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PubMedDate not supplied

CME and the role of the Journal of the Royal College of Physicians of London. Results of a survey of consultant and trainee physicians.

AIM: To assess (a) the views of Members and Fellows of the College on the role of reading general medical journals in continuing medical education (CME); (b) the place of the Journal of the Royal College of Physicians of London (JRCPL) in relation to seven other general medical journals; (c) the possible need for change in the content of the JRCPL and the demand for a systematic series of articles designed specifically for CME; (d) the extent of home ownership and use of computers and of readers' readiness for interactive teaching and electronic books and journals. METHOD: Distribution of a questionnaire to all Fellows and Collegiate members of the College, mailed with the JRCPL in May 1995. RESULT: Responses were received from 2,600 (26.4% home recipients and 8.4% overseas recipients). Journal reading was rated the most important form of CME. All eight journals listed play a part in CME, the three weekly journals playing the most prominent role. There was strong support for the introduction of a series of articles covering topics systematically as part of CME. Seventy-six per cent of respondents own a home computer and 40% of these have either a CD-ROM drive or full multimedia facilities. Most use their computers mainly as word-processors and few have access to the Internet or E-mail.

Data Collection↗
PubMed2002

The use of a multipurpose phantom for mailed dosimetry checks of therapeutic photon beams: 'OPERA' (operational phantom for external radiotherapy audit).

BACKGROUND AND PURPOSE: This study presents a technical description of the solid multipurpose phantom (MPP) 'OPERA' (operational phantom for external radiotherapy audit) for mailed dosimetry checks of photon beams in reference and non-reference conditions. The aim is to test the functionality of this phantom by comparing the results provided by the local treatment planning system (TPS) with the measurements by film and thermoluminescence dosimeters (TLDs) in a number of clinical conditions. MATERIAL AND METHODS: The polystyrene MPP is constructed to check the following five irradiation conditions: square fields, asymmetrical fields, wedged beams, oblique incidence and influence of inhomogeneities in the field. The absorbed dose on the central beam axis is measured with TLDs for the first three irradiation conditions and the relative dose distributions are verified with film. RESULTS: The 'OPERA' phantom and the corresponding instruction sheets were mailed to radiotherapy centres of 12 different countries, in order to verify its functionality. A good agreement between TPS and the film data is found: the mean deviations between relative dose profiles obtained from film and locally applied TPS data range between -1.2 and 0.4%, except for the short side of the asymmetrical field. The standard deviations (SDs) generally increase off-axis, with a large SD on the asymmetrical side. Considering the TLD results, a mean ratio of measured to stated dose of 0.995+/-0.014 (1 SD), 0.988+/-0.019 (1 SD) and 0.981+/-0.024 (1 SD) for set-up 1 (square field), 2 (asymmetrical field) and 3 (wedged field), respectively, has been found. CONCLUSION: The 'OPERA' phantom can be useful for on- and off-axis verification of the TPS, as well as for mailed dosimetrical checks of photon beams in reference and non-reference conditions.

Film Dosimetry↗
PubMed1995

Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey.

STUDY DESIGN: This report gives the results of a population-based cross-sectional mailed questionnaire, with prospective follow-up of survey responders and nonresponders. OBJECTIVE: To determine the 1-month period prevalence of low back pain in an adult population in the United Kingdom and to estimate the effect of nonresponse bias. SUMMARY OF BACKGROUND DATA: Previous United Kingdom population studies have reported a 1-year period prevalence of low back pain of 37%. However, the definitions of low back pain have varied, and the influence of nonresponse rarely has been reported. METHODS: The study population was made up of all 7669 adults (18 to 75 years old) registered with two family practices in a sociodemographically mixed suburban area. The questionnaire, including a pain drawing to identify the site of any pain, was mailed to the entire study population. Two repeat mailings were sent to nonresponders. Family practice consultations about low back pain by individuals from the study population were monitored over the following 12 months using computerized records of all surgery contacts. RESULTS: Of the study population, 4501 (59%) responded. The 1-month period prevalence of low back pain was 39% (35% in males, 42% in females). The age distribution was unimodal, with peak prevalence in those aged 45 to 59 years old. Responders to the first mailing had a small but nonsignificant increase in prevalence compared with those who responded to the second or third mailing. Nonresponders had a subsequent consultation rate for low back pain that was 22% lower than that for the survey responders. CONCLUSIONS: After considering potential differences in nonresponders, the estimated 1-month prevalence of low back pain was between 35% and 37%. Prevalence figures in survey responders may overestimate the true population prevalence by a modest amount.

