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PubMed1989

Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice.

Ambulatory Care Facilities↗
PubMed2006

Prophylactic antibiotics in pediatric shunt surgery.

INTRODUCTION: The optimal antibiotic prophylaxis for pediatric shunt-related procedures is not clear. There is much inconsistency among different medical centers. This paper summarizes and analyzes the various prophylactic antibiotic regiments used for shunt-related surgeries at different pediatric neurosurgery centers in the world. MATERIALS AND METHODS: A survey questionnaire was distributed through the Pediatric Neurosurgery list-server (an e-mail-based special interest group in pediatric neurosurgery). Forty-five completed questionnaires were received, one per medical center, primarily from pediatric neurosurgeons with the following geographic breakdown: 25 from North America, 13 from Europe, and 7 from Asia and other countries. All centers routinely administered prophylactic antibiotics for shunt-related procedures. The drugs of choice were first-generation cephalosporins (23), second-generation cephalosporins (10), naficillin/oxacillin (4), vancomycin (3), clindamycin (1), amoxicillin (1), and mixed protocols in three centers. The initial drug administration ("first dose") was: in the department before transfer to operating room (5), upon arrival to operating room (11), at induction of anesthesia (13), and at initial skin incision (16). The duration of antibiotic dosage also varied: single dose (13), 24-h administration (26), 48-h administration (2), and longer than 48 h in four centers. RESULTS AND DISCUSSION: Two general tendencies were noted, common to the majority of participating centers. There was a general trend to modify antibiotic treatment protocol in "high-risk" populations. The second common theme noted in more than half of responding centers was the use of long-term antibiotic treatment for externalized devices (such as externalized shunts, external ventricular drains or lumbar drains), usually till the device was in place.

Anti-Bacterial Agents↗
PubMed1997

[Clinical data on the diagnosis of colic in infants. Survey in 2,773 infants aged 15-119 days. Groupment des pédiatres de la région de Lyon (GPRL), le Groupment lyonnais de recherche en pédiatrie ambulatoire (GLYRPA), l'association des pédiatres de la région stéphanoise (APRS) et la Formation pédiatrique grenobloise (FPG)].

BACKGROUND: Crying is called "Infantile colic" when such cries are numerous, paroxystic, difficult to comfort, and without an obvious cause. METHODOLOGY: An information mailing on the study (named Encolie) and the associated methodology was distributed in April 1995 to 212 private practice pediatricians. They have included in the study all infants aged 15 to 119 days who were seen during consultation from June 12 to June 27. They filled out a two page, 32 item, epidemiological questionnaire. Question 31 asked; "following this consultation, would you call for an 'infantile colic' diagnosis for this child? Yes, no. if no, what is your diagnosis?" RESULTS: One hundred and sixty-nine private practice pediatricians out of 212 (79.7%) participated in the study, and have included 2,797 infants 2,773 infant files were analyzed. The 625 infants identified as "colic" (22.5% of all cases), differed from the 2,148 identified as "non-colic" by the following factors: average age (51.3 vs 61.3 days), birth weight (2,226 vs 3,307 g), being a first born (52.7 vs 45.1% of cases), and mother's anxiety (47.8 vs 29.1% of cases). Significant differences were observed concerning feeding behavior (slow or gluttonous feeding), digestive symptoms, and unexplained crying, always more frequent in the case of the infants identified as "colic". These infants received more drugs, and their parents were given more advice on diet and hygiene. The symptoms supporting the "infantile colic" diagnosis were derived using a statistical regression model. They included: frequent and/or unexplained crying at the time of the study, frequent and/or unexplained crying in the past, abdominal distention at the time of the clinical examination, and frequent gas emissions as indicated by parental questioning. Factors associated with this diagnosis were: young age of the child, drugs administered before the consultation, maternal anxiety, anomalies in feeding behavior, and to a lesser degree, low birth weight and mother or father atopy. CONCLUSION: Given the sample size and origin, and the rigor of both the study and the analysis, we believe that these data could be extrapolated to the usual pediatrician's patient population. This highlighting of differences between our two groups indicate the validity of this diagnosis.

Colic↗
PubMed2000

Health care utilization by people with multiple sclerosis in The Netherlands: results of two separate studies.

