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PubMed1999

Physician in conflict: a survey study of individual and work-related characteristics.

Relationship of individual and work-related factors to interpersonal conflicts at work was studied, using data from a nationwide survey in 1993 of the work environment and living conditions of physicians in Norway. The survey included a total of 1,800 questions spread over 16 questionnaires, which were distributed according to an 'overlapping questionnaire design'. Questionnaires were mailed to a random sample of 9,266 physicians, of whom 6,652 responded (72%). The results suggest that personality factors such as 'intensity' and 'reality weakness' are related to conflict with one's immediate superior, but not to conflict with others at work. Respondents reporting conflict with friends, relatives and spouse tended to report more conflict at work both with immediate superiors and others. The frequency of interpersonal conflict at work was not related to gender.

Conflict, Psychological↗
PubMed1997

[Anesthesiologists and information resources on the Internet].

The Internet connects computers around the world using the common protocol. Anesthesiologists are providing places on the Internet to exchange anesthetic information and share information resources, in the form of mailing lists and World Wide Web. They are also distributing anesthetic information to persons engaging in other medical services as well as to the general public. There are many information resources on the Internet that are useful for daily diagnosis and treatment, self-study, education and research by anesthesiologists.

Anesthesiology↗
PubMed2001

The use of e-mail by doctors in the West Midlands.

We surveyed the use of e-mail by doctors in the West Midlands. In addition to 224 questionnaires distributed to doctors at three large hospitals, 300 general practitioners (GPs) selected randomly from a list of 711 were also sent questionnaires. There was a 60% response rate. Overall, 65% of the 314 respondents used e-mail, but 84% of hospital doctors used email compared with 55% of GPs. E-mail was used mainly for communication with friends and family (92%) and work colleagues (61%), with only 7% using e-mail for transmitting clinical data and 3% to send or receive referrals. E-mail usage showed a significant trend with respect to age, being highest in the 20-29-year age group and lowest among those aged over 60 years. Over 60% of respondents felt that e-mail was not secure for the transfer of patient data. However, 90% felt that they would be using e-mail in a clinical setting in five years' time. Despite the relatively high use of e-mail for social communication, work-related use by doctors was low.

Adult↗
PubMed2003

A randomized study of electronic mail versus telephone follow-up after emergency department visit.

This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. Secondary outcome was the median time of response. There were 1561 patients initially screened. Of these, 444 had e-mail and were included in the study. Half were contacted by telephone and the rest via e-mail. Our telephone contact rate was 58% (129/222) after two calls in a 48-h period and our e-mail contact was 41% (90/222). The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.

Adult↗
PubMed2002

Biologic monitoring of dental office sterilizers in Mexico.

BACKGROUND: Biologic indicators (BIs) are the quality control applicable to sterilization cycles, but their use was not previously taught in Mexican dental schools or recommended by professional associations. A Mexican official standard, the Mexican Official Norm, published by health authorities in 1999 makes it compulsory for dentists to biologically verify sterilization cycles. However, only a few dentists comply because the use of BIs is largely unknown and the standard is not being enforced. OBJECTIVE: To evaluate the incidence of sterilization failures in a convenience sample of dental offices in Mexico. METHODS: Spore strips were distributed to dentists interested in using this service. The dentists mailed the processed BIs to the laboratory for culture. RESULTS: In 6 years, 3277 tests were submitted from 82 dental offices. Thirty-four offices (41%) submitted 1 to 12 tests, 22 (27%) sent 14 to 48 tests, 18 (22%) mailed 49 to 96 tests, and 8 (10%) sent >97 tests. The sterilization methods were steam (74.4%), dry heat (20%), and chemical vapor (5.6%). A total of 242 sterilization failures (7.4% of all cycles) were detected. Convection dry heat failed with a greater frequency with chi(2) analysis (chi(2) = 13.71, P =.0175). CONCLUSIONS: Sterilization failures occurred in instrument loads used in patient treatment. Steam and chemical vapor under pressure failed less often than convection dry heat. When corrective action is taken, routine use of BIs increases patient safety.

