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PubMed2001

Anaesthetic management of the airway in The Netherlands: a postal survey.

BACKGROUND AND OBJECTIVE: A postal survey was conducted in order to investigate current practice in airway management amongst Dutch anaesthetists and to investigate the role of recent training and the role of an 'Access to the Airway' airway management course. METHODS: A questionnaire containing 27 questions was sent to all practising anaesthetists in The Netherlands. Questionnaires were returned anonymously and were analysed using the Pearson chi(2)-test (P < 0.05) with the SPSSR version 8.0 statistical software program. RESULTS: The response rate was 42%. Of the respondents, 78% claim often or always to assess the expected degree of difficulty in tracheal intubation as part of routine preoperative assessment. The American Society of Anesthesiologist's Difficult Airway Algorithm was used by 19% of respondents. A wide variety of airway management techniques is being used. In 36% of all general anaesthetics a laryngeal mask airway is used. In 1.1% of all general anaesthetics tracheal intubation is performed with the flexible fibrescope. CONCLUSIONS: Dutch anaesthetists, who commenced anaesthetic training after 1988, and those who attended the airway management course 'Access to the Airway' are significantly more likely to follow the American Society of Anesthesiologist's Difficult Airway Algorithm and to use adjunctive techniques for airway management.

Airway Obstruction↗
PubMed2000

The extent of nursing research utilization in general medical and surgical wards.

There has been extensive speculation about the lack of research utilization in nursing but little attempt to quantify this phenomenon outside of North America. The current demands for evidence-based practice necessitate research utilization as one element of the process. As part of a larger project, this study aimed to describe the extent of research utilization by registered nurses in general medical and surgical wards in the Scottish Health Service. A postal survey was conducted for nurses to self-report their level of utilization of 14 research-based practices. The 14 practices represented examples of direct, indirect and methodological utilization of research. A research utilization score was constructed for each of the 14 practices and a total mean score constructed for all 14 practices. A random two-stage stratified sampling resulted in a total sample of 936 nurses from 25 hospitals. A 73% response rate was achieved. The total mean research utilization score for all nurses across all 14 nursing practices suggests that on average, nurses had heard, believed in and were beginning to use the practices. The sampling technique over-represents nurses in large hospitals and charge nurses, hence a weighting calculation on all scores was completed. There was little difference in weighted and unweighted scores. Scores on individual practices ranged from 60% (405/680) of nurses never having heard of a practice to 85% (574/680) always using a practice. This approach provides a valid and reliable method of assessing the extent of nursing research utilization. In several of the practices, nurses are making significant attempts at research-based practice. The level of research utilization compares favourably with research completed in North America and provides a baseline for United Kingdom and other country studies.

Clinical Nursing Research↗
PubMed2003

Critical incident reporting in UK intensive care units: a postal survey.

RATIONALE, AIMS AND OBJECTIVES: To review critical incident reporting in UK intensive care units (ICUs). METHODS: We conducted a postal survey of clinical directors of UK ICUs to ask if critical incident reporting was used in their ICU. Using a structured questionnaire, we also asked for details of critical incident reporting systems and for changes introduced as a result of incident reporting. RESULTS AND CONCLUSIONS: Eighty-six of a total of 256 questionnaires were returned. Sixty-one units had been using a critical incident reporting system for a median duration of 3 years (interquartile range 2-5 years). There were wide variations in the structures of reporting systems between units. A median of four (interquartile range 3-8) critical incidents were reported per unit per month. In 141 changes, the development of protocols and guidelines (18) and changes in drug prescription and checking (20) were most common. A more consistent approach to reporting could improve patient care and 65 responders felt that a national reporting system was potentially useful.

Clinical Protocols↗
PubMed2000

Evaluation of undergraduate medical education in Finnish community-oriented and traditional medical faculties: a 10-year follow-up.

OBJECTIVES: This study focused on Finnish physicians' views of their undergraduate medical education. Differences between traditional and community-oriented medical faculties were examined and changes which had taken place during a 10-year follow-up period were also assessed. METHODS: The study was based on data retrieved from a postal survey made among Finnish physicians in 1998. The study population consisted of all doctors who graduated between 1987 and 1996 (n=4926); those born on odd-numbered days were selected for this study (n=2492). A postal questionnaire and two reminders were sent to those selected, and 1822 questionnaires were returned, giving a response rate of 73.1%. RESULTS: Physicians who graduated from the community-oriented faculties were more satisfied with their undergraduate medical education when compared with their colleagues graduating from traditional faculties. There were some differences between the universities with respect to education for hospital work. The teaching of primary health care, however, was clearly more effective in community-oriented faculties. The proportion of graduates who were satisfied with their primary care education was over 70% in community-oriented faculties, whereas in the traditional faculties it was only 35-45%. CONCLUSIONS: According to graduates, the community-oriented medical school curriculum better meets the needs of practising physicians than that in traditional faculties. In curriculum reforms, more emphasis should be placed on comprehensive medical education, which includes both primary and secondary health care.