PURPOSE: For chronically ill persons it is assumed that they make heavy demands on health care services. In the literature one hardly finds any publications to substantiate or refute this assumption. The main purpose of our study is to describe the health care utilization of people with multiple sclerosis (MS) in the Netherlands and its relationships with severity and duration of the disease. METHODS: Two different samples of persons with MS were used. In the first sample (University Hospital Groningen) severity of MS was based on medical judgement, while in the second sample (Dutch Multiple Sclerosis Society) severity was self-reported. In both samples, use of health care facilities was assessed with a mail questionnaire. RESULTS: The methods for determining severity resulted in different distributions for severity of MS. However, the results were quite similar with respect to health care utilization. It appeared that the severity of MS was related to the number of professional caretakers MS-patients had contact with during one year. Duration of MS seemed not to be related to the number of caretakers. Only for specific caretakers, most notably GP, physiotherapist, home help and ergotherapist, the contact frequency increased with severity of MS. No such relationship was found between the frequency of contact with the neurologist and severity of MS. CONCLUSIONS: People with MS do not make a heavy demand on health care facilities in general but only on certain health care provisions. This is in contrast with the general notion that all chronically ill make a heavy demand on health care facilities in general.

Adult↗
PubMed2001

Practical approach to the use and monitoring of dofetilide therapy.

FDA's requirements for the use of dofetilide are described, and one hospital's strategy for meeting the requirements is discussed. Dofetilide is a specific class III antiarrhythmic agent approved for use in the conversion of atrial fibrillation and atrial flutter and the maintenance of normal sinus rhythm. It is available as an option for highly symptomatic patients who fail to respond to or do not tolerate other antiarrhythmic agents and patients with structural heart disease. Because of the risk of torsade de pointes associated with dofetilide, FDA has mandated in-hospital initiation of dofetilide therapy and has restricted its availability to hospitals and prescribers who have received appropriate education on dofetilide treatment initiation and dosing. Control of the drug's distribution is limited to a single wholesaler and a single mail-order pharmacy. These restrictions, along with the FDA labeling and the inherent risks associated with dofetilide use, have made this drug a complicated agent to use within an institution. When dofetilide was added to the formulary at Harper University Hospital, policies and procedures were developed to ensure appropriate use and monitoring. The use of dofetilide within health systems requires detailed procedures for prescribing, dispensing, and monitoring and thorough education of caregivers about those procedures. Pharmacists have a pivotal role in ensuring the appropriate use of dofetilide.

Anti-Arrhythmia Agents↗
PubMed2004

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

OBJECTIVES: The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. DESIGN: A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. RESULTS: Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. CONCLUSION: There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Adult↗
PubMed2006

The epidemiology of morningness/eveningness: influence of age, gender, ethnicity, and socioeconomic factors in adults (30-49 years).

The Horne and Ostberg Morningness/Eveningness Questionnaire (MEQ) is widely used to differentiate between morning and evening types, but there is very little epidemiological evidence about the distribution of MEQ chronotypes in the general population. The purpose of the present study was to simultaneously investigate the influence of demographic, socioeconomic, and work factors on the distribution of morningness/eveningness. A New Zealand version of the MEQ was mailed to 5000 New Zealand adults, ages 30 to 49 years, who were randomly selected from the electoral rolls (55.7% response rate). A total of 2526 questionnaires were included in the analyses. According to the Horne and Ostberg classification, 49.8% of the total population was classified as morning type compared to 5.6% having an evening-type preference. However, using new cutoffs for middle-aged working adults described by Taillard et al. (2004), 24.7% of the population was morning type and 26.4% was evening type. After controlling for ethnicity, gender, and socioeconomic deprivation, participants ages 30 to 34 years were more likely to be definitely evening type (odds ratio [OR] = 1.59, p < 0.05) and less likely to be morning type (moderately morning type, OR = 0.59, p < 0.01, or definitely morning type, OR = 0.59, p < 0.05) compared to those ages 45 to 49 years. Work schedules were also important predictors of chronotype, with night workers more likely to be definitely evening type (OR = 1.49, p = 0.05) and the unemployed less likely to be moderately morning type (OR = 0.64, p < 0.05) compared to other workers. Evening types were 2.5 times more likely to report that their general health was only poor or fair compared to morning types (p < 0.01). This study confirms that the original criteria of Horne and Ostberg (1976) are not useful for classifying chronotypes in a middle-aged population. The authors conclude that morningness/eveningness preference is largely independent of ethnicity, gender, and socioeconomic position, indicating that it is a stable characteristic that may be better explained by endogenous factors.

