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PubMed2002

2001 anthrax crisis in Washington, D.C.: clinic for persons exposed to contaminated mail.

An anthrax prophylaxis clinic is described. In October 2001, four workers from the U.S. Postal Service's Brentwood facility in Washington, D.C., were hospitalized with inhalational anthrax; many others may have been exposed to anthrax spores. U.S. Public Health Service (USPHS) teams were deployed to establish an anthrax prophylaxis clinic that would provide education and medication to workers and people who visited the mail facility. The temporary clinic was set up at D.C. General Hospital and was staffed primarily by health care professionals from USPHS. The protocol at the clinic involved three major phases. Phase 1 consisted of gathering information from the patient and distributing educational materials. Phase 2 involved presentations by a physician and a pharmacist concerning anthrax, followed by a question-and-answer session. In phase 3, a pharmacist selected the most appropriate prophylactic agent, dispensed the medication, counseled the patient, and referred patients with flu-like symptoms or skin lesions to a physician. Two floor plans were used to maximize the number of patients seen per hour without jeopardizing patient care. The clinic operated 14 hours a day for 14 days. The 136-member health care team included 52 pharmacists, and medication was dispensed to more than 18,000 patients. The clinic may serve as a model for pharmacists and other professionals in designing and implementing disaster plans. A multidisciplinary team established and operated a clinic to treat persons who may have been exposed to anthrax through contaminated mail.

Ambulatory Care Facilities↗
PubMed2000

Report of the Spanish Gaucher's disease registry: clinical and genetic characteristics.

BACKGROUND AND OBJECTIVES: Since 1993 the demographic, clinical, analytical, genetic and follow-up data of Spanish patients with Gaucher's disease (GD) have been collected in an anonymous national database. Some statistical analyses of these data are reported concerning the distribution, clinical and genetic characteristics of GD in Spain and the response to enzyme replacement therapy (ERT) is evaluated. DESIGN AND METHODS: We performed a cohort study in Spanish GD patients by national inquiry, submitted by mail to 75 Spanish hospitals (over 300 beds) directed to internal medicine, hematology and pediatric departments. The questionnaire included 30 questions (gender, height, weight, date of birth, date of diagnosis, abode and number of relatives affected, bone crises, neurologic symptoms, other symptoms, liver and spleen size, hemoglobin, leukocyte and platelet count, tartrate resistant acid phosphatase, ALT/AST, chitotrioxidase activity, total plasma cholesterol, triglycerides, high density lipoprotein cholesterol, enzymatic activity of acid -glycosides, mutation, X-ray examination, magnetic resonance imaging-MRI-evaluation, spleen removal, and orthopedic procedures (ERT, date of first infusion). Each case with a presumed diagnosis was considered an enrolled patient. Written informed consent was obtained from all patients. The cases without enzymatic or genetic diagnosis were studied in a reference laboratory (the same for all the samples). Clinical status was evaluated by Zimran's severity score index. The enzymatic activity of acid -glycosides was determined in cellular extracts of peripheral blood granulocytes by a fluorescent method using an artificial substrate (4-methyl-umbelliferyl -D-glycoside). Polymerase chain reaction (PCR) molecular analysis was performed in DNA samples to characterize the mutations (N370S, L444P, IVS2+1, 84GG, D409H, R463C and G377S) of the glycoside genes. Two groups were created according to age at diagnosis: children under 15 years and adults, in order to evaluate clinical, genetics and follow-up. Effectiveness of ERT was evaluated using objective parameters (hemoglobin, platelets, liver and spleen size, skeletal lesions), before and after therapy. In patients under ERT, quality of life (QOL) was assessed by a SF-36 modified inquiry, including 22 questions. Statistical analysis including descriptive and frequency distribution for each variable was performed, the ANOVA test was used to identify differences between groups. Paired t-tests (before and during therapy) were carried out. The degree of linear association among measured variables was estimated by Pearson's correlation. RESULTS: By December 1999 one hundred and fifty-five patients from 117 families had been included from 66 Spanish Hospitals; the inquiry was complete for 114 patients. Mean age at diagnosis: 24.0+/-16.9 years, M/F: 72/83. No symptoms were present at diagnosis in 19.3%; visceral disease was present in 95.6% and bone disease in 62.4%. Hemoglobin levels, leukocyte and platelet counts were below the normal range in 62.3% of cases. Higher acid phosphatase levels were observed in 99% of cases; biochemical liver dysfunction tests were found in 42.9%. The test for acid glycosidase showed a marked decrease in enzymatic activity. Morphologic documentation (spleen or liver tissue, bone marrow biopsy or aspirate) of GD was obtained in 71% of the patients. The most frequent mutations observed were N370S (46.3% of the alleles detected), and L444P (18.5%). In 18.7% of the cases the disease was stable or progressing slightly; in 23.8% the spleen had been removed between 1-14 years after diagnosis and 60.6% were under ERT. Children showed both greater liver enlargement and higher SSI (p = 0.0001). There was a correlation between SSI and clinical or analytical data in adults patients for spleen size (Z: 3.142; CI: 0. 173-0.637; p= 0.0017). In 35 patients on ERT, clinical and analytic data improved as did self-evaluated QOL (p< 0.0001). (A

