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PubMed1996

Quality assurance in Swiss University Hospitals: a survey among clinical department heads.

OBJECTIVE: To obtain information to help design and implement quality improvement programmes. DESIGN: Questionnaire survey. SETTING: Swiss University Hospitals. STUDY PARTICIPANTS: Clinical Department heads. MAIN OUTCOME MEASURES: Attitudes towards quality assurance and percentage of departments with procedures for measurement and improvement of structure, process and outcome of medical care. RESULTS: Among 138 departments responding, 69 indicated a designated person or group in charge of quality and 57 were involved in collaborative quality improvement programmes. Mortality data at the level of the department was unavailable to 33% of respondents, and data on adverse treatment effects to 67% of them. Most respondents (69%) favoured the use of outcome indicators for quality control; only 13% favoured indicators pertaining to process or structure of care. Among indicators of outcome, patient satisfaction was the preferred indicator (25% of respondents), followed by morbidity (16%) and mortality (12%) data. CONCLUSION: Although the quality of medical care in Switzerland enjoys an excellent reputation, this study highlights important gaps in the information system and the processes necessary to evaluate quality.

Adult↗
PubMed1997

The relationship between perceived evaluation of weight and treatment outcome among individuals with binge eating disorder.

OBJECTIVE: This study was designed to explore among individuals with binge eating disorder (BED) perceptions of others' evaluation of their weight-related behavior and affect aroused by such. METHOD: Prior to treatment for binge eating and weight loss, 47 subjects diagnosed with BED completed a questionnaire designed to assess the perceived evaluation of an understanding and a critical individual in both positive and negative weight-related situations and subjects' affective responses to being evaluated. RESULTS: Subjects exhibited characteristic patterns of affective response to perceived evaluation of their weight-related behavior, with negative situations and critical evaluators evoking greater degrees of negative affect. Negative affect in response to perceived evaluation was associated with poor outcome with weight loss but not binge eating. However, this finding was due to the correlation between negative affect in response to perceived evaluation and global severity of psychopathology (SCL-90-R). DISCUSSION: The results suggest that psychopathology in this population predicts poor outcome with weight loss, and further that independent of its relationship with depression, psychopathology is strongly associated with a tendency to experience negative affect in response to perceived evaluation by others of weight-related behavior.

Adult↗
PubMed2000

What are the factors associated with the follow-up preferences of women in long-term remission from gynaecological cancer?

We set out to examine factors associated with follow up preferences of women attending routine hospital follow up after treatment for early stage gynaecological cancer. This was a retrospective cohort study, using hospital records and questionnaire data, and was based in North Staffordshire, UK. Fifty-four women, who had undergone successful treatment for early stage gynaecological cancer and currently attending routine hospital follow up appointments, were studied. Follow-up preferences were established using a specially designed questionnaire. A questionnaire package containing psychological and demographic measures was used. Clinical details including site and stage of disease, treatment and follow-up type were obtained from medical records. There were no significant demographic or clinical differences between the women with preference for hospital follow-up and those women with a preference for discharge. Women with a preference for follow-up were found to have significantly higher anxiety (as measured by the MAC anxiety scale). These results were not found for the other anxiety scales (STAI and HADS). Three predictor variables (MAC anxiety, Education and Car ownership) were found to predict significantly group membership. It is not possible to predict follow-up needs using demographic, clinical or psychological factors. Follow-up needs are achieved through effective medical communication. The role of the specialist nurse is implicated. A larger scale study is necessary to elaborate this preliminary research.

Journal Article↗
PubMedDate not supplied

[Quality of life assessment in patients with blepharoptosis].

