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PubMed1983

Secular trends in the distributions of the breast cancer risk factors--menarche, first birth, menopause, and weight--in Hiroshima and Nagasaki, Japan.

The results of a mail survey completed by approximately 21,000 female atomic bomb survivors in Hiroshima and Nagasaki in 1970 are studied with respect to menarche, first birth, menopause, and weight. These known risk factors for breast cancer can be used to explain some but not all of the differences in Japanese and US breast cancer rates. The results for age at menarche are the most striking, with the presence of a strong secular trend. The average age at menarche in Japan was observed to decrease from 16.4 years for women born in 1902 to 14.4 years for women born in 1942. However, a temporary increase was observed in women whose menarche was expected to occur during the war years of the early 1940s. Differences between US and Japanese women were also observed in age at first birth and nulliparity rates. Age at menopause was similar for the two groups, although US women have a considerably higher rate of surgically induced menopause. Within each birth cohort, it is shown that body weight is negatively correlated with age at menarche and positively correlated with age at menopause.

Adult↗
PubMed1972

Ergonomic research in the German travelling mail services Part 2: results of ergonomic research in railway mail vans.

The travelling mail office clerks are shown, by medical examination and sociopsychological questionnaire, to be a very homogeneous naturally self-selected group with a low average age. The analysis of tasks shows a disadvantageous distribution of some main tasks over the work shift. Energy expenditure and cardio-vascular strain above physiological endurance limits occur mainly with the tasks of loading, handling and emptying mail bags. Environmental factors are mainly within acceptable standards. Fast-time simulation studies show that proposals can be made for organisation work (by job rotation) and selection of TMO clerks based on their individual working capacity.

Journal Article↗
PubMed2005

E-mail communications in primary care: what are patients' expectations for specific test results?

OBJECTIVES: The objectives of this study were to assess patients' willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends. METHODS: A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response. RESULTS: The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients' expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income. CONCLUSIONS: These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services.

Adult↗
PubMed1995

Pivot/Remote: a distributed database for remote data entry in multi-center clinical trials.

1. INTRODUCTION. Data collection is a critical component of multi-center clinical trials. Clinical trials conducted in intensive care units (ICU) are even more difficult because the acute nature of illnesses in ICU settings requires that masses of data be collected in a short time. More than a thousand data points are routinely collected for each study patient. The majority of clinical trials are still "paper-based," even if a remote data entry (RDE) system is utilized. The typical RDE system consists of a computer housed in the CC office and connected by modem to a centralized data coordinating center (DCC). Study data must first be recorded on a paper case report form (CRF), transcribed into the RDE system, and transmitted to the DCC. This approach requires additional monitoring since both the paper CRF and study database must be verified. The paper-based RDE system cannot take full advantage of automatic data checking routines. Much of the effort (and expense) of a clinical trial is ensuring that study data matches the original patient data. 2. METHODS. We have developed an RDE system, Pivot/Remote, that eliminates the need for paper-based CRFs. It creates an innovative, distributed database. The database resides partially at the study clinical centers (CC) and at the DCC. Pivot/Remote is descended from technology introduced with Pivot [1]. Study data is collected at the bedside with laptop computers. A graphical user interface (GUI) allows the display of electronic CRFs that closely mimic the normal paper-based forms. Data entry time is the same as for paper CRFs. Pull-down menus, displaying the possible responses, simplify the process of entering data. Edit checks are performed on most data items. For example, entered dates must conform to some temporal logic imposed by the study. Data must conform to some acceptable range of values. Calculations, such as computing the subject's age or the APACHE II score, are automatically made as the data is entered. Data that is collected serially (BP, HR, etc.) can be displayed graphically in a trend form along with other related variables. An audit trail is created that automatically tracks all changes to the original data, making it possible to reconstruct the CRF to any point in time. On-line help provides information on the study protocol as well as assistance with the use of the system. Electronic security makes it possible to lock certain parts of the CRF once it has been monitored. Completed CRFs are transmitted to the DCC via electronic mail where it is reviewed and merged into the study database. Questions about subject data are transmitted back to the CC via electronic mail. This approach to maintaining the study database is unique in that the study data files are distributed among the CC and DCC. Until a subject's CRF is monitored (verified against the original patient data residing in the hospital record), it logically resides at the CC where it was collected. Copies are transmitted to the DCC and are only read there. Any pre-monitoring changes must be made to the data at the CC. Once the subject's CRF is monitored, it logically moves to the DCC, and any subsequent changes are made at the DCC with copies of the CRF flowing back to the CC. 3. DISCUSSION. Pivot/Remote eliminates the need for paper forms by utilizing portable computers that can be used at the patient bedside. A GUI makes it possible to quickly enter data. Because the user gets instant feedback on possible error conditions, time is saved because the original data is close at hand. The ability to display trended data or variables in the context of other data allows detection of erroneous conditions beyond simple range checks. The logical construction of the database minimizes the problem of managing dual databases (at the CC and DCC) and keeps CC personnel in the loop until all changes are made.