Chi-Square Distribution↗
PubMed1998

The legal environment impeding access to sterile syringes and needles: the conflict between law enforcement and public health.

This article examines the legal environment for programs to prevent transmission of HIV and other blood-borne diseases among injection drug users (IDUs). Cost-effective public health programs often have questionable legal authority, and health professionals, community activists, and IDUs may be subject to arrest and prosecution. Legal impediments to the sale and distribution of syringes exist in every state: 47 states have drug paraphernalia statutes, 8 states have syringe prescription statutes, and 23 states have pharmacy regulations or practice guidelines. The Mail Order Drug Paraphernalia Act permits federal enforcement against individuals who knowingly sell or distribute syringes to IDUs. Congress has prohibited the use of federal funds for syringe exchange programs (SEPs). Legal restrictions on access to sterile syringes present formidable obstacles to public health prevention. These restrictions render it much more difficult for pharmacists to sell syringes over the counter or for physicians to prescribe syringes, create a chilling effect on IDUs seeking to comply with medical advice and protect themselves and their partners from disease, and place significant obstacles on the lawful establishment and operation of SEPs. Public health authorities have only sometimes creatively circumvented legal restrictions through judicial declarations of lawfulness, municipal declarations of a "state of emergency," and by use of the "necessity" defense. I recommend repeal of syringe prescription statutes and reform of drug paraphernalia statutes and pharmacy regulations.

Blood-Borne Pathogens↗
PubMed1995

The Icelandic child mental health study.

The purpose of this study was to test the applicability of a standardized procedure for assessing Icelandic children's behavior/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist by Achenbach to estimate the self-reported prevalence by parents and adolescents of emotional and behavior problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing lists with a letter to parents of children 2-10 years of age. The lists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the lists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 546 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group (47%), but increasing to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons are presented with the Child Behavior Checklist for this study with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries in behavior/emotional problems reported. The present study prevalence data behavior/emotional problems in Icelandic children from the general population from 4-16 year olds for 943 children is 17.5 (boys 19.1; girls 15.).

Adolescent↗
PubMed1995

The Icelandic Child Mental Health Study. An epidemiological study of Icelandic children 2-18 years of age using the child behaviour checklist as a screening instrument.

The purpose of this study was to test the applicability of a standardised procedure for assessing Icelandic children's behaviour/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist (CBCL) by Achenbach to estimate the reported prevalence of parents and adolescents of emotional and behaviour problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing checklists with a letter to parents of children 2-10 years of age. The checklists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the checklists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 545 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group 47%, but increased to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons with the Child Behavior Checklists from this study are presented with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries on the behaviour/emotional problems reported.

Adolescent↗
PubMedDate not supplied

Distributions of smokers by stage: international comparison and association with smoking prevalence.

OBJECTIVES: The goals of this study were to describe the distribution of smokers by stage of change in Geneva, Switzerland; to compare this result with distributions observed in other countries; and to assess whether, across samples from different countries, the stage distribution of current smokers was associated with the prevalence of smoking. METHODS: Two mailed surveys were conducted in Geneva in 1995-1996, in a representative sample of residents (n = 742) and in a representative sample of university members (n = 2,270). A literature review produced seven studies describing the stage distribution in representative samples. RESULTS: In the Geneva population, 74% of smokers were in the precontemplation stage, 22% in contemplation, and 4% in preparation. In the university sample, the corresponding figures were 72, 20, and 8%. Our results were similar to other European samples, but less favorable than in American samples, where these distributions were typically 40, 40, and 20%, respectively. Across all samples, a low prevalence of smoking was associated with a more favorable stage distribution (r = 0.88, P = 0.002). CONCLUSIONS: Interventions in Europe need to take into account the large proportion of precontemplators repeatedly observed among smokers. A shift to the right of the distribution of current smokers across stages may help increase quit rates and thereby reduce smoking prevalence. This hypothesis should be tested in prospective intervention studies.

Adolescent↗
PubMed2002

Scale-free topology of e-mail networks.

