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PubMed1995

Occupational exposure to hepatitis B virus and human immunodeficiency virus: a comparative risk analysis.

Health care workers have expressed concern regarding the risk of infection from patients with AIDS. Much less attention is given to the possibility of exposure to patients infected with the hepatitis B virus. This article reviews the data on the probability of exposure to HIV or hepatitis B and subsequent seroconversion, as well as the mortality and morbidity rates associated with both viruses. A decision-analytic analysis of the occupational risk for HIV and hepatitis B is also presented. This model indicates that quality-adjusted loss in life expectancy is greater after percutaneous exposure to a patient who is seropositive for the hepatitis B e antigen than after exposure to a patient with symptomatic HIV infection.

Blood-Borne Pathogens↗
PubMed1987

Comparative analysis of the effectiveness of the diaphragm and birth control pill during the first year of use among suburban adolescents.

Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based adolescent health service were interviewed at least one year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least one month while remaining sexually active. Regular use (diaphragm every intercourse, missing less than or equal to 1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least one pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous and regular use of either method. Because both methods present specific problems for certain patients, we suggest that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

Adolescent↗
PubMed1990

Relationship between rate of patient enrollment and quality of clinical center performance in two multicenter trials in ophthalmology.

Those responsible for managing and overseeing multicenter clinical trials often express concern that differential rates of patients enrollment among participating clinical centers may be reflected in poorer compliance with study protocols or poorer patient care in the centers enrolling fewer patients. The purposes of the present investigation were (1) to determine whether rate of patient enrollment was related to other measures of clinical center performance in two multicenter clinical trials in ophthalmology, the Macular Photocoagulation Study (MPS) and the Early Treatment Diabetic Retinopathy Study (ETDRS), and (2) to compare findings from these two studies with findings reported from cooperative oncology groups. Percent of major data forms ever failing computerized edit was the only measure of performance examined that demonstrated a strong positive relationship to rate of patient enrollment in both studies under both analytic approaches employed (F test for linear trend in means and Spearman's rank correlation). In the MPS, but not in the ETDRS, percent of patients who had missed all visits scheduled during the past 12 months (inactive patients) also was related to rate of patient enrollment. However, the major finding from this investigation has been that it is not possible to predict overall performance of an individual clinical center based on rate of patient enrollment. Clinical centers enrolling fewer patients in these multicenter clinical trials performed in some areas as well as or better than centers enrolling larger numbers of patients.

Diabetic Retinopathy↗
PubMed1993

Job satisfaction and dissatisfaction amongst neonatal nurses.

This study was conducted against the background of the concerns expressed in the press about the difficulties in recruiting and retaining nurses and midwives who were trained and experienced in the field of neonatal nursing. A small study (N = 50) was undertaken in one regional unit using semi-structured interviews. The interview schedule covered a broad range of topics which were identified in the literature as exerting an influence on job satisfaction and dissatisfaction. A relationship between job satisfaction/dissatisfaction, staff turnover, and recruitment was demonstrated. Unfortunately the clinical regrading exercise had a complex effect, which could not be fully assessed within the narrow terms of reference of this study. Interestingly the majority of the respondents found their work stimulating and rewarding. However, the overriding factor which was said to exert a negative influence at work was the way their individual contribution to neonatal care was valued by senior medical and nursing/midwifery colleagues.

Humans↗
PubMed1986

Attitudes of breast-feeding mothers: a survey of 649 mothers.

A consecutive sample of 1525 mothers were interviewed in hospital after delivery and breast-feeders were interviewed again 12 months later at home. This paper examines the attitudes of mothers to their breast-feeding experience in terms of their enjoyment, satisfaction, embarrassment, how they would choose to feed their next baby should they have one and whether they would encourage their friends to breast-feed. Mothers' attitudes to breast-feeding were strongly associated with the number of children they had, how definite they had been during pregnancy about wanting to breast-feed, the problems they encountered whilst establishing breast-feeding and how embarrassing they found breast-feeding. The length of time mothers breast-fed was also closely associated with the views they expressed concerned breast-feeding.

Attitude↗
PubMed1988

The social meanings of nervios: a case study of a Central American woman.

This paper analyzes nervios among Central American refugees living in the United States. Nervios is analyzed as personal descriptions of distress, statements about family relations, and commentaries on the broader social forces affecting people's lives. A description of the clinical presentations of 28 Salvadorans who suffer from nervios and an indepth analysis of an extended interview with a nervios sufferer are presented to examine the multiple meanings of nervios. Nervios is identified as a powerful idiom of distress used by Latinos to express concerns about physical symptoms, emotional states, and changes both in the family and in the broader society.

Adaptation, Psychological↗
PubMed1991

Creutzfeldt-Jakob disease from allogeneic dura: a review of risks and safety.

Surgeons and the lay public have recently expressed concern over the safety of allogeneic dura as it relates to the transmission of Creutzfeldt-Jakob Disease. Indeed, two cases have resulted from use of tissue procured from a commercial agency that did not adhere to criteria accepted by the American Association of Tissue Banks or the Southeast Organ Procurement Foundation. This review discusses the risks and safety of allogeneic dura. The findings should reassure the surgeon of the safety of allogeneic dura when it is properly processed and catalogued by a bona fide, reputable tissue bank. To date, there have been no documented cases reported to the Center for Disease Control in which Creutzfeldt-Jakob Disease was transmitted from allogeneic dura obtained from a registered tissue bank.