Computer Communication Networks↗
PubMed1996

Patient satisfaction in the ambulatory setting. Influence of data collection methods and sociodemographic factors.

To evaluate the impact of patient characteristics and method of data collection on satisfaction results used for the comparison of practice locations, questionnaires were distributed to 1,208 adult outpatients at five medicine clinics, either on-site or by mail. Patient dissatisfaction with three service domains was measured: communication with the provider, courtesy of the office staff, and timeliness of care. Practice location, survey methodology, and patient characteristics were significant predictors of dissatisfaction, and adjustment for the latter two factors affected the rankings of practices by dissatisfaction rates for all three domains. Further study of the impact of patient characteristics and method of data collection should be conducted before the comparison of unadjusted satisfaction results becomes the accepted standard.

Adult↗
PubMed2005

The 2002 European registry of cardiac catheter interventions.

OBJECTIVE: The tradition of yearly reports on cardiac catheter interventions in Europe has been initiated in 1992. This 11th report presents aggregated data on cardiac catheter procedures in 30 European countries in the year 2002. DESIGN AND SETTING: A detailed questionnaire addressing summary data of all cardiac interventions was mailed to presidents or delegates of the national societies of cardiology in Europe. The questionnaire was distributed to all institutions with cardiac catheterisation programs. All questionnaires were compiled in a national summary data sheet, then entered into a central database and subsequently analysed. MAIN OUTCOME MEASURES: Coronary angiography, PTCA, and stenting in absolute numbers and per million inhabitants in the participating countries and the whole of Europe. RESULTS: Overall, 1,901,932 coronary angiograms were reported. The population-adjusted rate of coronary angiograms amounted to an absolute mean of 3358 per 10(6) inhabitants, an increase of 7% compared with 2001. A total of 686,869 PTCA procedures were reported. The mean European number of PTCAs per 10(6) inhabitants increased by 10% from 1103 in 2001 to 1213 in 2002. Procedures with stenting increased by 17% from 508,999 to 593,906. The stenting rate was 86% compared with 82% in 2001. CONCLUSIONS: In pace with epidemiological demand and the need to catch-up from underuse in certain countries, a continuous and considerable growth of coronary interventions can be observed. It will take years to find out whether the announced change of paradigm in the treatment of multivessel disease in the wake of drug-eluting stents will come true.

Angioplasty, Balloon, Coronary↗
PubMed1996

Transanal mucosectomy: a modification of the Soave procedure for Hirschsprung's disease.

In the Soave procedure for Hirschsprung's disease, the mucosectomy of the aganglionic segment of colon is performed transabdominally. The authors describe an innovative modification of the standard Soave procedure, in which a transanal mucosectomy is performed as the abdominal incision is made. The transanal mucosectomy technique was compared with the conventional approach. From 1974 to 1993, 51 patients underwent a Soave procedure for Hirschsprung's disease. Twenty-six (51%) had the standard Soave procedure (STD) (1974-1984), and 25 (49%) had the modified procedure (MOD) (1984-1994). In the latter, the entire mucosal dissection was performed through a transanal approach. Surgical data were accumulated by database analysis. Each case was entered into a database at the time of operation, and follow-up data were obtained through mail-in questionnaires or personal communication. The two groups were comparable with respect to number, gender distribution, and average age at the time of operation. There were two superficial wound infections in the STD group and two superficial wound infections and one death (secondary to cardiac arrest in a patient with trisomy 21 and a severe congenital cardiac anomaly) in the MOD group. The average postoperative stay for the STD group was 10.8 days; that for the MOD group was 6.8 days (t test: P < .0001). The operating time was shorter for the MOD procedure. Follow-up data were available for 25 (96.2%) patients in the STD group and 25 (100%) in the MOD group. The two groups were comparable in all respects except for the average length of follow-up, which was longer for the STD group. No patients had, urinary incontinence or sexual dysfunction (when applicable). Overall, patients/parents in both groups rated the outcome as "good." This modification of the Soave technique for Hirschsprung's disease is both safe and effective. Compared with the standard procedure, it is associated with shorter operating time (because the transanal mucosectomy is performed as the abdomen is opened) and a shorter stay postoperatively. The results have been excellent.

