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PubMed2002

GP letter writing in colorectal cancer: a qualitative study.

BACKGROUND: The usual mode of communication with the specialist in the UK is a referral letter. Letters now primarily document the GPs' concerns for the patient and are no longer required to persuade the specialist to offer an appointment. The content of referral letters from GPs has failed to satisfy specialists responding to a series of surveys. Evidence suggests that GPs who improve their letters to specialists also refer more cases with significant pathology. AIMS: The aims of this research are to explore the factors that may influence GPs in writing the referral letter when consulting patients presenting with lower bowel symptoms. METHODS: A convenience sample of twelve GPs was interviewed in Nottinghamshire and inner city Sheffield practices. A framework approach was utilised in the analysis of data. Data from the interviews followed the prescribed steps, including: familiarisation, identifying a thematic framework, indexing, charting and mapping, and interpretation. RESULTS: The thematic framework reflected four major themes. These were: (1) the nature and content of referral letters, (2) knowledge about colorectal cancer, (3) issues relating to the quality of referral letters in colorectal cases and (4) factors that effect the use of guidelines for referral. CONCLUSIONS: GPs only have very short consultations in which to address many and complex issues. Pre-referral assessment in colorectal cases includes intimate examination of the patient. Therefore the writing of the letter of referral is often postponed until long after the patient has left the GP's office. Some GPs do not believe the consultant reads the letter of referral. However, GPs are keen to provide best care and welcome feedback about the quality of their letters. They acknowledge the responsibility to communicate with colleagues effectively and have differing ideas about what constitutes an adequate referral letter.

Adult↗
PubMed2006

Dimensions of good and poor handwriting legibility in first and second graders: motor programs, visual-spatial arrangement, and letter formation parameter setting.

First and second graders who were good and poor handwriters completed three writing tasks: writing letters of alphabet in order from memory, letter copying in a passage, and composing on provided topics. A coding scheme was used to evaluate these dimensions of legibility: spacing between words and between letters within words, alignment (letter placement on lines), letter height, letter slant, reversals, added strokes, missing strokes, and missing letters. Although results were somewhat task dependent, most differences between good and poor handwriters involved poor handwriters generating more letters with added strokes, producing smaller letters, and exhibiting more variability in spacing and alignment. The good and poor handwriters did not differ on average performance in alignment of words on the baseline or in spacing of letters within words and spacing between words. Each of three dimensions of handwriting contributed uniquely to the handwriting of first and second graders: motor programs, visual-spatial arrangement on the written page, and letter formation parameter setting.

Chi-Square Distribution↗
PubMed2006

Letters and notes in orthopaedic surgery.

INTRODUCTION: Accurate written communication is essential in orthopaedic surgery. Incomplete and poorly structured letters can lead to poor knowledge of a patient's diagnosis. MATERIALS AND METHODS: Structured and traditional letter formats were compared for speed of reading and preference by general practitioners (GPs), consultants, registrars and out-patient nursing staff. In addition, out-patient clinic letters and notes were analysed and compared for speed of reading and ease of assimilating information and content. RESULTS: There was overwhelming preference for the structured letter format. This style of letter could be read significantly more quickly with information better assimilated and relevant data included more frequently. However, only 26% of letters generated contained a complete set of information sought by GPs and hospital staff. CONCLUSIONS: Structured letters are better in orthopaedics because it is easier to access the contents. The structured format disciplines medical staff to address essential information. Even with a structured format the majority of letters omitted essential information. Training in letter writing is necessary. A structured letter format next to dictating machines might improve the quality of letters generated.

Attitude of Health Personnel↗
PubMed2003

An appraisal of the quality of referral letters from general dental practitioners to a temporomandibular disorder clinic.