PURPOSE: To assess the health-related quality of life in blepharoptosis patients and the impact after surgical management on their quality of life. METHODS: Twenty-one patients with congenital or acquired blepharoptosis completed a questionnaire which was adapted from the Visual Function Questionnaire (VFQ), before and after surgical management. RESULTS: Mean preoperative score was 74 and mean postoperative score was 81 and there was a statistically significant difference between mean pre- and postoperative scores of 7 (p=0.004). There was a statistically significant difference only for the mental health subdomain (p=0.001) in the evaluation of the questions (alpha=0.002) and subdomains (alpha=0.004). CONCLUSION: The quality of life in blepharoptosis patients was significantly better after surgical management in the assessment using the VFQ. The outcomes emphasize the need for of using questionnaires designed specifically for this disease.

Adult↗
PubMedDate not supplied

Hepatitis C--knowledge & practices among the family physicians.

BACKGROUND: Hepatitis C virus (HCV) is an important cause of end stage chronic liver disease worldwide. There is plethora of informations on hepatitis C virus in the recent hepatology related periodicals. However, family physicians to whom such patients initially present, should be aware of various aspects of hepatitis C virus infection. Therefore, the present study evaluated the information on hepatitis C virus known to practicing family physician in the state of Punjab. MATERIAL & METHODS: Nine hundred thirty six family physicians were randomly selected from 7 districts of Punjab and were mailed a questionnaire designed to test their knowledge on HCV, its transmission, clinical presentation, complications and treatment. In addition, questions were asked to assess commonly employed mode of therapy for short duration illnesses and the practice of reusing syringes/needles. All question had unequivocal answer. The questionnaire reply was anonymous. RESULTS: Only 28% (n = 262) doctors returned the questionnaire. The response to different sections of questionnaire was variable. Seventy six percent doctors (n = 176) were aware that HCV is parenterally transmitted. 18% (n = 41) doctors were still reusing needles and syringes. Fifty eight percent (n = 134) doctors considered hepatitis C as a common cause of acute viral hepatitis. Only 72% (n = 166) of doctors knew about the relevant tests for diagnosis of hepatitis C. CONCLUSIONS: Despite having knowledge about parenteral route of transmission of HCV infection, a sizeable proportion of family physicians in the Punjab state continues to reuse needles and syringes. Information on the virology, clinical presentation, diagnostic tests and management approaches were lacking among a substantial proportion of family physician. Therefore, awareness about HCV need to be increased among the practicing physicians.

Clinical Competence↗
PubMed1995

Health promotion in primary care: physician-patient communication and decision making about prescription medications.

To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we are interested in how communication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in enabling patients to increase control over their health involves developing their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report focuses on communication and decision making about prescription medications, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instruments were employed to collect data about physicians, patients and their consultations: a Video Analysis, which allowed assessment of actual communication behavior; a Patient Questionnaire designed to gauge perceptions of the encounter and collect demographic information; a Medical-Record Review, which provided information on utilization, diagnosis and treatment; a Telephone Interview, conducted 14 days after the consultation to obtain follow-up information (e.g. experience with the prescribed medication); and a Doctor Questionnaire that focused on attitudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering their opinion or initiating discussion about any aspect of the treatment. We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abilities to follow through with the treatment plans. The research design proved useful in highlighting discrepancies between perceived and actual communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicited patients' opinion about the prescribed medication and discussed risks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when, in fact, they had not been mentioned at all. The pattern of results illustrates the complexity of health promotion in primary care, and underscores the importance of attending to both perceived and actual communication in medical encounters.

Adolescent↗
PubMed2003

Directing student response to early patient contact by questionnaire.