Child, Preschool↗
PubMed1997

Implications of computer networking and the Internet for nurse education.

This paper sets out the history of computer networking and its use in nursing and health care education, and places this in its wider historical and social context. The increasing availability and use of computer networks and the internet are producing a changing climate in education as well as in health care. Moves away from traditional face-to-face teaching with a campus institution to widely distributed interactive multimedia learning will affect the roles of students and teachers. The use of electronic mail, mailing lists and the World Wide Web are specifically considered, along with changes to library and information management skills, research methods, journal publication and the like. Issues about the quality, as well as quantity, of information available, are considered. As more and more organizations and institutions begin to use electronic communication methods, it becomes an increasingly important part of the curriculum at all levels, and may lead to fundamental changes in geographical and professional boundaries. A glossary of terms is provided for those not familiar with the technology, along with the contact details for mailing lists and World Wide Web pages mentioned.

Computer Communication Networks↗
PubMed2004

Family physicians' perspectives on practice guidelines related to cancer control.

BACKGROUND: Family physicians (FPs) play an important role in cancer control. While FPs' attitudes towards, and use of guidelines in general have been explored, no study has looked at the needs of FPs with respect to guidelines for the continuum of cancer control. The objective of this study was to understand which guideline topics FPs consider important. METHODS: Five group interviews were conducted by telephone with FPs from across Ontario, Canada. Transcripts were analyzed inductively. Content analysis identified emergent themes. Themes are illustrated by representative quotes taken from the transcripts. RESULTS: The main areas where FPs felt guidelines were needed most included screening - a traditional area of responsibility for FPs - and treatment and follow-up - areas where they felt they lacked the knowledge to best support patients. Confusion over best practice when faced with conflicting guidelines varied according to disease site. FPs defined good guideline formats; the most often cited forms of presentation were tear-off sheets to use interactively with patients, or a binder. Computer-based dissemination was acknowledged as the best way of widely distributing material that needs frequent updates. However, until computer use is a common aspect of practice, mail was considered the most viable method of dissemination. Guidelines designed for use by patients were supported by FPs. CONCLUSIONS: Preferred guideline topics, format, dissemination methods and role of patient guidelines identified by FPs in this study reflect the nature of their practice situations. Guideline developers and those supporting use of evidence-based guidelines (e.g., Canadian Strategy for Cancer Control) have a responsibility to ensure that FPs are provided with the resources they identify as important, and to provide them in a format that will best support their use.

Adult↗
PubMed2000

Assessment of patients' perceptions and beliefs regarding herbal therapies.

We evaluated the demographics and beliefs regarding safety and efficacy of herbal therapy among individuals in Iowa and assessed the willingness to discuss the use of these products with health care providers. We distributed 1300 surveys to two random samples: patients attending eight clinics, and residents of the state (mailing). Data were categorized according to herb use and compared between users and nonusers. The response rate was 61% (794 people), with 41.6% of respondents reporting herb use. They were predominately white women and were likely to have had education beyond high school (p<0.05). Their use of prescription drugs was high (p<0.05). Although users rated safety and efficacy of herbs higher than nonusers (p<0.05), both groups believed that health care providers should be aware of use and would provide this information.

Adult↗
PubMed1997

Attitudes of physical therapists who possess sports specialist certification.

