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PubMed2001

Knowledge, attitudes and practices regarding evidence-based medicine and outcome assessment: a survey of British Columbia cataract surgeons.

BACKGROUND: While the advantages of practising evidence-based medicine are well-documented, it is frequently suggested that doctors' attitudes are a major roadblock to its implementation. We carried out a survey to determine the knowledge, attitudes and practices of British Columbia cataract surgeons regarding evidence-based medicine and outcome assessment. METHODS: The survey was conducted in the spring of 1999. The study population was drawn from the directory of the British Columbia College of Physicians and Surgeons. A 16-item questionnaire designed to elicit the knowledge of, attitudes toward and use of evidence-based medicine and outcome assessment was sent to all surgeons performing cataract surgery in British Columbia. RESULTS: Of the 103 eligible participants, 70 (68%) returned completed questionnaires. Surgeons affiliated with the University of British Columbia were more likely to respond than those not affiliated with the university (81% vs. 58%) (p < 0.05). Most surgeons (89%) viewed the responsibility of monitoring quality of care as primarily their own. Although 79% of the respondents felt that outcome assessment is an effective method for determining quality of care, less than half (49%) reported that they routinely include some form of outcome assessment in their clinical practice. There was wide variation in the respondents' understanding of the nature of outcome assessment and evidence-based medicine. Respondents professed little inclination or motivation to committing time or resources to an outcome program. They also expressed concerns over the use of outcome data for external management activities. INTERPRETATION: Cataract surgeons in British Columbia clearly appreciate the advantages of outcome assessment, but translation of this understanding into practice is limited. There appears to be a need for further education on outcome assessment and evidence-based medicine through academic bodies and professional societies.

British Columbia↗
PubMed2005

Changes in iodine excretion in 50-69-y-old denizens of an Arctic society in transition and iodine excretion as a biomarker of the frequency of consumption of traditional Inuit foods.

BACKGROUND: Iodine intake in Greenland has been hypothesized to exceed 10 times the recommended amount. The transition from a traditional Arctic society may change the iodine intake, but no field studies have been performed. OBJECTIVE: We aimed to ascertain iodine intakes, factors affecting iodine intake in circumpolar populations, and the usefulness of urinary iodine excretion as a biomarker for validation of Inuit food-frequency questionnaires. DESIGN: Data were collected in a cohort study of 4 Greenland population groups: Inuit living in the capital city, the major town, and settlements in East Greenland and non-Inuit. Supplement use and lifestyle factors were evaluated with questionnaires, and dietary habits were ascertained with a food-frequency questionnaire. Iodine was measured in spot urine samples. RESULTS: One percent of the population of Greenland was invited, and the participation rate was 95%. Less than 5% of Inuit but 55% of non-Inuit had urinary iodine excretion < 50 microg/24 h. Median urinary iodine excretion declined with the degree of decrease in the traditional lifestyle: it was 198, 195, 147, and 58 microg/24 h among Inuit in settlements, town, and city and in non-Inuit, respectively (P < 0.001). Participants were divided into diet groups calculated from Inuit food frequency. Iodine excretion decreased with increasing intake of imported foods (P < 0.001). In regression models, type of diet and the subject's lifestyle, sex, weight, ethnicity, and intake of iodine-containing supplements affected urinary iodine excretion. CONCLUSIONS: Circumpolar non-Inuit are at risk of iodine deficiency. Departure from the traditional Inuit diet lowers iodine intake, which should be monitored in Arctic societies. Urinary iodine excretion may be a useful biomarker of traditional Inuit food frequency.

Aged↗
PubMed2005

Validation of a parent outcome questionnaire from pediatric cochlear implantation.

This paper analyzes the reliability and validity of a questionnaire designed by Archbold, Lutman, Gregory, O'Neil, and Nikolpoulos (2002) for the assessment of pediatric cochlear implantation. Parents of 61 youngsters (age range 5 to 16 years), who had the implant for at least 3 years, responded to the questionnaire and to an interview. The alpha reliability of the 11 questionnaire scales varied between .41 and .74. Content validity was assessed by comparison with parents' responses to an interview. In general, there was agreement between parents' concerns and views expressed in the interview and as assessed by the questionnaire. However, extra issues were identified in the interview, which suggest the need for increasing the breadth of the questionnaire. Criterion validity was assessed by identifying contrasting cases, with very low or very high scores in each scale, and analyzing the descriptions obtained in the interviews. For nine scales this analysis provided support for the validity of the questionnaire; two scales did not produce positive results. Correlations with interview scores were calculated for only four scales: two were positive and significant whereas two were not significant. A factor analysis of the questionnaire scales identified four components, interpreted as the child's functioning in social situations, attitudes to the process of implantation, support required in the long term, and effective use of the implant. Suggestions for further research and descriptive comments provided by parents are included.