Adult↗
PubMed1994

Preventing morphological disturbances in burn-scarred children wearing compressive face garments.

Continuous external compression in the form of elasticized garments is a well-accepted and substantiated form of management for postburn hypertrophic scarring. Children who have sustained deep partial thickness and/or full skin thickness burns to the face and head are frequently prescribed elasticized compressive face garments in the post-acute stage of their recovery. Recurrent concerns expressed by parents prompted investigation into the frequency of sleep disturbances, such as snoring subsequent to the application of face garments, and the possibility of changes to the developing dentition. This preliminary study utilized a single case design to demonstrate the effectiveness of a bimaxillary mouthguard in circumventing such problems.

Bandages↗
PubMed1996

Results of the 1993 association of residents in radiation oncology survey.

In 1993, the Association of Residents in Radiation Oncology (ARRO) conducted its tenth annual survey of all residents training in radiation oncology in the United States. The characteristics of current residents are described. Factors influencing the choice of Radiation Oncology as a medical specialty, and posttraining career plans were identified. Residents raised issues on the adequacy of training, problems in work routine, and expressed concerns about board certification and recertification, and about decreased future practice opportunities.

Adult↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations.

Up to 50% of the 36 months of resident training in emergency medicine may be on off-service rotations. The experience on these rotations can lack educational content and opportunity pertinent to emergency medicine. The resident rarely has readily available and structured guidance to optimize training in terms of the anticipated needs of the specialty. In response to this problem, the authors have written curricula containing subject content listings, objectives, and supplied references for 16 off-service rotations. A plan for implementing the materials and an example from the obstetrics-gynecology rotation is given. After 12 months' experience, the authors have subjective responses from residents and off-service program directors that support the value of this information. Positive reports include: Residents having a better understanding of faculty expectations, improved "consistency of experience," residents appreciating the added attention, improved performance, and expanded reading efforts. One expressed concern is "too much to read." The project continues to evolve.

Curriculum↗
PubMedDate not supplied

Tailoring nicotine addiction treatments for chemical dependency patients.

The growing scientific evidence for addressing nicotine addiction in chemical dependency (CD) treatment programs is reviewed. This evidence provided the impetus for a survey of smoking patterns and quitting motivation and barriers among CD patients to identify ways to tailor standard nicotine addiction treatment methods and goals to their needs. Smoking history questionnaires were administered to 118 consecutive patients in a residential CD treatment program. The 66% of patients who smoked were predominantly heavy smokers, highly addicted (mean 25 cigarettes per day, 76% smoking within 30 minutes of waking). Although 63% of patients were "precontemplators," most of the sample had a history of one or more serious quit attempts, most reported strong beliefs in smoking harms and quitting benefits, and almost half reported a strong desire to stop smoking. Major quitting barriers included the usual psychological and physical sequelae of tobacco abstinence in addition to being around other smokers. Surprisingly, very few patients expressed concerns that quitting smoking would threaten drug or alcohol sobriety. Treatment implications are discussed. In addition, a pilot 4-session group treatment program is described. This program was geared to motivating smokers in "precontemplation" and "contemplation" stages of change to move ahead into the "action" stage (i.e., taking steps to quit).

Adult↗
PubMedDate not supplied

Physical activity programs offered in substance abuse treatment facilities.

Responses from 50 practicing therapeutic recreation specialists indicate that physical activity programs are an important part of substance abuse treatment. Walking, games, sports, weight training, and aerobics were offered most frequently. Respondents expressed concern about their academic preparation in physical activities and offered suggestions for curricular revision. Recreation or activity therapists responding to this survey indicated that additional coursework would have prepared them more thoroughly to facilitate physical activity programs. Coursework suggested included: physical education, exercise programming, aerobics, aquatics, and physical assessment. Data indicated that over half the respondents received specialized training in physical activities after graduation through continuing education.

Adult↗
PubMed1987

The accuracy of surface-contamination measurements; survey of UK hospitals, 1986.

In response to a number of concerns expressed at both national and international levels, the National Physical Laboratory (NPL) conducted a survey of UK hospitals and associated Regional Radiation Protection Services. Sources of surface contamination were distributed and participants were requested to measure these and interpret the relevant responses in terms of emission and activity per unit area. The analysis of the returns demonstrates that the vast majority of results was significantly in error and that the quality of radiation protection may be impaired.

Hospitals↗
PubMedDate not supplied

Preventing day-care--related illnesses.

The number of children enrolled in out-of-home day care has increased dramatically. One of the concerns expressed about the use of day care is the contribution of group settings to childhood morbidity. Children who are placed in groups of other children experience more illnesses than their peers who remain at home. However, disease transmission can be minimized by infection control behaviors. Unfortunately, day-care staff and parents are often inadequately prepared in such behaviors. Consequently, by becoming involved in day care, nurses can play a role in reducing the number of day-care--related illnesses.