We study the topology of e-mail networks with e-mail addresses as nodes and e-mails as links using data from server log files. The resulting network exhibits a scale-free link distribution and pronounced small-world behavior, as observed in other social networks. These observations imply that the spreading of e-mail viruses is greatly facilitated in real e-mail networks compared to random architectures.

Journal Article↗
PubMed2003

Determination of vital status at the end of the DIG trial.

The Digitalis Investigation Group (DIG) trial was a randomized, double-blind placebo-controlled trial whose primary objective was to determine whether digoxin had beneficial, harmful, or no effect on total mortality in patients with heart failure who were in sinus rhythm and whose ejection fraction was </=0.45. The study was designed as a large simple trial with a large number of centers (302) in the United States and Canada, many of which were inexperienced in research. To ensure that the results of the trial would be reported accurately without possible bias due to missing data, the study leadership decided that no outcome results would be reported until the vital status at the end of the study was known for at least 97% of the study participants. Planning for closeout of the study began a year prior to the common end date of December 31, 1995 and included plans for obtaining vital status on December 31, 1995. Participants were given postcards at their final study visit to be completed and mailed on or after January 1, 1996. Of 5602 postcards distributed, 5070 (90.5%) were completed and returned. A contract search agency was hired to locate the remaining participants. Of the total 7788 participants entered into the DIG trial, only 97 participants (1.2%) could not have their vital status as of December 31, 1995 determined. It is recommended that investigators having an outcome measure with a common end date include plans in their protocols for obtaining their measures and activate those plans as early as possible during the course of the study.

Digitalis Glycosides↗
PubMed1995

Emergency department quality assurance/improvement practices for the pediatric patient.

STUDY OBJECTIVE: To describe emergency department quality assurance (QA)/improvement (QI) practices for pediatric patients. DESIGN: Mail survey of a cohort of emergency physicians. PARTICIPANTS: Pediatric Section members of the American College of Emergency Physicians and a computer-generated random sample of general ACEP members. RESULTS: Pediatric Section and general ACEP physicians were mailed a 13-question QA survey. Of the 500 surveys distributed, 207 (41.4%) were returned. Three emergency care settings for pediatric patients seen in the ED were identified: (1) children's hospital ED (14%), (2) general ED with a separate area designated for the evaluation of pediatric patients (12%), and (3) general ED where pediatric and adult patients are evaluated in the same area (74%). Separate QA indicators were used to monitor care of the pediatric patients seen in the ED by 61% of the respondents; 39% used "adult" indicators only. High pediatric census was associated with pediatric representation on the ED QA/QI Committee, the use of separate pediatric indicators to monitor care of pediatric patients in the ED, the separation of pediatric and adult patient care areas and satisfaction with the respondent's ED QA/QI plan. CONCLUSION: The bulk of pediatric emergency patients are cared for in a general ED. Most ACEP members surveyed reported the use of separate QA indicators to monitor the care of pediatric patients seen in the ED. This survey provides the first description of QA/QI practices for pediatric patients by EDs nationwide.

Child↗
PubMed1993

The use of consumer-satisfaction surveys by an air medical program.

Surveys were distributed to referring and receiving hospitals or to EMS agencies that used the air medical service. The respondents were asked to evaluate the dispatcher's, pilot's and flight crew's professionalism and courteousness on a Likert scale and through written comments. Phase 1 of the survey distribution was discontinued after problems were encountered due to the distribution process. Phase 2 consisted of the air medical program mailing surveys directly to the referring and receiving facilities or to the EMS agencies. In terms of courteousness and professionalism, 90% of the respondents' answers fell within the strongly agree to neutral range. Questions regarding pilots and dispatchers were often left unanswered. Two areas were identified as needing further work on the part of the medical flight crew: follow-up with referring hospitals on patient outcome and identification of flight physicians vs. flight nurses.

Aircraft↗
PubMed2000

Radiology quality and performance metrics on the Web: a management information and communications tool.