Adult↗
PubMed1994

Report of survey: pregnancy outcomes in medical laboratory technologists.

A survey was published and distributed in the CSLT Bulletin. Completed surveys were returned anonymously by mail. Of the surveys returned (n = 2002), 16 were not usable due to incomplete information. Spontaneous abortion (SA) occurred in 19.9% of the total responders' pregnancies. Technologists not employed during pregnancy had a lower rate of SA (13.2%) compared to those working full-time (19.9%) (p < 0.001). Including all types of early (< 28 wk) pregnancy terminations (except induced abortion) the non-employed group had a 17% incidence of fetal loss compared to 23% in the group employed full-time (p < 0.001). The differences in SA rate could not be accounted for by mother's age at pregnancy nor previous obstetric history. The incidence of cesarean section was higher in the full-time employed group (16%) compared to the non-employed group of technologists (9.9%) (p < 0.001). There were 141 reported birth defects representing an overall incidence in responders of 4.8%, comparable to literature values for the general population (6.0%). The incidence of specific birth defects was not different in the working group.

Abortion, Spontaneous↗
PubMed2000

Assessment of ophthalmology residents' contact lens training.

PURPOSE: To characterize the nature and duration of contact lens training in ophthalmology residency training programs and to ascertain the comfort level of residents in fitting various types of contact lenses and in dealing with common contact lens-related complications. METHODS: Surveys were mailed to 126 ophthalmology residency program directors/coordinators and requested to be distributed to 1,381 ophthalmology residents. The questionnaire addressed issues related to contact lens training, hours of clinical and didactic training, comfort with fitting a variety of different types of contact lenses and dealing with common contact lens-related complications, and plans for incorporation of contact lens dispensing into future practice. RESULTS: Two hundred and forty-nine residents (18%) responded from 84 programs (67%). Most programs (87%) have some form of supervised contact lens training, frequently conducted by an optometrist (61% of programs), that consists of 20 hours or less of clinical experience and 20 hours or less of didactic training. A majority of the responding graduating residents (66%) feel comfortable fitting spherical soft contact lenses, while less than half of all residents feel comfortable fitting any other type of contact lens. In addition, most residents (65%) feel comfortable diagnosing and treating common contact lens-related complications. CONCLUSIONS: Most ophthalmology residency programs offer some form of supervised contact lens training which allows a majority of residents to feel comfortable fitting only spherical soft contact lenses, while also dealing comfortably with most contact lens-related problems. A comparison with previous data suggests increasing comfort with fitting most types of contact lenses over the last decade.

Contact Lenses↗
PubMedDate not supplied

Faculty openings and recruitment in dental hygiene education.

The purpose of this study was to obtain information on the availability of full-time teaching positions, job qualifications, and methods of recruitment in dental hygiene education. A questionnaire was mailed in 1990 to 198 dental hygiene program directors to acquire data on faculty positions and recruitment. The initial and follow-up mailings produced an 86% response rate. Data were analyzed using frequency distributions and chi-square analyses. Seventy-seven authorized openings for full-time faculty were reported: 60 were vacancies resulting from the departure of a faculty member. The minimum educational qualification was the baccalaureate degree for faculty positions in associate degree programs, and the master's degree or higher for teaching positions in baccalaureate degree programs. The type of experience required was primarily clinical, although teaching and research were preferred. The majority of positions available were at the entry levels of instructor and assistant professor. The recruitment method reported to be most successful in locating prospective faculty candidates was placement of a notice in a professional journal.

Chi-Square Distribution↗
PubMed1989

Occurrence of sexual behaviour related to the risk of HIV-infection. A survey among Danish men, 16-55 years of age.

To describe the occurrence of sexual behaviour involving increased risk of HIV-infection in a representative sample of Danish men, 16-55 years of age, a self-administered anonymous questionnaire was distributed in connection with a personal health interview and returned by mail. The response rate was 55% corresponding to 1,155 participants. The sexual behaviour of 33% of the men was potentially risky, with a chance of HIV-infection. Homosexual experience was reported as 3% and sexual contact with female prostitutes as 14%. During the previous twelve months, 1% had had homosexual contact, 2% had had contact with prostitutes, and 22% had more than one female partner; most of these men had "one night stands" and used condoms infrequently. Consequently, a significant minority of the participants engaged in sexual behaviour which might facilitate the dissemination of HIV-infection. Although the prevalence of HIV among heterosexuals in Denmark is low, intense health education will be needed in order to prevent heterosexual spread of HIV in the future.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Continuous subcutaneous insulin infusion therapy in Japan, 1984: a survey by questionnaires.