AIM: To assess the usefulness of referral letters from general dental practitioners (GDPs) to a clinic seeing referrals related to temporomandibular disorders. DESIGN: A retrospective analysis of all referral letters received by the TMD clinic at Manchester Dental Hospital over a ten-week period. METHODS: The new patient referral letters to the TMD clinic were examined against suggested criteria of 16 points of information considered to be useful by clinicians working in the clinic. The letters were then assessed using a quality scale based on the level of useful information given in the letter, and using this scale, classified into groups of 'very helpful', 'some help' or 'a little helpful'. RESULTS: Out of the 100 letters analysed, the majority (94) proved to be a 'little helpful' for the TMD clinician; that is to say, the letter included only 0-4 points (out of 16) regarded as important information for the specialist. The maximum number of points of information contained in a letter was nine. No letters were categorised as 'very helpful' for the clinician, and only 6% of the referral letters were considered to provide some help (5-12 points). CONCLUSIONS: During the period of the study, in general, referral letters to the TMD clinic concerned contained insufficient information. The introduction of a referral pro forma, produced by the TMD clinic, and guidelines might improve the quality of referrals.

Correspondence as Topic↗
PubMed1998

Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization.

BACKGROUND: Immunization rates have improved in the United States, but are still far from the national 90% goal for the year 2000. There is scant evidence about the effectiveness and costs of automated telephone messages to improve immunization rates among privately insured children. OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of sending letters, automated telephone messages, or both to families of underimmunized 20-month-olds in a health maintenance organization (HMO). METHODS: In this randomized trial, underimmunized 20-month-olds identified by the HMO's computerized immunization tracking system were assigned to one of four interventions: 1) an automated telephone message alone; 2) a letter alone; 3) an automated telephone message followed by a letter 1 week later; and 4) a letter followed by an automated telephone message 1 week later. The primary outcome was receipt of any needed immunization by 24 months of age. Decision analysis was used to evaluate the projected cost-effectiveness of the alternative strategies. RESULTS: A total of 648 children were randomized. A letter followed by a telephone message (58% immunized) was significantly better than either a letter alone (44% immunized) or a telephone message alone (44% immunized). A telephone message followed by a letter (53% immunized) also was more effective than either alone, although the differences were not statistically significant. Among a similar comparison group that received no systematic intervention, 36% were immunized. The estimated cost per child immunized was $7.00 using letters followed by automated telephone messages, $9.80 using automated telephone messages alone, and $10.50 using letters alone. Under alternative cost assumptions for automated telephone messages and mailed messages, the cost per child immunized ranged from $2.20 to $6.50. CONCLUSIONS: For underimmunized 20-month-olds in this HMO setting, letters followed by automated telephone messages were more effective and cost-effective than either message alone. The cost-effectiveness of automated telephone messages and letters may vary widely depending on the setting, and choices among strategies should be tailored to the populations being served.

Cost-Benefit Analysis↗
PubMed1992

Reaction time for global and local identification of small-large composite letters presented in different orientations.

Eight men and eight women were timed as they made judgments about a large capital letter F composed of small versions of the same letter. The subjects were asked to indicate by manual key-pressing responses whether either the large letter (global identification task) or the small letters (local identification task) were normal or reflected letters. With both the large and small letters always in the same orientation but sometimes conflicting in their normal-reflected aspect, the letters were presented in six different angular orientation. Analysis showed that reaction time (RT) (1) increased in relation to the deviation of the letters from standard upright, (2) was slower when both small and large letters were reflected than when both were normal, and (3) was faster for the global than for the local identification task when the letters were completely inverted. The study provided only qualified evidence that global identification of the normalness-reflectedness of letters occurs more quickly than local identification of this attribute.

Female↗
PubMed1979

Orthographic regularity, positional frequency, and visual processing of letter strings.

Previous research has demonstrated that familiarity with the orthographic structure within a letter string can facilitate the processing of the component letters. The current research was directed at discovering the psychologically relevant properties of this structure. Two fundamental descriptions were independently varied in the construction of six-letter nonword strings. A probabilistic description based on the frequency of occurrence of letters in each position was factorially combined with a rule-governed description defined in terms of graphemic and phonological constraints. College sophomores and sixth-grade readers were asked to indicate whether or not a predesignated target letter was present in these strings. For both groups of readers, orthographic regularity and summed positional frequency were found to have only a small facilitative effect on reaction time (RT). In contrast, RTs to say "no" increased dramatically with increases in the number of letters in the catch string that were physically similar to the target letter. In another experiment, the letter string was presented for a short duration, followed immediately by masking stimulus and then the target letter. College students indicated whether or not the target was present in the test string. Accuracy of performance was critically dependent on the orthographic regularity and summed positional frequencies of the letters in the test string. No effect of letter similarity was observed. The large differences that were observed between these two tasks were accounted for in terms of the stages of processing that are critical for performance in the tasks.

