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PubMed1993

Multiple-site physician practices and their effect on service distribution.

OBJECTIVE: This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING: A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service area) and adjacent communities in September 1990. Data on community characteristics were obtained from the 1990 U.S. census and state government documents. STUDY DESIGN: Descriptive statistics and maps were used to summarize the attributes of single- and multiple-site practices and the communities where they were located. Key practice and community variables were analyzed. DATA COLLECTION/EXTRACTION METHODS: The questionnaires were coded and entered into a digital database with the tabulated community data. Responses of individual physicians were grouped by practice. PRINCIPAL FINDINGS: Multiple-site practices were common. Second-order sites accounted for 23 percent of total appointment capacity and were located in communities with higher than average elderly populations and incomes and lower than average minority populations. CONCLUSIONS: Analysis of multiple-site practices is important for the accurate assessment of medical service availability. Further research is needed to document the functioning of multiple-site practices across other specialties and geographic areas.

Catchment Area, Health↗
PubMed2002

Gender differences in the psychological determinants of cigarette smoking.

AIMS: To compare the distributions of smoking-related variables and the size of associations between these variables in men and women. DESIGN AND PARTICIPANTS: Mail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow-up after 7 months in 2456 people (84%). SETTING: Community setting (French-speaking part of Switzerland, 1998). FINDINGS: Women smoked less than men (18 versus 22 cigarettes per day, p < 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as 'coping with the temptation to smoke' and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow-up, smoking cessation rates were similar in men and women (6% versus 5%, p=0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self-change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are 'self-restrained' smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking-related variables was similar in men and women. CONCLUSIONS: Even though there were gender differences in the distributions of some smoking-related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women.

Adaptation, Psychological↗
PubMed1995

Seroepidemiology of Q fever in Nova Scotia: evidence for age dependent cohorts and geographical distribution.

To determine the incidence of Q fever in Nova Scotia, a randomly selected sample of 492 volunteers aged 18-70 years was recruited by mail from all 18 urban and rural counties in this province. Volunteers were followed from 1988 to 1991 for antibody titres to Coxiella burnetii antigens. Analysis of seroprevalence by age revealed two statistically different cohorts. Those younger than 35 years had a low, stable seroprevalence while those 35 years and older had a seroprevalence statistically correlated with increasing age. The finding of age related cohorts suggests a sporadic or cyclical infection rate. An age-independent geographical clustering was also noted, with higher seroprevalence in a major agricultural area of the province. No seroconversions were observed, but four subjects had seroreversions. At baseline, 72 (14.6%) of the 492 subjects were considered seropositive (> or = 1:8 C. burnetti phase II antibody titre by microimmunofluorescence). Of 47 seropositive subjects who provided yearly serum samples, two (4.3%) showed > or = 4-fold increase in antibody titre and did not react to antigens of the 11 other respiratory pathogens tested, suggesting a reactivation of Q fever. All 22 subjects positive to phase I antigen were positive to phase II antigen. This study suggests that the rate of infection in Nova Scotia has been low since the 1960's and that risk of infection is associated more with a geographically clustered reservoir of infection than with occupation or gender.

Adolescent↗
PubMed1994

ASHP national survey of pharmaceutical services in federal hospitals--1993.

The results of a national mail survey of pharmaceutical services in federal hospitals conducted by ASHP from May to July 1993 are reported. Mailing lists were compiled of all Air Force, Army, Navy, Public Health Service, and Department of Veterans Affairs (VA) hospitals, as well as some federal prison hospitals. Questionnaires were mailed to each chief of pharmacy. The adjusted gross population size was 326. The net response rate was 76%. Complete unit dose drug distribution was offered by 85% of respondents, and 83% offered complete, comprehensive i.v. admixture programs. About half of the pharmacies provided decentralized services. Over 99% provided services to ambulatory care patients. A computerized pharmacy system was present in 99% of the departments. More than 95% of hospitals participated in adverse drug reaction, medication error management, and drug-use-evaluation programs. A total of 93% provided drug therapy monitoring, and 89% provided patient education. About 70% provided written documentation of pharmacist interventions in the medical records, and 57% participated in drug research. A total of 42% provided pharmacist-managed drug clinics, 41% participated in drug management of medical emergencies, 30% provided written medication histories, and 30% provided drug therapy management planning. Pharmacokinetic consultations were provided by 64% of departments. About 90% had a well-controlled formulary system and prescribing restrictions. Therapeutic interchange was practiced by 64%. Diversified pharmaceutical services included telephone or mail-in refill services (80%), mail-out pharmaceutical services (58%), and services to long-term-care facilities (49%). A total of 70% of the hospitals were affiliated with a pharmacy school. The first ASHP national survey of pharmaceutical services in federal hospitals showed that comprehensive distributive and clinical services were offered by most of the facilities.