Adult↗
PubMed2001

Teaching consultation skills: a survey of general practice trainers.

BACKGROUND: Consultation skills are vitally important in general practice (GP), and now form part of the summative assessment of GP registrars in the UK. GP trainers need to be skilled in teaching consultation skills, and also need the time and resources to ensure that their registrars are competent in consultation skills. AIMS: To describe the teaching methods used by GP trainers in one deanery, the frequency of teaching of consultation skills, the problems encountered and the training that GP trainers have themselves received both in consultation skills and how to teach them. METHOD: Postal questionnaire survey of all the 164 trainers in the Yorkshire Deanery. RESULTS: Replies were received from 129 trainers (response rate 79%) of which 123 could be analysed. Of these trainers, 45 (37%) trainers taught consultation skills fewer than five times a year, 45 (37%) five to 10 times, and 14 (11%) more than 10 times a year. A total of 24 trainers reported problems with teaching consultation skills, most commonly lack of time, technical difficulties, and unreceptive registrars, and 97 (79%) trainers had had some postgraduate training in consultation skills with 112 (91%) reporting some form of teacher training. CONCLUSION: There is considerable variation in the reported frequency of teaching consultation skills, the models used, and the preparation of trainers for teaching, despite a systematic approach to teacher training in the Yorkshire Deanery.

Clinical Competence↗
PubMed2001

Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study.

CONTEXT: Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful. OBJECTIVES: To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school. SUBJECTS: A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year. METHODS: A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression. RESULTS: Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.

Adaptation, Psychological↗
PubMed2001

What happens to medical students who complete an honours year in public health and epidemiology?

BACKGROUND: Around one-third of medical students in the UK take an intercalated honours degree in addition to their basic undergraduate course. The honours year has been reported to have a major influence on subsequent career choice; honours students show greater interest in research and laboratory medicine careers and less in general practice and public health.1,2 AIMS: To examine the career choice of Nottingham medical students who completed an honours year in public health and epidemiology (including general practice). METHODS: Postal questionnaire and telephone follow-up of a cohort of 266 students who entered the honours year in Public Health and Epidemiology between 1973 and 1993. RESULTS: Career information was available on 203 students; 78% (195) of those are currently employed in medicine. 44% were working in general practice (expected 40-45%) and 8% in public health medicine (expected 2%). Overall 19% (expected 4-11%) had chosen academic careers including nine of the 15 choosing an academic career in public health. The majority (60%) reported that the honours year had influenced their career choice, while 55% reported that the year had increased their likelihood of choosing an academic career. CONCLUSIONS: The honours year does encourage entry into academic and research careers in general and the type of honours year department strongly influences the subsequent choice of specialty.

Career Choice↗
PubMed2001

Preparing tomorrow's doctors: the impact of a special study module in medical informatics.

BACKGROUND: In response to the call for more informatics teaching in the medical curriculum, an elective special study module has been offered to first-year students at Queen's University since 1997. OBJECTIVES: To assess the impact of a medical informatics course in terms of the use of skills acquired and attitudes held about information technology (IT) in medicine. METHODS: A postal structured questionnaire was sent to all 30 students who took the medical informatics special study module in 1997 and to all 29 students who took the module in 1998, plus an age and sex-matched group of controls in each year. Main outcome measures included attitudes to the role of IT in medicine and declared frequency of use of various software packages. RESULTS: Compared with the control group, those taking the module felt less confident initially with computers. There was a high level of positive attitude to computers in medicine following the course, in both study and control groups. There was a significantly greater use of word-processing (P=0.001) and presentation packages (P=0.0005) amongst third-year students compared with second-year students, but there was no significant difference in this regard between those taking the module and controls. CONCLUSIONS: Students' use of computer technology and IT skills, is more influenced by the demands of the overall curriculum than by undertaking a single module in medical informatics. A special study module may, however, provide valuable support by performing a 'remedial function'. The authors found the module a useful first step in the process of introducing medical informatics to the core curriculum.

Attitude of Health Personnel↗
PubMed2001

A Canadian faculty of medicine and dentistry's survey of career development needs.