Adolescent↗
PubMed2004

On neurosensory disturbance after sagittal split osteotomy.

PURPOSE: The purpose of this retrospective study was to assess the incidence of the neurosensory disturbance (NSD) after sagittal split osteotomy and evaluate NSD in relation to patient age, gender, satisfaction, and effect of steroids. PATIENTS AND METHODS: Questionnaires were mailed to all patients (31 women, 19 men) who underwent bilateral sagittal split osteotomy between 1995 and 1999, at least 1 year after the operation. Patients were queried about perceived NSD in the distribution of both inferior alveolar and lingual nerves, duration of these changes, and any influence of these changes on their quality of life. RESULTS: Eighty-six percent of the mailed questionnaires were returned and analyzed (27 women, 16 men). Eight patients with 10 affected sides (11.6% of sides) reported long lasting NSD corresponding to the distribution of the inferior alveolar nerve. NSD was reported in 16.7% of the operated sides in women, while 3% of the operated sides in the men had such changes. Fifty percent of the operated sides in patients over 40 years of age were affected. Steroid treatment seemed to decrease NSD. Four patients (9%) were not satisfied, but only 1 attributed the dissatisfaction to sensory impairment. CONCLUSION: The incidence of NSD after sagittal split osteotomy increases in patients over the age of 40. Steroid regimen might be beneficial in reducing NSD after sagittal split osteotomy, although further investigation is required. The discomfort of the nerve damage seems outweighed by the result of function and esthetics.

Adolescent↗
PubMed1998

Application and evaluation of a mailed questionnaire for an epidemiologic study of Corynebacterium pseudotuberculosis infection in horses.

The objective of this study is to describe the design, application and validity of a self-administered (mailed) questionnaire to collect data on potential risk factors for Corynebacterium pseudotuberculosis infection in California horses. Horses admitted to the UC Davis Veterinary Medical Teaching Hospital (VMTH) between 1 July 1992 and 30 June 1994 served as the study base for case identification and simple random sampling of 800 control horses. A questionnaire was mailed to owners of the study horses, followed by a reminder postcard and a second copy of a questionnaire. Data were collected on owner and horse identity and demographics, horse management and use, geographic location, and general health-related issues. Return pattern over time as well as differential return proportions were described. The overall return proportion was 66% (587/890), and the completion proportion 55% (491/890). The number of returns over time followed a negative binomial distribution, with over 90% of all returns being in by the end of the fifth week after mailing, and over 99% at the end of the tenth week. Some categories within the variables age (between 2 and 3 years), breed (Thoroughbred and Standardbred horses) and gender (stallions) had significantly lower return proportions than expected (differential return; p < 0.05). The profile of these horses fits a section of the racehorse population that is served by the VMTH. Age, breed and disease status information was available from the VMTH medical records and from the questionnaire, and was used to determine the validity of the survey data. There was good agreement between the data from the two sources, and we therefore concluded that the quality of the survey information was sufficient to perform a risk-factor analysis. The mailed survey provided a rapid and cost-effective method of collecting additional information to supplement existing medical records.

Animals↗
PubMed2006

Impact of neurofibromatosis 1 on Quality of Life: a cross-sectional study of 176 American cases.

Neurofibromatosis 1 (NF1), a genetic condition most commonly characterized by the presence of dermal neurofibromas and café au lait macules, has a significant impact on Quality of Life (QoL). There is a wide range of phenotypic variability, so that affected individuals may have either medically devastating or relatively mild manifestations that do not impact their daily lives. In this study, the SF-36 and Skindex questionnaires were used to quantitatively investigate the impact of severity and visibility on QoL in an American population. Participants were recruited primarily through advertisements distributed by The Children's Tumor Foundation (CTF). The majority participated by completing a mailed questionnaire in which they rated themselves using Ablon's visibility and Riccardi's severity scales, and then completed the SF-36 and Skindex questionnaires. Participants with NF1 reported a significant impact in all aspects of skin-disease-specific QoL, but the emotional aspect demonstrated the greatest effect. Participants with more visible signs of NF1 reported significantly greater overall effects on their skin-disease-specific QoL than those whose manifestations were more subtle. All domains of general health QoL were affected as well, especially in participants who reported having severe complications. Interestingly, greater visibility was not found to be associated with a significant decrease in general health QoL. These findings are consistent with those found in a French cohort, and demonstrate the utility of incorporating tools designed for use in both the general population and for patients with skin disease in examining the impact of NF1 on QoL.