Adolescent↗
PubMed2006

Reliability and validity of the ESRD Symptom Checklist--Transplantation Module in Norwegian kidney transplant recipients.

BACKGROUND: The aim of the study was to validate the Norwegian version of a self-administered 43-item questionnaire designed to assess quality of life in kidney transplant recipients, the End-Stage Renal Disease Symptom Checklist--Transplantation Module (ESRD-SCL). METHODS: In total, 53 kidney transplant recipients from one university-affiliated hospital responded to a questionnaire including the ESRD-SCL and the Short Form 36 (SF-36). We assessed internal consistency reliability and test-retest reliability with 2 weeks between assessments. Construct validity was assessed by correlations of the ESRD-SCL subscales with related and unrelated SF-36 scales, demographic, and clinical characteristics. RESULTS: Subscales of the ESRD-SCL showed good internal consistency reliability (Cronbach's = 0.72-0.81) and for the aggregate total scale alpha was 0.94. Test-retest reliability median 14 days apart was excellent with intraclass coefficients ranging from 0.87 to 0.95. The pattern of correlations of the ESRD-SCL scales with related and unrelated scales SF-36 scales and demographic and clinical characteristics gave support to the construct validity of the ESRD-SCL. CONCLUSION: The Norwegian translation of the ESRD-SCL showed satisfactory internal consistency reliability, test-retest reliability and construct validity, at the level of the original German version.

Adult↗
PubMedDate not supplied

Patient and family perspectives on early discharge and care of the older adult undergoing fractured hip rehabilitation.

PURPOSE: To examine the impact of enhanced early discharge on families experiencing repaired hip fracture in an older adult. DESIGN: Qualitative. SAMPLE: Convenience sample of 23 care recipients over the age of 60 years who had experienced a hip fracture and their caregivers. METHODS: Families were interviewed 4 to 6 weeks postdischarge from the hospital. Prior to the interview a questionnaire designed to measure intra-family strain was mailed to the main caregiver. The resulting narratives were analyzed for recurring themes. FINDINGS: A high number of clients and their families experienced a high degree of mismatched care, especially in relation to care received by nursing staff. This perception was not influenced greatly by location (i.e., hospital or community) and was exacerbated during periods of transition. CONCLUSION: Heightened communication involving clients and families, especially during transition from hospital to home, may lessen family/client perceptions of mismatched care. IMPLICATIONS FOR NURSING RESEARCH: Communication methods, role clarification of the professional nurse, and the ability to provide more holistic care during transition phases of health care are areas that need to be explored and developed.

Adult↗
PubMed2005

Effective rehabilitation for children and adolescents with brain injury: evaluating and disseminating the evidence.

OBJECTIVE: To develop and evaluate literature reviews of the effectiveness of rehabilitation interventions for children with brain injury. DESIGN: We wrote 6 research summaries, which were evaluated by study participants. SETTING: Community. PARTICIPANTS: A convenience sample that included 18 parents of children with brain injury, 18 service providers, and 12 insurance industry representatives. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Questionnaire designed for the evaluation of printed material. RESULTS: Few articles were found that focused on evaluation of rehabilitation interventions for children with brain injury. Study participants were representative of a broad range of educational and professional backgrounds. Before reading the research summaries, service providers reported greater familiarity with the topics than did parents and insurance representatives. Despite this finding, there were no significant between-group differences in the format, content, and impact ratings provided by the 3 participant groups. CONCLUSIONS: Research summaries written in a clear, straightforward manner are appropriate for people with different educational and professional backgrounds. Further research into the effectiveness of rehabilitation interventions is needed to support informed decision-making that results in the best outcomes for children with brain injury.

Adolescent↗
PubMed2003

Evaluation of self-management education for asthmatic patients.

