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PubMed1994

A survey of methods to calculate monitor settings.

PURPOSE: The results of a survey of how radiation oncology institutions calculate the monitor setting (or time) to deliver the prescribed dose in a photon-beam treatment are presented. METHODS AND MATERIALS: The participants in the mail survey were 94 institutions in the Pediatric Oncology Group. They were asked to calculate for a hypothetical clinical case requiring the use of photon beams with corner blocks. A questionnaire was also distributed to gather supplemental information. RESULTS: Of the 94 institutions whose responses were analyzed, 77% selected an isocentric setup while the others used a "fixed-SSD" approach. The proportions were reversed for the choice of the reference geometry and the majority of the participants set one monitor unit equal to 1 cGy at depth of electron equilibrium with isocenter placed at the surface. The tissue-maximum ratio was the most popular quantity for description of beam characteristics, but several other choices were common. Different names were sometimes used for the same concept. CONCLUSION: The variation among institutions made the review time-consuming, but no serious systematic errors were detected. Some standardization of nomenclature and techniques may be desirable.

Humans↗
PubMed2002

Communication between family physicians and registered dietitians in the outpatient setting.

OBJECTIVE: To elicit how registered dietitians and family physicians communicate in the outpatient setting. DESIGN: A descriptive pilot study using two mailed surveys was conducted to elicit aspects of outpatient communication between registered dietitians and family physicians. A sample of nutrition correspondence from registered dietitians to family physicians was also requested. SUBJECTS: Surveys were distributed to 504 licensed dietitians and 626 family physicians. STATISTICAL ANALYSES: Descriptive statistics were used to analyze survey results. RESULTS: Responses were received from 389 registered dietitians (77% return rate) and 235 family physicians (37.5% return rate). We received 104 sample notes of correspondence with physicians from dietitians. Among dietitians, 80% reported that they always assess a patient's lifestyle and educational level before choosing an educational approach, and 69% send the nutrition treatment plan to the referring family physician. Among family physicians, 49% often or always find the communications they receive from registered dietitians to be helpful. However, 41% of family physicians reported that they rarely receive detailed nutrition assessments or recommendations about the referred patient from the dietitian, and 54% of all family physicians surveyed often think that this lack of feedback compromises patient care. APPLICATIONS/CONCLUSION: Dietitians can improve communications with family physicians by standardizing the format and focus of nutrition correspondence and assuring that the referring family physician receives the patient's nutrition care plan. These simple changes would close a very important communication loop, forge stronger partnerships between dietitians and family physicians, and potentially improve patient outcomes.

Ambulatory Care↗
PubMed2002

Sociodemographic factors of families related to postnatal depressive symptoms of mothers.

Postnatal depression in mothers is commonplace as it affects 10-15% of recent mothers. Postnatal depression is still an under-diagnosed illness and if unidentified, is often left untreated. If left untreated, the depression can have an adverse effect not only on the mother, but also on the child's development and on the well-being of the whole family. The aim of this survey was to investigate the prevalence of postnatal depressive symptoms among Finnish mothers and to ascertain the relationship with sociodemographic factors in mothers. A sample of 1000 families at 2 months postnatal was studied by mailing the Edinburgh Postnatal Depression Scale to mothers and a questionnaire on demographic characteristics to mothers and fathers. The response rate was 39%. The data were examined by means of frequency and percentage distributions. Connections were examined using Spearman correlation coefficient and analysis of variance. In all, 373 mothers and 314 fathers took part in the study. Fifty-five (13%) mothers had depressive symptoms. Results show that the number of pregnancies, deliveries or children, the mode of delivery or the mother's age were not associated with depressive symptoms. However, mothers who had depressive symptoms had fewer years of education, shorter duration of breast-feeding and were more dissatisfied with family life compared with mothers who exhibited no depressive symptomatology. The families of mothers with depressive symptoms had also experienced more problems and changes having a profound impact on the family compared with other mothers.

Adult↗
PubMed2003

Evolution and operation of a pharmacy residency on-call program.