Adult↗
PubMed2000

[Effect of goal setting on information processing in letter comparison tasks].

In two laboratory experiments (N1 = 84, N2 = 20) the impact of goal setting on information processing (perception) in letter-matching tasks was examined. It was expected that setting difficult goals for reaction times improves performance because identification and especially semantic classification of letters should be speeded up under goal-setting instructions. Three findings can be emphasized. (1) Current models of simultaneous letter matching are incomplete because they do not account for differences in reaction time based on alphabetic variations (lower case vs. upper case letters) within a pair of letters that are largely independent of real letter sizes. (2) In both experiments and for all types of letter pairs (AA, Aa, Ab AB), goal-setting effects are found as expected. In addition, the explanation that these effects are due to a speed-accuracy trade-off can be excluded. (3) Moreover, in some conditions goal-setting effects are also influenced by special features of letter pairs. Specifically, goal-setting effects are especially strong for letter pairs in which the right letter was enlarged and in which alphabetic differences and semantic differences within pairs call for opposite answers (Aa, AB). Based on the overall pattern of results, it is concluded that difficult goals lead to a general facilitation of processes in visual perception and, in addition, to a reduction of stimulus-induced, performance-delaying inhibition processes if linguistic information is processed predominantly in the left hemisphere.

Adult↗
PubMed1998

Affective Disposition and the Letter of Reference.

The present study attempted to determine the relationship between affective disposition and the favorability of letters of reference. We hypothesized that individuals with positive dispositions would write more favorable letters than would individuals with less positive or neutral dispositions. In addition, we also hypothesized that length of letter would partly mediate the relationship between affective disposition and letter favorability. To test these hypotheses, two studies were conducted. In order to present letter writers with a controlled stimulus, Study 1 entailed having 110 undergraduate students write letters of reference for two hypothetical job candidates in a laboratory setting. In order to test the generalizability of the laboratory study, Study 2 involved 95 faculty members who submitted three recent letters of reference they had written. Results showed that affective disposition was related to the favorability of letters of reference in both studies. Results also revealed that length of letter partly mediated the relationship between affective disposition and letter favorability. Copyright 1998 Academic Press.

Journal Article↗
PubMed1993

The effect of contrast polarity on letter identification.

To determine the effect of contrast polarity on the spatial characteristics of letter identification, we measured contrast sensitivity for individual Sloan letters that were presented either as luminance increments or luminance decrements relative to a continuously presented adapting field. The temporal mode of presentation consisted of either a rapid onset with a Gaussian offset, or the reverse. When contrast was specified in terms of Rayleigh (Michelson) units, the contrast sensitivity function for letters of positive contrast extended to smaller letter sizes than the function for letters of negative contrast. However, when contrast was defined in Weber terms, letter contrast sensitivity functions were identical for letters of positive and negative contrast, indicating that letter identification was equivalent for luminance increments and decrements that had equal absolute magnitude. Onset-offset characteristics had no differential effect on letter contrast sensitivity by either contrast definition. These findings provide a basis for predicting the effect of contrast polarity on tasks that involve letter identification.

Adaptation, Ocular↗
PubMedDate not supplied

Effects of Medicaid drug utilization review intervention letters.

The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians and six pharmacists, meets quarterly to determine criteria for implementing retrospective DUR. The board agreed to send intervention letters to physicians concurrently prescribing: (1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters, approximately half of these physicians were randomly chosen to receive a letter while the others served as a control group and did not receive letters. This project focused on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective one was to examine feedback from the physicians who received the letters, and objective two was to review and compare patient profiles 6 months after the letters were sent. Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117 identified patient profiles) were selected to receive an intervention letter with their patient's profile or profiles, a response form, and a stamped envelope addressed to the Texas Department of Human Services. A 67.5% response rate was obtained. Of these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter. The remaining indicated responses such as "not my patient," they were no longer seeing the patient, or that they did not prescribe the medication in question. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Learning of letter names and sounds and their contribution to word recognition.