Drug Information Services↗
PubMed2006

The relationship between alcohol use and cigarette smoking in a sample of undergraduate college students.

During the decade of the 1990s, smoking prevalence increased nearly 30% in the college student population. Although most college students initiate smoking before the age of 18, recent evidence suggests a sizable minority of undergraduates report starting smoking while in college. This study examined the concurrent use of alcohol and tobacco as well as the relationship between alcohol use and smoking initiation among a sample of undergraduate students attending a large public university in the southwestern United States. We defined three categories of smoking status for this study: never smokers (n=777), experimenters (n=158), and smokers (n=178). Both experimenters and smokers reported consuming significantly more drinks per occasion in the past 28 days and more drinks on one occasion in the past 2 weeks compared to never smokers; however, there was no significant difference between experimenters and smokers on either of these measures of consumption. The results of two multinomial logistic regression models showed that measures of alcohol consumption and drinking frequency were significantly associated with being an experimenter or smoker after controlling for demographic and other drug use covariates. Results of a logistic regression analysis revealed a significant relationship between past year drinking frequency and smoking initiation among respondents who reported that they were not smoking at all 12 months prior to their survey participation. The influence of alcohol consumption on smoking initiation among college students is discussed.

Adult↗
PubMed2000

The association between exposure to a rear-end collision and future neck or shoulder pain: a cohort study.

Neck pain is the most frequently reported feature in connection with whiplash injury, but it is also a common complaint in the general population. Therefore it is crucial to include an unexposed comparison group when evaluating the association between neck pain and a previous motor vehicle crash (MVC). To determine whether exposure to a rear-end collision, without or with whiplash injury, is associated with future neck or shoulder pain, a cohort study was conducted. The study population consisted of persons covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups, without reported whiplash injury (n = 204) and with reported whiplash injury (n = 232). Two comparison groups, unexposed to MVCs, consisting of 1599 and 2089 persons, were selected with consideration taken to the age and gender distribution in the exposed subgroups. A questionnaire concerning neck or shoulder pain and other subjective health complaints was mailed to all the study subjects at follow-up in 1994, 7 years after the rear-end collision. The relative risk of neck or shoulder pain at follow-up was 1.3 (95% CI 0.8-2.0) in the exposed subjects without whiplash injury compared with the unexposed. The corresponding relative risk in subjects with whiplash injury was 2.7 (95% CI 2.1-3. 5). We conclude that there is no increased risk of future neck or shoulder pain in drivers who did not report whiplash injury in connection with a rear-end collision 7 years earlier. In drivers with reported whiplash injury, the risk of neck or shoulder pain 7 years after the collision was increased nearly three-fold compared with that in unexposed subjects.

Accidents, Traffic↗
PubMed2003

Methods of measuring asthma severity and influence on patient assignment.

BACKGROUND: There is a need for nonclinical measures in studies where objective clinical data used to determine asthma severity, such as spirometry and peak expiratory flow rate meter readings, are not available. OBJECTIVE: To determine whether different methods of defining asthma severity provide different distributions of patients across the categories of mild, moderate, and severe asthma. METHODS: Data were obtained from a mail survey and the database of a managed care organization located in Michigan. Seven methods of asthma severity that used either patient self-report or claims data were evaluated and divided into 3 categories: patient-perceived severity (1 method), symptom-derived severity (4 methods), and medication-derived severity (2 methods). To further evaluate the extent of the degree of agreement among the 7 severity methods, percent agreement and Cohen K scores were calculated. RESULTS: Surveys were sent to 1,139 persons, and 603 responses were usable. Substantial differences exist in the number of patients in each severity level for different methods of determining asthma severity. The proportion of persons identified as having mild, moderate, and severe asthma ranged from 48% to 82%, 16% to 38%, and 2% to 33%, respectively. The percent agreement and Cohen kappa scores were generally low among the 7 methods. CONCLUSIONS: Due to variations caused by the method of measuring asthma severity, comparability among studies using different methods of classifying asthma severity is limited. Although a uniform evaluation of asthma severity is needed, the results of this study do not identify one preferable method. Rather, investigators should know the limitations of the methods used.

