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PubMed2002

Nationwide survey of pediatric residency training in newborn medicine: preparation for primary care practice.

OBJECTIVE: Pediatric residency training programs need regular revision, but there is little evidence to support changes. The recent reduction in time spent in the newborn nursery may negatively affect the care of infants in pediatric practice. This survey was undertaken to assess the preparation of recent graduates of training programs with respect to newborn care in their current practice. METHODS: A nationwide survey was sent to 1997 pediatric residency graduates in May 1999. The American Medical Association Masterfile was used to identify pediatricians who met the criteria. The survey included questions about preparation and confidence in topics obtained from the Residency Review Committee guidelines for the newborn nursery. There were questions about duration of nursery experience, learning barriers, teaching preferences, current nursery responsibility, and practice location along with other information about the respondents. RESULTS: After 2 mailings, 801 surveys were received. Practice distribution was comparable to those who took the pediatric boards for the first time in 1997, and response was nationwide. Overall, 45% attend deliveries and 71% care for sick newborns. Respondents with only 1 month of normal newborn nursery felt this was insufficient preparation. Bedside teaching by faculty members was rated most highly. The most commonly rated areas of poor preparation were prenatal visits, perinatal infections, and management of breastfeeding issues. CONCLUSIONS: The current structure of nursery training in many residency programs may be insufficient preparation for primary care practice. Results of this and future surveys of recent graduates provide evidence to direct changes in residency training.

Chi-Square Distribution↗
PubMed2003

A longitudinal replicate study of immunosuppressive drugs: a College of American Pathologists study.

OBJECTIVE: To identify the sources of analytical variation for cyclosporine and tacrolimus in a 3-year longitudinal study. DESIGN: Two pools of whole blood were spiked with cyclosporine and tacrolimus, respectively. One aliquot of cyclosporine and 2 of the tacrolimus pool were distributed in the first and last mailing for years 1999 to 2001. For both drugs, the total variance for each method was partitioned into within- and between-laboratory components. SETTING: The A and C mailings of the 1999, 2000, and 2001 AACC/CAP [American Association for Clinical Chemistry/College of American Pathologists] Immunosuppressive Drugs (CS) Monitoring Survey. MAIN OUTCOME MEASURES: For each drug, total variance was partitioned into specimen, mailing, year, and interlaboratory effects for each analytical method. PARTICIPANTS: The 292 laboratories for cyclosporine and 177 laboratories for tacrolimus enrolled in the survey from 1999 to 2001. RESULTS: For both cyclosporine and tacrolimus, the major source of imprecision came from within-laboratory factors, which accounted for nearly 85% (range, 77% to 90%) of the total variance. For cyclosporine, the major component of within-laboratory variance was between-mailing, within-year effect, whereas for tacrolimus it was the between-year, within-laboratory variation. CONCLUSION: The major source of long-term survey imprecision for cyclosporine and tacrolimus is within-laboratory factors. The finding that 85% of the total variance was due to within-laboratory variation is similar to other therapeutic drugs.

Analysis of Variance↗
PubMed2006

Documentation of surgical specimens using digital video technology.

CONTEXT: Digital technology is commonly used for documentation of specimens in anatomic pathology and has been mainly limited to still photographs. Technologic innovations, such as digital video, provide additional, in some cases better, options for documentation. OBJECTIVE: To demonstrate the applicability of digital video to the documentation of surgical specimens. DESIGN: A Canon Elura MC40 digital camcorder was used, and the unedited movies were transferred to a Macintosh PowerBook G4 computer. Both the camcorder and specimens were hand-held during filming. The movies were edited using the software iMovie. Annotations and histologic photographs may be easily incorporated into movies when editing, if desired. RESULTS: The finished movies are best viewed in computers which contain the free program QuickTime Player. Movies may also be incorporated onto DVDs, for viewing in standard DVD players or appropriately equipped computers. The final movies are on average 2 minutes in duration, with a file size between 2 and 400 megabytes, depending on the intended use. Because of file size, distribution is more practical via CD or DVD, but movies may be compressed for distribution through the Internet (e-mail, Web sites) or through internal hospital networks. CONCLUSIONS: Digital video is a practical, easy, and affordable methodology for specimen documentation, permitting a better 3-dimensional understanding of the specimens. Discussions with colleagues, student education, presentation at conferences, and other educational activities can be enhanced with the implementation of digital video technology.