INTRODUCTION: Career development efforts for adult learners are more likely to succeed if they are responsive to the learners' needs, offered at convenient times, and provided in a variety of forms. METHODS: The Faculty of Medicine and Dentistry at the University of Alberta conducted a self-administered career development needs survey of full-time academic faculty. Faculty members were asked to identify how useful each of 35 career development skills would be to them and at which stage in an academic career it would be most useful. Preferred educational modes and times of delivery were also assessed. The mean rankings of skill needs were examined overall as well as by gender, academic rank, departmental category (clinician versus basic scientist), marital status, and the presence of school-aged children at home. RESULTS: 185 of 446 (41%) mailings were returned, of which 181 were evaluated. The number one perceived career development need across all subgroups was 'Effective writing of grants and publications'. Six of the top 10 needs were identified as useful at all career stages. Significant differences in rankings of needs were noted between subgroups. Half days were preferred to full days for career development efforts and short courses to other educational modes. DISCUSSION: Several career development skills were identified as priorities independently of gender, academic rank, and clinical versus basic science career tracks. Differences suggest that within a basic global programme, a variety of career development modules may need to be developed for subgroups.

Alberta↗
PubMed2003

Using commercial telephone directories to obtain a population-based sample for mail survey of women of reproductive age.

In the United States, sampling women of reproductive age from the general population for research purposes is a challenge. Even more difficult is conducting a population-based study of couples attempting pregnancy to assess fecundity and fertility or related impairments. To address the problem of obtaining representative samples from the population in order to study such health-related issues, a commercially and readily available CD-ROM telephone directory was used and tested as a sampling framework for studies aimed at enrolling gravid women aged 18-44 years. A self-administered questionnaire (SAQ) was mailed to a stratified random sample of 10 005 (3%) households in Erie County, NY, USA. Overall, 17% of the questionnaires were undeliverable despite updating all addresses with residential software before mailing. Thirteen per cent (n = 1089) of the households returned completed questionnaires, of which 35% (n = 377) were completed by women aged 18-44 years. Using 1990 census information for zip code, respondents were more likely to be white and to have higher median household incomes than non-respondents. Of the 377 women who completed the questionnaire, 79% had been pregnant at least once, 5% reported being unable to become pregnant, and 16% reporting never trying to become pregnant. Despite the overall low response to the SAQ, the sampling framework captured a diverse group of women of reproductive age who reported various fecundity and fertility outcomes. The use of low-cost commercially available software linked to census data for selecting samples of women or couples for reproductive and perinatal research may be possible; however, oversampling of households, use of incentives and follow-up of non-respondents is needed to ensure adequate sample sizes.

Adolescent↗
PubMed1999

Postal survey of the anaesthetic techniques used for paediatric tonsillectomy surgery.

A postal survey of anaesthetic techniques used for tonsillectomy surgery in children (age 3-16 years) was performed with particular reference to the use of the reinforced laryngeal mask airway and the use of suxamethonium. From 110 questionnaires despatched, replies were obtained from 88 consultant anaesthetists with commitments to otolaryngologic (ENT) anaesthesia (response rate 80%). In paediatric practice, the reinforced laryngeal mask airway was routinely used by 14 (16%) respondents from the 88 who replied. Thirteen (33%) respondents out of 39 respondents who replied saying that they had used the reinforced laryngeal mask airway at some point, reported problems with its use. Suxamethonium was used routinely by 40 consultants (45%) for tonsillectomy surgery. Severe problems with its use had been encountered by 26 (30%) respondents

Adolescent↗
PubMed2003

An investigation into nonresponse bias in a postal survey on urinary symptoms.

OBJECTIVE: To investigate nonresponse bias in a postal survey on urinary symptoms in people aged >or= 40 years. SUBJECTS AND METHODS: Nonresponders to a postal survey on incontinence and other urinary symptoms were studied. A random sample of 1050 nonresponders (stratified for age and sex) was traced by a team of interviewers. Eligible nonresponders were asked several questions from the postal questionnaire, and their reason for not participating in the postal survey. RESULTS: Only 1% of those not responding were not traced in person or accounted for, and 12% were identified as not eligible to be in the survey sample (moved from address, deceased, residential home). Half of the eligible nonresponders (51%) did not answer the interviewer's questions, the main reason being general unwillingness or disinterest. The number in whom poor health was the reason increased with age. Comparing nonresponders who answered the interviewer's questions with a random sample of responders from the postal survey showed little difference in the reporting of urinary symptoms, although there were differences in general health and long-term health problems. Separate analyses by age showed greater reporting of some urinary symptoms and of poorer general health in the older nonresponders (>or= 70 years). CONCLUSION: Overall, for people aged >or= 40 years there was no evidence of a nonresponse bias in the reporting of urinary symptoms, providing confidence in such prevalence rates. However, poorer general health and greater reporting of some urinary symptoms by the older nonresponders (>or= 70 years) suggests prevalence rates in this age group may be underestimated.