Adolescent↗
PubMed2003

Do you know your students' basic clinical skills exposure?

BACKGROUND: Undergraduate medical education in the United States is changing. Many medical schools have developed a set of basic clinical skills (BCS) that all students are required to have mastered; however, very few have acquired objective information regarding specific student experiences. The purpose of this study was to determine the BCS encounters for junior medical students at a large midwestern university utilizing a handheld personal digital assistant (PDA). METHODS: A core curriculum of BCS was proposed and involved 52 procedures/skills. An electronic BCS database was developed utilizing HanDBase software and then placed on a PDA (Palm) and distributed to 25 third-year medical students randomly as they entered their clinical year. Students logged their skill encounters for 9 months and then electronically transferred the database by e-mail. RESULTS: Students participated in 1,115 procedural/skill encounters (range 17 to 90; median 41; average 44.6). Of the 52 core BCS, all students performed 10. Fewer than 50% of students had any exposure to very common skills. Thirty-four percent of skill encounters occurred at a county hospital, 19% at a clinic, 10% at a university hospital, 10% at a private hospital, 7% at a VA hospital, 4% at a children's hospital, and 16% at miscellaneous locations. CONCLUSIONS: The PDA devices were simple and convenient to use, while allowing for easy transfer and tabulation of database information by electronic mail. Significant gaps in BCS exposure were noted across the curriculum. Mentor sign-off on the PDA permitted early feedback opportunities. We can now begin to reward educators for skills mentoring and perform formal assessment of BCS within specific clerkships to enhance future educational objectives.

Clinical Clerkship↗
PubMedDate not supplied

Practicing procedures on the recently dead.

We sought to measure the prevalence of practicing procedures on the recently dead in emergency departments. Surveys were mailed to all medical students, interns, residents in Emergency Medicine, emergency physicians, and trauma team leaders working in the teaching hospitals of a city with a population of 600,000. Of 447 distributed surveys, 222 (49%) were returned. Participants were divided into learners and teachers. Of the learners (n = 162), 6 (4%) had practiced intubation and 4 (3%) had practiced pericardiocentesis on a recently dead patient. Of the teachers (n = 30), 8 (27%) had had learners practice intubation and 4 (13%) had had learners practice pericardiocentesis on a recently dead patient. Of the students and teachers who practiced procedures on recently dead patients, none had obtained consent. The prevalence of practicing procedures on recently dead patients appears to be less than has been reported previously. Intubation is the most commonly practiced procedure on recently dead patients. None of the participants obtained consent before practicing a procedure.

Cadaver↗
PubMedDate not supplied

Personnel resource distribution for nursing programs in Carnegie-classified Research I and II and Doctoral I institutions.

Increasingly, nursing education programs, like other major institutions in the United States, are being charged to "do more with less." How to acquire sufficient human and material resources is a continuing challenge in an era of economic constraint. Benchmark data on the distribution of personnel resources within nursing programs is nearly nonexistent. To assess the personnel resources of nursing programs of major size and stature within the United States, a Personnel Resource Survey was mailed to the universe of all nursing programs located in Carnegie-designated Doctoral I, Research II, and Research I universities and/or colleges in the United States (n = 96). The return rate was 58 per cent, with a useable survey rate of 51 per cent (n = 49). Comparative numbers and ratios of administrators, faculty, students, and various levels and types of support staff by Carnegie-type institutions are presented. Findings indicate that, overall, nursing programs in Research I universities had 1.5 to 2 times as many personnel resources per student than programs in Doctoral I and Research II institutions. Doctoral I and Research II programs closely resembled each other. The details of the data, as well as its standardization into full-time equivalents, are useful to both university and nursing administrators, faculty, and staff in their comparisons and procurement of needed resources.