Documentation↗
PubMed1999

A preliminary study of African-American physician involvement in the care of HIV-infected patients.

In 1995, questionnaires were sent to the mailing list of the National Medical Association (NMA). The mail responses were supplemented by questionnaires distributed at the NMA annual meeting. Of the 709 respondents, approximately 63% were primary care providers, pediatricians, or obstetrician-gynecologists; 72% were treating from zero to 10 human immunodeficiency virus (HIV) patients while 9% were treating > 90 HIV patients; and 12% had been treating HIV patients > 10 years. The majority of these patients were African American; male-to-male sex and injecting drugs were the two major risk factors. Complexity of HIV care and lack of reimbursement were the principal barriers to providing HIV care. The burden of providing HIV care is borne by a relatively small number of physicians, and African-American physicians are actively involved in this care. Programs are needed to increase the number of African-American providers treating HIV patients and to provide appropriate reimbursement for providing this care.

Black or African American↗
PubMed2003

Canadian dentists' view of the utility and accessibility of dental research.

As part of a major reorganization of health and health care research in Canada, a study was performed to investigate the views of Canadian dentists on the utility and accessibility of the results of dental research. A cross-sectional survey design was used. Questionnaires and a postage-prepaid reply envelope were mailed with the December 2001 issue of the Journal of the Canadian Dental Association (JCDA) to all registered Canadian dentists. No second mailing occurred. Of 17,648 questionnaires distributed, 2,797 were returned representing a 15.8 percent response rate. In this sample, 64.3 percent found research findings easily available, 88.8 percent found research findings useful, and 95.8 percent had already changed one or more aspects of their clinical practice due to research findings. Significant differences in preferred means of learning the results of research and preferred formats for written reports of research findings were evident between generalist/clinicians and specialist/researchers. These results suggest that Canadian dentists are interested in the results of research and apply them to their practice, but that there are two main groups (generalist/clinicians and specialist/researchers) with different needs for learning the results of that research.

Adult↗
PubMed2003

Implementation of the Methamphetamine Anti-Proliferation Act; thresholds for retailers and for distributors required to submit mail order reports; changes to mail order reporting requirements. Final rule.

This regulation implements the new threshold requirements and mail order reporting requirements of the Methamphetamine Anti-Proliferation Act of 2000 (MAPA), which was enacted on October 17, 2000. DEA is amending its regulations to reduce the thresholds for pseudoephedrine and phenylpropanolamine for retail distributors and for distributors required to submit mail order reports. Also, DEA is amending its regulations to require mail order reports for certain export transactions. DEA is codifying exemptions from the mail order reporting requirements for certain distributions to nonregulated persons and certain export transactions. This rule is consistent with the intent of MAPA to prevent the diversion of drug products to the clandestine manufacture of methamphetamine and amphetamine, and simultaneously reduce the industry reporting burden.

Drug Industry↗
PubMed2005

[Survey on public health nursing education-in the comparison of nursing education courses, universities, advanced courses for public health nurse with junior nursing colleges, and public health nursing school].

PURPOSE: Changes in public health nursing education have been consideration. Theses changes include a dramatic increase in the number of public health nurses (PHNs) who have enrolled for nursing courses at university. This study was conducted to assess the current status and future of public health nursing education as perceived by teachers and students at three types of schools: universities offering nursing courses, advanced courses for PHNs with junior nursing colleges, and public health nursing schools. METHODS: Questionnaires were distributed to teachers and students by mail. The questions that were sent to teachers asked which subjects were required to become a certified PHN, which lecture methods were employed to teach public health-particularly community health assessment methods, and what was the level of awareness of the activities of PHNs. Students were asked about their motivation to be a PHN, their understanding of public health, their views of public health activities and their images of PHNs. RESULTS: Responses were analyzed and differences between questionnaires from different schools were noted. These included the number of subjects and the total number of hours spent doing practical training and field experience in universities and the other types of schools, and the number of teachers. Differences also were noted among students at three types of schools about their age, methods of public health activities, knowledge about activities undertaken by PHNs, and their images of PHNs. No differences were observed among the schools with respect to the students' conceptual understanding of public health. CONCLUSION: Student age, practical training and field experience were found to contribute to their level of understanding of public health and public health nursing. It is thus necessary to consider the teaching methods employed by universities that administer nursing courses and the effectiveness of courses offered by graduate schools.