This study investigated knowledge of letter names and letter sounds, their learning, and their contributions to word recognition. Of 123 preschoolers examined on letter knowledge, 65 underwent training on both letter names and letter sounds in a counterbalanced order. Prior to training, children were more advanced in associating letters with their names than with their sounds and could provide the sound of a letter only if they could name it. However, children learned more easily to associate letters with sounds than with names. Training just on names improved performance on sounds, but the sounds produced were extended (CV) rather than phonemic. Learning sounds facilitated later learning of the same letters' names, but not vice versa. Training either on names or on sounds improved word recognition and explanation of printed words. Results are discussed with reference to cognitive and societal factors affecting letter knowledge acquisition, features of the Hebrew alphabet and orthography, and educational implications.

Child, Preschool↗
PubMed2006

Rightward bisection errors for letter lines: the role of semantic information.

When bisecting words in their middle, people reveal leftward bisection errors. This tendency might emerge from an attentional bias towards the beginning of the word. However, when longer meaningless letter strings are presented, people reveal a rightward bisection bias. To test the role of semantic information on leftward or rightward bisection biases, we tested letter line bisection performance in healthy right-handed students in four independent experiments. A third of the letter lines contained an embedded four-letter word to the left of true centre, another third contained an embedded four-letter word to the right of true centre, while the remaining lines contained no words. Half of these words were emotional words, the other half were neutral words. Results across experiments revealed a stronger rightward bisection bias: (i) for letter lines containing emotional as compared to neutral words, (ii) for letter lines containing words in the left as compared to right half of the lines, and (iii) for those experiments in which the spatial position of letter lines remained within a narrow body-centred space. Findings from this study suggest that letter line bisection performance might be only minimally determined by visuo-spatial attention. Rather, letter line perception might activate the left hemisphere more than the right hemisphere, shifting the subjective midpoint to the right of true centre. Leftward bisection biases for words only, as had been described in the literature, may thus have resulted from automated reading strategies rather than from attentional biases towards the left hemispace.

Adolescent↗
PubMed2000

Apparent string shortening concomitant with letter crowding.

In our previous studies of the crowding effect, we have observed that human observers tend to underestimate the length of a letter string (the number of letters in the string) when the letters are close to visual acuity, and the interletter spacings are small. In this study, we asked our observers to identify letters in randomly presented four-letter and five-letter strings. We found that, when a priori knowledge of the lengths of letter strings was not available, the probability of underestimating string length increased with decreasing interletter spacing. The causes of underestimation errors appeared to be the omission of an interior letter and the merging of two neighboring letters. Since our experiments were conducted in the foveal region, neither spatial uncertainty nor split attention can explain the underestimation errors. The effect of the point spread function of the eye on closely packed letter strings is discussed.

Adult↗
PubMed1999

A letter-recognition task to assess lingual tactile acuity.

PURPOSE: This study evaluated a novel neurosensory test based on letter recognition developed for the assessment of spatial acuity of the tongue. PATIENTS AND METHODS: An up-down tracking procedure was used to estimate the threshold height for the recognition of embossed letters of the alphabet examined by the tongue tip. The 48 stimuli consisted of acrylic strips, one side of which bore a letter (A, I, J, L, O, T, U, or W) of 3, 4, 5, 6, 7, or 8 mm in height. Twenty neurologically normal young adults were tested. RESULTS: Stable estimates of the threshold height were obtained after delivery of only 15 trials. Threshold height averaged 5.1 mm (range, 3.7 to 6.6 mm) and was unaffected by gender (P>.88). Although the letters were identified correctly 54% of the time, on average, the tangibility of individual letters varied from 5% correct (for W) to 82% correct (for T). The letter W was never identified by 16 of 20 subjects; T, O, and U were identified by all subjects. Analysis of errors confirmed that subjects relied on spatial cues to make the discriminations; 58% of the incorrect responses were made to 1 or 2 letters with spatial features similar to those of the stimulus letter. CONCLUSIONS: The threshold height for letter recognition can be obtained easily and rapidly, exhibits low among-subject variability, and reflects the capacity to extract and process spatial information. Letters of similar legibility on the tongue should be used to minimize underestimation of subjects' true acuities.