Physical therapists contemplating sports specialist certification need research-based information to facilitate their decision-making process. The purpose of this study was to investigate the attitudes of physical therapists who have received sports specialist certification. These attitudes encompass the physical therapists' sense of fulfillment and their feelings of satisfaction or dissatisfaction with the certification process. Factors contributing to the therapist's decision to become sports specialist certified have also been investigated. Physical therapists who are sports certified specialists (N = 110) participated in this study. Questionnaires were mailed to the entire population of physical therapists who are sports certified specialists (N = 148). Frequency distributions and percentages were used on qualitative data, and mode was calculated for quantitative data. One hundred ten surveys were returned, for a response rate of 74.3%. Analysis of responses from the subject group suggests that physical therapists feel a high level of satisfaction with their decision to specialize, and that continued professional growth, development, and personal achievement are the major contributing factors in their decision to specialize. Based on these findings, physical therapists appeared to display overall satisfaction in their attitudes toward sports specialist certification. Further research may be warranted to further examine sports certified therapists' attitudes toward the specialization process.

Adult↗
PubMed2004

What are entrepreneurial dietitians charging? The Consulting Dietitians Network National Fee Survey.

To respond to a need to develop a national fee guideline, the Consulting Dietitians Network conducted a membership fee survey. A questionnaire requesting fee information for various nutrition consulting services was distributed to members as an insert with the Consulting Dietitians Network quarterly newsletter and by electronic mail. The response rate was 38.4% (98 respondents) and most respondents (74.5%) had urban practices. The most frequently charged fees (mode) for individual counselling ($75/hour), industry and commercial firm consultations ($150/hour), group facilitation ($150/hour), and media consultations ($150/article) were highest in the region of Ontario, Quebec, and the Atlantic provinces. The most frequently charged fees (mode) for home visits ($100/hour), writing for newspapers ($250/hour), and menu reviews ($60/hour) were highest in the region of Saskatchewan and Manitoba. The minimum and maximum fees were significantly different for the three regions (Ontario, Quebec, and the Atlantic provinces; Manitoba and Saskatchewan; and Alberta, British Columbia, and Yukon Territory) studied for initial client consultations, industry and commercial firm consultations, and menu reviews (p<0.05). For home visits, teaching in an institution, seminar presentations, group facilitation, media consultations, and writing media articles, the differences in the minimum and maximum fees charged were highly significant (p<0.001). Entrepreneurial dietitians may use these data as a reference to establish and negotiate consultation fees.

Canada↗
PubMed2000

[Evaluation of the Norwegian Medical Association's campaign for improved contraception and fewer induced abortions].

BACKGROUND: Two thirds of the young women who want induced abortions have not used contraception, and it is likely that improved education in contraception will lead to a decline in induced abortions. The Norwegian Medical Association sees this as its responsibility, and in 1995 proposed a campaign to improve the quantity and quality of physicians' advice on contraceptive use. A booklet was produced and mailed with a poster to all general practitioners in May 1997. MATERIAL AND METHODS: Before the distribution of the information package a questionnaire on how contraception was taught was sent to a representative sample of 211 general practitioners. Six months later the same 211 received a similar questionnaire with a few questions added on the possible effect of the information package. RESULTS: 132 physicians responded the first time and 105 the second. Four out of five general practitioners have consultations where they advise on contraception at least weekly. 70% had attended courses on sexology or contraception. 80% found the booklet useful, and 12% had changed their routines as a consequence of the campaign. Routine examinations before prescription of contraceptives were more extensive than the booklet advises. There was no measurable difference in reported practice before and after the campaign, but by using the more than 20,000 potential annual consultations as the unit instead of the physicians, there were significant moves in the right direction. INTERPRETATION: Even if the evaluation cannot document improved contraception as a result of the campaign, the quality of the physicians' advice on contraception has improved.

Abortion, Induced↗
PubMed1976

National survey of selected hospital pharmacy practices.

The incidence of 10 selected hospital pharmacy programs in short-term hospitals which contained a pharmacy was surveyed. A short questionnaire was mailed to a national sample of 738 hospitals. The 10 programs surveyed were: unit dose drug distribution; pharmacy-prepared i.v. admixtures; pharmacy-controlled drug administration; radiopharmaceutical dispensing; drug usage review; use of computers in the dispensing process; 24-hour pharmacy service; participation in group purchasing; pharmacy operation of central supply; and pharmacists' authority to select the brand or supplier of drugs. In addition, the volume of drug and supply purchases was determined. A large number of pharmacies (41%) belonged to a group purchasing plan, and a high percentage (67%) reported that pharmacists had authority to select the source of supply for all drug orders unless noted otherwise by the prescriber. Less than 10% of the hospitals had both complete unit dose drug distribution and intravenous admixture programs; an additional 10% had implemented such programs partially. Only 17% of the pharmacies in large hospitals were open 24 hours a day. Computer-assisted medication dispensing was used by 13% of the large hospitals and 5% of the small hospitals. Total pharmacy purchases for all short-term hospitals in 1974 was estimated to be 1.5 billion dollars.