Data Collection↗
PubMed1991

A survey of nursing students' knowledge of cancer pain control.

The World Health Organization estimates that approximately 3.5 million people suffer daily from cancer pain. Recently, a Midwestern state was named by the World Health Organization to lead worldwide efforts in controlling the pain experienced by cancer patients. As part of this effort, the Nursing Education Committee conducted a statewide study of first year and final year nursing students from 19 nursing programs. The purpose of this study was to determine nursing students' perceptions and knowledge about cancer pain control. After the deans and directors of the nursing programs were contacted to obtain their agreement to participate, questionnaires composed of 26 items were mailed to each nursing school and distributed to students. Nine hundred thirty-eight questionnaires were returned to the researchers, realizing a 40% return rate. Data analysis reflects poor knowledge about the prevalence of cancer pain and its management. Using the student's t-test, significant differences between the scores of first year and last year students were found with last year students achieving higher mean scores. It was concluded that more information about how to manage cancer pain needs to be provided in nursing curricula. It is recommended that faculty members frequently update their knowledge and skills about cancer pain management.

Adult↗
PubMed1978

Characteristics of hospital pharmacy practice in Indiana.

Hospital pharmacy practice in Indiana was surveyed to determine drug distribution services, additional services, staffing and salaries. Questionnaires were mailed to the directors of the 113 licensed hospital pharmacies in the state; 63% responded. Unit dose drug distribution systems were used by 19% of the hospitals for all beds; by 16% for some of their beds. Intravenous admixture services were provided by 43% of the respondents. Drug use review, patient education and inservice education were all provided by more than 10 of the respondents; in general, clinical services were not well developed. Salaries for directors were related more to hospital bed size than to years of experience as a pharmacist. Howeever, salaries for staff pharmacists were related more to years of experience than to hospital bed size. It appeared that staff pharmacists who want to earn more income must consider an administrative position.

Indiana↗
PubMed1990

The use of mail reminders in STD contact tracing in Ibadan, Nigeria.

Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide, and different strategies have been introduced into it in recent years to improve its effectiveness. Of all these strategy components, index patient counselling and co-operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first two years of its usage. It demonstrates that, like the other components of the contact tracing strategies, it is not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. The intensification of efforts towards encouraging the index patient in contact tracing must therefore be ever more strongly emphasised as the top priority in STD control in Nigeria and similar developing countries for the success of this strategy.

Communicable Disease Control↗
PubMed1993

Ineffectiveness of a mass mailing campaign to improve poison center awareness in a rural population.

The distribution of poison prevention and education literature represents a significant part of poison center outreach programs. Yet the effectiveness, in terms of cost and impact, of mailing this material in an unsolicited fashion has not been investigated. We questioned the effectiveness of poison education literature through mass mailing to increase poison center awareness and improve one's ability to comprehend and retain appropriate first aid response in the event of a poisoning emergency. Two poison education brochures, in English and Spanish translation, and 2 telephone stickers were mailed third class to all 8,948 households in 1 rural county at a total cost of $3,420. A total of 397 (4.4%) households were randomly selected and successfully completed a 23-question telephone survey 6 mo after the mailing. The primary language spoken by the respondents were English, 311 (78%) and Spanish, 86 (22%). Children under the age of 6 y were present in 101 (25%) households. Only 50 (13%) respondents remembered having received any poison education brochures. Although 147 (37%) responded that they had heard of the regional poison center, only 63 (16%) said they would call the poison center first in the event of a poisoning. Forty-four percent indicated they would call 911 first. Only a small increase in penetrance rate was found when comparing 6 mo periods before and after the mailing. We conclude that mass mailing of poison education brochures made little impact in improving poison center awareness and first aid response and was not a cost effective method of poison education.

Advertising↗
PubMedDate not supplied

The Ottawa patient decision aids.