Adolescent↗
PubMed1976

The familiarity effect for single-letter pairs.

A familiarity effect in these experiments is defined as a subject's ability to respond more rapidly to a familiar stimulus than to an unfamiliar stimulus. In the first experiment, responding faster to familiar letters (upright) than to unfamiliar letters (inverted) occurred only when the two stimulus types were presented in a random order. These results were interpreted in terms of the effects of processing strategy changes. The second experiment compared the responding of Japanese and American subjects to Japanese and English letters. American subjects responded faster to English letters and Japanese subjects responded faster to Japanese letters. This familiarity effect was obtained even when stimulus presentation was organized by letter type and subjects knew which letter type to expect. The final experiment compared English and Japanese letters in a memory search task. The rate of search for Japanese letters was slower than for English letters. However, no zero-intercept difference was obtained. The evidence indicates that familiarity does not affect an initial encoding process, but it can affect a comparison process.

Discrimination, Psychological↗
PubMed1993

Evaluation of resident applicants by letters of recommendation: a comparison of traditional and behavior-based formats.

RATIONALE AND OBJECTIVES: Traditional, narrative letters of recommendation solicited by medical students applying for radiology residency are widely used as a selection tool. Letters of recommendation are considered a source of reliable information about the attitudes and behaviors (non-cognitive variables) of the resident applicant. However, in many instances, this information is not present or is highly encoded and cannot be extracted. This study attempted to document the deficiencies of traditional letters of recommendation and determine the effectiveness of a structured letter of recommendation in obtaining information regarding noncognitive variables. METHODS: One hundred thirteen randomly selected letters of recommendation were analyzed by two radiologists with experience in residency selection. Deficiencies in inclusion of information or the ability to extract information about noncognitive variables were documented. A standard behavioral assessment was sent to the writers of these letters of recommendation and these results tabulated. RESULTS: The traditional letters of recommendation were frequently deficient in data regarding the noncognitive variables. In letters that contained such data, two experienced reviewers could not reliably extract the information. The structured form produced clearly identifiable information about the letter writer's assessment of noncognitive variables. CONCLUSIONS: Traditional letters of information are frequently deficient in data regarding noncognitive variables. A standardized statement is effective in eliciting information on noncognitive variables related to applicant performance.

Internship and Residency↗
PubMed1996

Evaluation of physician intervention letters.

OBJECTIVES: The Omnibus Budget Reconciliation Act of 1990 requires that Medicaid Agencies perform drug utilization review (DUR). The Texas Medicaid Agency, in cooperation with the Texas DUR Board, have chosen to mail intervention letters to physicians with patient profiles that indicate possible inappropriate use of medications. The objective of this study was to assess the effect of intervention letters indicating duplicative anti-ulcer medications. METHODS: Analysis of Medicaid prescription claims produced 335 patient profiles involving concurrent therapy. Physicians for 174 patients were selected randomly to receive an intervention letter, a response form, and a stamped envelope. The remaining patients served as a control group. RESULTS: A 71.2% response rate was obtained. Of these responses, 48.9% agreed with the letter and 19.1% disagreed with the letter. Profiles generated 6 months after the letters were sent indicated that 47.7% of the patients in the experimental group were still on concurrent therapy compared with 64.4% of patients in the control group (P = 0.007). CONCLUSIONS: The high response rate to the letter, the moderately high agreement with the letters, and the statistically significant reduction of duplicative therapy in the experimental group indicate that intervention letters can be an effective way to change prescribing. Future research is needed to assess the effects of educational intervention letters for other drug categories, for other populations, and for longer periods of time; and the effect these changes may have on true patient outcomes.

Anti-Ulcer Agents↗