A pharmacy residency on-call program designed to contribute to residents' competence in patient care and to extend the functions of the pharmacy department is described. The program, which was begun at the University of Kentucky Chandler Medical Center in 1984, offers a supportive environment in which the resident is held accountable for pursuing optimal outcomes of drug therapy. The program provides opportunities for the resident to engage in independent decision-making, care for a wide variety of patients, and manage acute illness. On-call services are provided in single 24-hour shifts beginning at 0800 each day. Residents assess and respond to supratherapeutic serum drug concentrations, perform pharmacokinetic monitoring, provide drug information, evaluate patients for specific drug therapy, obtain medication histories for HIV-seropositive patients, and participate in emergency patient management. Residents provide services in the absence of the primary pharmacist on nights, weekends, and holidays and devote a four-hour period to drug distribution. Each pharmacy resident participates in the on-call program, regardless of the chief focus of his or her residency. Residents' activities are documented electronically, and preceptors give feedback via e-mail. The program and its activities have evolved over the years to reflect changes in pharmacy practice. An on-call program for pharmacy residents provides a valuable learning experience while enhancing patient care.

Education, Pharmacy, Graduate↗
PubMed2005

Dyspnea in elderly family practice patients. Occurrence, severity, quality of life and mortality over an 8-year period.

BACKGROUND AND OBJECTIVES: This study examined the prevalence and severity of dyspnea in patients >/=70 years of age and its impact on the quality of life. We also examined the prognostic significance of dyspnea for mortality. METHODS: The cohort study started with a mailed questionnaire, supplemented with an interview. From the population of elderly patients in a family practice health center, a one in five sample (n = 124) was randomly selected, similar in age and sex distribution to those not in the sample. Demographic and other relevant variables were examined for their association with dyspnea. Cox proportional hazards ratio analysis was done with dyspnea (MRC, BDI scores) as independent and mortality as dependent variable. RESULTS: Baseline data indicated that 23% (MRC) to 37% (BDI) of the patients had moderate to severe dyspnea. Shortness of breath was associated with older age, poor perceived health, more anxiety and depressive symptoms, impaired daily functioning, and lower happiness. Moderate and severe dyspnea measured with BDI and MRC was a significant predictor of death within eight years due to cardiovascular or lung disease. Selective participation did not appear to have biased this outcome. CONCLUSIONS: Dyspnea occurs frequently in the elderly, is associated with poor health, and interferes with daily functioning. Results suggest that dyspnea contributes to mortality. Development and implementation of guidelines would be highly desirable. Early diagnosis is valuable because this provides opportunities to positively influence the patient's functional condition.

Age Factors↗
PubMed1995

Ownership and utilization of MR imagers in the Commonwealth of Virginia.

PURPOSE: To assess distribution, operation, and ownership of magnetic resonance (MR) imagers in Virginia in 1991. MATERIALS AND METHODS: Questionnaires regarding ownership, location, hours of operation, annual throughput, sources and amounts of revenue, and expenses were mailed to identified providers. Data, specifically regarding ownership and location, were analyzed. RESULTS: Staff from 95% of MR facilities responded. Most facilities were located in and around major metropolitan areas. Population density per imager ranged from one per 76,000 to one per 222,000 persons. Imagers in larger metropolitan areas were operated for longer hours with higher revenues and greater expenses than were those in lower-population-density areas. Imagers owned by physicians in a position to self-refer had the highest patient throughput, the most revenue, and a much lower percentage of revenues from Medicare and Medicaid than did other ownership types. CONCLUSION: Patient access to MR services in Virginia is inhomogeneous. Important aspects of utilization are location and ownership. Ownership by physicians who can self-refer is associated with higher use, greater overall revenues, and less service to the poor and elderly.

Costs and Cost Analysis↗
PubMed2004

A polymorphic CYP19 TTTA repeat influences aromatase activity and estrogen levels in elderly men: effects on bone metabolism.