Caregivers↗
PubMed1993

A developmental approach to sexuality education: implications for medical practice.

Medical professionals are increasingly expected to address issues of sexuality and acquired immunodeficiency syndrome (AIDS) with young patients and their parents. Focus group interviews were conducted with parents (n = 43) and adolescents (n = 800) to determine the preferred physician role regarding families and sexual development. Parents believed that a physician was an appropriate expert to assist in preventing negative risk behaviors (e.g., drugs, alcohol, sexual intercourse) and emphasized the importance of the physician developing a comfortable relationship early on with parents and youth to allow for reciprocal dialogue about sensitive topics. Parents also commented that physicians generally appeared uncomfortable when discussing personal issues (viz., sexuality) and frequently lacked communication skills (e.g., use of open-ended questions or statements) to foster conversation. Youth identified physicians as a logical source of information about sexuality but felt hesitant to ask questions that might prompt value-based discussion. Youth also expressed concern about confidentiality in the doctor-patient relationship. Adolescents desired physicians to be more "askable" than they are perceived to be. Guidelines are offered for strengthening office interactions and improving communication skills.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The relationship between perceived and objective cognitive functioning in multiple sclerosis.

The relationship between perceived cognitive functioning and objective cognitive functioning was studied in 221 patients with multiple sclerosis. Perceptions of global cognitive functioning as well as perceptions of performance on specific cognitive tests were assessed. Patients' perceptions of global cognitive functioning in their daily lives were unrelated to their objective performance on the full cognitive test battery. However, patients' perceptions of their performance on specific tasks correlated with their objective performance on those tasks, even though they underestimated their performance on these tasks. The present study also evaluated predictors of patients' perceived cognitive functioning. Depression, anxiety, fatigue, and level of disability predicted perceptions of global cognitive functioning, whereas objective cognitive performance did not. These results add to our understanding of patients' expressed concerns regarding their cognitive functioning in the wake of multiple sclerosis, suggesting that such concerns should be interpreted with caution by clinicians.

Adult↗
PubMed2006

Physicians' counseling of patients when prescribing nicotine replacement therapy.

AIMS: Nicotine patches and gum are now available without a prescription in many countries. Some have expressed concern that allowing access to these medications without a prescription may deprive smokers of the instruction and support they would otherwise have received from their physician. We assessed the value of physician involvement in NRT prescription. DESIGN AND PARTICIPANTS: We analyzed data interviews from 993 subjects who had filled prescriptions for patch (n=669) or gum (n=324) about physician behavior when prescribing patch and gum when these were available only by prescription. FINDINGS: 82% of smokers actually met with the physician; however, only 67% received some instruction in using the medication; only 50% were told about potential side effects; and substantial fractions were prescribed a dose that differed from that recommended on the usage instructions (patch: 24%; gum: 33%). Participants who received no intervention from their physicians were significantly more likely to be abstinent than those participants who received smoking cessation advice and support, likely because physicians offered help to those who most needed it, biasing the association. CONCLUSIONS: These findings suggest that physicians did not typically perform the helpful behaviors often expected of them or attributed to them.

Attitude of Health Personnel↗
PubMed2005

Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee.

Since 2002, 4 states have enacted legislation that requires health care organizations to publicly disclose health care-associated infection (HAI) rates. Similar legislative efforts are underway in several other states. Advocates of mandatory public reporting of HAIs believe that making such information publicly available will enable consumers to make more informed choices about their health care and improve overall health care quality by reducing HAIs. Further, they believe that patients have a right to know this information. However, others have expressed concern that the reliability of public reporting systems may be compromised by institutional variability in the definitions used for HAIs, or in the methods and resources used to identify HAIs. Presently, there is insufficient evidence on the merits and limitations of an HAI public reporting system. Therefore, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has not recommended for or against mandatory public reporting of HAI rates. However, HICPAC has developed this guidance document based on established principles for public health and HAI reporting systems. This document is intended to assist policymakers, program planners, consumer advocacy organizations, and others tasked with designing and implementing public reporting systems for HAIs. The document provides a framework for legislators, but does not provide model legislation. HICPAC recommends that persons who design and implement such systems 1) use established public health surveillance methods when designing and implementing mandatory HAI reporting systems; 2) create multidisciplinary advisory panels, including persons with expertise in the prevention and control of HAIs, to monitor the planning and oversight of HAI public reporting systems; 3) choose appropriate process and outcome measures based on facility type and phase in measures to allow time for facilities to adapt and to permit ongoing evaluation of data validity; and 4) provide regular and confidential feedback of performance data to healthcare providers. Specifically, HICPAC recommends that states establishing public reporting systems for HAIs select one or more of the following process or outcome measures as appropriate for hospitals or long-term care facilities in their jurisdictions: 1) central-line insertion practices; 2) surgical antimicrobial prophylaxis; 3) influenza vaccination coverage among patients and healthcare personnel; 4) central line-associated bloodstream infections; and 5) surgical site infections following selected operations. HICPAC will update these recommendations as more research and experience become available.

Cross Infection↗