CONTEXT: First year medical students experienced early patient contact by observing outpatient consultations. OBJECTIVES: To evaluate a questionnaire designed to examine emerging attitudes during the development of a doctor-patient relationship. METHODS: First year medical students participated in medical outpatient consultations as observers. These consultations represented a total of 295 registered clinical appointments. After each observation, the students completed a questionnaire surveying themes related to the doctor-patient encounter. An instructor met the students at the end of the appointments to discuss the questions raised. The Dundee Ready Education Environment Measure was used to assess the course environment. RESULTS: Students found the activity useful and enjoyable. They reported increased self-esteem and enhanced enthusiasm for the study of medicine. They completed write-ups describing and evaluating the questionnaire data. The questionnaire notes showed homogeneity among the students. The Dundee Measure indicated the students regarded the learning environment positively (62.2%); social and ambient conditions were rated highly (64.6% and 64.7%, respectively). CONCLUSION: The teaching of humanitarian attitudes by observation of the doctor-patient relationship in practice was welcomed by students. The environment in which this educational programme was carried out was considered adequate. The outpatient service schedule and the limited time available for student instruction on the part of staff doctors made this activity productive. The programme motivated students towards higher achievement and the pursuit of medical responsibility as well as more developed humanitarian behaviour patterns.

Ambulatory Care Facilities↗
PubMed1998

Effect on attendance at breast cancer screening of adding a self administered questionnaire to the usual invitation to breast screening in southern England.

STUDY OBJECTIVE: The primary aim of the research described in this paper was to ascertain whether inclusion of a self administered questionnaire with the usual invitation to routine breast screening affected screening uptake. Secondary aims included establishing appropriate questionnaire distribution and collection methods within the framework of the National Health Service Breast Screening Programme and optimisation of questionnaire design. DESIGN: Randomised study. SETTING: Oxfordshire and West of London Breast Screening Units. PARTICIPANTS/METHODS: 6400 women invited for routine screening mammography were individually randomised to receive either the usual breast screening invitation alone, or to receive the usual invitation accompanied by a self administered questionnaire, to be returned at the time of screening. Participants were then followed up and attendance rates at screening were compared between groups. MAIN RESULTS: Screening attendance rates were similar in women who did and did not receive a questionnaire (71% in each group). Of those who were sent a questionnaire and attended for screening, 77% returned a completed questionnaire. Screening uptake was not affected by the way in which the questionnaire was returned or by whether or not personal details and signed permission for follow up were requested. CONCLUSIONS: The inclusion of a self administered questionnaire accompanying the invitation to breast screening did not adversely affect screening uptake. A high proportion of women completed the questionnaire.

Breast Neoplasms↗
PubMed2006

[Validation of a scale to measure ill-treatment of women].

OBJECTIVES: To analyse the validity of content and of structure and the reliability of a questionnaire designed to measure ill-treatment (IT) of women by their partners. DESIGN: Descriptive, transversal, multi-centre study. SETTING: Four urban health centres in Granada, Spain. PARTICIPANTS: Three hundred and ninety one women of 14 and over who consulted in primary care and had a stable partner for at least 3 months. MAIN MEASUREMENTS: Questionnaire by means of interviews between December 2000 and May 2001, with 10 Likert-like questions on physical, psychological, and sexual mistreatment, social and demographic questions and various health indicators. We analysed content validity by means of exploratory factorial analysis, reliability of alpha-Cronbach factors and of corrected scale-item correlation coefficients, and structure validity. RESULTS: We obtained 2 empirical IT factors that did not correspond to the theoretical dimensions of physical, psychological, and sexual mistreatment and explained 64.21% of variance. The first included all the questions on psychological abuse, one on physical abuse and the sexual abuse dimension. The second covered the remaining questions on physical IT and "breaking things in the home". The factors gave reliability coefficients of 0.8688 and 0.7072. Comparison by means of extreme groups technique showed that the questionnaire's structure is valid. CONCLUSION: We found this was a reliable and valid questionnaire for evaluating ill-treatment of women. Its use, particularly in primary care, could help expand and deepen understanding of the problem.

Adult↗
PubMed2004

Living with classical galactosemia: health-related quality of life consequences.