Current evidence suggests that estrogen plays a dominant role in determining bone mineral density (BMD) in men, and inactivating mutations in the aromatase CYP19 gene have been associated with low bone mass in young males. We previously reported an association between a TTTA repeat polymorphism in intron 4 of the CYP19 gene and osteoporotic risk in postmenopausal females. Here we explore the role of this polymorphism as a genetic determinant of BMD in a sample of elderly males who were recruited by direct mailing and followed longitudinally for 2 (n = 300) and 4 (n = 200) yr. Six different allelic variants, containing seven, eight, nine, 10, 11, and 12 TTTA repeats, were detected. There was a bimodal distribution of alleles, with two major peaks at seven and 11 repeats and a very low distribution of the nine-repeat allele. Men with a high-repeat genotype (>nine repeats) showed higher lumbar BMD values, lower bone turnover markers, higher estradiol levels, and a lower rate of BMD change than men with a low-repeat genotype ( 25), suggesting that the effect of CYP19 genotypes on bone may be masked by the increase in fat mass. Moreover, the high-repeat genotype was less represented, although not significantly, in the vertebral fracture group with respect to the nonvertebral fracture group. Functional in vitro analysis after incubation with [3H]-androstenedione showed a higher aromatase activity in fibroblasts from subjects with a high-repeat genotype than in fibroblasts from subjects with a low-repeat genotype. In conclusion, differences in estrogen levels due to polymorphism at the aromatase CYP19 gene may predispose men to increased age-related bone loss and fracture risk.

Aged↗
PubMed2003

Pediatricians' reported practices regarding early education and Head Start referral.

BACKGROUND: Early learning programs have proven benefits for impoverished children; Head Start is the most widespread of such programs. The current involvement of pediatricians in the Head Start enrollment process is unknown. OBJECTIVES: 1) To assess the knowledge, attitudes, and reported practices of pediatricians on referring families to Head Start; 2) to assess pediatricians' receptivity to a potential practice-based intervention to enhance their ability to make Head Start referrals. METHODS: Mail survey to stratified random sample of pediatricians practicing in poor and non-poor US zip codes. Prevalence estimates and logistic regression models were estimated using weighted data. RESULTS: Of 1000 surveys distributed, 472 of 772 presumed-eligible subjects completed surveys for a response rate of 61%. Respondents and nonrespondents were similar with regard to age, gender, years in practice, and urban/rural practice setting. Eighty percent of pediatricians reported discussing child care arrangements with a majority of their preschool-aged patients' families, while only 14% reported actually assisting these families in applying to Head Start. Lack of time (77% of pediatricians) and nonphysician office staff (71%) were listed as the most significant barriers to helping families apply to Head Start. Unfamiliarity with early childhood education (10%) was generally not seen as a barrier to this practice. Head Start knowledge (adjusted odds ratio [aOR]: 1.43; 95% confidence interval [CI]: 1.01, 2.02), self-efficacy in advising families how to access local Head Start programs (aOR: 3.49; 95% CI: 1.46, 8.38), and the belief that it is the pediatrician's responsibility to do so (aOR: 9.98; 95% CI: 3.91, 25.48) were significantly associated with assisting families with Head Start enrollment. The majority of respondents (77%) reported a willingness to participate in a proposed computer-based intervention to aid eligible families in applying to Head Start. Having access to a social worker (aOR: 2.48; 95% CI: 1.17, 5.21) and respondent age (aOR: 0.96 for each year; 95% CI: 0.93, 0.99) were significantly associated with likely participation in the intervention. CONCLUSIONS: Although pediatricians report commonly discussing child care issues, few actively assist patients in the application process for Head Start. An intervention to facilitate Head Start referral from the physician's office must address time and staff limitations; education of pediatricians is a secondary need.

Child, Preschool↗
PubMed2006

Should our well-child care system be redesigned? A national survey of pediatricians.

OBJECTIVE: The goal was to examine pediatricians' views about whether and how well-child care for children 0 to 5 years of age should be changed. METHODS: A mail survey of a national random sample of 1000 general pediatricians was performed with a survey instrument that examined pediatricians' attitudes and behaviors toward our current way and an ideal way of providing well-child care. Results were analyzed for the following 3 major domains of change in well-child care: provider type, visit format, and visit location. RESULTS: Sixty percent (n = 502) of eligible subjects responded to the survey. Nearly all respondents (97%) rated the current US system as excellent or good in providing well-child care. Most pediatricians (85%-91%) reported that they are currently the main providers of anticipatory guidance, developmental screening, and psychosocial screening. However, a majority (54%-60%) reported that, in an ideal system that maximized the effectiveness and efficiency of care, nonphysicians would provide these services. Fewer pediatricians (24%) reported that ideally nonphysicians should provide the physical examination. The majority of respondents (79%-93%) reported that at least some anticipatory guidance, minor acute care, and chronic care services could be conducted through telephone or e-mail communication, and 55% stated that at least some well-child care services should be provided in alternative locations, such as day care centers. In multivariate analysis, support for these changes was distributed widely across pediatricians with varying personal and practice characteristics. CONCLUSIONS: Although most pediatricians are generally satisfied with our current way of providing well-child care, a majority think that a system that is less reliant on physicians and face-to-face office visits would be a more effective and efficient way to provide care.

