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PubMed2006

Nursing students learning to utilize nursing research in clinical practice.

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward.

Attitude of Health Personnel↗

PubMed2002

A survey of medical students' views about the purposes and fairness of assessment.

OBJECTIVE: To survey medical students' views about the purposes and fairness of assessment procedures. METHOD: The survey used a 19-item questionnaire designed for self-completion. Respondents were invited to "strongly agree", "agree", "disagree" or "strongly disagree" with a series of statements about the purposes and fairness of assessment. There was space for free text comments relating to each statement. RESULTS: A total of 312 students out of a sample of 381 completed questionnaires (82% response rate). Whilst the majority of students (> 95%) agreed that ensuring competence, providing feedback and guiding student learning were important purposes of assessment, only half (51%) felt that assessment should be used to predict performance as a doctor. A clear majority of students (81%) agreed that, on the whole, assessment at Newcastle Medical School was fair. Data interpretation papers (comprising a combination of multiple true/false, "one best answer" and short answers) were perceived to be the fairest assessment tool; the assessment of clinical rotations by supervisors was perceived as the least fair. Differences in perception about the fairness of several assessment methods emerged between junior and senior students. A large number of respondents expressed desire for the provision of more feedback on performance in order to guide future learning. CONCLUSIONS: Whilst students' views about the fairness of specific assessment tools may sometimes be at variance with published research on assessment, their perceptions will influence the acceptability of assessment. Students would welcome the introduction of methods that provide meaningful assessment feedback.

Curriculum↗

PubMed1989

Validity and repeatability of self-reported occupational and industrial history from patients in EEC countries.

The results of a study to assess the feasibility and acceptability of a questionnaire designed to ascertain occupational history and the repeatability of coding occupational and industrial status using an abbreviated version of the coding status are presented for EEC countries. The study demonstrates the difficulty of recruiting cancer patients below age 65. The percentage of useful information among patients who completed a self-administered questionnaire was slightly lower than those who completed an administered questionnaire but in general the response rate for most items in the questionnaires in any group was above 90%. The repeatability of coding occupational status and industrial status for current or last job was satisfactory with Kappa values of 65% and 76% respectively. The within-individual repeatability for these variables had similar Kappa values. The validity of coding occupational status with an abbreviated version of coding status compared to the full instructions was satisfactory for current or last occupation. However, observer variability may be fairly large for the abbreviated version. An increase in the coding repeatability could probably be achieved with few modifications to the description of occupation status groups and clearer headings for each division of the Industrial Occupation Classification and greater training of coders.

Adult↗

PubMed1996

Transcutaneous electrical nerve stimulation (TENS) treatment outcome in long-term users.

OBJECTIVE: Previous reviewers of the literature on transcutaneous electrical nerve stimulation (TENS) outcome have concluded the following: (a) there are few long-term TENS follow-up studies, and (b) fewer studies have addressed the effect of long-term TENS use on outcome variables other than pain (e.g., function). DESIGN/SETTING/PARTICIPANTS/OUTCOME MEASURES: From a population of 2,003 chronic pain patients (CPPs) who bought a TENS device for pain management, 506 patients were randomly selected and interviewed by telephone long enough after purchase to allow at least 6 months of TENS use. The interview process used a structured "skip" questionnaire designed to assess the CPPs' perceptions regarding the effectiveness of TENS for a variety of outcome variables. Of the 506 CPPs interviewed, 376 (74.3%) had used their TENS device for 6 months or longer and were defined as long-term users. The responses of this group of CPPs to the telephone questionnaire were then subjected to statistical analysis. RESULTS: Paired t-tests, correlated z-tests, SS Wilks, and chi-square tests demonstrated statistically significant change or improvement (p < 0.05) that paralleled the introduction of TENS use in the following outcome variables: less pain interference with work, home, and social activities; increased activity level and pain management; decreased use of other therapies (e.g., physical therapy, occupational therapy, chiropractic); decreased use of narcotics, tranquilizers, muscle relaxants, nonsteroidal anti-inflammatory drugs and steroids. CONCLUSIONS: The results suggest that TENS is associated with improvement on multiple outcome variables in addition to pain relief for CPPs who are long-term users. Also, for some CPPs, long-term TENS use continues to be effective.

Chronic Disease↗

PubMed2006

Review of data of the patients receiving total parenteral nutrition at the intensive care unit of a university hospital.

Parenteral nutrition is commonly administered to patients in intensive care units who cannot be fed gastrointestinally. Several problems might be encountered during parenteral nutrition. We designed this study to evaluate two years' data of the patients who received parenteral nutrition at the intensive care unit of the university hospital. Forty-five patients who were treated at this hospital between January 1, 2004 and December 31, 2005 were included in this study. Patient data were collected via questionnaires designed based on the information in the literature. Blood, urinary, oropharyngeal and catheter entry site cultures were obtained and analyzed on the third and seventh days of the treatment. We found the following results: 31.1% of the patients received parenteral nutrition due to renal insufficiency; ready-made amino acid/lipid solutions were used in 86.7% of the patients; 77.8% of the solutions were administered through a peripheral vein; 88.6% of total parenteral nutrition solutions given thorough the peripheral vein had higher osmolarities than 800 mOsmol/L; routine Fe and Fe binding capacity, prothrombin time, cholesterol and triglyceride level assessments were not performed before the initiation of treatment; and the culture tests most commonly revealed Staphylococcus epidermidis in the blood, Candido species in urine, Streptococcus in throat, and Staphylococcus aureus at catheter entry sites. Based on these results, we suggest that organizing a nutrition support team would be useful in order to improve the quality of the nursery and to provide close and rational management and follow-up of the patients receiving total parenteral nutrition.