Adolescent↗
PubMed2001

Sexual abuse knowledge base among residents in family practice, obstetrics/gynecology, and pediatrics.

STUDY OBJECTIVE: To investigate resident physician knowledge about sexual abuse prevalence and understanding about potential perpetrators. DESIGN: Questionnaires were mailed to program directors in family practice, obstetrics and gynecology, and pediatric residency programs. PARTICIPANTS: The questionnaires were distributed to senior residents in their final months prior to graduation. INTERVENTIONS: Residents were asked to fill out the questionnaire anonymously and return it to our institution in the prepaid envelope provided. MAIN OUTCOME MEASURES: Demographic characteristics and knowledge of sexual abuse prevalence and perpetrator characteristics were assessed. Chi-square contingency table analysis was used to compare responses of the three specialties. RESULTS: The overwhelming majority (98.8%) of residents correctly identified a family member as the individual most likely to sexually abuse a child. Approximately half of the residents knew the correct prevalence of sexual abuse among females and among males. There was a weak understanding of the potential youthfulness of juvenile offenders. CONCLUSION: We believe that resident understanding of sexual abuse prevalence and about the youthfulness of juvenile offenders can be improved in all three specialties.

Adult↗
PubMed2005

[Quality of surgical continuing education in Germany].

BACKGROUND: One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. METHODS: A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. RESULTS: The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. CONCLUSIONS: Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.

Congresses as Topic↗
PubMed2000

Activities and procedures performed by nurse practitioners in emergency care settings.

INTRODUCTION: Although nurse practitioners (NPs) have been practicing in emergency care (EC) settings for at least 25 years, little is known about the activities and procedures they perform. METHODS: A questionnaire was sent by either by E-mail or US mail to a convenience sample of 96 subjects. These 96 NPs were instructed to duplicate the questionnaire and distribute it to other NPs they may know who also work in EC settings. The questionnaire contained 71 activities and procedures obtained from Clinical Procedures in Emergency Medicine by Roberts and Hedges. The NPs were asked to rate the 71 activities and procedures according to the frequency with which they performed them, where they learned to perform them, and how important they believe it is that NPs in EC settings know how to perform them. RESULTS: Seventy-two NPs in EC settings responded. Fifty percent (n = 36) or more had performed 35 of the 71 activities and procedures. Almost every NP (n = 71) had used fluorescein staining, and only 3 procedures--culdocentesis, venous cutdown, and insertion of pins for skeletal traction--had never been performed. The majority of NPs learned to perform each of the activities and procedures through on-the-job training and continuing education courses. Fifty percent or more identified 56 activities and procedures as being important for NPs to know how to perform in EC settings. DISCUSSION: The results of this study indicate that whereas 50% or more of the NPs in EC settings had performed 35 out of 71 activities and procedures, 50% or more indicated that a larger skill set of 56 activities and procedures is believed to be needed for practice.

Adult↗
PubMed2001

Construct validation and test-retest reliability of the seniors in the community: risk evaluation for eating and nutrition questionnaire.

BACKGROUND: We performed two studies. Study 1 was a construct validation of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN), a 15-item questionnaire for assessing nutritional risk. In Study 2, we examined the test-retest reliability of SCREEN. METHODS: Study 1 was a cross-sectional study, and Study 2 was a cohort study. For Study 1, ten diverse community sites were used to recruit participants. A total of 128 older adults attended a clinic to provide medical and nutritional history and anthropometric measurements. A dietitian interviewed each participant. Dietitians used clinical judgment to rate the probability of nutritional risk from 1 (low risk) to 10 (high risk). Spearman's rho correlation and receiver operating characteristic curves were completed. An abbreviated SCREEN was developed through multiple linear regression analysis. In Study 2, SCREEN was randomly distributed to members of a seniors' recreation center where a self-selected sample (n = 124) completed two mailed SCREENs, 4 weeks apart. The test-retest reliability was estimated through paired correlations of total scores and individual items. RESULTS: In Study 1, total and abbreviated SCREEN scores were significantly associated with the dietitian nutritional risk rating (rho = -.47 and rho = -.60, respectively). Study 2 revealed that the test-retest reliability of SCREEN was adequate. CONCLUSIONS: SCREEN appears to be a valid and reliable tool for identifying community-dwelling older adults at risk for impaired nutritional states.

Aged↗
PubMed1999

Management of nonspecific low back pain by physiotherapists in Britain and Ireland. A descriptive questionnaire of current clinical practice.