CONTEXT: Shared decision-making programs, or patient decision aids, have been developed for difficult decisions in which patients need to consider benefits versus risks. PRACTICE PATTERN EXAMINED: Decision aids currently used in practice in Ottawa, Ontario, Canada. DATA SOURCES: Published studies of patients faced with decisions about hormone therapy, prenatal testing, lung cancer treatments, and anticoagulation for atrial fibrillation; administrative data on distribution of decision aids; and a survey mailed to pulmonologists and surgeons. RESULTS: Although most patients considering health care options arrive for counseling with strong predispositions toward a particular option, some are uncertain about their choice and express the need for information, clarification of values, and advice about their options. Decision aids prepare patients for decision making by increasing their knowledge about expected outcomes and personal values. The aids are used in our local centers, and more than 6000 kits have been distributed in Canada, the United States, Europe, and Australia. They primarily affect the decisions of patients who are undecided at baseline and sometimes reduce the proportion of patients who choose more intensive options. CONCLUSION: The Ottawa patient decision aids assist patient decision making, particularly among those who are undecided.

Adult↗
PubMed2004

Is mass-mailing an effective form of passive poison center awareness enhancement?

This project determined whether the massive distribution of poison center telephone number (Poison Help 800-222-1222) awareness stickers via a direct mail campaign, as a passive education technique, enhanced poison center awareness and was cost-effective. A regional ambulance service conducts an annual membership renewal/solicitation drive via mail to all residents within its service area. A sheet of Poison Help stickers was inserted in each ambulance service recruitment envelope and mass-mailed in 3 separate mailings over 4 w to 51% of households in a single county (population 368,983) at a direct expense of 4,477 dollars. Call volumes from zip codes that received the mailing were compared to an identical benchmark time period from the previous year. Analysis of call volume data over the study period revealed that call volume decreased by 1.3% during the study period. A mass-mail campaign to enhance poison center awareness failed to increase poison center call volume from the targeted county and, cannot be construed as cost-effective.

Advertising↗
PubMed1997

E-mail access to NetCME: implementation of server push paradigm.

We describe the implementation of a Continuing Medical Education project which utilizes e-mail delivery of HTML documents to facilitate participant access to case material. HTML e-mail is displayed directly within the e-mail reader of the Netscape browser. This system of proactive educational content delivery ensures simultaneous distribution to all participants. Although a more effective method of content distribution, the system preserves user confidentiality and maintains security. HTML e-mail is non-proprietary and could be integrated into existing Internet-based educational projects to facilitate user access.

Computer Communication Networks↗
PubMed1981

[Clarification of anemia: quality control in the general practice laboratory].

In mailed blood samples from 602 adult patients with beta-thalassaemia trait, a mean MCH value of 20.5 pg with a 2 s range of 17-24 pg was found. These values are identical to those determined in fresh blood samples. Furthermore, the Gaussian distribution indicates that reliable values are obtained in mailed blood samples. From patients with previous blood analyses in hospital and biochemical laboratories the MCH values of the foreign laboratories correlated well with our results (r = 0.87). On the other hand, a poor correlation was observed for private practice laboratories (r = 0.71). The difference of the two correlation coefficients is statistically highly significant (p less than 0.001). There is clearly a need for MCH quality control in the laboratories of many practitioners. Continuous quality control by means of values from healthy persons and the use of stabilized control blood is recommended.

Erythrocyte Count↗
PubMedDate not supplied

Evaluation of a public health newsletter intended for travel agents.

OBJECTIVES: Travel agents are in a key position to encourage travelers to seek consultation in travel clinics. Since the beginning of the year 2000, a newsletter specifically designed to sensitize travel agents to travel health has been published by the public health authorities and distributed to all travel agencies in Quebec. This study was undertaken to evaluate the utilization and appreciation of the newsletter by travel agents and its impact on preventive practices. METHODS: During the autumn of 2001, a cross-sectional descriptive survey was carried out among travel agencies in Quebec. Data were collected using a self-administered questionnaire sent by fax with a postal follow-up. RESULTS: A total of 252 of the 950 travel agencies contacted (27%) answered our questionnaire. In all, 78% of respondents said their agency receives the newsletter. Among these agencies, the majority of respondents considered that the subjects discussed in the newsletter are interesting (often or in general: 96%), that the subjects and preventive recommendations for travel destinations are useful in the travel agent's practice (often or in general: 89%), and generally presented in an adequate way (96%). According to the respondents, the newsletter encouraged them, often or very often, to inform travelers about travel-related health problems (70%) or to recommend a consultation in a travel clinic (63%). The impact of the newsletter on the recommendation to consult was greater among agents having more than 10 years' experience (odds ratio [OR] 3.2). When asked about the best way to send them the newsletter, only 31% identified bulk mailing, which was the current mode of distribution. CONCLUSION: Satisfaction rate with the newsletter appears to be high among respondents who receive it. However, the low response rate to the survey may indicate that as a whole, the travel agents' interest in the newsletter is mitigated. Despite the limitations of this study, the results will allow us to modify some aspects of the publication, especially regarding its distribution.