Child Health Services↗
PubMed1997

Copy management in a shared care environment using the Internet.

A new approach to sharing medical records using a demand-based database replication method and the Internet e-mail facility is proposed. The underlying model allows subscribed physicians to collect patient records from distant nodes and have local access to these records when needed. A system called the Internet-Based Distributed Medical Information System has been developed and implemented in a shared care environment comprising outpatient clinics, independent practitioners, and diagnostic laboratories. This tool may be highly beneficial in improving coordination among health care professionals and reducing unnecessary repeat investigations.

Ambulatory Care Information Systems↗
PubMed2002

Evaluating Australia's National Medicines Policy using geographical mapping.

BACKGROUND: There has been a proliferation of quality use of medicines activities in Australia since the 1990s. However, knowledge of the nature and extent of these activities was lacking. A mechanism was required to map the activities to enable their coordination. AIMS: To develop a geographical mapping facility as an evaluative tool to assist the planning and implementation of Australia's policy on the quality use of medicines. METHODS: A web-based database incorporating geographical mapping software was developed. Quality use of medicines projects implemented across the country was identified from project listings funded by the Quality Use of Medicines Evaluation Program, the National Health and Medical Research Council, Mental Health Strategy, Rural Health Support, Education and Training Program, the Healthy Seniors Initiative, the General Practice Evaluation Program and the Drug Utilisation Evaluation Network. In addition, projects were identified through direct mail to persons working in the field. RESULTS: The Quality Use of Medicines Mapping Project (QUMMP) was developed, providing a Web-based database that can be continuously updated. This database showed the distribution of quality use of medicines activities by: (i) geographical region, (ii) project type, (iii) target group, (iv) stakeholder involvement, (v) funding body and (vi) evaluation method. At September 2001, the database included 901 projects. Sixty-two per cent of projects had been conducted in Australian capital cities, where approximately 63% of the population reside. Distribution of projects varied between States. In Western Australia and Queensland, 36 and 73 projects had been conducted, respectively, representing approximately two projects per 100,000 people. By comparison, in South Australia and Tasmania approximately seven projects per 100,000 people were recorded, with six per 100,000 people in Victoria and three per 100,000 people in New South Wales. Rural and remote areas of the country had more limited project activity. CONCLUSIONS: The mapping of projects by geographical location enabled easy identification of high and low activity areas. Analysis of the types of projects undertaken in each region enabled identification of target groups that had not been involved or services that had not yet been developed. This served as a powerful tool for policy planning and implementation and will be used to support the continued implementation of Australia's policy on the quality use of medicines.

Australia↗
PubMed2000

Trends in the incidence of hip fracture in Japan, 1987-1997: the third nationwide survey.

The third nationwide survey for hip fracture incidence was conducted in 1997 following the first such survey in 1987 and the second in 1992. The purpose of this study was to investigate the trends in the incidence and regional distribution of this disease during 10 years. Of 10271 orthopedic institutions in Japan, 4503 were selected as subjects for the study using the optimum allocation method. Questionnaires concerning new patients with hip fracture were mailed. The replies were obtained from 2930 institutions by the end of December 1998; the response rate was 65.1%. The number of new patients was estimated to be 89900-94900 [mean, 92400; 20100-21400 (20800) men and 69600-73600 (71600) women]. The number of cases in 1997 was about 1.7 times higher than that in the first survey and 1.2 times higher than that in the second survey. The age-specific incidence (per 10000 per year) in men and women in 1997 was 0.30 and 0.13, respectively, for age under 40 years; 0.91 and 0.60, 40-49 years; 2.00 and 2.39, 50-59 years; 5.12 and 9.07, 60-69 years; 17.3 and 40.8, 70-79 years; 57.4 and 147.8, 80-89 years; and 128.9 and 281.0, for age over 90 years. The incidence was increased compared with that of the first survey, and similar to the second survey, excepting that of women aged 80 years or older. Concerning regional differences, hip fracture incidence was relatively low in the eastern area compared to the western area in Japan, which was a trend identical to that in the previous nationwide surveys.