Adult↗
PubMed2006

Quality of life and return to work following electrical burns.

To investigate the psychosocial outcomes following electrical burns, a cross-sectional survey of electrical burn patients was done using three outcome tools: the Burn Specific Health Scale brief version (BSHS-B), the Coping with Burns Questionnaire (CBQ), and the Pain Patient Profile (P3). Questionnaires were mailed to electrical burn patients discharged from an adult regional burn centre, and also distributed to attendants of an electrical utility conference in Toronto. Twenty-six of 88 patients who were discharged from the regional burn centre during the study period with updated residential information were contacted and 14 (54%) completed the questionnaires. Twenty questionnaires were also distributed at the conference and 8 (40%) were completed; leaving a total of 22 (48%) patients for the study. The average patient age was 44.0+/-11.7 years; 21 (96%) were men, and the average time from injury to survey completion was 5.3+/-4.9 years. Five (23%) of the 22 patients returned to the same work duties, 10 (45%) changed duties, and 7 (32%) did not return to work. BSHS-B scores were low for all patients. Participants with high voltage burns (>1000 V) had worse sexuality scores (p<0.05), while those with larger burns (>10% TBSA) had worse physical scores (p<0.05). Patients surveyed >5 years from injury showed improvement in physical scores. CBQ scores indicated that optimism was the most commonly used coping strategy. P3 showed significant levels of emotional distress in all patients, with anxiety being more common in high voltage injuries (p<0.05). The data suggests that electrical burn patients may have a limited ability to return to work and an overall poor quality of life. Emotional distress is the dominant feature influencing long-term outcome in these patients. Further studies are warranted to validate these findings.

Activities of Daily Living↗
PubMed1993

Breast cancer patients--the support given by nurses.

The purpose of this part of a larger study on breast cancer patients' recovery was to analyse the support that nurses offer breast cancer patients before, during, and after their hospitalization, as seen from the nurses' viewpoint. The sample group consisted of 125 registered and radiological nurses at university and regional hospitals in southwestern Finland. A questionnaire was devised and mailed to the subjects. The statistical analysis of the data was based on percentage distributions, with correlations, cross-tabulation, and loglinear models. The nurses reported that patient support is inadequate before and after hospitalization. However, most nurses maintained that the patients were well supported in hospital by the health care staff. The same nurses considered that their duty was to offer information and try to ensure continuity of care for the patient. They regarded their work as challenging, and they paid more attention to patients' relatives, too. However, there were differences of opinion as to whether the nurses actually gave support or not. We concluded that the concept support and its different implications for different groups (e.g. patients, nurses) must be studied in more detail, since the nurses' viewpoint is the one upon which care is currently based.

Adult↗
PubMed1995

Experimental teleradiology. Novel telematics services using image processing, hypermedia and remote cooperation to improve image-based medical decision making.

We illustrate the possible impact of information technology on digital radiology using two pilot projects. The first aimed to improve the transfer of radiological information and the interaction between radiologist and referring physician, using hypermedia documents and hypermedia electronic mail. During a 12-month evaluation period, approximately 100 hypermedia reports were generated and distributed to hepatologists and neurosurgeons. The second project aimed to improve planning of orthopaedic surgery, using an image processing service for three-dimensional visualization and a conferencing system to support active cooperation. Over two months, 12 routine cases were reconstructed in three dimensions and conferencing was carried out between surgeons and radiologists in hospitals 15 km apart. Initial results were encouraging. Telematics may be valuable in reconciling the growing need for multidisciplinary cooperation with the growing geographical and organizational separation of different experts. We conclude that to benefit from information technology, the focus should not be on a direct translation of traditional working methods, but rather on possibilities that were not available in the film-based environment.

Belgium↗
PubMed1981

Optometric practice patterns: British Columbia.