Benchmarking↗
PubMed1992

Are we pushing the limits of public health interventions for smoking cessation?

The phenomenon of smoking cessation that takes place outside formal programs, which serve a small proportion of smokers, is an important public health issue. Self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large groups of smokers. In this issue of Health Psychology, Gritz, Berman, Bastani, and Wu (1992) demonstrate that the mailing of self-help smoking cessation materials to nonvolunteer women in a health maintenance organization, without any personal contact, produces little behavior change beyond what occurs in the environment without such distribution. This outcome is not surprising and does not illiminate the possibility of efficacious use of self-help materials with a nonvolunteer population. An essential question is: Could these materials have been distributed in such a way as to increase their use and eventual efficacy? Efforts to attract more smokers to use existing materials are an essential element of self-help strategies. An effective public health approach is a comprehensive one that successfully engages the individual and, through multiple channels in the community, provides reinforcement, supports, and norms for not smoking.

Behavior Therapy↗
PubMed2004

Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach.

The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.

Asthma↗
PubMed1991

Reporting errors in time-to-pregnancy data collected with a short questionnaire. Impact on power and estimation of fecundability ratios.

Few tools exist in reproductive epidemiology for studying adverse effects on fertility. Data on time to pregnancy (the number of menstrual cycles required to conceive) can be used to estimate fecundability ratios, a sensitive endpoint for identifying factors associated with reduced fertility. Time-to-pregnancy data can be collected in detailed interviews. The accuracy of data collected on brief, self-administered questionnaires is not known. In a study of occupational exposures to dental assistants conducted in 1987-1988, 523 women provided time-to-pregnancy data both on a short, mailed questionnaire and in a detailed telephone interview. The correlation between the two measures was 0.82. Assuming that the detailed data were accurate, reporting errors in data from the short form were distributed nondifferentially with respect to most covariates of interest in fecundability analyses. Simulation studies were conducted to estimate bias and loss of power from the misclassification. Bias was toward the null. Substantial power was lost in detecting weak exposures. However, exposures that reduce fecundability by 50 percent (equivalent to adding about three cycles to the median time to pregnancy) could still be detected with 80 percent power in samples of about 100 women (half of them exposed to a possible toxin). The authors conclude that time-to-pregnancy data collected with a few self-administered questions can be useful in a variety of epidemiologic studies, including occupational and environmental surveillance programs.

Bias↗
PubMedDate not supplied

Can leaflets assist parents in preparing children for hospital?

This article outlines the findings and implications of a small study designed to investigate the perceived usefulness of an information leaflet entitled 'Preparing your child for hospital: a parents' guide'. The study was carried out in an ear, nose and throat unit where children are admitted for elective surgery. A leaflet was developed and field tested before being mailed to a group of parents. An analysis of the data collected demonstrated considerable parental satisfaction with the information contained in the leaflet. The authors believe that similar leaflets should be routinely distributed to families with children awaiting hospital admission.

Adult↗
PubMed1983

Characteristics of estrogen-treated women. A descriptive epidemiological study of a Swedish population. Part II.

A cohort of 23 233 women who had received estrogen prescriptions was recruited for a prospective study of estrogen therapy and the associated risk of endometrial cancer. For a detailed study, a comprehensive questionnaire was mailed to 735 randomly sampled cohort members, and 89 per cent of them responded. Estrogen exposure and its implications were described in a preceding paper (part I). The present paper reports the distribution in the cohort sample of personal features known to be risk factors for endometrial cancer. A comparison with results from various materials derived from population-based surveys and case-control studies implied that the cohort members might have a lower proportion of nulliparity (infertility) and a somewhat higher prevalence of hypertension. Differences in the distributions of age at menarche or menopause, weight, height and prevalence of diabetes were according to these comparisons slight and probably without clinical significance. It was concluded that the prevalence of risk factors for endometrial cancer other than estrogen exposure was not higher in the cohort than in the background population. Moreover, approximately one-fifth of the estrogen takers had been freed of their risk through hysterectomies.

Adolescent↗
PubMed1998

Dietetic Internship: Evaluation of an Integrated Model.

