practitioners, educators, and consumers. A qualitative method of inquiry, the Delphi technique, was used to aggregate opinions of an expert panel of health care professionals, health care educators, and consumer representatives. The 66 experts who agreed to participate in the study consisted of 10 from pharmacy education, 10 from pharmacy professional associations, 20 from managed care, 19 from primary care, and 7 consumers (public members of health care regulatory and governing boards). Each participant was sent a questionnaire designed to evaluate a preliminary definition of CDTM and gather opinions on related topics. A second questionnaire was sent to the participants to determine the extent of their agreement with each statement generated by the first questionnaire. A third questionnaire was sent, asking participants to reconsider their ratings in light of the group's responses and to choose the most important elements. The response rates were 83% for the first questionnaire, 70% for the second, and 76% for the third. The panel reached a high level of agreement on a definition of CDTM. Panel members also identified many critical aspects of CDTM, including what makes it worthwhile, barriers to and facilitators of engaging in CDTM, key participants, ways in which responsibility for CDTM may be shared, and the competencies needed for CDTM. An expert panel of health care leaders and future leaders, within and outside the pharmacy profession, reached a high level of agreement on a definition of CDTM and identified many critical aspects of this concept.

Consumer Behavior↗

Benefits of cochlear implantation in early-deafened adults: the Toronto experience.

OBJECTIVE: To present the results of a survey administered to a group of early-deafened cochlear implants adults and to report the level of perceived benefit. DESIGN: Prospective. SETTING: Large tertiary referral centre. METHOD: A 47-item questionnaire designed to evaluate cochlear implant use and benefit was sent to 42 early-deafened adult cochlear implant users. The questionnaire can be divided into seven subcategories: time of use, associated symptoms, communication, employment status and function, socialization, perceived benefit, and the impact on quality of life. Responses from 30 patients were received. RESULTS: The majority of our patients use their cochlear implant all of their waking hours. The majority of patients continue to depend on lip-reading and hearing as their main mode of communication, although they reported improved lip-reading skills with their cochlear implant. Twenty-three patients (76.7%) were employed. Eleven patients had a change in employment subsequent to cochlear implantation, nine (81.8%) of whom attributed this to their cochlear implant. Our patients als reported greater independence, a greater sense of safety in their environment, and an improved social life. Twenty-nine patients (96.7%) said that they were satisfied with their implant, 28 (93.3%) said that they would go through the same process again, and 27 (90%) said that they would recommend it to a friend in a similar situation. Twenty-nine patients (96.7%) stated that the cochlear implant has had a positive effect on their quality of life. Family and peer support, prior auditory-verbal therapy, and a positive attitude were the most commonly cited factors in successful cochlear implant use. CONCLUSIONS: Early-deafened adult cochlear implant users perceive significant benefit from cochlear implantation. Importantly, family and peer support, prior auditory-verbal therapy, and a positive attitude are considered important factors in maximizing this benefit.

Adult↗

Health related quality of life in patients treated with radical cystectomy and urinary diversion for urothelial carcinoma of the bladder: development and validation of a new disease specific questionnaire.

PURPOSE: The impact of treatment on the health related quality of life (HRQOL) of patients is being recognized with increasing importance, particularly in those with urological malignancies. However, a validated disease and treatment specific instrument to assess HRQOL following radical cystectomy (RC) and urinary diversion (UD) is currently lacking. We report the results of a new questionnaire designed specifically to measure HRQOL in these patients. MATERIALS AND METHODS: A 45-item questionnaire consisting of the Functional Assessment of Cancer Therapy (FACT)-General and 17 additional items designed to measure disease and treatment specific health outcomes were combined to form the Vanderbilt Cystectomy Index (FACT-VCI). FACT-VCI and the generic RAND 36-Item Health Survey (SF-36) were administered to 50 patients from our institution RC data base who were more than 1 year from the time of surgery. Each patient was asked to complete the survey at 1 and 4 weeks. The results of the SF-36 and FACT-VCI were correlated along with the first and second administration of the FACT-VCI. RESULTS: Overall FACT-VCI was found to have adequate internal consistency (Cronbach's alpha >0.70). Furthermore, intraclass correlation for the first and second administration of the VCI was 0.79. In addition, there was good correlation between the validated SF-36 and FACT-VCI (r = 0.81). The result was initial validation of a questionnaire for the assessment of HRQOL in patients following RC and UD. CONCLUSIONS: Instruments designed to measure accurately HRQOL following RC and UD are in early development. We have now constructed and validated a disease and treatment specific questionnaire that can objectively assess HRQOL following RC and UD. A prospective longitudinal study of FACT-VCI is currently ongoing.

Adult↗

The social origins of infantile colic: questionnaire study covering 76,747 infants.