Self-management of asthma, achieved through an effective educational program for asthmatic patients, is very important in facilitating adaptation to illness and positive response to treatment. An effective self-management plan helps patients to gain information about and skills in life style modifications, self-monitoring, and environmental control. The study, both descriptive and analytic, was planned as a means to evaluate the need of asthmatic patients for self-management education and to design supportive educational programs. The study group consisted of 42 adult patients who were chosen randomly from among patients treated in the Chest Diseases Department of the Medical Faculty of Istanbul University. The following evaluation tools were used: St. George Respiratory Questionnaire, a questionnaire designed by the research team, and patients' asthma diaries. The survey form designed by the research team included questions about demographic characteristics, asthma triggering factors, and morbidity factors. An asthma educational program, consisting of one session that lasted for 120 minutes, was implemented by doctors and nurses in cooperation and, 2 months later, patients were followed up. After completion of the educational program, it was found that patients related their health during the last month and the extent to which they drew benefits from their treatment with higher scores, the result clearly stating that the impact of asthma on their lives has experienced a decrease. The educational program was thus implemental in improving the quality of patients' lives. Results have finally shown that our educational program can be used as a model by other health care centers in our country.

Activities of Daily Living↗
PubMed2001

Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study.

OBJECTIVES: To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have "Gulf war syndrome," to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not. DESIGN: Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health. PARTICIPANTS: 2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%). MAIN OUTCOME MEASURE: The proportion of veterans who believe they have Gulf war syndrome. RESULTS: Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome. CONCLUSIONS: Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice.

Adult↗
PubMed2003

Neonatal encephalopathy and cerebral palsy: a knowledge survey of Fellows of The American College of Obstetricians and Gynecologists.

OBJECTIVE: To assess practicing obstetricians' knowledge of the etiology and pathophysiology of neonatal encephalopathy and its relationship to cerebral palsy. METHODS: A questionnaire designed to test both knowledge and practice patterns was mailed to 413 members of the Collaborative Ambulatory Research Network of The American College of Obstetricians and Gynecologists (ACOG), as well as 600 randomly selected non-Network ACOG Fellows. The questionnaire was composed of 15 knowledge questions and three clinical scenarios containing seven knowledge questions. Six of the questions directly assessed knowledge of cerebral palsy. RESULTS: Of those who returned the questionnaire, 351 practiced obstetrics and were included in the statistical analyses. For the majority of questions, "Don't know" was the most frequent response. The next most frequent response for 8/13 questions was the correct answer. Performance was strongest as regarded actual clinical practice and relatively weak regarding the antecedents of neonatal encephalopathy and cerebral palsy. The physicians' actual knowledge scores showed a significant correlation with their self-assessments of knowledge (r =.41, P <.001). The majority of physicians rated their training on this topic in medical school, residency, and through continuing medical education as marginal or inadequate. CONCLUSION: The results of this survey identified large knowledge gaps in this area, suggesting a need to develop educational projects to address these deficits by both professional organizations and individual teachers.

Adult↗
PubMed2003

Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States.

OBJECTIVE: To assess whether intake of fruits and vegetables was associated with change in body mass index (BMI) among a large sample of children and adolescents in the United States. DESIGN: Prospective cohort study of children and adolescent who were 9-14 y of age in 1996, when the study began. SUBJECTS: The subjects included 8203 girls and 6715 boys in an ongoing cohort study who completed at least two questionnaires between 1996 and 1999. MEASUREMENTS: Fruit and vegetable intake was assessed in 1996-1998 with a validated food frequency questionnaire designed specifically for children and adolescents. The outcome measure was change in age- and gender-specific z-score of BMI (kg/m(2)). Self-reported weight and height, which were used to calculate BMI, were collected annually from 1996 to 1999. RESULTS: During 3 years of follow-up, annual changes in BMI were slightly greater among the boys than the girls. After controlling for Tanner stage of development, age, height change, activity and inactivity, which are known or suspected predictors of change in BMI, among the girls there was no relation between intake of fruits, fruit juice, or vegetables (alone or combined) and subsequent changes in BMI z-score. Among the boys, intake of fruit and fruit juice was not predictive of changes in BMI, however, vegetables intake was inversely related to changes in BMI z-score (beta per serving=-0.003). However, after adjusting for caloric intake, the magnitude of the effect was diminished and no longer significant. CONCLUSION: Our results suggest that the recommendation for consumption of fruits and vegetables may be well founded, but should not be based on a beneficial effect on weight regulation.

Adolescent↗
PubMed1997

Effects of a self-administered previsit questionnaire to enhance awareness of patients' concerns in primary care.