A government task force on vision care delivery in British Columbia studied the practice patterns of optometrists in that province. Their aim is to develop a coordinated system of vision care. A questionnaire was mailed to all optometrists in the province. The 84% response rate, with representative regional distribution, gave information on professional time spent in various activities, the use of assistants, indications of attitude toward and participation in community activities, and satellite practices. The information is compared with other studies and inferences are made in relation to workload and the efficient allocation of time. Special note is made of political and other factors that must be rationalized in order to provide a coordinates system of vision care which utilizes the expertise of optometrists in an optimal manner.

Adult↗
PubMed1994

Efficacy of carbamazepine compared with other agents: a clinical practice survey.

BACKGROUND: To gain an impression of the experience with and efficacy of carbamazepine relative to other agents and relative to its use in treating psychiatric and neurologic disorders in general clinical practice, a survey was distributed in 1988 to psychiatrists practicing in the United States. METHOD: The survey was mailed to 9030 members of the American Psychiatric Association (APA) who had expressed an interest in the study and treatment of affective disorders in a 1982 APA survey. The survey sampled clinicians' experience of the efficacy and side effects of carbamazepine in a number of psychiatric and neurologic conditions. Each clinician also provided global impression ratings of the efficacy of a variety of traditional and novel treatments. RESULTS: Completed surveys were returned by 2543 (28%) physicians. Carbamazepine was reported to be moderately to markedly effective in the following percentage of patients: partial complex seizures, 85.2%; generalized seizures, 82.9%; trigeminal neuralgia, 81.5%; mania prophylaxis, 72.9%; acute bipolar depression, 67.5%; intermittent explosive disorder, 65.2%; acute mania, 62.2%; schizoaffective disorder, 58.8%; other pain syndromes, 51.2%; posttraumatic stress disorder, 48.1%; borderline personality disorder, 43.0%; unipolar depression, 32.2%; schizophrenia, 25.7%; and alcohol withdrawal, 15.9%. About 4.4% of the patients reported were withdrawn from carbamazepine because of side effects. CONCLUSION: Carbamazepine was widely used to treat a variety of psychiatric conditions in 1988 and found to be of use in the acute and long-term treatment of bipolar illness. It was rated slightly less effective than lithium, electroconvulsive therapy, or neuroleptics, but more effective than several other agents. The results of the survey highlight many areas in need of further systematic investigation.

Attitude of Health Personnel↗
PubMed1987

Campaign against AIDS in Switzerland: evaluation of a nationwide educational programme.

The campaign against the spread of the acquired immune deficiency syndrome (AIDS) in Switzerland includes a nationwide educational programme. A booklet about AIDS was mailed to every Swiss household in March 1986, and in 1987 there has been a mass media campaign promoting the use of condoms. We evaluated the results of the first phase--the distribution of the booklet--using a separate sample pretest and post-test design. The pretest was carried out 15 days before the booklet was mailed (sample n = 1056) and the post-test two months after the booklet was mailed (n = 1278). Of the population aged 20-69, to whom the book was sent, 56% read the booklet. For those who read the booklet compared with those who did not the results showed an improvement in knowledge and a better understanding of the risks of specific behaviours and of exposed groups and thus less fear of becoming infected through daily activities. The mean indices of knowledge and beliefs were significantly different when tested by the Kruskal-Wallis method. Having better information does not imply that people will change their behaviour, but both the high reading rate and the increase in knowledge suggest that the Swiss educational programme reached its objectives. Moreover, the success of this campaign helps to support other campaigns that are being developed to promote the use of condoms.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Perimesencephalic and nonperimesencephalic subarachnoid haemorrhages with negative angiograms.