The purpose of this study was to utilize graduate and employer perceptions of outcomes of the Mount Saint Vincent University (MSVU) Co-operative Education (Co-op) Dietetics program to determine if an integrated model was an acceptable alternate method of dietetic education. Acceptable alternate was defined as: "facilitating achievement of entry level competence for dietetic practice". A self-administered, validated and piloted questionnaire was utilized to collect qualitative and quantitative information concerning employability, professional preparedness and program outcomes. Surveys were mailed to all program graduates (1989-1993) (n=24) and their first employers (n=19). Response rates were 96% and 89% respectively. Close-ended questions were analyzed quantitatively by determining frequency distributions. Data were also subjected to Chi-square to identify dependent factors. Qualitative responses to open-ended questions were analyzed by thematic content analysis. Results revealed all graduates were employed by six months after graduation. Competency development, a component of professional preparedness, was rated as average or above average by the majority of graduates and employers. Analysis of open-ended responses indicated that the introduction of experience while students were establishing theoretical foundations was perceived as beneficial. An integration of qualitative findings led to the development of a model depicting how professional competency development, readiness for practice, a realistic approach to dietetic practice and a high standard of practice were developed within an evolving personal and contextual framework. Socialization and mentoring opportunities, evaluation processes and the integration of theory and practice influenced professional development. In conclusion, both employer and graduate responses indicated overall program satisfaction suggesting that the Co-op program is an acceptable alternate method of dietetic education.

Journal Article↗
PubMed2002

Physical therapists' perceptions of factors influencing the acquisition of motor abilities of children with cerebral palsy: implications for clinical reasoning.

BACKGROUND AND PURPOSE: Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. SUBJECTS: Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. METHODS: The nominal group technique was used to conduct the focus groups. RESULTS: Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). DISCUSSION AND CONCLUSION: The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.

Attitude of Health Personnel↗
PubMedDate not supplied

Effects of changing U.S. parenting styles on dental practice: perceptions of diplomates of the American Board of Pediatric Dentistry presented to the College of Diplomates of the American Board of Pediatric Dentistry 16th Annual Session, Atlanta, Ga, Saturday, May 26, 2001.

PURPOSE: This study surveyed board-certified pediatric dentists on their opinions about changes in U.S. parenting styles and the effects on the practice of pediatric dentistry. METHODS: A questionnaire was developed, piloted, and mailed to 1,129 members of the College of Diplomates of the American Board of Pediatric Dentistry during the summer of 2000. RESULTS: A total of 577 respondents (51%) returned questionnaires, equally distributed across AAPD districts, with male:female ratio of 4:1 and 90% married. A majority perceived parenting styles had changed during their practice lifetime (88% "absolutely or probably changed"), with older practitioners significantly more likely to say so. Ninety-two percent felt changes were "probably or definitely bad" and 85% felt that these changes had resulted in "somewhat or much worse" patient behavior. Practitioners report performing less assertive behavior management techniques than in the past due to these changes. CONCLUSIONS: Diplomates report that parenting changes have occurred and they believe these are negative (bad) and have adversely influenced behavior and caused changes in pediatric dentists' behavior management.

Adult↗
PubMed2003

Causes and effects.

Most companies make charitable donations, but few approach their contributions with an eye toward enhancing their brands. Those that do take such an approach commit talent and know-how, not just dollars, to a pressing but carefully chosen social need and then tell the world about the cause and their service to it. Through the association, both the business and the cause benefit in ways they could not otherwise. Organizations such as Avon, ConAgra Foods, and Chevrolet have recognized that a sustained cause-branding program can improve their reputations, boost their employees' morale, strengthen relations with business partners, and drive sales. And the targeted causes receive far more money than they could have from direct corporate gifts alone. The authors examine these best practices and offer four principles for building successful cause-branding programs. First, they say, a company should select a cause that advances its corporate goals. That is, unless the competitive logic for supporting the cause is clear, a company shouldn't even consider putting its finite resources behind it. Second, a business should commit to a cause before picking its charitable partners. Otherwise, a cause-branding program may become too dependent on its partners. Third, a company should put all its assets to work, especially its employees. It should leverage the professional skills of its workers as well as its other assets such as distribution networks. And fourth, a company should promote its philanthropic initiatives through every possible channel. In addition to using the media, it should communicate its efforts through the Web, annual reports, direct mail, and so on. Cause branding is a way to turn the obligations of corporate citizenship into a valuable asset. When the cause is well chosen, the commitment genuine, and the program well executed, the cause helps the company, and the company helps the cause.