OBJECTIVE: To determine if a self-administered previsit questionnaire designed to increase awareness of patients' concerns alters the visit duration, content of the discussion, and patient and physician satisfaction. DESIGN: A balanced, two-arm trial in which physicians were randomized. SETTING: Two primary-care clinics affiliated with a university hospital. PATIENTS/PARTICIPANTS: Ten physicians and 201 continuity-care patients. INTERVENTIONS: In intervention visits, patients completed a previsit questionnaire asking about the desire for medical information, psychosocial assistance, therapeutic listening, general health advice, and biomedical treatment. Physicians reviewed questionnaires with patients during the visit. MEASUREMENTS AND MAIN RESULTS: We used audiotapes of encounters to quantify the duration of the encounter and measured the number and type of diagnoses discussed in the visit, and patient and physician satisfaction with the encounter. Intervention visits were 34% longer (increase of 6.8 minutes; 95% confidence interval [CI] 0.4, 13.2) than control visits with most of the additional time spent in discussion of biomedical diagnoses (3.35 minutes; 95% CI 0.00, 6.72) and in the performance of the physical examination (2.7 minutes; 95% CI 0.5, 4.9). The number of diagnoses discussed per visit was 30% higher in intervention visits (increase of 1.7 diagnoses per visit; 95% CI 0.3, 3.2), but patients' satisfaction with these visits tended to be lower. CONCLUSIONS: Using a previsit questionnaire to increase awareness of the patients' concerns may entail a trade-off between conflicting goals: trying to respond to patient concerns while not significantly increasing the cost per visit. A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respond adequately to patients' concerns.

Adult↗
PubMed2005

The health workforce crisis in TB control: a report from high-burden countries.

BACKGROUND: Human resources (HR) constraints have been reported as one of the main barriers to achieving the 2005 global tuberculosis (TB) control targets in 18 of the 22 TB high-burden countries (HBCs); consequently we try to assess the current HR available for TB control in HBCs. METHODS: A standard questionnaire designed to collect information on staff numbers, skills, training activities and current staff shortages at different health service levels was sent to national TB control programme managers in all HBCs. RESULTS: Nineteen HBCs (86%) replied, and 17 (77%) followed the questionnaire format to provide data. Complete information on staff numbers at all service levels was available from nine countries and data on skill levels and training were complete in six countries. Data showed considerable variations in staff numbers, proportions of trained staff, length of courses and quality of training activities. Eleven HBCs had developed training materials, many used implementation guidelines for training and only three used participatory educational methods. Two countries reported shortages of staff at district health facility level, whereas 14 reported shortages at central level. There was no apparent association between reported staff numbers (and skills) and the country's TB burden or current case detection rates (CDR). CONCLUSION: There were few readily available data on HR for TB control in HBCs, particularly in the larger ones. The great variations in staff numbers and the poor association between information on workforce, proportion of trained staff, and length and quality of courses suggested a lack of valid information and/or poor data reliability. There is urgent need to support HBCs to develop a comprehensive HR strategy involving short-term and long-term HR development plans and strengthening their HR planning and management capabilities.

Journal Article↗
PubMed1989

A comparison of nurses' and patients' perceptions of intensive care unit stressors.

This study was designed to compare intensive care unit (ICU) nurses' and patients' perceptions of the stressfulness of items in the environment for patients in an ICU. The sample consisted of 20 ICU patients and 23 registered nurses employed in the medical and surgical ICUs at a large midwestern university hospital. The patients were contacted 1 to 2 days after transfer from an ICU and asked to complete the Intensive Care Unit Environmental Stressor Scale (ICUESS), a Likert-type questionnaire designed to measure the stressfulness of commonly occurring items in the ICU environment. The nurses were asked to complete the same questionnaire as they believed an ICU patient would complete it. They were asked to complete the questionnaire after the completion of a shift worked in an ICU. A series of one-way ANOVAs were done to compare the patients' and nurses' responses. In every comparison, nurses rated the items as being significantly more stressful than did the patients. Items with the highest mean ratings by patients were: (1) having tubes in your nose or mouth; (2) being stuck with needles; (3) being in pain; (4) not being able to sleep; and (5) being thirsty. Patients and nurses also were asked to list the three most stressful items from the ICUESS. These responses were compared using chi-square tests for homogeneity. Nurses mentioned 'being tied down by tubes' and 'not being in control of oneself' significantly more times than did patients. The items 'being in pain', 'having tubes in your nose or mouth', and 'not being able to sleep' were listed most often by both nurses and patients.

Adult↗
PubMed2004

Marfan syndrome in Europe.

