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[Development and validation of a quality of life scale associated with health status, specific for benign hypertrophy of the prostate and including a sexuality evaluation scale].

In order to develop a quality of life scale related to the state of health, specific for benign prostatic hypertrophy, a group of French specialists constructed a self-administered questionnaire, designed to complete the usual evaluations of the efficacy and safety of new medical treatments for this disease. This questionnaire was well accepted, reliable, clinically valid and sensitive to clinical changes occurring in a given patient. It includes questions concerning sexuality. An abbreviated form of the questionnaire was then developed in order to obtain a tool suitable for use in daily practice, in combination with the International Prostate Symptom Score (IPPS).

Aged↗

A risk-related patient-administered medical questionnaire for dental practice.

This study deals with an improved medical questionnaire designed on the basis of the results of previous studies. The form consists of 27 items, each subdivided into a main question and one or more subquestions. The medical problems involved are categorised according to the risk-classification system of the American Society of Anaesthesiologists (ASA). An affirmative answer to the main question always results in ASA class II; the subquestions are designed to discriminate between ASA classes II, III and IV. For each of the 27 medical problems in the questionnaire, the implications for dental treatment are explained and an ASA risk classification proposed. The questionnaire can also be a useful tool in medical pre-assessment control.

Anemia↗

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.

Community Health Nursing↗

Tuberculosis screening in a sexually transmitted diseases clinic.

BACKGROUND AND OBJECTIVES: Patients attending sexually transmitted diseases (STD) clinics may be at high risk for tuberculosis (TB) infection. The authors conducted a pilot study of TB screening in this setting to determine the prevalence of TB infection and compliance of the population with a screening program. GOALS: To determine the prevalence of positive skin test results indicating TB among patients attending an STD clinic and to test a simple incentive designed to enhance compliance with return visits for skin test interpretation. STUDY DESIGN: Skin tests for TB were offered to clients attending an STD clinic. Testing was accompanied by self-assessment questionnaires designed to assess risk for TB. After 2 months, a simple incentive package was initiated to enhance compliance with skin test interpretation. RESULTS: The prevalence of positive skin test results was 34%. Compliance with return visits was doubled by use of the simple incentive package. CONCLUSIONS: Patients attending STD clinics are at high risk for TB and can be motivated toward increased compliance by the use of simple incentives.

Adult↗

A hospital-wide clinical findings dictionary based on an extension of the International Classification of Diseases (ICD).

The use of a controlled vocabulary set in a hospital-wide clinical information system is of crucial importance for many departmental database systems to communicate and exchange information. In the absence of an internationally recognized clinical controlled vocabulary set, a new extension of the International statistical Classification of Diseases (ICD) is proposed. It expands the scope of the standard ICD beyond diagnosis and procedures to clinical terminology. In addition, the common Clinical Findings Dictionary (CFD) further records the definition of clinical entities. The construction of the vocabulary set and the CFD is incremental and manual. Tools have been implemented to facilitate the tasks of defining/maintaining/publishing dictionary versions. The design of database applications in the integrated clinical information system is driven by the CFD which is part of the Medical Questionnaire Designer tool. Several integrated clinical database applications in the field of diabetes and neuro-surgery have been developed at the HUG.

Databases as Topic↗

Senior house officers' work related stressors, psychological distress, and confidence in performing clinical tasks in accident and emergency: a questionnaire study.

OBJECTIVE: To investigate the relation between accident and emergency senior house officers' psychological distress and confidence in performing clinical tasks and to describe work related stressors. DESIGN: Questionnaire survey with data collected at four points during senior house officers' six month attachment to accident and emergency departments. SUBJECTS: 171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region. MAIN OUTCOME MEASURES: Psychological distress measured with a 25 item questionnaire; confidence in performing a range of 35 clinical and practical activities (visual analogue scales); reported consultation stress factors, other work related stressors, and personal stressors. RESULTS: Overall confidence scores in carrying out a range of clinical and practical activities increased significantly between the end of the first and the end of the fourth month (Z = -6.05, P < 0.001). Senior house officers with higher psychological distress scores at the end of their first and fourth month had significantly lower confidence scores (Z = -3.20, P < 0.001; Z = -1.90, P < 0.05). Senior house officers with lower increases in confidence between the first and fourth month had significantly higher distress than those with greater increases (Z = -2.62, P < 0.001). Factors identified as causing stress during consultations included difficulties with communication, certain clinical presentations, and department organisational factors (particularly the intensity of workload). CONCLUSIONS: Psychological distress is linked to confidence in senior house officers. This supports the need to monitor and build confidence in senior house officers and to address work related stressors. Additional communication skills training needs to be considered.