A country-wide survey of the continuous subcutaneous insulin infusion (CSII) therapy was carried out in the summer of 1984 in Japan. Questionnaires were mailed to doctors of 456 diabetes clinics and other questionnaires were distributed to patients taking CSII therapy by salesmen of the infusion pump makers. 275 doctors and 86 patients responded to the questionnaires. CSII therapy was conducted in 110 clinics (40%), but it was done mostly in inpatients. Decrease in blood glucose (91%) and improvement of general body condition (65%) were achieved by the therapy, but cutaneous complications, such as skin reaction to the tapes (33%), pigmentation (46%), induration (35%) and lipodystrophy, and hypoglycemic (83%) or ketoacidotic (16%) episodes were experienced in many cases. 211 doctors predicted bright prospects for the CSII therapy, 86 (41%) speculated a spread in the popularity of the therapy and 44 (21%) opined that the therapy was a passing phenomenon (only a fashion).

Adult↗
PubMed1993

[The role of hospital personnel in quality assurance activities at Danish hospitals].

Over the last few years there has been considerable activity concerning quality assurance (QA) in health care. In order to investigate the actual consequences, we mailed a questionnaire to all Danish hospital managements, asking them to distribute it to leading doctors and nurses. 349 questionnaires from 51 hospitals were returned. The questionnaire was concerned with QA-activities, topics and methods, organisational aspects and attitudes amongst the professionals. Forty-eight percent of all hospitals, evenly distributed over all hospital and department categories, were represented in the survey. Fifty percent of respondents were doctors, 40% nurses. Eighty-seven percent had started quality assurance activities, typically clinically oriented research where doctors were concerned, and typically projects concerning communication with patients when initiated by nurses. Both groups had many projects concerning personnel policy, especially educational aspects. 3% of the activities were concerned with patient satisfaction. Knowledge of quality assurance principles was not yet widespread among the professionals, but 87% expressed positive attitudes. There is a need to define the concept of QA and to spread knowledge of QA-methods, if a systematic approach to QA is to be implemented.

Denmark↗
PubMed2004

Family satisfaction with nursing facility care.

BACKGROUND: We present the psychometric properties of our nursing facility family satisfaction questionnaire (NF-FSQ), and the steps used to develop this instrument. METHODS: Family members from 14 nursing facilities in Pennsylvania were mailed the NF-FSQ. Factor analyses were used to test the extent to which the items in each domain represented the same underlying construct. To further report the applied psychometric properties of the instrument we used the completeness of data, score distributions, item-scale consistency and reliability of domain scores. RESULTS: Of the 550 surveys mailed, 387 usable surveys were returned (70% response rate). Factor analyses show that the items were representative of the underlying factors. The percentage of family members not providing responses for each question was low, and varied from 1.0% to 3.4%. The floor and ceiling effects of the responses for each of the 20 questions were low. The item-scale internal consistency analyses determined that the correlation of items within indexes were higher than those with other indexes. Cronbach's alphas for the domains were all higher than usually recommended levels. CONCLUSIONS: We believe we have produced a short, psychometrically sound family member satisfaction instrument for use in nursing homes. We also show that response rates from family members can be very high.

Data Collection↗
PubMed2003

[May heart murmurs be assessed by telemedicine?].

BACKGROUND: Children often have heart murmurs; referral to a specialist is common. A service for remote auscultation of heart murmurs was established in which heart sounds and short texts were sent as attachment to e-mails. Our aim was to assess the quality of this method. MATERIAL AND METHODS: Heart sounds from 47 patients with no murmur (n = 7), innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor-based stethoscope and e-mailed to a computer. The sounds were repeated giving 100 cases, randomly distributed on a CD. Four specialists categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded assessment time, degree of certainty, and need for referral. RESULTS: On average 2.1 minutes were spent on each case. Mean sensitivity and specificity were 90% and 98%, respectively. Inter- and intra-observer variability were low (kappa 0.81 and 0.87). 93% of cases with a pathological murmur and 13% with an innocent murmur were recommended for referral. INTERPRETATION: Telemedical referral of children with heart murmurs to a cardiologist is safe, reduces travelling, and saves time. Skilled auscultation is adequate to detect those with innocent murmurs.

