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PubMed1991

Comparing sources of drug data about the elderly.

OBJECTIVE: This project assessed the extent of agreement between drug-taking data obtained from an in-home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire. DESIGN: The underlying assumption is that an in-home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in-home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value. SETTING: Kaiser Permanente, Northwest Region, a prepaid group practice HMO. PARTICIPANTS: All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly). MAIN OUTCOME MEASURES: The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member. MAIN RESULTS: The in-home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in-home assessment and mail questionnaire were in less agreement. Agreement was less for non-prescription drugs. CONCLUSIONS: An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.

Aged↗
PubMed2004

Advanced cancer at home: caregiving and bereavement.

BACKGROUND: The advanced and terminal phases of cancer are being increasingly treated at home with the aid of palliative care teams. It is well known that caregivers are overburdened emotionally, financially and physically, and some studies have demonstrated that this overload extends beyond the period of mourning. Identifying caregivers at risk of bereavement maladjustment is a useful means of ensuring prompt psychological and social assistance, and optimising the available resources. METHODS: One hundred and eleven caregivers of home-treated patients with advanced/terminal cancer were recruited by the palliative care unit operating in their place of residence. After giving their informed consent, all of the caregivers were asked to complete questionnaires designed to evaluate various emotional, financial and social aspects. Three, six and 12 months after the decease of their patients, the caregivers were contacted again and asked to complete other questionnaires aimed at assessing their emotional reactions and bereavement-related problems. RESULTS: The 12-month follow-up was completed by 93 caregivers. Their bereavement maladjustment problems correlated with their perception of emotional distress and the caregiving-related problems detected at the time of referral, particularly among females. Spouses, subjects aged over 61 years and those perceiving a substantial emotional burden proved to be at greater long-term risk. CONCLUSIONS: The identification of overburdened caregivers and those at risk of long-term bereavement maladjustment may facilitate the programming of ad hoc interventions that could reduce inherent health and social costs. Palliative care teams can usefully include someone to identify such caregivers by means of inexpensive and objectively predictive instruments.

Adult↗
PubMed1999

Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35.

PURPOSE: The aim of this study was to define the scales and test the validity, reliability, and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-H&N35, a questionnaire designed to assess the quality of life of head and neck (H&N) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30. PATIENTS AND METHODS: Questionnaires were given to 500 H&N cancer patients from Norway, Sweden, and the Netherlands as part of two prospective studies. The patients completed the questionnaires before, during (Norway and Sweden only), and after treatment, yielding a total of 2070 completed questionnaires. RESULTS: The compliance rate was high, and the questionnaires were well accepted by the patients. Seven scales were constructed (pain, swallowing, senses, speech, social eating, social contact, sexuality). Scales and single items were sensitive to differences between patient subgroups with relation to site, stage, or performance status. Most scales and single items were sensitive to changes, with differences of various magnitudes according to the site in question. The internal consistency, as assessed by Cronbach's alpha coefficient, varied according to assessment point and within subsamples of patients. A low overall alpha value was found for the speech and the senses scales, but values were higher in assessments of patients with laryngeal cancer and in patients with nose, sinus, and salivary gland tumors. Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core questionnaire. CONCLUSION: The QLQ-H&N35, in conjunction with the QLQ-C30, provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before, during, and after treatment with radiotherapy, surgery, or chemotherapy.

Aged↗
PubMed1990

Speech-language pathologists' opinions on the management of velopharyngeal insufficiency.

A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.

Adenoidectomy↗
PubMed2003

Validation of a self-reported physical activity questionnaire for schoolchildren.

BACKGROUND: There is little information about validation of young children's self-reported physical activity. This study assessed the validity of a self-reported questionnaire designed to measure children's physical activity. METHODS: Subjects were 34 boys from 4th to 6th grade of a public elementary school. Contents of the self-reported physical activity questionnaire included participation in sports club, physical activity intensity, preference for physical activity, and frequency of physical activity. Subjects were equipped with a Lifecorder and an Actiwatch for 7 consecutive days to monitor physical activity. Physical activity index was calculated from the Lifecorder data of total energy expenditure per day (TEE) divided by basal metabolic rate. Unpaired t-test, analysis of variance, and multiple linear regression analysis were performed to clarify the relationship between the objective and subjective data. RESULTS: Subjects who reported participation in a sports club had a higher physical activity index and energy expenditure originating from physical activity than those who did not. Those characterized by a "vigorous" physical activity intensity had a higher physical activity index (1.63 +/- 0.08), when compared with peers in "moderate" (1.59 +/- 0.06) or "light" categories (1.54 +/- 0.07) (p for linear trend p < 0.05). A high frequency of physical activity was significantly associated with an increasing trend in energy expenditure originating from physical activity, steps, and activity counts. Preference for physical activity was significantly related to data from the Lifecorder and the Actiwatch. CONCLUSIONS: Schoolchildren's self-reported physical activity is in accordance with the objective data, and could be used as a valid measure to evaluate physical activity level in school settings.