Adult↗
PubMed2004

Service provision by patient and visit characteristics in Australian oral and maxillofacial surgery: 1990 to 2000.

This study was set-up to describe main areas of service by patient and visit characteristics and compare trends in services between 1990 and 2000. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Service provision data were collected from a one-week log. Data were available from 79 surgeons from 1990 (response = 73.8%) and 116 surgeons from 2000 (response = 65.1%). Service distributions were dominated by dentoalveolar surgery in 1990 (66.6%) and 2000 (63.5%). Multivariate analysis showed: patient age, location of visit (office/theatre/inpatient facility) and referral source (general/specialist and dental/medical) were associated with all five main areas of service; type of visit (consult/operation/review) was associated with four main areas; patient sex and place of visit (private/public) was associated with three main areas; the only significant change over time was an increased percentage of orthognathic surgery, odds ratio = 1.4 (95% CI: 1.1-1.7) times higher in 2000 compared to 1990. Main areas of service were associated with a range of explanatory variables such as age and sex of patients, and place, location and type of visit, and referral source. However, the distribution of services remained relatively stable over time.

Adolescent↗
PubMed1999

Influence of follow-up response on risk-factor analysis.

BACKGROUND: Long-term analyses after coronary artery bypass grafting (CABG) are used to investigate therapeutical options and factors influencing the natural course of ischemic heart disease. In general, long-term studies require a follow-up. Dependent on the interval between the intervention and the follow-up procedure a certain amount of patients is lost to follow-up. The aim of the present study was to examine the influence of incomplete follow-up on conclusions regarding the postoperative patient outcome. For the investigation, the same statistical methods were applied to the data accumulated by the 70% and by the 90% responses. METHODS: 2012 patients underwent isolated CABG between June 1988 and December 1992. For data acquisition, tools of the HVMD (Heidelberger Verein für multizentrische Datenanalyse e.V.) were used. Analyses were performed using tools of SAS (Statistical Analysis Systems, Inc.). The parametric, time-adjusted hazard function method was employed. A first follow-up questionnaire, was distributed six months after operation with a 97.8% response. In February 1997 the same questionnaire was sent to patients and their general practioners. The primary response to that was 68.9% (approximately 70%). Then another mailing of the same questionnaire and phone calls to patients and their home doctors raised the response to 93.7% (approximately 90%). RESULTS: The mean follow-up was 1378 days in the group with 70% response and 1682 days in the group with 90% response. The parametric, time-adjusted hazard function showed a very similar pattern of factors in the early phase of both groups. In the 90% response group, the intermediate phase reached a higher relative influence than in the 70% response group. The relative influence of the late phase showed an inverse pattern. In the multivariate analysis most of the variables which had been identified by the 70% response model reappeared in the 90% response model. However, there were some potentially important and interesting differences. CONCLUSIONS: The results indicate the necessity to carefully consider the acceptance of incomplete follow-up for differentiated risk adjustment.

Coronary Artery Bypass↗
PubMedDate not supplied

Results of a physical therapy manpower survey adaptable to other areas of health care.

The Northwest Area Health Education Center used mailed surveys to document and describe physical therapy personnel in a 17-county area in northwest North Carolina. These surveys provide baseline information for examining and responding to trends in health manpower recruitment, retention, distribution, and education. While this project was conducted in the field of physical therapy, it provides a model that can be adapted to other allied health professions. The methodology, results, and recommended actions are discussed.

Area Health Education Centers↗
PubMed2006

Modeling bursts and heavy tails in human dynamics.