Adolescent↗
PubMed1997

The structure of radiation oncology in the United States in 1994.

PURPOSE: 1) to measure the basic structural characteristics of radiation oncology facilities for the entire country, providing census data for January 1, 1994; 2) to allow comparisons by facility type, equipment, or patient load; 3) to allow comparisons of the patterns of equipment and personnel to previous surveys; and 4) to make a preliminary assessment of the geographic distribution of facilities. METHODS AND MATERIALS: A mail survey verified whether each potential facility delivered megavoltage radiation therapy and collected data on treatment machines, other equipment, personnel, new patients, and procedures performed. Responses were obtained from 99% of potential facilities. The census data was summarized for the entire country, by hospital-based, free-standing, or federal category, by single or multiple treatment machine group, and by new patient load category. Geographic analysis compared the center of radiation oncology facilities with the center of cities or towns having a population of more than 25,000 residents in 1990. RESULTS: In the United States in 1994, 1542 facilities delivered megavoltage radiation therapy, with 2744 treatment machines, 2777 FTE radiation oncologists, 1349 FTE physicists, 1314 FTE dosimetrists, and 7167 FTE radiation therapists. They treated 560,262 new patients and reported that 60% were treated with curative intent. Eighty percent of the facilities had a dedicated treatment planning computer and 15% had a time-sharing treatment-planning computer, but 5% had no treatment-planning capability. Ninety-five percent of all facilities reported that patients were simulated at that facility. Fourteen percent of all facilities used hyperthermia, 8% intraoperative radiation therapy, 12% stereotactic radiosurgery, and 19% conformal therapy with 3D planning. Of all facilities 35% reported having a dedicated CT scanner and 12% reported having a CT simulator in the department. The distributions of these measures were reported for hospital-based, free-standing, and federal facilities, for single-treatment machine, and multiple-treatment machines facilities, and for three categories based on patient load. Only 18 cities with a population over 25,000 were more than 25 miles from a radiation oncology facility, of which only eight were more than 50 miles from a facility. CONCLUSION: The Facilities Surveys continue to provide a unique source of census data on radiation oncology in the United States, allowing comparisons by facility group and over time.

Facility Design and Construction↗
PubMed1993

Prescribing attitudes of different physician groups regarding fluoxetine.

OBJECTIVE: To determine the attitudes and prescribing patterns of family medicine and psychiatric physicians regarding fluoxetine. DESIGN: A three-part questionnaire was distributed to the Departments of Family Medicine and Psychiatry. The survey included topics associated with fluoxetine use that have received broad professional attention, such as drug-induced suicidal and aggressive behavior. SETTING: The Family Practice Medical Group and the Department of Psychiatry at the University of Florida. PARTICIPANTS: Mailing lists from both above departments were used to distribute surveys to residents, fellows, and attending/faculty members of each department. Eighty-seven surveys were mailed. MAIN OUTCOME MEASURES: Survey questions were divided into three sections to help determine current attitudes of prescribing fluoxetine: eight short cases, 16 statements, and demographic data. RESULTS: The return rate was 69 percent following a mailing and a hand-delivered copy. Responses were dichotomized to agree or disagree and were analyzed by Fisher's exact test. Psychiatrists were much more likely than family practitioners to prescribe fluoxetine for obsessive-compulsive disorder (OCD), and more likely to prescribe for a patient with a history of substance abuse or seizure disorder. Psychiatrists were more aware of safety issues; however, drug-interaction knowledge was weak in both groups. CONCLUSIONS: Family practitioners, being the most predominant of medical specialists, appeared equally comfortable with prescribing fluoxetine in most circumstances compared with psychiatrists. However, there is a need for pharmacists to provide up-to-date drug information on fluoxetine to all healthcare professionals.

Depressive Disorder↗