Body Mass Index↗
PubMed1975

Some preliminary observations on a questionnaire technique for classifying depressive illness: its relationship with clinical diagnosis and a biological technique for depressive classification.

A questionnaire designed to assist in the classification of depressive illness, was administered to 20 acute depressive patients and 10 normal controls. Patient classification according to the decision rules employed by the questionnaire, were compared with patient classification arrived at by symptomatic (diagnostic) and physiological (G.S.R. inhibition threshold) means. It was found that a preponderance of patients classified as "endogenous depressives" by the questionnaire technique, also had clinical diagnoses of endogenous depression, and had low G.S.R. inhibition thresholds relative to normals. Furthermore a preponderance of patients classified as "non-endogenous depressives" by the questionnaire technique, had clinical diagnoses of neurotic depressive illness, and had high G.S.R. inhibition thresholds relative to normals. This supports the assertion that the questionnaire technique has some validity in the classification of depressive illness.

Adjustment Disorders↗
PubMed2005

The evaluation of the Turkish version of the Well-being Questionnaire (WBQ-22) in patients with Type 2 diabetes: the effects of diabetic complications.

OBJECTIVE: Psychopathological conditions including depression and anxiety are important in patients with diabetes due to their negative effects on the quality of life, treatment and glycemic control. The specially designed questionnaire for diabetics, the Well-being Questionnaire (WBQ-22), was used to determine the psychological well-being in Turkish diabetic patients. METHOD: A total of 100 patients, 45 males and 55 females, were included in the study. Patients completed WBQ-22 questionnaire. RESULTS: Sex, in-patient follow-up, age, duration of diabetes, form of treatment, diabetic microvascular complications, diabetic foot, and increased number of complications were the factors detected to have an effect on the scores of general well-being or its subscales. Scores of depression and general well-being were 7.10 +/- 3.82 and 39.74 +/- 12.27 in females, and 4.20 +/- 3.48 and 48.84 +/- 11.45 in males (p<0.05). Anxiety score was found to be 5.70 +/- 3.71 in the outpatient clinic, and 7.28 +/- 4.38 in the inpatient clinics (p<0.05). General well-being score was 49.40 +/- 8.83 in patients having a diabetes duration of 1 yr or less and 33.70 +/- 8.83 in patients with 20 yr or more (p<0.05). Patients treated with insulin had depression score of 7.02 +/- 4.07 whereas patients treated with diet had 4.50 +/- 3.27 (p<0.05). The increasing total chronic complication points were also found to have a negative effect on WBQ-22 scores. General well-being score was 51.08 +/- 9.84 in patients with no complications and 34.50 +/- 14.14 in patients with 4 complications (p<0.05). CONCLUSIONS: Psychosocial support should be provided to Type 2 diabetic patients by studying the psychological well-being with WBQ-22 questionnaire.

Adult↗
PubMed1994

Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden.

OBJECTIVE: To identify factors that affect physicians' choice of specific antidepressant drugs in order to evaluate the validity of epidemiological studies of the risks (particularly suicide) and benefits of different compounds. DESIGN: Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden with validation of data by independent prescription surveys. SETTING: Urban area of greater Stockholm and rural county of Jämtland, Sweden. SUBJECTS: 228 physicians (86%) who answered the questionnaire. MAIN OUTCOME MEASURES: The drugs used as first line drugs of choice, as drugs of choice in particularly severe depression, and as drugs of choice for disorders other than depression. RESULTS: Amitriptyline was the most common first line drug of choice among both psychiatrists and general practitioners. The patterns of choice of antidepressants in the two areas accorded with prescribing patterns in two independent prescription surveys. Amitriptyline was chosen even more frequently for severe depression and depression with severe insomnia. Clomipramine was chosen comparatively more often for depression with severe anxiety. Low toxicity compounds (mainly lofepramine, mianserin, and moclobemide) were more often the drug of choice in depression associated with overt risk of suicide. Amitriptyline and clomipramine were used extensively for disorders other than depression (40% and 54% of prescriptions, compared with 13-19% for some other major antidepressants). CONCLUSION: Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lofepramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.

