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PubMed2006

Providing patients with reviews of evidence about COPD treatments: a controlled trial of outcomes.

Studies in many countries have identified gaps between what is known from research evidence and what is done in clinical practice. Merely making research evidence available to practitioners does not cause much change in their behaviour, and researchers are now looking for more effective ways to improve the implementation of evidence. We report outcomes at three months of a parallel group trial of an evidence based patient manual designed to improve implementation of evidence by the patient's doctors. The patient manual was produced with extensive patient and professional input. It contained summaries of the evidence for treatments used in COPD (chronic obstructive pulmonary disease) and prompted discussion of evidence with doctors. Participants in the intervention arm of the trial (n = 125) were supplied with the manual and participants in the control arm (n = 124) were supplied with a pamphlet about COPD produced by the Australian Lung Foundation. The primary outcome measure (rates of current influenza vaccination and bone density testing) was an indicator of evidence based management of COPD. Secondary outcomes were quality of life (mastery component), satisfaction with information, communication with usual doctor, and anxiety. At three months no pattern of benefit in outcome measures was found for either group. Process measures showed high levels of personal use of the manual but progression to conversations with doctors for fewer than half of participants, and little treatment change. The findings highlight the difficulties of promoting changes in health behaviour and show that even when all stakeholders are consulted success is not guaranteed. Further research is required to identify those patients most likely to use manuals such as the one reported here, and how to make patient mediated interventions more effective for a greater proportion of the target population.

Aged↗
PubMed2006

The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research.

OBJECTIVES: The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice. METHODS: Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study. RESULTS: Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain. CONCLUSIONS: There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

Emergency Medicine↗
PubMed1983

Community networking for improved services to children with chronic illnesses and their families.

The authors describe a program, developed under the auspices of the Association for the Care of Children's Health (ACCH), that focuses on community networking among children with chronic illnesses and their families. The program rests on two beliefs: (a) that a network can successfully focus on the generic needs of children with chronic or handicapping conditions and of their families; and (b) that a network can improve care by enhancing coordinating collaboration among existing services without creating new ones. Efforts of the past two years have centered on three specific areas: preparation and dissemination of written materials; creation of new links among families, health and education professionals, organizations, associations, and community institutions; and training in networking techniques. ACCH has prepared two pamphlets for families, schools, and health professionals on community issues and on hospitalization. In addition, a demonstration model for community networking has been established in the Houston/Galveston area. Finally, training programs in the skills of community networking have been established. Work is beginning to replicate the community networking model through other ACCH regional affiliates.

Child↗
PubMed2000

The relation of communication to risk judgment and preventive behavior related to lead in tap water.

More and more communities are becoming concerned about health risks posed by lead and other health hazards in their drinking water. Our study, applying the model of innovation diffusion to the adoption of preventive health behaviors, found that reliance on health professionals for information about lead in tap water was associated with residents perceiving risk from this hazard, their sense of efficacy in dealing with it, and their adoption of preventive behaviors. Mass media and pamphlets mailed directly to residents were relatively ineffective. Results suggest that interpersonal channels may be the best way to reach individuals who live in areas of highest risk from tap water lead.

Communication↗
PubMed2003

Examining influences of pharmacists' communication with consumers about antibiotics.

A national study was conducted of community pharmacists to examine influences on their communication with consumers about antibiotics and antibiotic resistance. The objective was twofold: to explore the nature of barriers that might be changed to allow pharmacists greater participation in educational campaigns, and to discover which variables would best predict communication using a modification of the Theory of Reasoned Action model. Whereas most pharmacists agreed that their role in educating patients is important, they also noted several barriers prevent them from engaging in campaigns, such as time constraints, lack of educational materials, and fear of harming relations with physicians. Pharmacists' discussion about antibiotics in general was predicted primarily by attitudes about their role and efficacy, by their autonomy, and by enabling measures-such as pamphlets-that would better aid them in participating in a judicious antibiotic use campaign. Discussion about resistance was predicted by attitudes and enabling measures.

Adult↗
PubMed1982

Actual and intended health-related information seeking and health locus of control.

Individuals with an internal health locus of control orientation and high health value have been found to express an intent to obtain a greater mean number of health pamphlets than people with an external orientation and/or low health value. After measures of behavioral intent were obtained, college students were afforded the opportunity to actually receive health-related written information. The previously stated finding was replicated for intended but not for actual health-related information seeking. The weak relationship found between actual and intended information seeking calls into question studies using intent measures as if they were almost identical to actual behavior.

Adult↗
PubMed1999

[Development and assessment of the pharmaceutical management and guidance services for inpatients considering clinical value and economy].