OBJECTIVE: Classical galactosemia (McKusick 230400) is an autosomal recessive disorder of galactose metabolism caused by a deficiency of galactose-1-phosphate uridyltransferase (EC 2.7.712). Treatment, consisting of a severe restriction of dietary galactose, is life saving, but most patients develop abnormalities despite this diet. The aim of this study was to study the influence of galactosemia on the patients' health-related quality of life (HRQoL), on educational levels, and on the specific galactosemia-related concerns of these families. METHODS: Age-specific HRQoL questionnaires, a classical galactosemia-specific questionnaire designed by the authors, and a list of questions regarding educational attainment were handed out or sent to all 75 members of the Dutch Galactosemia Society and their families. RESULTS: Sixty-three (84%) patients with classical galactosemia from 58 families returned the questionnaire. Concerning HRQoL, significant differences between patients aged 1 to 5 and healthy children were found on the domains of abdominal complaints and communication. Patients aged 8 to 15 years differed from their healthy peers on the domain of cognitive function. Mothers of patients aged 6 to 15 reported a significantly lower HRQoL on the domains of motor and cognitive function. Patients 16 years and older had significant lower scores on the domains of cognitive and social function. The percentage of patients who attend special schools is significantly higher than in the general population, and the educational attainment is significantly lower in patients with classical galactosemia. CONCLUSIONS: This is the first study to describe the HRQoL of patients with classical galactosemia using well-developed and validated instruments in different age groups. The results of the present study indicate that having galactosemia negatively influences the HRQoL. Early and regular evaluation and support of possible cognitive problems should be a major part of the protocol for the follow-up of patients with classical galactosemia.

Adolescent↗
PubMedDate not supplied

[Impact of integrated asthma treatment on the patients' quality of life].

BACKGROUND: Patient's perception about the effect of disease's manifestations on daily activities is called health-related quality of life, and it is used to evaluate the individual response to treatment. At present, there are some questionnaires designed to evaluate it. OBJECTIVE: To evaluate the effect of integral treatment dosage on quality of life in asthmatic adults. MATERIAL AND METHODS: A prospective, longitudinal and experimental study was made. We included male and female adult patients, with allergic asthma. A standardized questionnaire of quality of life was applied to all of them in every visit, for eight times. The integral treatment was based on Global Initiative for Asthma judgments. RESULTS: Ten patients were included, 70% of them were women. The media age was 37.4 +/- 15.73 years old. The asthma was diagnosed as intermittent in 10% cases, mild persistent in 20%, moderate persistent in 20% and severe persistent in 50% patients. The group of age most frequently affected was that of 20 to 30 years old. The media index of quality of life was 2.43 +/- 0.91 at the first visit and it was 5.73 +/- 1.11 at eighth visit. It was found a significant difference. CONCLUSION: Integral treatment improves quality of life in asthmatic adults.

Activities of Daily Living↗
PubMed1993

A survey of the use of live animals, cadavers, inanimate models, and computers in teaching veterinary surgery.

A questionnaire, designed to gather information regarding the use of live animals, cadavers, inanimate models, and other innovative methods to teach veterinary surgery, was mailed to individuals in the surgery sections of all 31 veterinary schools in the United States and Canada. Of the 31 questionnaires mailed, 27 (87%) were completed and returned. Mean number of total, general, small-animal, and large-animal surgery laboratory sessions were 22, 5.9, 11, and 7.4, respectively. At 7 of 26 (27%) schools, animals were euthanatized prior to recovery from anesthesia in all teaching laboratories; in 18 schools (69%), small animals were euthanatized prior to recovery from anesthesia. In 4 (20%) of the 20 schools that offer large-animal laboratory courses, large animals were euthanatized prior to recovery from anesthesia. In 24 schools (88%), cadavers, models, or both were used in at least 1 laboratory session in their surgery training program. Models were used most frequently to teach suturing, knot typing, and hemostasis. Plastic bones were used in 8 (30%) schools to teach fracture repair. In several schools, models were used to teach other general psychomotor skills, and at several schools, models were available for sale to other teaching institutions. At 16 (59%) of the 27 veterinary schools, some type of program has been developed with local humane societies. At 13 (81%) of the 16 schools with such a program, small animals were euthanatized prior to recovery from anesthesia in their traditional laboratories. At 10 (37%) of the schools, some process was used to evaluate students in the laboratory, and at 5 (19%), course evaluations were completed by students taking the laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Welfare↗
PubMed1995

Current state and trends in minimal access surgery in Europe.