Adult↗
PubMed2003

Destruction of Bacillus anthracis strain Sterne 34F2 spores in postal envelopes by exposure to electron beam irradiation.

AIMS: To determine the irradiation dose necessary to reduce the populations of Bacillus anthracis spores in a dry medium in postal envelopes. METHODS AND RESULTS: Bacillus anthracis Sterne 34F2 spores were dispersed in non-fat dry milk and then placed into standard business postal envelopes. The spores were treated with a sequence of irradiation doses to determine the decimal reduction value (D10) in kiloGrays (kGy). The average D10 value was 3.35 +/- 0.02 kGy. CONCLUSIONS: An irradiation dose of 40.2 kGy would be required to result in a process equivalent to the thermal canning process (12 D10 reduction) to eliminate Clostridium botulinum spores. SIGNIFICANCE AND IMPACT OF THE STUDY: Irradiation is an effective means of reducing or eliminating B. anthracis spores in a dry medium in postal envelopes.

Anthrax↗
PubMed2002

Impact of physician reminders on the use of influenza vaccinations: a randomized trial.

OBJECTIVE: To analyze the impact of mailed physician reminders to immunize their patients. DESIGN: Randomized trial involving Washington State physiatrists participating in the Medicare program. In 1997, all physiatrists in the state were separated into solo or group practice. Solo physicians and group practices were then separately randomized to receive 4 monthly reminders to have their patients immunized. In 1998, the intervention and control groups were switched. SETTING: The state of Washington. PATIENTS: A total of 4300 Medicare outpatients seen in Washington State in 1997 and 4025 patients in 1998. INTERVENTION: Repeated mailer. MAIN OUTCOME MEASURE: By using multivariate analysis, Medicare billing data was analyzed to determine the impact of the physician reminders on influenza vaccination rates. RESULTS: Among solo practitioners, patients whose physiatrist received the reminder letters in 1998 were 34% more likely (adjusted relative risk [RR] = 1.34; 95% confidence interval [CI],.96-1.88) to have a vaccination billing. Among group practitioners, those patients whose physiatrist received the reminder letters in 1997 were 26% more likely (RR = 1.26; 95% CI,.98-1.60) to have a vaccination billing. These differences, however, were not statistically significant. The adjusted RRs for the remaining intervention groups, solo practitioners in 1997 (RR =.89; 95% CI,.63-1.26), and group practitioners in 1998 (RR = 1.00; 95% CI,.73-1.36), revealed no increase in vaccination billings for patients whose physiatrist received the intervention. CONCLUSIONS: Repeated physician reminders did not increase the vaccination rate of Washington State Medicare patients who were seen by physiatrists in 1997 and 1998. These results were consistent whether the physiatrists were in solo or group practice. Other methods should be considered to improve the primary care delivered to this Medicare population.

Aged↗
PubMed1999

Screening for hand osteoarthritis (OA) using a postal survey.

OBJECTIVE: The aim of this study was to determine the feasibility of screening for hand osteoarthritis (OA) using a postal survey. METHODS: Men and women aged 40-79, selected at random from a general practice in Nottingham, were sent a postal survey concerning arm pain. Subjects were asked to identify presence of any nodes, based on a diagrammatic example, and to document specific distal (DIP) and proximal (PIP) nodes. One hundred and thirty-nine subjects were subsequently assessed by a nurse metrologist, blinded to the subjects assessment. Subject-observer agreement was measured by calculating unweighted kappa (kappa). In addition, sensitivity and specificity were calculated, taking observer-identified nodes as the 'gold standard'. Intraobserver reproducibility was assessed on 10 subjects with nodes. RESULTS: Intraobserver reproducibility was reasonable at all sites (kappa>/=0.59). Of the 56 subjects with observer-identified 'any nodes', 40 subjects had correctly identified them (sensitivity 71.4%); with three subjects incorrectly identifying nodes (specificity 96.4%). Corresponding kappa was 0.70. Subject-observer agreement was higher for presence/absence of any DIP nodes than PIP nodes (kappa=0.67 and 0.36 respectively). As with nodes overall, specificity was high (100% and 96.6% respectively). Agreement was generally poor for specific joint involvement. CONCLUSION: A postal survey is a useful screening tool for identifying subjects with nodes. Although sensitivity may not be sufficient to permit assessment of prevalence of hand OA in the community, it has potential applications in terms of identifying and defining cases for further study.

Adult↗