Clinical Competence↗

Oral cancer awareness and prevalence of risk behaviours among dental patients in South-western Nigeria.

The present study, based in a tertiary hospital in South western Nigeria, assessed cancer awareness among patients seeking dental treatment. A specially designed questionnaire was used to collect information on the knowledge, beliefs and habits of those attending the dental hospital within a designated period of the year. Almost 61% of the respondents had post-secondary education. The level of oral cancer awareness was remarkably high (72%), but this was low compared to awareness about occurrence of cancer in other parts of the body (89.9%). Awareness was found to be closely associated with educational status. The study also revealed that 50% had previous information on oral cancers from mass media as against 20.1% who were informed through health care professionals. Almost half of the study sample recalled episodes of previous oral ulceration and of these, greater than 50% indulged in either self medication (38.1%) or no medication at all (18.4%). The prevalence of alcohol consumption and smoking habits among the respondents was low being, 16.3% and 4.2% respectively. The lack of association, in this study, between oral cancer incidence and the known risk behaviours, is an obvious indication for investigation into other predisposing factors such as nutrients, genetic predisposition and the role of chronic infections. Perhaps one or more of these might be more relevant in this environment.

Adolescent↗

Type A behavior and social support among employed women.

The current study investigated the relation between Type A behavior and social support among working women. The research design closely paralleled a previous study of employed men. A convenience sample of 89 employed women (age range, 22-58 years) completed the Jenkins Activity Survey (JAS), a short aggression scale, a questionnaire designed to measure their proneness to seek support in problem situations, and a questionnaire assessing both structural and functional aspects of their social network. As was true with their male counterparts, the Type A women were less inclined than were Type B women to consider family as important members of their social network. Unlike Type A men, however, Type A women did not appear to close themselves off from their social network. Instead, Type A women were more likely to report feeling that they were not sufficiently cared for or loved.

Adult↗

Auditory brainstem implant part II: subjective assessment of functional outcome.

UNLABELLED: OBJECTIVE The purpose of this study was to present the patients' recommendations and judgments about their hearing and communication abilities with the help of the auditory brainstem implant. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: This evaluation was based on the data obtained by the self-administered questionnaires designed for the European Auditory Brainstem Implant Multicenter Clinical Trial. Eleven patients who had used their auditory brainstem implant for a minimum of 6 months to a maximum of 41 months were evaluated with the help of these questionnaires. RESULTS: All the patients had used their implant on a regular daily basis for an average of 13 hours per day. None of them experienced any side effects during the daily use of the device. Nine patients (82%) used their auditory brainstem implant in both quiet and noisy surroundings. The most common cause of disturbance was a noisy surrounding. All the patients were able to distinguish speech from environmental sounds. The role of the auditory brainstem implant in differentiating various environmental sounds was considered to be very useful by 9 patients (82%). As an adjuvant to lip-reading, the auditory brainstem implant was considered most useful for understanding speech in quiet surroundings. DISCUSSION AND CONCLUSION: It was concluded that the auditory brainstem implant is an effective support for receiving and, to some degree, differentiating environmental sounds, and that as an adjuvant to lip-reading, it enhances speech perception, especially in quiet surroundings. A comparison between the results of this study and the results of the audiologic tests presented in Part I of this study (published earlier) revealed that patient satisfaction was not directly correlated with the results of the objective auditory tests. In general, patients' judgments of their individual hearing and communication abilities usually rated higher than could have been predicted by the objective audiometric data.

Auditory Brain Stem Implants↗

A factor analysis of chronic fatigue symptoms in a community-based sample.

BACKGROUND: This study examined characteristics of fatigue in individuals with chronic fatigue from a community-based study. Most studies of chronic fatigue have been based on patients recruited from primary or tertiary care settings. Samples such as these might not be representative of patients within the general population. The purpose of this study was to determine the factor structure of participants' symptoms in a random community sample of individuals with chronic fatigue. METHOD: A random sample of 18,675 respondents in Chicago received a brief telephone questionnaire designed to identify individuals with chronic fatigue. A group of 780 (4.2%) with chronic fatigue received further interview via telephone questionnaire involving characteristics of their fatigue. The analyses for this study were based on those people identified with having chronic fatigue. A factor analysis was conducted on responses to questionnaire items, and a four-factor solution emerged. Mean factor scores were derived and analyzed in relation to sociodemographic characteristics and sample subgroups. RESULTS: The four factors were labeled: Lack of Energy, Physical Exertion, Cognitive Functioning, and Fatigue and Rest. CONCLUSIONS: Results indicated that individuals with chronic fatigue have symptoms that can be differentiated into theoretically distinct factors.