We developed pharmaceutical management and guidance services for inpatients in a ward of circulatory medicine, considering clinical and economical standpoints. In these services, pharmacists deliver drugs prescribed for inpatients with individual drug information papers, explain to them about their drugs using information papers and give counsel. Since most of the patients were aged people, developing many kinds of diseases and taking many kinds of drugs, they had many problems such as lack of knowledge of the effects of drugs. First, we surveyed views of patients, physicians and nurses on these services. Consequently, all of them advised us that "pharmacists should explain to patients about the prescribed drugs using information papers." The patients preferred pharmacists as expositors of drugs to physicians or nurses. The physicians considered that "pharmacists have to attach importance to clinical information and package-inserts of drugs and explain to patients about drug information using pamphlet in response to the understanding of patients." The nurses wanted to cooperate with pharmacists in "improving medication compliance." On the basis of these views, we improved our services. Next, we made a survey of patients' knowledge about their drugs. We found that in the patients the level of knowledge concerning "ways," "effects" and "reasons" of taking drugs and that of "compliance" and "satisfaction in taking drugs" were improved through these services. The patients reentered in the hospital kept a high level. The ratio of patients taking drugs by themselves increased. Last, we also applied this method to wards of "blood and collagen diseases" and "pediatrics." The demand for these services increased smoothly. We compared these services based on our method with all other services by hospital pharmacists from the viewpoint of economy. We found that only our service method was beneficial.

Drug Therapy↗
PubMed2003

HIV in insurgency forces in sub-Saharan Africa - a personal view of policies.

The special requirements for HIV-prevention programmes by armed forces or insurgency groups in very poor countries that are in active conflict have not been well described. Customary military programme components include: education on sexually transmitted diseases, condom distribution, and HIV testing. Programmes for these armed forces must address: a command structure that may not prioritize this activity, severe resource and logistical constraints, weak health systems for treating sexually transmitted illness, beliefs in traditional medicines for symptoms of sexually transmitted illness, illiteracy that diminishes the utility of educational pamphlets, rape and sexual bartering by soldiers, battlefield transfusions, tattooing and the co-epidemic of tuberculosis.

Africa South of the Sahara↗
PubMed2006

Lyon Playfair (1818-1898) and compulsory vaccination.

Lyon Playfair was born in India but brought up by his uncle in St Andrews. He studied medicine in Glasgow and Edinburgh but never practised as a doctor. Instead he worked for the chemist Thomas Graham in London and then studied for a PhD with Liebig in Germany. While serving on a government commission he became very interested in public health, particularly the control of infectious diseases. In 1883, while a member of parliament, he made a passionate speech in support of a government bill in favour of compulsory vaccination against smallpox. He was violently attacked for his speech in a pamphlet by William White, an adherent of the teachings of the Swedish mystic Emanuel Swedenborg. Playfair died in 1898 and is buried in St Andrews.

History, 19th Century↗
PubMed1990

The nutrition information sources of elderly New Zealanders.

A questionnaire was sent to 230 elderly New Zealanders selected at random from the age/sex registers of medical practitioners to investigate their current usage and perceptions of nutrition information sources. The sample selected was representative of the New Zealand elderly population in terms of age, sex, and socioeconomic status distribution. Forty five per cent of respondents indicated they had obtained nutrition information in the past twelve months. Doctors (GP's) were the most common source of nutrition information--used by 20% of the respondents--and many also considered them to be the most reliable and trustworthy. Newspapers and magazines were considered to be the least reliable source of nutrition information. Approximately two thirds of respondents expressed a desire for more nutrition information; pamphlets and GP's were the favoured sources. This study suggests lower socioeconomic groups of elderly people are less receptive audiences for nutrition information. As other research indicates these elderly people are also at greater nutritional risk, reaching these groups present a major challenge to nutrition educators.

Aged↗
PubMed1979

Representations of homosexuality in health science textbooks.

Discussions of homosexual behavior in 35 publications (textbooks, trade books, pamphlets) in the fields of health science and sex education were reviewed. Ten books referred to the subject. Major findings of the study were: homosexual behavior receives significant attention in only 1 of the 10 publications; discussions of homosexuality contain a number of hidden biases; a large number of factual errors can be identified in most publications; and most authors seem to believe that homosexual behavior may be tolerated during adolescence but, at the same time, should be a source of concern to teenagers.

Attitude↗
PubMed1985

Kertbeny and the nameless love.

The word homosexuality, in its German form Homosexualität, was first used in an anonymous pamphlet published in Germany in 1869. Documentary evidence is given here confirming that the writer Karl Maria Kertbeny was its author. A sketch of Kertbeny's life is given, along with a discussion of the historical background and reasons for his introduction of the new terminology. The role that this and rival terminologies played in the changing attitudes toward homosexuality is traced through the following century in Germany, concluding with the reclaiming of the derogatory word schwul by the modern gay movement.

Europe↗
PubMed1997

Horizontal wires replace the vertical files.

Traditionally, clippings of newspaper articles, pictures from magazines, pamphlets, charts, graphs, posters, proceedings, or copies thereof, and other miscellaneous information sources have been stored in vertical files in libraries. The practice of creating and maintaining vertical files is extremely time consuming. In a medical library, in particular, old information about diagnosis, treatment, and prognosis can quickly become incorrect, misleading, and possibly harmful. Adequately tending to the vertical files can require a librarian to create a balancing act between properly maintaining vertical files and meeting the needs of the users in other areas of the library. The maintenance of vertical files is, by nature, highly consumptive of paper and space consuming. A reasonable alternative to the traditional vertical files is the World-Wide Web. Search engines exist for locating specific information, and bookmarks and/or links which point users to particularly useful sites can be set in search software. Some methods for searching are discussed, and a variety of World-Wide Web information sources are offered.