OBJECTIVES: Marfan syndrome (MFS) is a relatively frequent systemic connective tissue disorder with an important physical morbidity and mortality. The influences of MFS on physical problems, perception of severity, and impact on the quality of life and psychosocial well-being have been studied only limitedly. The aim of this study was to assess the association between the severity derived from the reported symptoms and subjectively experienced severity of MFS (expressed as a global judgment), with special emphasis regarding impact on relationships and pregnancies, psychosocial adjustment, and differences between the seven European countries. METHODS: A questionnaire designed specifically for this study and translated in each of the native languages was sent to 2,080 members of one of the patient support groups in Belgium, Denmark, France, Germany, The Netherlands, Switzerland, and the United Kingdom. 857 MFS patients of 13 years and older completed the questionnaire and were included in the data analysis. RESULTS: Physical impairments were scored by perception of severity of physical symptoms by the patients (physical severity perception score) and by their perception of the influence of MFS on their life (subjective severity score). Main discrepancy between physical severity perception and subjective severity score was the higher percentage of patients scoring in physical severity perception as severe (53.5%) compared to subjectively severe (26.5%). 61% of those who scored on the physical severity score as severely affected were designated as being mildly-moderately affected on subjective scoring. Both severity scores increased significantly with age. Two hundred-twenty women have carried 430 pregnancies (1.95 pregnancies/woman), with cardiovascular complications in 1.6%. Prenatal studies for MFS were rejected by 7.6% of MFS patients of 25 years and older, 33.6% were undecided, and 48.5% favored prenatal diagnosis for MFS if available. A positive general self-image was reported by 91.5% of patients. However, more than 90% stated that MFS had a negative influence on their sexual relationships, which they ascribed to negative perception of their body image. CONCLUSIONS: MFS has significant impact on daily life activities, but the majority of patients come to terms with their condition. Acceptance is mainly determined by subjective severity, and less by physical symptoms as reported by the patients themselves. It is important to stimulate a positive attitude towards MFS.

Adolescent↗
PubMed1982

Increased child abuse in families with twins.

Close spacing of children may be a significant risk factor for subsequent abuse in some families. Twin births are an extreme example of close spacing. Therefore, the authors hypothesized that twin births may predispose to an increased incidence of child abuse. Thirty-eight families with twins were compared with 97 single birth families and matched for birthdate, maternal age, race, and socioeconomic status. Families with twins experienced a significantly higher incidence of child abuse and neglect than did those with single births (p less than .003). A written questionnaire designed to study mothers' feelings and perceptions of support systems showed a significant difference only in greater difficulty in feeding twins as compared with single infants (p less than .001). Mothers of abused children were more likely not to answer the questionnaire at all (p less than .005). Neither mothers of single births nor those of twins felt that health professionals provided adequate education or support following the birth of their infants.

Child Abuse↗
PubMed1990

Identifying the needs of coronary patient wife-caregivers: implications for social workers.

Ninety-three women married to men who had experienced major medical crises resulting from coronary heart disease responded to a mail questionnaire designed to elicit the needs directly or indirectly created for them by their husbands' disease. The three areas of need--education, prevention, and support services--selected for evaluation had not been submitted previously for assessment with this population. Responses to the questionnaire indicated strong needs in all three areas. The results of the survey have implications for intervention with families by professionals in the areas of assessment, programming, and the professional's relationship to individual members of this population.

Adult↗
PubMed1999

Sodium hyaluronate--application in a community practice.

This office tracked the clinical results of 73 patients who received sodium hyaluronate for their knees, as well as two ankle patients and one elbow patient. A questionnaire designed to evaluate six areas of function-relief of pain, stiffness, walking tolerance, pain while negotiating stairs, swelling, night symptoms--was mailed to patients who had received the series of five sodium hyaluronate injections. Ninety-five percent of the questionnaires were completed and returned. We found that injectible sodium hyaluronate is a viable treatment option for properly selected patients, namely those with mild to moderate osteoarthritis of the knee. We found that it relieved pain and stiffness in most patients. The majority of patients were willing to repeat the treatment if necessary. Sodium hyaluronate allows the physician to relieve patient pain in early stages of the disease and to manage the patient comfortably until surgery is a viable option. With the appropriate precertification and billing protocol, reimbursement should not be an obstacle in using this product.

Adjuvants, Immunologic↗
PubMedDate not supplied

Occupational therapy for independent-living older adults. A randomized controlled trial.

CONTEXT: Preventive health programs may mitigate against the health risks of older adulthood. OBJECTIVE: To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults. Design.-A randomized controlled trial. SETTING: Two government subsidized apartment complexes for independent-living older adults. SUBJECTS: A total of 361 culturally diverse volunteers aged 60 years or older. INTERVENTION: An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months. MAIN OUTCOME MEASURES: A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms. RESULTS: Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02). CONCLUSIONS: Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.

Activities of Daily Living↗