Adult↗

Pain experience following radical treatment for head and neck cancer.

During an investigation into the quality of life of people in the year following radical treatment for head and neck cancer, it became apparent that pain was a significant problem. Therefore, the current study was conducted to gain an understanding of the incidence and nature of pain in people who had received radical treatment for head and neck cancer and to explore their attitudes to pain and pain relief. A single cohort study was undertaken using a structured questionnaire designed for people with head and neck cancer (the EORTC QLQ-C30 and the EORTC QLQ H+N35). Fifty questionnaires were received from people who had received radical treatment between 6 and 12 months previously and who were disease-free. Twenty nine of the respondents also consented to a follow-up semi-structured interview. The interviews generated qualitative data about personal experiences of pain and pain management in head and neck cancer. Patient recollections from interviews identified that only nine out of 29 (31%) interviewees had pain at diagnosis. However, 74% (37) of respondents to the questionnaire reported some degree of pain at follow-up. Patients having both surgery and radiotherapy were significantly more likely to have troublesome pain than patients who received radiotherapy only (Fisher's exact test=0.039). The qualitative data identified a wide variety of pain sites, a number of which were not covered by the EORTC tool. A significant number of patients were rejecting regular pharmacological management and using a variety of other pain-relieving measures. We conclude that through an understanding of pain experience and attitudes to pain management, nurses can facilitate the care and support of patients in pain following treatment for head and neck cancer.

Journal Article↗

A review of chest physiotherapy in neonatal intensive care units in Australia.

Clinical techniques and protocols for chest physiotherapy vary greatly from one Neonatal Intensive Care Unit to another. In 1988 a questionnaire designed to investigate differing techniques used was distributed to Neonatal Intensive Care Units (NICU) around Australia. Fourteen of the 15 questionnaires were completed and returned. The results revealed that the methods of chest treatment and the indicators for commencing chest treatment were similar throughout NICU. Both physiotherapists and nursing staff played a role in the performance of chest treatment in all but one unit where it was the responsibility of nursing staff. However, the area in which there was most variability between NICU was the individual treatment protocols employed pre- and postextubation of the neonate. A review of literature over the past 10 years also demonstrates variability in chest physiotherapy. It was concluded that further well-controlled studies with larger sample sizes are needed to validate the use of chest physiotherapy for the neonate, especially in relation to the techniques and specific protocols employed.

Australia↗

Self-administered clinical questionnaire for outpatients.

A self-administered questionnaire designed for prerecording the routine clinical information required from outpatients has been found to be acceptable to them. Such a questionnaire should greatly ease the collection and recording of basic clinical information and offer the doctor more effective use of his time. With the questionnaire more information was recorded and therefore available in the case notes than at a conventional doctor-patient consultation. No administrative problems occurred in its distribution, use, and return.

Aged↗

Monitoring outcomes of arthritis and longitudinal data collection using patient questionnaires in routine care.

Though quantitative data might lead to improved information for clinical decisions, at the present time decisions in routine rheumatology practice generally are based largely on qualitative impressions, rather than on data. Patient questionnaires are readily accessible tools that the rheumatologist can use to go beyond impressions and to institute evidence-based guidelines appropriate to his or her own patient population and practice style. The Health Assessment Questionnaire (HAQ) and its derivatives have been shown to be the best predictors of functional and work disability, costs, joint replacement surgery, and mortality. Such questionnaires are at least as good as joint counts, radiographs, and laboratory tests in predicting these outcomes. Every encounter of a patient with a rheumatologist provides an opportunity to collect data. Based on experience with the Brooklyn Outcomes of Arthritis Registry Database, the author advocates distributing a waiting-room questionnaire to every patient who comes for an office visit. Potential benefits of recording questionnaire-based information include identifying trends or important changes in a patient's pain or physical function, providing a baseline for success with various treatment strategies for conditions of the rheumatologist's own practice, allowing patients an opportunity to express concerns, encouraging patients to disclose information they may feel is too minor to mention, and providing control data for research studies. A short questionnaire designed specifically for clinical, rather than research, use does not create a burden for office staff. Consistent use of patient questionnaires and systematic storage of the information gained can help document, track, and improve patient care in routine rheumatology practice.