OBJECTIVE: To describe risk factors for infantile colic. DESIGN: Questionnaire administered by health visitors. SETTING: Sheffield. SUBJECTS: Mothers of 76,747 infants born between 1 August 1975 and 31 May 1988, interviewed when the infant was 1 month old. MAIN OUTCOME MEASURES: Reporting of infantile colic and its duration; weight of infant leeding, state of the home, socioeconomic characteristics of the parents, parents' age, and mother's parity. RESULTS: The odds of reporting infantile colic were increased with breast feeding (odds ratio of breast v bottle feeding 1.35 (95% confidence interval 1.28 to 1.43)), increasing parental age, lower parity, increasing parental age at leaving full time education, and more affluent homes and districts of residence. In a logistic regression analysis, mother's age and parity and socioeconomic factors remained the most important risk factors for the reporting of infantile colic (each P < 0.005), and the effect of breast feeding was attenuated (odds ratio of breast v bottle feeding 1.09 (1.02 to 1.15)). CONCLUSION: At a population level, dietary factors contribute little to mothers' reporting of infantile colic, and dietary change should not be the primary intervention.

Age Factors↗

Patient attitudes to glove use by dentists.

OBJECTIVE: To evaluate the attitudes of patients on the importance of glove wearing by dentists. DESIGN: A patient survey using a self-completed patient questionnaire. SETTING: Ireland. SUBJECTS AND METHODS: 164 consecutive patients attending a dental accident and emergency department were asked to participate. All the patients were aged 16 years or over. Of the surveyed patients, 157 completed a questionnaire designed to elucidate the patients' attitudes to the wearing of gloves by dentists. RESULTS: Most patients (93.6%; n = 147) considered that dentists should routinely wear gloves, while 1.9% (n = 3) thought the wearing of gloves was unnecessary. 94.9% (n = 149) considered that gloves were worn to protect both the dentist and the patient, with 1.9% (n = 3) feeling that only the dentist was protected. 72% of patients (n = 113) would not attend a dentist who did not wear gloves. 87.2% (n = 138) of patients thought that the dentist should change gloves between patients, while 1.3% (n = 2) considered glove washing to be sufficient. The remaining 11.4% (n = 17) felt that this decision should be left to the dentist. CONCLUSION: The majority of surveyed individuals indicated that dentists should wear gloves while treating patients. The results suggest that many patients refuse to have dental treatment carried out by a dentist who does not wear gloves.

Adolescent↗

Chronic pain in the elderly: occupational adaptation as a means of coping with osteoarthritis of the hip and/or knee.

OBJECTIVE: To determine whether elderly individuals with chronic pain as a result of osteoarthritis of the hip and/or knee would report adaptations to their activities, or occupational adaptations, as a coping response to pain and, if so, to describe these adaptations and their relation to chronic pain, functional difficulty, depression, social support, and life satisfaction. DESIGN: Thirty elderly individuals completed rating scales and a structured questionnaire designed to measure occupational adaptation and the importance of activity. SETTING: Participants were community-dwelling elderly individuals and were interviewed in their homes or in a research office setting. PATIENTS: Consecutive orthopedic surgeon, family physician, or Arthritis Society patients, whose names were provided with the patient's consent, to the researcher. RESULTS: Individuals reported two approaches to occupational adaptation: they changed how they performed personal activities of daily living that they rated as most important and they stopped performing a number of avocational activities that they rated as less important. Statistically significant correlations were found among occupational adaptation, pain, depression, and difficulty with functioning. These variables were inversely related to life satisfaction. CONCLUSIONS: This sample of elderly individuals with chronic pain described occupational adaptations, or adaptations to "doing," as a means of coping with their chronic pain. There appeared to be a relation among pain, functional difficulty, depression, social support, and occupational adaptation. Additional research to increase the understanding of occupational adaptation as a means of coping with chronic pain is warranted.

Activities of Daily Living↗

Bakery foods are the major dietary source of trans-fatty acids among pregnant women with diets providing 30 percent energy from fat.

OBJECTIVE: To estimate intake and identify major dietary sources of trans-fatty acids consumed by healthy, pregnant women. DESIGN: Cross-sectional prospective study using a food intake questionnaire designed specifically to estimate trans-fatty acid intakes calculated from a trans-fatty acid food database developed by food analysis. SUBJECTS/SETTING: Healthy, pregnant women (n=60) were recruited in Vancouver, BC, Canada. STATISTICAL ANALYSES PERFORMED: Using the Statistical Package for the Social Sciences version 9.0, descriptive statistics were applied to all variables and paired t tests were used to determine differences in intakes between second and third trimester of pregnancy. RESULTS: The mean fat intakes (in g/person/day) for the second and third trimesters, respectively, were: 85.8 and 73.9 total fat, 31.5 and 26.4 monounsaturated, 29.7 and 26.3 saturated, 13.6 and 12.2 polyunsaturated, and 3.8 and 3.4 trans. Fat represented 28% of dietary energy in both trimesters. The major sources of trans-fatty acids were bakery foods (33% of trans-fatty acid intake), fast foods (12%), breads (10%), snacks (10%), and margarines/shortenings (8%). APPLICATIONS/CONCLUSIONS: Women following diets providing about 30% energy from fat consumed about 90% of trans-fatty acids as invisible fat, with less than 10% from table spreads. Dietitians should educate pregnant clients about hidden sources of trans-fatty acids and emphasize the importance of dietary fat composition.

Adult↗