RATIONALE AND OBJECTIVES: The purpose of this study was to demonstrate the feasibility of using the World Wide Web to communicate critical radiology quality and performance metrics to departmental and hospital management staff. MATERIALS AND METHODS: Data on report turnaround, appointment access, patient and physician satisfaction, and financial performance were harvested from a variety of sources. These were then standardized and condensed so they could be displayed electronically in a concise, information-dense fashion. RESULTS: The final product was a series of graphic materials on a single Web site. The most informative was a summary "spiderweb chart" that indicated the percentage of specified performance goals achieved for 12 operational parameters. These graphic materials were distributed to management staff monthly by means of e-mail. CONCLUSION: The use of simple Web-based technology facilitates the collection of key departmental performance data and the dissemination of these data to a wide audience.

Humans↗
PubMed2004

Burnout in residency: a statewide study.

OBJECTIVE: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. METHODS: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and chi2 tests were used for analysis; values of P < 0.05 were significant. RESULTS: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). CONCLUSIONS: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Burnout, Professional↗
PubMed2005

Use of antidepressant combinations: which, when and why? Results of a Spanish survey.

OBJECTIVE: The present study uses the data from a large survey conducted to examine the general practice of Spanish psychiatrists on the use of antidepressant combinations in the treatment of depressive disorders. METHOD: The sample was drawn from specialists and psychiatric residents practicing in Spain who were respondents to a questionnaire distributed during an annual national psychiatry meeting and sent by mail. RESULTS: A total of 1032 questionnaires were collected; following the data-filtering, 831 were analysed. Most psychiatrists (89%) believe that many patients do not respond to the first treatment; in such cases of non-response, 58% choose a combination of antidepressants as the next treatment option. Reasons for using the combined treatments include greater efficacy (57%), overcoming resistance to the first antidepressant (27%), faster onset of action (21%) and avoidance of side effects (17%). The most sought after pharmacological profile was serotonergic-noradrenergic (96%) and the most popular combinations were selective serotonin reuptake inhibitor (SSRI) + mirtazapine, SSRI + reboxetine and SSRI + tricyclic antidepressant. CONCLUSION: Antidepressant combinations are frequently used in clinical practice. Pharmacological profiles are always considered and SSRIs + mirtazapine is the option usually chosen.

Antidepressive Agents↗
PubMed2004

Factor structure of the Minnesota Satisfaction Questionnaire short form for restaurant employees.

The factor structure of the Minnesota Satisfaction Questionnaire short form for nonsupervisory restaurant employees was explored in questions among 2000 employees of three full-service restaurant chains operating in midwestern United States. A total of 2000 surveys were distributed to hourly employees of the three chains. From the mailing, 924 surveys were returned and found useable, a 46.2% response rate. Principal factors analysis identified a four-factor structure for the employees, in contrast to the original two-factor structure, but as in other studies the structure was multifactorial.

Adult↗
PubMed1999

Medical students and debt: a survey of students at the School of Medicine, University of Auckland.

AIMS: To assess the extent of Auckland medical students' debt, the types of debt accrued and to establish data on part-time employment, income, parental support and living circumstances for these students. METHODS: Medical students at the University of Auckland were asked to complete a written survey questionnaire, which was distributed in lecture classes for years 1-5 and by mail for year 6. The questionnaire asked about biographical data, types and amounts of debt, the use of student loan scheme money, employment, income, student allowances, parental financial support and living situation. Students not sent the survey by mail were informed about the survey several days prior to receiving it to enable them to collate the necessary financial information. Data entry was completed via an electronic scanning system and questionnaire responses were analysed using a tabular analysis of the various classes. RESULTS: There were 522 responses received, comprising 73% of students (48% male, 52% female). The major source of debt was to the Government student loan scheme (39% of students in year 1, rising to 75% in year 6). Average (median) debt to the Government loan scheme rises from $5000 in year 1 to $26,000 in year 6. Fourteen per cent of students receive a targeted student allowance and 30% have a part-time job. Average summer vacation earnings do not exceed $4000. Thirty-four percent receive no financial support from their parents and 18% receive support with some costs only. With the exceptions of students in year 1, more than 50% of students live away from home. CONCLUSION: Medical students are predominantly in debt to the Government student loan scheme and the level rises by approximately $5000 per year from year 1 to year 6. It is expected that these levels will increase in the future.

Adult↗