Arthritis, Rheumatoid↗

Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties.

PRIMARY OBJECTIVE: This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community. RESEARCH DESIGN: Questionnaires were mailed-out to people with ABI and nominated proxies. METHODS AND PROCEDURES: Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS). MAIN OUTCOMES AND RESULTS: Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41-0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration. CONCLUSIONS: Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.

Activities of Daily Living↗

Patient safety features of clinical computer systems: questionnaire survey of GP views.

AIM: To investigate general practitioners' (GPs') stated knowledge, use and training needs related to the patient safety features of computerised clinical systems in England. DESIGN: Questionnaire survey. SUBJECTS AND SETTING: GPs from six English primary care trusts. OUTCOME MEASURES: GPs' views on the importance of specified patient safety features on their computer system; their knowledge of the presence of specified safety features; previous training and perceived future training needs. RESULTS: Three hundred and eighty one GPs (64.0%) completed and returned the questionnaire. Although patient safety features were considered to be an important part of their computer system by the vast majority of GPs, many were unsure as to whether the system they were currently using possessed some of the specified features. Some respondents erroneously believed that their computers would warn them about potential contraindications or if an abnormal dose frequency had been prescribed. Only a minority had received formal training on the use of their system's patient safety features. CONCLUSIONS: Patient safety was an issue high on the agenda of this GP sample. The importance of raising GPs' awareness of both the potential use and deficiencies of the patient safety features on their systems and ensuring that appropriate training is available should not be underestimated.

Adult↗

Cervical smear screening: questionnaire study of histories and attitudes of patients with squamous cervical carcinoma.

OBJECTIVE: To determine why invasive cervical carcinoma still occurs despite the availability of cervical smear screening services. DESIGN: Questionnaire survey and retrospective study of patient records of women who attended a gynaecological oncology out-patients clinic from 13 February 1997 to 30 June 1997. SETTING: Public hospital, Hong Kong. PATIENTS: Ninety-nine women (median age, 53 years; range, 30-79 years) who gave a history of squamous cervical carcinoma. MAIN OUTCOME MEASURES: The date of the last cervical smear test prior to the development of cervical carcinoma; reasons for non-attendance; attitudes to screening; and the stage and histological diagnosis of disease. RESULTS: Only 19 (19.2%) of the 99 patients had received routine cervical smear testing during the previous 3 years prior to their disease; 76 (76.8%) had not been tested within the past 10 years. The major reasons for not having been tested included being unaware that cervical carcinoma is preventable by screening or can be asymptomatic, being too busy to go for screening, and not knowing where to go for screening. After receiving treatment, 17 (17.2%) of the 99 patients still thought screening was unnecessary and 20 (20.2%) had no idea how frequently smears should be taken. CONCLUSION: The greatest barrier to effective cervical screening is patient ignorance. Public education about cervical smear screening in Hong Kong is needed.

Journal Article↗

Artificial nutrition support in intensive care units in Spain. Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMIUC).

OBJECTIVE: A multicenter survey to study the use of nutritional support in patients admitted to the ICU in Spain. DESIGN: The survey was announced during the annual Spanish Society of Intensive Care Medicine and Coronary Units (SEMIUC) congress meeting. SETTING: Questionnaires designed to determine current clinical practice concerning artificial nutrition were sent to the 27 ICU who accepted to participate. PATIENTS AND PARTICIPANTS: In each center the 235-question form was filled out individually for each patient admitted to the ICU during the month of March, 1992. INTERVENTIONS: To validate the study a preliminary pilot surveys were conducted to ensure that there was a correct interpretation of the questions. The replies were entered into a database for analysis. RESULTS: A total of 1261 patients were studied; 33.9% received artificial nutrition (AN). The administration of AN was significantly higher in the medical group (44%), than in the surgical (37%) and the trauma group (19%). AN was significantly lower in patients admitted to private clinic than public institutions (26.7% versus 34.7%). Among the patients who received AN, enteral nutrition (EN) was administered to 59.7% of the patients, total parenteral nutrition (TPN) to 38.5%, and peripheral parenteral nutrition (PPN) to 18.2%. Medical patients received significantly more EN than surgical and trauma patients. Surgical patients received more PN than medical and trauma groups. CONCLUSIONS: Nutritional support is a common practice in the treatment of ICU patients in our country. All information concerning its use is necessary to optimize it.

Humans↗