Antidepressive Agents↗
PubMed1991

A brief dietary assessment to guide cholesterol reduction in low-income individuals: design and validation.

Low-income Americans are at greatest risk for coronary heart disease. Dietary assessment methods are needed that can efficiently and effectively guide diet counseling to reduce serum cholesterol in this population. The Dietary Risk Assessment is a brief food frequency questionnaire designed to guide an intervention program for cholesterol reduction. It can easily be administered and scored in 10 to 15 minutes by persons who are not trained in nutrition. The assessment is culturally specific for a low-income southern population, identifies positive as well as problematic dietary behaviors, is easily interpreted, and measures potential barriers to dietary change. The assessment was validated against 3 days of dietary recall data in a sample of 42 low-income individuals recruited from the waiting room of an ambulatory care clinic. A Keys score, which measures the serum-cholesterol-raising potential of the diet, was calculated for each patient from their recall data. The Keys and Dietary Risk Assessment scores were significantly correlated (r = .60, P less than .001). We conclude that the Dietary Risk Assessment can rank individuals by level of dietary atherogenic risk adequately to guide a dietary treatment program for low-income patients, an underserved population with a high prevalence of diet-induced elevations in serum cholesterol.

Cholesterol↗
PubMed2004

A study into the educational needs of children's hospice doctors: a descriptive quantitative and qualitative survey.

OBJECTIVES: To identify and explore the educational needs of children's hospice doctors in England. DESIGN: A descriptive quantitative and qualitative survey. SETTING: Children's hospices in England. PARTICIPANTS: All children's hospice doctors (n =55) in England were approached, and 35 (65%) consented. INTERVENTIONS: A questionnaire designed to survey doctors' self-assessed educational competencies (confidence and perceived need for training) in subject areas derived from analysis of existing children's palliative care literature. Educational diaries used prospectively in practice to identify areas of unmet educational need. MAIN OUTCOME MEASURES: Self-perceived confidence and usefulness scores for each subject area. An analysis of support, education and training needs deriving from educational diaries and one-to-one interviews. RESULTS: Confidence and usefulness scores suggest that respondents would most value support, education and training in the management of emergencies, symptoms and physical disease. Educational diary analysis revealed that respondents would most value support, education and training in communication skills, team-working skills, and personal coping strategies. CONCLUSIONS: There is a disparity between educational needs as derived from self-rated competencies and from educational diary keeping; suggesting that children's hospice doctors may not be fully aware of their own educational, support and training needs. Self-rated competencies emphasise the value of education in craft or clinical skills; whereas personal diary keeping emphasises the value of education in intrapersonal and interpersonal skills such as communication, team-working and personal coping skills. The current curricula and educational resources need to acknowledge that interpersonal and intrapersonal competencies are as important as clinical competencies. While the study looks particularly at the educational needs of children's hospice doctors, readers may feel that the findings are of relevance to all specialities and disciplines.

Child↗
PubMedDate not supplied

Effects of osseointegrated implants on psychological and social well-being: a comparison with replacement removable prostheses.

Sixty-one patients participated in a longitudinal study designed to compare the psychological effects of osseointegrated implants with those of conventional denture replacements. Thirty-two patients who requested either relining or reconstruction of their dentures were asked to complete questionnaires designed to measure their psychological well-being while they were on a waiting list and then again 6 months after treatment. Their responses were compared with those of 29 patients who had received an osseointegrated implant. While the implant patients had reported significant declines in psychological distress, there was no such change for the denture patients. Although both groups experienced fewer disabling symptoms, the decline was greater for the implant group. Finally, neither group showed evidence of any change in self-esteem. The results suggest that osseointegrated implants can have a more positive effect on well-being than denture replacements.

Aged↗
PubMed2003

Intensive care admission decisions for a patient with limited survival prospects: a questionnaire and database analysis.