The outcome of the two questionnaires designed to determine the current state and trends in minimal access surgery (MAS) conducted amongst members of the European Association of Endoscopic Surgery (EAES) from April to June 1992 and subsequently the same period in 1993 are presented and compared. For the first questionnaire the data were received from 266 surgical departments in Europe and 360 departments in 1993 responded to the second survey. In both instances the same forms were used. The questionnaire was focused on basic aspects of MAS, the motives, the procedures performed, attitudes to training and different aspects of equipment used. This communication presents a comparison of the outcome of the survey as available from 182 departments participating and responding to both the first and second questionnaires. The outcome of both surveys confirms that laparoscopic cholecystectomy became a better alternative to open surgery and is the cornerstone of abdominal MAS. Antireflux procedures, thoracoscopic operations and staging laparoscopy form a solid base for future development and the spread of MAS.

Data Collection↗
PubMed2006

Evaluation of risk factors for Cryptococcus gattii infection in dogs and cats.

OBJECTIVE: To determine risk factors associated with Cryptococcus gattii infection in dogs and cats residing on Vancouver Island in British Columbia, Canada. DESIGN: Matched case-control study. ANIMALS: 20 dogs and 29 cats with C gattii infection and matched controls. PROCEDURE: Dogs and cats with a confirmed or probable diagnosis of cryptococcosis resulting from infection with C gattii were enrolled by veterinarians, and owners completed a questionnaire designed to obtain information pertaining to potential risk factors for the disease. Owners of matched control animals were also interviewed. Odds ratios and 95% confidence intervals or paired t tests were calculated to determine significant associations. RESULTS: Animals were enrolled during 2 noncontiguous periods in August 2001 to February 2002 (8 dogs and 9 cats enrolled) and May to December 2003 (12 dogs and 20 cats enrolled). Risk factors significantly associated with development of cryptococcosis included residing within 10 km of a logging site or other area of commercial soil disturbance, above-average level of activity of the animal, travelling of the animal on Vancouver Island, hunting by the animal, and owners hiking or visiting a botanic garden. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that dogs and cats that were active or that lived near a site of commercial environmental disturbance had a significantly increased risk of developing C gattii infection. Veterinarians should communicate these risks to owners in context because cryptococcosis was an uncommon disease in this population.

Animal Husbandry↗
PubMed1999

Tobacco smoking contributes little to facial wrinkling.

BACKGROUND: The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias. OBJECTIVE: This study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior. SUBJECTS: Eighty-two smokers (> 10 cigarettes per day) and 118 non-smokers (< 100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling. METHODS: Three dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P < 0.1 level of independent significance. RESULTS: Overall the model accounted for 75.4% (P = 0.0001) of the variance in wrinkling, and predictive variables (P < or = 0.02) included age (partial R2 = 0.69), smoking pack years (R2 = 0.04), hours of outdoor work (R2 = 0.008), freckling (R2 = 0.007), and eye color (R2 = 0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P < 0.08) included education (partial R2 = 0.08), smoking pack years (R2 = 0.05), hours of outdoor work (R2 = 0.03), weight change (R2 = 0.02), female sex (R2 = 0.02), hours of lifetime sun (R2 = 0.03), tanning bed use (R2 = 0.01), and sunscreen use (R2 = 0.02). CONCLUSIONS: Smoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.

Adult↗
PubMed2004

Reproducibility, validity, and responsiveness to change of a short questionnaire for measuring fruit and vegetable intake.