Computer Communication Networks↗
PubMedDate not supplied

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.

Adult↗
PubMedDate not supplied

Medication safety: patients' experiences, beliefs, and behaviors.

OBJECTIVE: To measure patients' experiences with medication errors and examine how these experiences relate to their beliefs about pharmacy safety and their engagement in medication-safety behaviors. DESIGN: Cross-sectional study. SETTING: Primarily Michigan. PARTICIPANTS: 920 employees and retirees from the University of Michigan. INTERVENTIONS: Mail survey. MAIN OUTCOMES MEASURES: Patients' experiences, beliefs, and behaviors related to medication safety. RESULTS: Of the respondents, 168 (18.3%) reported that they had experienced a medication error at some time in their lives and 193 (21.0%) knew a family member or friend who experienced an error; 63 (6.8%) had experienced an error within the past year and 5 (0.5%) had required additional medical attention because of an error. The majority of respondents did not worry about pharmacy safety and generally believed that the drug dispensing process at their pharmacy was safe. Approximately 80%-90% of respondents engaged in basic safety-related behaviors when receiving a prescription medication (e.g., checked for their name on the label or checked the directions on the label). While 72.3% of respondents reported that they read the medication pamphlet provided by the pharmacy, only 27.3% talked to the pharmacist about their medications. Respondents who had personal experiences with medication errors--or knew someone who had encountered such errors--had lower perceptions of pharmacy safety and were more likely to engage in several safety-related behaviors. CONCLUSION: Patients who have experienced medication errors have lower perceptions of pharmacy safety and are more likely to engage in behaviors to protect themselves from future errors, as compared with those who have not had an error experience.

Aged↗
PubMed1998

Information contents of drug advertisements: an Indian experience.

OBJECTIVE: To critically analyze the drug information contained in Indian pharmaceutical advertisements. DESIGN: Analysis of pharmaceutical advertisements supplied by drug representatives (DRs) to prescribers from July 1, 1995, to June 30, 1996. SETTING: A university-affiliated urban teaching hospital in India. PARTICIPANTS: 585 pharmaceutical ad pamphlets. MAIN OUTCOME MEASURES: The ads supplied by DRs to physicians in different clinical departments of the hospital were collected. These were distributed to different systems/categories and a special reference to fixed-dose drug combinations was given. The drug information contained in these ads was evaluated by using a checklist, framed by incorporating the World Health Organization ethical guidelines for medicinal drug promotion and some relevant items from other studies. RESULTS: The most frequently occurring ads were for antimicrobial agents. The ads on fixed-dose drug combinations constituted 37.9% of the total. More than 85% of the ads mentioned the generic name, brand name, contents, and pharmaceutical dosage forms, as well as the name and address of the company. The information concerning adverse effects, precautions, contraindications, warnings, major interactions, ingredients known to cause problems, pharmacology, drug overdose, references, drug storage, and cost was present in less than 40% of these ads. CONCLUSIONS: There has been inadequate information in pharmaceutical ads supplied by DRs to the physicians in India. The current scenario could be improved by formulating some definite legislative guidelines for the minimum level of information to be included in pharmaceutical ads and adhering to that legislation.

Advertising↗
PubMed1999

Role of anagrelide in the treatment of thrombocytosis.

OBJECTIVE: To review the role of anagrelide in the management of essential thrombocythemia. DATA SOURCES: A MEDLINE search (January 1966-August 1998) was performed using the key terms anagrelide, thrombocytosis, and essential thrombocythemia. In addition, the package insert, product monograph, and patient information pamphlets were reviewed. DATA SYNTHESIS: Recently, there has been a trend toward the use of anagrelide in the management of thrombocythemia. Anagrelide lacks leukemogenic and mutagenic potential and possesses a more favorable adverse effect profile compared with other therapeutic agents. At recommended doses, anagrelide induces thrombocytopenia in thrombocythemic patients with a concomitant reduction in the incidence of disease-related symptoms. CONCLUSIONS: Although the treatment of choice for thrombocythemia is still an area of debate, anagrelide has distinct advantages over alternative therapies. Anagrelide represents an important therapeutic option in the treatment of patients with thrombocythemia.

Humans↗
PubMed1999

Cancer control research and literacy.

Low literacy may be an important predictor of increased cancer risk and poor participation in cancer control programs. Results of the National Adult Literacy Survey indicate that about 90 million individuals, slightly less than half of the U.S. adult population, demonstrate low or limited literacy skills. In contrast, the average health education brochure, pamphlet, or instruction sheet requires a 10th-grade or higher level of reading ability to be understood. Guidelines exist for the development of more readable printed materials; studies have also found that nonprint approaches such as video education are viable alternatives to printed materials. Research on patient populations indicates that educational approaches targeted to low-literacy groups can be effective in reaching individuals with cancer control information. This review identifies the most important areas of needed research and makes recommendations for the development of a research agenda on cancer control and literacy.

Adult↗