OBJECTIVE: To explore the concept of futility by asking clinicians for estimates of survival and admission decisions for an intensive care unit patient with little chance of survival, and to compare these estimates with results from an intensive care database. DESIGN: Questionnaire based on the presenting features of a genuine patient. It asked for estimated hospital survival, decision on intensive care admission, resuscitation status and importance of family views. Analysis of a regional intensive care database. SETTING: Physicians working in British intensive care units. PARTICIPANTS: We received 169 replies, 146 from consultants. MEASUREMENTS AND RESULTS: Median estimated hospital survival was 5%; 60% of consultants and 76% of trainees would have admitted the patient, with 9% and 14%, respectively, prepared to perform further cardiopulmonary resuscitation. Among those estimating survival probability as less than 1%, 17.2% would have admitted the patient. Family opinions were vital to 4.3% of respondents and unimportant to 9.8%. There were 251 patients in the database with similar physiological derangements. Their observed hospital mortality was 91%. At intensive care admission an admitting physician assessed 111 of these patients as 'expected to die'. Mortality in this group was 99.1% (one survivor). CONCLUSIONS: Experienced intensivists did not agree on estimated survival. Even when estimates agreed, admission decisions varied. Database analysis suggested that clinical judgement is relevant when assessing the risk of dying. Lack of consensus on survival estimates and admission decisions suggests that it would be difficult to achieve agreement on appropriate use of intensive care resources and on what constitutes futile treatment.

Critical Illness↗
PubMed2003

Development of the National Eye Institute refractive error correction quality of life questionnaire: focus groups.

OBJECTIVE: To identify the content area for a questionnaire designed to measure the vision-targeted, health-related quality of life for persons with well-corrected refractive error. DESIGN: Cross-sectional study. PARTICIPANTS: Fifty-two focus groups were conducted with 414 patients from 5 geographically diverse ophthalmic and optometric sites to identify the content area of a questionnaire for use among persons with myopia and hyperopia. METHODS: A standard protocol was used to structure each focus group discussion, and groups were led by centrally trained moderators at each participating site. Results were summarized and analyzed using a standard set of codes. Qualitative and quantitative analyses were conducted. MAIN OUTCOME MEASURE: Self-reported observations or comments about vision, vision correction, and other aspects of quality of life. RESULTS: Among the 414 participants, 9262 mentions of comments were recorded. The most frequent comments reported by participants were about types of vision correction, followed by comments with their own vision and vision-related symptoms. The distribution of comments by topic domain was generally similar across types of correction and type of refractive error. The most frequent specific comments about glasses concerned problems with reading, adjustment between near and far vision, and appearance. The most frequent comments about contact lenses included those on symptoms such as dry eyes, itching and tired eyes, and headaches, and negative comments about ease of use. The most frequent comments among patients with surgical correction concerned fewer driving problems; fewer symptoms; and improvement in vision, recreation, and comfort. Participants provided equal numbers of positive and negative comments about glasses. Twice as many positive as negative comments were given by contact lens wearers, and 4 times as many positive comments were provided by patients who had undergone surgical correction. CONCLUSIONS: Using focus groups, we were able to identify content areas and aspects of visual functioning in persons with refractive error that are not measured by standard visual acuity testing in the clinic or by other vision-targeted, health-related quality of life instruments such as the 25- or 51-item National Eye Institute-Visual Functioning Questionnaire. The similarity of problems mentioned across refractive error type and correction method suggests it will be possible to develop a single questionnaire with adequate content validity to compare the impact of different modes of correction in vision-targeted, health-related quality of life.

Adult↗
PubMed2002

[Disease anxiety among medical students and law students].

BACKGROUND: Medical students and other people with knowledge about health and disease are often thought to have more anxiety about their health than others. MATERIAL AND METHODS: 80 medical students and 100 law students were asked to fill in a questionnaire designed to identify higher disease anxiety (Whiteley Index). A high total score on the Whiteley Index indicates high disease anxiety. 62 medical students (78%) and 70 law students (70%) returned the questionnaire in an anonymous form. RESULTS: Medical students had lower total score compared with law students (p < 0.01). One medical student and six law students had a total score susceptible of hypochondriasis. Male students had a non-significantly higher mean total score than female students. Those with depressive mood (n = 5), had higher total score than the others (p < 0.01.) Those who had experienced disease in their family (n = 83) tended to have lower total score. INTERPRETATION: Medical students have less disease anxiety than law students, contrary to what is often believed.

Adult↗
PubMed2003

Doctors' views of their first year of medical work and postgraduate training in the UK: questionnaire surveys.

OBJECTIVE: The first year of postgraduate work for newly qualified doctors in the UK, the pre-registration year, is spent working intensively in training posts under supervision. Our aim was to report the views of pre-registration doctors on these posts. DESIGN: Questionnaire survey. SUBJECTS: All medical graduates of 1999 and a 25% sample of graduates of 2000 from all UK medical schools. MAIN OUTCOME MEASURES: Doctors' views on the pre-registration house officer (PRHO) year, recorded as ratings in answers to questions and statements about the year. RESULTS: In reply to the question 'How much have you enjoyed the PRHO year overall?', rated on a scale from 0-10 (0 = no enjoyment; 10 = enjoyed it greatly), 44% of respondents (1341/3068) gave scores of 8-10; in all, 83.2% of respondents gave scores in the upper half of the scale (> or =6). However, there were criticisms of specific aspects of working conditions. Only a third agreed that their training during the year had been of a high standard. Posts in medicine were rated more highly than those in surgery for quality of training. Differences in views held by women and men junior doctors were few. However, where differences existed, women were slightly more positive about their work than men. CONCLUSION: Most graduates enjoyed the pre-registration year but there is still considerable scope for improvement in working conditions and training. Men and women gave similar responses, which suggests that later divergence in their career pathways is not attributable to different views formed about work in their pre-registration year.