The reproducibility, relative validity, and responsiveness to change of an eight-item food frequency questionnaire designed to measure fruit and vegetable consumption was assessed among 157 women (mean age = 41 years) in the Netherlands from spring 2001 to spring 2002. Plasma concentrations of vitamin C and total and specific carotenoids served as biomarkers against which validity was assessed. The questionnaire was completed and biomarker concentrations were determined three times: immediately preceding and following a controlled intervention of 1 month aimed at increasing fruit and vegetable consumption and 1 year after the start of the intervention. The 1-month and 1-year reproducibility of total fruit and vegetable consumption assessed in the control group was 0.80 and 0.79 (Spearman's r ). Correlations between consumption and plasma carotenoids and vitamin C at baseline were 0.39 and 0.37, respectively, for fruits and 0.24 and 0.26, respectively, for vegetables. Correlations between changes in consumption and plasma carotenoids and vitamin C were 0.32 and 0.33, respectively, for fruits and 0.28 and 0.30, respectively, for vegetables. On the basis of similar correlations reported in the literature, the authors conclude that the questionnaire appears to be suitable for ranking individuals according to their consumption of fruits and vegetables and according to changes in their consumption. However, the validity of the questionnaire remains to be established in males, other age groups, and populations of lower educational levels.

Adult↗
PubMed1998

[Use of a questionnaire for quick identification of the principal foci of urinary bilharziasis in central Ivory Coast].

Simple questionnaires designed for use in schools have been used to identify communities at high risk for urinary schistosomiasis in several African countries but not in the Cote d'Ivoire. The primary purpose of this study was to assess the acceptance and feasibility of the school questionnaire approach in the Cote d'Ivoire. Questionnaires were distributed to 136 schools in central Cote d'Ivoire. Responses were obtained within 6 weeks from 124 schools (91.2%). A total of 12,479 school children were interviewed. At 60 schools, reagent stick tests were performed within two weeks to detect microhematuria by trained teachers. A biomedical team was sent to 14 selected schools to check results by reagent stick testing and urine filtration. Reagent stick tests showed high specificity (97%) and moderate sensitivity (67%). A strong statistical correlation was observed between responses to two key questions concerning "blood in urine" and "having had schistosomiasis" and the results of reagent stick testing (Spearman rank correlation, p < 0.0001). Our findings are in good agreement with previous reports. Using the data obtained, we were able to accurately map the distribution of urinary schistosomiasis in the study area. Use of this questionnaire for quick identification of high risk communities for urinary schistosomiasis was recommended as a preliminary step in the planned national control program and should allow better targeted of scarce resources.

Child↗
PubMed2006

Resident education regarding technical aspects of cesarean section.

OBJECTIVE: To survey obstetric/gynecologic residents around the country regarding different technical aspects of and indications for cesarean section, trends in vaginal birth after cesarean (VBAC) and patient choice of cesarean. STUDY DESIGN: A questionnaire was designed to address the above issues and selected demographic information. The questionnaire was sent by e-mail to all the residency programs in the country. The first 400 responses were analyzed. RESULTS: Although a midline vertical incision is considered faster for entry into the abdomen, 77% of residents use a Pfannenstiel incision for urgent/emergency cesarean sections. Fifty-five percent of respondents use single-layer closure of the uterine incision, 37% use double-layer closure, while 11% use single-layer closure only in patients undergoing concomitant sterilization. When questioned regarding a trial of labor, one-third of respondents stated that they would not induce labor in patients with a prior cesarean if the patients did not go into labor spontaneously but offer repeat cesarean for fear of a uterine rupture. Further, 42% said that they would never offer VBAC for an undocumented scar, 12% would and 45% would depending on the history. Regarding the issue of cesarean section by patient request, 94% would not offer an elective cesarean section for uncomplicated primigravidas, while 6% would. However, if a well-informed patient desired an elective cesarean delivery, the majority of residents would respect the patient's request. CONCLUSION: There is wide variation in the way residents are trained regarding different technical aspects of and indications for cesarean section, choice of repeat cesarean versus VBAC and patient choice of cesarean. Recent trends in the literature are not always reflected in reported practice patterns.

Cesarean Section↗