The dynamics of many social, technological and economic phenomena are driven by individual human actions, turning the quantitative understanding of human behavior into a central question of modern science. Current models of human dynamics, used from risk assessment to communications, assume that human actions are randomly distributed in time and thus well approximated by Poisson processes. Here we provide direct evidence that for five human activity patterns, such as email and letter based communications, web browsing, library visits and stock trading, the timing of individual human actions follow non-Poisson statistics, characterized by bursts of rapidly occurring events separated by long periods of inactivity. We show that the bursty nature of human behavior is a consequence of a decision based queuing process: when individuals execute tasks based on some perceived priority, the timing of the tasks will be heavy tailed, most tasks being rapidly executed, while a few experiencing very long waiting times. In contrast, priority blind execution is well approximated by uniform interevent statistics. We discuss two queuing models that capture human activity. The first model assumes that there are no limitations on the number of tasks an individual can handle at any time, predicting that the waiting time of the individual tasks follow a heavy tailed distribution P(tau(w)) approximately tau(w)(-alpha) with alpha=3/2. The second model imposes limitations on the queue length, resulting in a heavy tailed waiting time distribution characterized by alpha=1. We provide empirical evidence supporting the relevance of these two models to human activity patterns, showing that while emails, web browsing and library visitation display alpha=1, the surface mail based communication belongs to the alpha=3/2 universality class. Finally, we discuss possible extension of the proposed queuing models and outline some future challenges in exploring the statistical mechanics of human dynamics.

Journal Article↗
PubMed1999

Insomnia in primary care patients.

STUDY OBJECTIVES: To determine the prevalence and characteristics of insomnia in primary care patients, to examine patients' help-seeking behavior, and to compare the frequency of insomnia in primary care patients to the general population. METHODS: 286 patients from primary care clinics in San Diego, California (n = 96), and in Haleiwa and Honolulu, Hawaii (n = 190) participated. Sleep study questionnaires were distributed by front desk receptionists to all patients over 18 years of age upon arrival at the clinic for an appointment with the physician. Completed questionnaires were collected at the clinic or returned by mail. Comparisons were made by using nonparametric statistics. A logistic regression analysis using backward elimination was done to develop a model showing predictors of who would consult with the physician about a sleep problem. RESULTS: The prevalence of insomnia in primary care patients was 69%, with 50% reporting occasional insomnia and 19% reporting chronic insomnia. As expected, patients with chronic insomnia had the most severe sleep complaints as well as the poorest daytime functioning, and exhibited the most help-seeking behaviors. The four predictors of discussing insomnia with a physician were how patients felt physically, number of years of insomnia, age, and income. CONCLUSIONS: The primary care population has a higher prevalence of insomnia than the general population, probably because of concomitant psychiatric and medical illnesses. Although many of the characteristics of the sleep complaints are easily detected, most patients with insomnia are not treated effectively.

Adolescent↗
PubMed2005

[Questionnaire study of general practitioners regarding experience and attitude to opioid substitution therapy].

UNLABELLED: General practitioners (GPs) in their surgeries and substitution treatment centres are the major providers of opioid maintenance treatment in a number of European countries. Although in the Czech Republic any GP has been allowed to prescribe buprenorphine (Subutex) since 2001, the opioid substitution treatment provided by primary care professionals has not been the subject of research to date. OBJECTIVE: To collect and analyze data on GPs' experience gained with opioid maintenance treatment in the Czech Reupblic, their attitudes and needs. METHOD: A structured questionnaire was distributed via the Bulletin of the Association of General Practitioners and district Association representatives. The validity of study results may be affected by a low respondence rate (10%) with 398 questionnaires only returned by mail. RESULTS: Twenty-eight (7%) GPs reported to have gained experience with buprenorphine which was most frequently prescribed in the regions with the highest prevalence of heroin users, i.e. in Prague and the Ustí nad Labem region (27% and 12%, respectively). Other regions, including wes- tern and southern Bohemia with relatively high prevalence of heroin users, showed lower buprenorphine prescription rates (0-6%). Most buprenorphine prescribers (78%) rated their experience as positive or highly positive. Availability and effectiveness were seen as the main pros of the substitution treatment. One third of the GPs who have not prescribed opioid maintenance treatment yet are considering doing so in the future. Greater awareness of drug abuse issues and availability of methodical guidance and consulting in opioid substitution treatment are going to become the most relevant factors in the future. Possible reportability of data on opioid maintenance treatment to a central registry does not seem to be a major obstacle to implementing the substitution treatment in the GPs' surgeries. Decision makers should take advantage of the GPs' potential to promote the opioid maintenance treatment in the Czech Republic.

Adult↗