Attitude of Health Personnel↗
PubMed1994

Quality assurance in a neurophysiology laboratory.

In order to assess patient satisfaction with the Neurophysiology Services within our department, we undertook a pilot study using a simple questionnaire designed by staff members (MAHB and ABB). Patients were approached after their tests (nerve conduction tests (NCTs), electromyography (EMG) and electroencephalography (EEG)) were completed, by staff not involved in the testing. 31 patients were approached and all completed the questionnaire. None reported being inconvenienced by an undue waiting time. All felt that adequate information about the test had been provided, that their personal comfort and feelings were considered, and that they were adequately informed of the time and place at which the test results would be available. 61% considered their overall treatment excellent, the remainder good. To date, increased departmental awareness has resulted in staff participation in program evaluation, design of an outcomes hierarchy for the department, redesigning the patients' waiting area and, overall, a more active participation in quality assurance. We see this pilot study as a baseline for future more in-depth client and staff evaluations thereby promoting quality performance improvement.

Electroencephalography↗
PubMed1996

The effect of ward design on the well-being of post-operative patients.

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

Adult↗
PubMed2003

[Epidemiology and therapy of Lyme arthritis and other manifestations of Lyme borreliosis in Germany: results of a nation-wide survey].

AIM OF THE STUDY: Only little is known about the epidemiology of Lyme borreliosis in Germany. As an example, it is still unclear if there are regional differences in the incidence of Lyme disease in general or of certain clinical manifestations like Lyme arthritis. Moreover, standardization of diagnostic or therapeutic procedures does not exist. Therefore, a Germany-wide questionnaire-based survey was conducted in order to achieve more epidemiological data and to obtain more information about the diagnostic and therapeutic approaches of general practitioners and specialists. METHODS: A self-designed questionnaire was distributed along with two editions of the journal "Deutsches Arzteblatt" (which is delivered to every physician in Germany) and additionally by a pharmaceutical company. During the collection period from March 1, 1998 to February 28, 1999, patients with Lyme disease were reported and information was given about site of infection, diagnostic procedures, clinical symptoms, treatment, and outcome. RESULTS: Altogether 3935 patients were reported. Their mean age was 43.4 years with the peak incidences around the ages of 10 and 60 years. 37.3% of the questionnaires were sent in by general practitioners, 17.6% by dermatologists, 15.7% by pediatricians, 9.7% by internists, and 2.7% by neurologists. 83% of the patients did not have a special infecion risk. The most frequent clinical Lyme manifestation was erythema migrans (EM), which occurred in 50.9% of the patients. 21.3% suffered from general symptoms. Of special interest, 24.5% of the patients had Lyme arthritis (14.7% mon- or oligoarthritis, 9.8% polyarthritis). Therefore, arthritis was more frequently reported than neuroborreliosis (18.4%). Only 16% of the neuroborreliosis patients and 32% of the arthritis patients remembered having had an EM. 189 patients (4.8%) with lymphadenosis cutis benigna and 100 patients (2.5%) with acrodermatitis chronica atrophicans were reported. In 80.4% of the patients, positive Lyme serology was detected. In a few cases, the diagnosis was established by isolation of borreliae, PCR or histology. 3754 patients were treated by antibiotics. The most frequently used compounds were doxycycline (50.4%), followed by ceftriaxone (22.4%), amoxicillin (13.6%), penicillin (7%), and erythromycin (4.2%) with differences depending on clinical manifestations and specialization of the prescribing physician. In less than 10% of the cases, not evaluated or recommended therapeutic procedures were performed. DISCUSSION: Lyme disease is endemic throughuot Germany. The most frequent manifestations are EM, followed by Lyme arthritis and neuroborreliosis. Less than one third of patients suffering from disseminated or chronic Lyme disease remembered an EM. Most of the physicians taking part in this survey follow treatment recommendations concerning choice of antibiotics and treatment durations.

Adolescent↗