STUDY DESIGN: A descriptive questionnaire of chartered physiotherapists. OBJECTIVE: To investigate current physiotherapeutic management of low back pain throughout Britain and Ireland. SUMMARY OF BACKGROUND DATA: Physiotherapists play a key role in low back pain management. Although clinical guidelines for best practice have been developed recently, there has been no large-scale attempt to describe current physiotherapeutic treatment approaches within Britain or Ireland. METHODS: After semi-structured interviews (n = 6) and two pilot studies (n = 77) were done, postal questionnaires were distributed to four regional cluster samples of the membership of two physiotherapy professional organizations (n = 2654). After two mailings, a random sample of 90 nonresponders were followed up. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Ltd., Woking, Surrey, UK), and precision of the survey estimates was assessed by calculation of sampling errors and intraclass correlation coefficients for cluster sampling. RESULTS: Results were received from 1548 therapists (total response rate, 58.3%); of these, 813 reported that they were practicing in settings in which they treated patients with low back pain. Analysis of the results indicated the overall popularity of the Maitland mobilization and McKenzie approaches among physiotherapists. Although exercise per se was mentioned frequently by respondents, a marked difference in opinion among therapists regarding the optimal type of exercise for low back pain was obvious. Little evidence was demonstrated of the use of manipulation, fitness programs, or multidisciplinary efforts involving behavioral and physical aspects of treatment. Commonly used methods of electrotherapy were interferential therapy, ultrasound, pulsed short-wave diathermy, and transcutaneous electrical nerve stimulation. CONCLUSIONS: The results of this study emphasize the need to evaluate further and improve the dissemination of findings regarding the effectiveness of specific physiotherapy approaches for low back pain management.

Adult↗
PubMed2003

Clinical Evidence: a useful tool for promoting evidence-based practice?

BACKGROUND: Research has shown that many healthcare professionals have problems with guidelines as they would prefer to be given all relevant information relevant to decision-making rather than being told what they should do. This study assesses doctors' judgement of the validity, relevance, clarity and usability of the Italian translation of Clinical Evidence (CE) after its free distribution launched by the Italian Ministry of Health. METHODS: Opinions elicited using a standardised questionnaire delivered either by mail or during educational or professional meetings. RESULTS: Twenty percent (n = 1350) doctors participated the study. Most of them found CE's content valid, useful and relevant for their clinical practice, and said CE can foster communications among clinicians, particularly among GPs and specialists. Hospital doctors (63%) more often than GPs (48%) read the detailed presentation of individual chapters. Twenty-nine percent said CE brought changes in their clinical practice. Doctors appreciated CE's nature of an evidence-based information compendium and would have not preferred a collection of practice guidelines. CONCLUSIONS: Overall, the pilot initiative launched by the Italian Ministry of Health seems to have been well received and to support the subsequent decision to make the Italian edition of Clinical Evidence concise available to all doctors practising in the country. Local implementation initiatives should be warranted to favour doctor's use of CE.

Attitude of Health Personnel↗
PubMed2004

What is a picture worth? Digital imaging applications in autopsy reports.

CONTEXT: An image-enhanced report (IER) containing color digital images can serve as an educational tool and document important gross and microscopic findings in anatomic pathology. OBJECTIVE: To determine the clinical impression of IERs on an academic autopsy service. DESIGN: Autopsy IERs were initiated at this institution in December 2001. From January 2002 to July 2003, 261 hospital-service autopsies were performed; color images were produced for 39 (15%) of these autopsies. Of these IERs, 29 were distributed to 74 hospital-employed physicians. Each hospital physician recipient was sent a 6-question e-mail survey to evaluate his or her impression of image quality and added value. RESULTS: Of the 74 hospital-employed physicians sent an IER, 41 responded to the survey (response rate, 55%). Twenty-one respondents recalled receiving a report with color images. Image quality was uniformly rated as good or excellent. Ninety-five percent thought the images increased their understanding of the report, and 76% thought that the images increased the utility of the report. All respondents stated they would (or did) use the images for educational purposes. Twenty-one percent of all respondents thought the presence of color images would increase their likelihood of requesting a future autopsy. CONCLUSIONS: Color digital images are perceived as a valuable addition to the autopsy report. Although clinicians did not consider color images a strong motivator to request a future autopsy, most thought that the images enhanced their understanding and the utility of the report. All respondents stated they would use the images to educate themselves, medical students, residents, and/or the patient's family.