Computers↗
PubMedDate not supplied

Women in medical specialty societies. An update.

The question of whether women are joining medical specialty societies at the same rate as their male counterparts has not been studied. A questionnaire was mailed to 48 medical specialty societies representing the 37 specialties listed in the Physician Characteristics and Distribution in the U.S., 1986 Edition. The response rate was 79%. Twenty organizations were able to identify the sex of their members, including the 7 specialty societies that represent the 6 most frequently chosen specialties of women physicians. Only in the American Psychiatric Association and the American Academy of Family Physicians was the enrollment of potential female members equivalent to that of male members. If the medical specialty societies do not address the issue of women being underrepresented in their societies, they will lose a large potential resource of leadership, participation, and financial support. More important, the societies will not be truly representative of their specialties.

American Medical Association↗
PubMed1993

Current trends in the usage of the Adaptability Rating for Military Aviation (ARMA) among USAF flight surgeons.

The Adaptability Rating for Military Aviation (ARMA) is that portion of the initial flight physical that assesses an aviator candidate's motivation for and potential adaptability toward an aviation career. A survey was mailed to all USAF operational flight surgeons in the continental U.S. to describe the frequency and distribution of ARMA usage and attitudes. Descriptive statistics suggest that the ARMA is used suboptimally in accordance with current USAF regulation. ARMA training, flight surgeon satisfaction and lack of regulation clarity are described and discussed. More flight surgeons are dissatisfied with the ARMA than are satisfied, and the regulation is perceived as unclear in the area of final disposition for candidates with equivocal ARMA's. A post-hoc analysis to rule out the influences of rank, gender, experience and residency training was performed. Residency training in Aerospace Medicine is beneficial in terms of doing an ARMA, when required, and covering recommended areas. Females and those with less than 1 year experience perform an ARMA more frequently than males and experienced flight surgeons. Despite the limitations of the current ARMA, it should not be abandoned. Recommendations to improve it are provided. Doing better ARMA's can lead to decreased illness, injury, accidents, and attrition.

Adaptation, Psychological↗
PubMed2005

Swiss teleradiology survey: present situation and future trends.

The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1-2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.

Humans↗
PubMed1994

Insulin availability among International Diabetes Federation member associations. Report of the Task Force on Insulin Distribution.

OBJECTIVE: To assess the availability of insulin and diabetes supplies among International Diabetes Federation (IDF) member associations. RESEARCH DESIGN AND METHODS: A mail survey of IDF member associations asked about the following issues: 1) diabetes prevalence and insulin use, 2) availability and cost of insulin and supplies, 3) availability of glycemic monitoring supplies, 4) cost of insulin and supplies to patients, and 5) availability of oral hypoglycemic agents. RESULTS: Of 85 member associations, 60 responded. The mean prevalence of diabetes was 3.7%. Of the 39 with a population-based survey data, the prevalence was 3.9%. Insulin use was reported for 19.2% of diabetes patients and, for the 15 with population-based data, the proportion using insulin was 16.1%. Of the respondents, 47 (78%) reported insulin was always available, 11 (18%) reported insulin was available from 25 to 99% of the time, and 2 (Uganda and Tanzania) reported insulin was available < 25% of the time. Insulin is free to patients in 39 (65%) of the countries. The average cost of the least expensive insulin was U.S. $9.62 per vial. Fifteen countries imposed a mean 13% customs charge. Disposable syringes were available in 42 (72%) of countries all of the time. Glucose meters were in use in 49 countries. The most common oral agent was glyburide, which was available in 57 countries. CONCLUSIONS: Insulin is in reasonable supply in IDF member countries. Cost and customs charges are an impediment to universal access. IDF now can recommend programs based on this data.

Diabetes Mellitus↗