BACKGROUND: van Gijn and co-workers identified "Perimesencephalic haemorrhage" (PM) as distinct, benign, non-aneurysmal subarachnoid haemorrhage. However, there is only one retrospective series of this entity outside the Netherlands. PURPOSE: to confirm (or not) the benign nature of perimesencephalic subarachnoid haemorrhage by evaluating its clinical course and long-term follow-up in a consecutive series of patients admitted to a University Hospital. METHODS: Patients with subarachnoid haemorrhage and negative cerebral angiography admitted between January 1985 and April 1992 were classified according to the distribution of blood on a CT scan performed within 72 hours after onset, in perimesencephalic and non-perimesencephalic haemorrhages. Demographic and clinical data (collected consecutively), complications and long-term follow-up (obtained by chart review and follow-up by mail) were compared in the two groups. RESULTS: Seventy one cases, 36 perimesencephalic and 35 nonperimesencephalic were included. Sex and age distribution were similar in the two groups. A normal examination on admission was the rule in the perimesencephalic group. Only one patient with perimesencephalic haemorrhage had a complication--transient neurological signs during angiography--and there were no deaths or morbidity during follow-up. In the non-perimesencephalic group three patients rebleed, four developed hydrocephalus and two had delayed cerebral ischaemia. Mean duration of follow-up was 27.6 months for the perimesencephalic and 30.8 months for the non-perimesencephalic group. After discharge there was a fatal rebleed in the latter group. Fifteen percent of the subjects (11% of the perimesencephalic group and 20% of the non-perimesencephalic group) retired from work during the follow-up period. Headaches and depression were found in similar percentages (22-25%) in both groups. CONCLUSIONS: This study confirms that perimesencephalic haemorrhage is a distinct entity within the larger group of subarachnoid haemorrhage with negative angiograms, with a good short term and long-term prognosis, and no need for repeated angiographic investigation.

Adult↗
PubMed1997

Distributional dilemmas in health policy: large benefits for a few or smaller benefits for many?

OBJECTIVES: To examine funding priorities assigned by health ministry officials when choosing between clinical programs that offer similar overall benefits distributed in different ways (e.g. large gains for a few versus small gains for many), and to compare the relative magnitude of any distributional bias to age biases. METHODS: A survey consisting of paired hypothetical health care programs was mailed to the 135 most senior officials of the Health Ministry in Ontario, Canada (population 11.5 million). Respondents were asked to assume they were members of a panel allocating a fixed sum of money to one of two programs in each pair. All program descriptions included the number of persons affected each year by a given disease and the average survival gains from the hypothetical programs. Some scenarios also mentioned the side-effects associated with programs and/or the average age of the beneficiaries. RESULTS: Four respondents had retired/died. Of 131 eligible respondents, 80/131 (61%) provided usable responses. Asked to choose between providing large benefits to a few citizens and small benefits to a great many, 23% (95% CI: 14%, 33%) of respondents were unable to decide, but 55.8% (95% CI: 47%, 70%) favored providing large benefits to fewer patients. Eliminating the 23% unable to decide, 47/62 or 76% (CI 63%, 86% expressed a distributional preference. With a smaller distributional discrepancy, indecision increased, with 35% of respondents having no preference and the remainder split almost evenly between the two programs. Other scenarios showed that health officials' pro-youth biases were only slightly larger than their distributional preferences and that distributional preferences were magnified when combined with minor differences in average ages of beneficiaries. CONCLUSIONS: A substantial minority of health care decision-makers had difficulty choosing between programs with similar overall gains and distributional differences--a result consistent with the utilitarian assumptions of cost-effectiveness analysis. However, when distributional differences were large, decision-makers clearly favored large gains for a few beneficiaries rather than small gains for many. Policy analysts should explicitly weigh distributional issues along with aggregate health gains when addressing resources allocation problems.

Administrative Personnel↗
PubMed2001

Prioritization of professional issues by Idaho Dental Hygienists.

PURPOSE: The Idaho Dental Hygienists' Association (IDHA) and other constituents use surveys to establish the goals of the association and better represent members. This study was conducted to assess dental hygienists' opinions about professional issues related to dental hygiene practice and legislative activities in Idaho. METHODS: In 1998, a questionnaire was mailed to all active Idaho dental hygiene licensees (N = 652). The coded questionnaire contained two sections. Section I included items on demographic and employment characteristics, and Section II included items on legislative and professional issues. Respondents were asked to rank 14 professional issues by selecting the top five concerns about dental hygiene practice in Idaho. Research questions asked included: 1) Do entry-level baccalaureate degrees in dental hygiene affect the ranking of professional concerns of Idaho dental hygienists? 2) Does being a member of the American Dental Hygienists' Association (ADHA) affect Idaho dental hygienists' ranking of professional concerns? Data were analyzed using frequency distributions and nonparametric tests of association. RESULTS: A 74% (N = 431) response rate was obtained after two mailings. Three professional issues were ranked as important concerns by at least 50% of respondents. They were 1) the "national trend to reduce entry-level education for dental hygienists," 2) "dental assistants performing dental hygiene services," and 3) "legalizing self-regulation." CONCLUSIONS: It is incumbent upon constituent dental hygienists' associations to obtain and utilize information from members for strategic planning and legislative efforts. A statewide membership study clearly can provide direction. Idaho dental hygienists are concerned about maintaining quality education programs, reducing illegal practices, and regulating themselves. Also, the state association and regulatory agencies need to take an active role to assure that dentists, dental hygienists, and dental assistants are educated about state laws.