Autopsy↗
PubMed2006

Widespread pain following whiplash-associated disorders: incidence, course, and risk factors.

OBJECTIVE: To investigate the incidence and course of widespread pain (WP) subsequent to localized pain in subjects with whiplash-associated disorders (WAD); and to investigate the influence of depressive symptoms, neck pain intensity, number of whiplash-associated symptoms, and number of painful body areas on such conditions. METHODS: From a large prospective cohort of injury claimants who reported WAD after motor vehicle collision (MVC; n = 7462), we identified a subgroup with only localized head/neck/back pain, and who responded to one or more followup questionnaires mailed at 6 weeks and 4, 6, and 12 months after the MVC (n = 266). Pain drawings were distributed at the followup, and we defined WP as having 9 or more painful areas, including posterior neck, at any of these occasions. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale and pain intensity with on a visual analog scale (VAS). RESULTS: The cumulative incidence of WP was 21%, and it occurred early after the injury. Continuous WP over the 12 months was rare. The odds for developing WP were greater in those with depressive symptoms (OR 3.2, 95% CI 1.6-6.3), VAS pain intensity 55-100 (OR 3.2, 95% CI 1.3-8.0), reporting > or = 3 pain-associated symptoms (OR 1.9, 95% CI 0.9-3.8), and those reporting 4 or 5 painful body areas (OR 2.6, 95% CI 1.3-5.4). CONCLUSION: WP occurred early in the course. Even though the cumulative incidence was 21%, continuous WP was rare. Subjects with WAD who report early depressive symptoms and more severe neck injury symptoms are at risk of developing WP after MVC.

Accidents, Traffic↗
PubMed1995

Surveying donor families: a comparison of two organ procurement organizations.

The primary purpose of this study was to identify variables that affect cadaveric donor family satisfaction with the donation process and coping with grief. A secondary purpose was to describe the variation of respondents from two different donor populations to establish whether donor families in one geographic region differ from donor families in another. A survey was mailed to 233 families over a 16-month period. Data analysis of returned surveys was based on frequency distributions, measures of association and factor analysis. Identical items in the Regional Organ Bank of Illinois (ROBI) Survey and the Hartford Transplant Center (HOPO) Survey were compared and tested for significance. Eighty-nine percent of the donor families understood what "brain death" meant, and 85% felt that the donation request was appropriate when it was made less than 6 hours after a diagnosis of brain death. Family members provided the most helpful information about donation to other family members 65% of the time. The two most important reasons for donation were "to make something positive come out of the death" and "family member's belief in helping others". These responses also ranked highest in the HOPO survey. The support of family, friends and religion were the most frequent coping mechanisms for grief. In comparing responses from ROBI and HOPO, significant differences were found on two items relating to agency procedure, but no significant differences were found when family responses were compared. Factors were identified which predicted the desire to donate, the likelihood of increased stress and a "sharing" factor that related to the wishes of the family member and further participation with the organ procurement organization.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1993

A survey of eye and vision care in Oklahoma.

We examined the spectrum of vision care intensity, and the relationships of the three principal providers of vision care in Oklahoma. They were active family and general physicians (MD and DO), ophthalmologists (MD and DO), and optometrists. There were 1,356 surveys mailed to the three groups. We determined that vision care services in Oklahoma appear very accessible, are well distributed and generally affordable. The referral patterns appear to be less than optimal and optometrists are not fully utilized. This added cost and travel time for patients.

Eye Diseases↗
PubMed1995

Physical and sexual abuse among orofacial pain patients: linkages with pain and psychologic distress.

This study examines the incidence of and the potential correlates of sexual and physical abuse among facial pain patients. An anonymous survey composed of standardized self-report measures of abuse, pain, and psychologic status was distributed to 120 adult facial pain patients following their initial evaluations. Forty-five questionnaires were returned by mail. In addition, 206 charts were randomly selected from a population of 520 new patients seen at the Orofacial Pain Center during the same time period that data from the anonymous survey were collected. Results of the anonymous survey indicated that 68.9% of the patients reported a history of abuse. Conversely, a chart review revealed that only 8.5% of the patients indicated a history of abuse on the clinic questionnaire. History of abuse was significantly related to greater pain severity, depression, psychologic distress, and various personality characteristics. Overall, this study indicates that the assessment of the history of abuse may be an important factor in the evaluation and treatment of facial pain.

Adaptation, Psychological↗