Commerce↗
PubMed2006

Antenatal screening tests: knowledge and practice patterns of obstetricians in Utah.

We sought to assess knowledge and practices of obstetricians regarding antenatal testing and test the efficacy of continuing education via a direct mailing. In June 2004, an educational brochure entitled "New Options for Maternal Serum Screening for Birth Defects" as well as an anonymous survey pertaining to antenatal testing was sent to 241 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows residing in Utah. Data from the 85 (35%) respondents were analyzed. The majority of respondents practice obstetrics (81/85, or 95%). Of these, 67% of respondents perform sonograms routinely in their offices. Respondents were distributed evenly across all years of practice. Respondents offer HIV screening routinely (85%), but only 40% follow ACOG cystic fibrosis (CF) screening recommendations. Midtrimester serum screening is offered routinely by 89% of the respondents, but only 54% adequately understood the capabilities and limitations of the test. Questions related to the patient education brochure included in the mailing were answered correctly more often than the other questions. The brochure emphasized the usefulness of combined integrated screening for detecting Down syndrome, and 94% of respondents subsequently understood this concept. We show that in Utah, ACOG recommendations for HIV and maternal serum testing are being followed uniformly, but CF screening is still not being routinely offered. The accurate responses to questions related to an enclosed education brochure suggest that direct mailings may be useful for provider education, especially in regions where many providers practice remote from academic centers.

Cystic Fibrosis↗
PubMed2003

The West Midlands Matching Scheme 2000: a survey of participant satisfaction and outcomes.

CONTEXT: The West Midlands Matching Scheme has been in operation since 1999 and is one of a number of schemes used for the allocation of pre-registration house officer positions in the UK. METHOD AND RESULTS: A questionnaire was distributed amongst candidates applying to the scheme in 2000. A response rate of 73.7% was obtained (160 replies from a sample population of 217). Half the responders reported to be dissatisfied with the explanation of the matching scheme given. A total of 66.6% were satisfied with the scheme being run via the Internet and E-mail. For 6-month positions in medicine, 85% of the candidates were happy with the job they had received. The figures for surgical jobs were similar and for rotations even higher. However, 23.8% of the sample was missing one or two jobs at the end of the matching process. This figure was still high when non-responders were taken into account. This group was not happy with the way in which the remaining jobs were distributed to them (71% dissatisfied). CONCLUSION: Although the matching scheme matched a high proportion of responders to jobs they were satisfied with, there was a significant group without jobs who were unhappy with the scheme. Some of those with jobs were also dissatisfied with the jobs they had received. Both problems should be addressed in future schemes. Further work in this area should examine the characteristics of the group without jobs and look at the success of other schemes in order to determine the optimal way in which to allocate PRHO jobs.

Attitude of Health Personnel↗
PubMed1987

Nurses' job satisfaction: a longitudinal analysis.

A causal model of nurses' job satisfaction was tested using longitudinal analysis of 13 causal determinants and five correlates measured at Time 1, and job satisfaction measured at Time 2. Data were collected from 370 registered nurses at five hospitals using questionnaires mailed eight months apart. Four different models were analyzed using the LISREL maximum likelihood procedure to estimate the path coefficients. Variables reaching statistically significant levels included, in order of importance, routinization, promotional opportunity, distributive justice, age, day shift, workload, kinship responsibility, and opportunity for jobs outside the employing hospital. With the prior level of job satisfaction controlled, only the effects of day shift remained significant.

Adult↗
PubMed1983

Visitors: a smouldering issue for burn unit personnel.

Recent acknowledgement by medical care providers of the psychosocial role in health restoration has brought the issue of patient visiting to the forefront. The intense environment characteristic in critical care areas such as burn units has necessitated a carefully balanced 'compromise' between scientifically sound medical care and psychosocially oriented interventions. This is a current area of attention in the development of policy for burn unit operations. However, the 'compromise' seems to have been individually interpreted by professionals. This study investigated visitor policy components involved in shaping the staff-visitor-patient constellation. It also probes the consequences of this shaping process. Surveys were mailed to all 174 American burn units listed in the Directory of Burn Care Facilities (January, 1979). Our completed study reflected data reviewing the following characteristics: demographics (that is, age specification and bed distribution, bed allocation); visitor policy determination; visitor policy specifications (that is, who, when, how many); visitor policy, regulation and enforcement; and visitor integration (that is, rooming-in, programme involvement).

Burn Units↗