Adult↗
PubMed2001

Global surveillance of emerging diseases: the ProMED-mail perspective.

The Internet is changing the way global disease surveillance is conducted. Countries and international organizations are increasingly placing their outbreak reports on the Internet, which speeds up distribution and therefore prevention and control. The World Health Organization (WHO) has recognized the value of nongovernmental organizations and the media in reporting outbreaks, which it then attempts to verify through its country offices. However, WHO and other official sources are constrained in their reporting by the need for bureaucratic clearance. ProMED-mail has no such constraints, and posts outbreak reports 7 days a week. It is moderated by infectious disease specialists who add relevant comments. Thus, ProMED-mail complements official sources and provides early warning of outbreaks. Its network is more than 20,000 people in over 150 countries, who place their computers and time at the network's disposal and report on outbreaks of which they have knowledge. Regions and countries could benefit from adopting the ProMED-mail approach to complement their own disease surveillance systems.

Animals↗
PubMed1997

Magnetic resonance imaging: utilization in the management of central nervous system trauma.

OBJECTIVE: To determine the availability, use, and perceived value of magnetic resonance imaging (MR) in the management of acute central nervous system (CNS) trauma in United States Level I (or equivalent) trauma centers (TCs). DESIGN, MATERIALS, AND METHODS: One hundred sixty-nine American College of Surgeons, state or locally designated Level I (or equivalent) TCs were identified using compiled lists and telephone contacts. Surveys about MR use in CNS trauma were mailed to each institution. Follow-up telephone calls were made to nonresponding institutions. Data were analyzed using frequency distribution. MEASUREMENTS: Using returned questionnaires from trauma directors and follow-up telephone contacts, data on the physical location, technologist availability, and patient monitoring capabilities were accrued. The questionnaire addressed the perceived value and cost-effectiveness of MR for acute CNS trauma in general, distinguishing between spinal cord and traumatic brain injury, using a Likert-type rating scale. MAIN RESULTS: One hundred nine (65%) of identified TCs responded by mail. Sixty (33%) required contact by telephone. One hundred fifty-two (93%) reported MR scanners "on site." Five of seven TCs without on-site MR had facilities within 5 miles. No TC reported the inability to obtain MR scans. Seventy-four percent of TCs reported MR angiography capabilities. Ninety-seven percent of MR facilities were staffed 24 hours per day, 83% by on-call, out-of-hospital technologists at night and on weekends. TCs reported patient monitoring capabilities including cardiac monitoring (83%) and pulse oximetry (91%). Seventy-one percent reported the ability to scan intubated patients. Forty-five percent of TCs "rarely" use MR, 51% report "occasional" use, and 4% "frequently" use MR for acute trauma. Ninety-four percent of trauma directors agreed or strongly agreed that MR directed management and was cost-effective for spinal cord trauma. Fifty-four percent agreed or strongly agreed that MR directed management and was cost-effective for traumatic brain injury. No correlation existed between perceptions of MR applicability in CNS trauma and the number of trauma admissions or on-site availability. CONCLUSIONS: Most trauma directors consider MR important in the acute evaluation of spinal trauma and, to a lesser extent, for traumatic brain injury. Despite these opinions, the vast majority of these centers reported only "rare" to "occasional" use of MR in the setting of acute CNS trauma. Our results show that most TCs have on-site and continuously available MR facilities capable of cardiac and pulmonary monitoring. Other factors such as the higher relative cost of MR may be responsible for the discrepancy between the perceived value and the actual utilization of MR imaging in the setting of CNS trauma.

Brain Injuries↗