Electronic Mail↗
PubMed2006

Fish consumption and advisory awareness among expectant women.

During the spring of 2003, the Wisconsin Department of Health and Family Services (DHFS) piloted a fish consumption advisory program targeted at pregnant women. Fish consumption recommendations and information about the prenatal effects of methylmercury were illustrated in multilingual posters, brochures, fact cards, and other promotional items. These materials were mailed to Women, Infants and Children (WIC) program providers, local health departments, and medical clinics, along with a cover letter that encouraged them to display the materials in waiting areas and distribute them to new mothers and expectant women who visited their facilities. In August 2003, a survey was mailed to 1000 women who had given birth during the first week of June 2003. The survey was intended to provide an estimate of the number and types of fish meals the women had consumed during pregnancy and evaluate their familiarity with the outreach materials. On average, survey respondents consumed 3 fish meals a month. The most frequently consumed fish were canned tuna and frozen fish. Approximately one third of women knew that older fish and predatory fish have the highest levels of mercury. While almost half of the women were aware of Wisconsin's sport fish advisory, only 13% of them remembered seeing any of the outreach materials.

Adult↗
PubMed1998

Automatic extraction of motifs represented in the hidden Markov model from a number of DNA sequences.

MOTIVATION: Automatic extraction of motifs that occur frequently on a set of unaligned DNA sequences is useful for predicting the binding sites of unknown transcription factors. Several programs for this purpose have been released. However, in our opinion, they are not practical enough to be applied to a large number of upstream sequences. RESULTS: We propose a new program called YEBIS (Yet another Environment for the analysis of BIopolymer Sequences) which is capable of extracting a set of motifs, without any a priori knowledge, from a number of functionally related DNA sequences. Using the hidden Markov model, these motifs are represented in a more general form than other conventional methods, such as the weight matrix method. When applied to several sets of benchmark data, it was found that YEBIS had comparable capability to the existing methods, but was much faster. Moreover, it could extract all known motifs from the LTR sequences (long terminal repeat sequences) in a single run. Finally, it could be successfully applied to approximately 400 human promoter sequences and some of the extracted motifs turned out to be known cis-elements. Therefore, YEBIS could be a practical tool for exploring the upstream sequences of genomic ORFs, some of which are regulated in a similar fashion. AVAILABILITY: YEBIS will be distributed to academic users free of charge. All requests should be sent to the address below. CONTACT: E-MAIL: yada@tokyo.jst.go.jp

Algorithms↗
PubMed1998

A retrospective analysis of lingual nerve sensory changes after mandibular bilateral sagittal split osteotomy.

PURPOSE: The purpose of this retrospective study was to determine the patient-reported incidence, duration, and perceived deficit in daily activities associated with lingual nerve (LN) sensory changes after bilateral sagittal split osteotomy (BSSO) of the mandible and to compare them with inferior alveolar nerve (IAN) sensory changes in the same study population. MATERIALS AND METHODS: Questionnaires were mailed to 316 patients who had undergone BSSO procedures between 1980 and 1993. The patients were queried for perceived sensory changes in the distribution of the IAN and LN; duration of these sensory changes; and alteration in daily activities caused by these sensory changes. The same questionnaire was mailed to 47 patients who had undergone isolated genioplasty (GP) to control for the normal variance of non-BSSO surgery on perceived LN sensory changes. RESULTS: Forty-three percent of the BSSO patients and 38% of the GP patients returned the questionnaires. Within the BSSO group, 19.4% reported LN sensory changes, of which 69.3% reported that these changes resolved within 1 year; 88% reported altered daily activities. By comparison, 95.5% reported a perceived IAN sensory change, of which 27.3% reported that these changes resolved within 1 year; 57% reported altered daily activities. Within the GP control group, 11% reported LN sensory changes; none of the reported sensory changes lasted longer than 1 month. CONCLUSIONS: A small percentage of patients report LN sensory changes after BSSO. When compared with IAN reported sensory changes, LN sensory changes resolve more frequently and sooner, but they are associated with greater perceived deficits in daily activity. The interpretation of the reported incidence of LN change must be critically reviewed because control subjects also responded positively.

Activities of Daily Living↗