Adult↗

PubMed1996

Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers.

Finlay and Khan have recently suggested that the Dermatology Life Quality Index (DLQI) can be used to measure the effects of dermatological conditions on the quality of patients' lives. The aims of this study were to assess its applicability in a nonclinic sample of vitiligo sufferers and to measure its relationship with questionnaires designed to measure a variety of psychological and demographic factors. The DLQI was completed by 614 members of the Vitiligo Society in a postal survey. The results supported the validity of the DLQI for this sample. DLQI scores were related to perceived stigma (a version of Ginsburg and Link's psoriasis stigma questionnaire), recent experiences, self-esteem (Rosenberg's scale), personal distress (both a symptom checklist and the 12-item General Health Questionnaire) and race, suggesting that levels of disability might be reduced by interventions that target these variables.

Adolescent↗

PubMed2002

Surveying physicians: do components of the "Total Design Approach" to optimizing survey response rates apply to physicians?

BACKGROUND: Surveys serve essential roles in clinical epidemiology and health services research. However, physician surveys frequently encounter problems achieving adequate response rates. Research on enhancing response rates to surveys of the general public has led to the development of Dillman's "Total Design Approach" to the design and conduct of surveys. The impact of this approach on response rates among physicians is uncertain. OBJECTIVE: To determine the extent to which the components of the total design approach have been found to be effective in physician surveys. DESIGN: A systematic review. RESULTS: The effectiveness of prepaid financial incentives, special contacts, and personalization to enhance response rates in surveys of physicians have been confirmed by the existing research. There is suggestive evidence supporting the use of first class stamps on return envelopes and multiple contacts. The optimum amount for incentives and the number of contacts necessary have not been established. Details of questionnaire design and their impact on response rates have received almost no attention from researchers. Few studies have assessed the usefulness of combinations of components of the total design approach. CONCLUSIONS: Despite the number of surveys conducted among physicians, their cost, the level of interest in their findings, and in spite of inadequate response rates, there have been few randomized trials conducted on important aspects of enhancing response in this population. Until this gap has been filled, researchers conducting surveys of physicians should consider including all components of the total design approach whenever feasible.

Attitude of Health Personnel↗

PubMedDate not supplied

Practice of endoscopic surgery in Europe. Current state.

The outcome of a questionnaire designed to determine the current state of endoscopic surgery conducted amongst members of the European Association for Endoscopic Surgery (EAES) in April to June 1992 is presented. The data received from 266 surgical departments in 26 countries of Europe involved 2,592 staff surgeons of whom 866 practice endoscopic surgery are evaluated. The questionnaire is focused on basic aspects of minimal-access surgery--the motives, the procedures performed, attitudes to training, and different aspects of equipment used. The outcome confirms the presence of a solid beginning for the future development and spread of minimal-access surgery.

Data Collection↗

PubMed2006

The Seattle Pediatric Palliative Care Project: effects on family satisfaction and health-related quality of life.

PURPOSE: This paper presents the components of a pediatric palliative care demonstration program implemented in Seattle during the period 1999-2001. It reports findings from the evaluation of quality of life and family satisfaction among enrolled participants. The program was designed to enhance patient-provider communication using the Decision-making Tool (DMT) and experimented with co-management by clinicians and insurers to support decision making in advanced serious pediatric illness. DESIGN: The project design consisted of ethical decision-making, provider education, and flexible administration of health benefits through co-case management between insurers and care providers. The evaluation study design is a non-experimental pretest, posttest design comparison of pediatric quality of life and family satisfaction at program entry with repeated measures at 3 months post-program entry. Quality of life was measured with parent proxy reports of health-related quality of life using the PedsQL() Version 4.0, and family satisfaction was measured with a 31-item self-administered questionnaire designed by project staff. RESULTS: Forty-one patients ranging in age from infancy to 22 years old were enrolled in the program over a 2-year period. Parents consented to participate in the evaluation study. Thirty one specific diagnoses were represented in the patient population; 34% were some form of cancer. Improvements in health-related quality of life over baseline were observed for 21 matched pairs available for analysis in each domain of health-related quality of life; positive changes in reports of emotional well-being were statistically significant. Improvements over baseline in 14 of 31 family satisfaction items were statistically significant. CONCLUSIONS: Pediatric palliative care services that focus on effective communication, decision support, and co-case management with insurers can improve aspects of quality of life and family satisfaction.

Adolescent↗

PubMed1987

Improved estimates of discordance ratios in twin studies.

In the study of monozygotic twins relative to disease and risk factors, particular interest focuses on the subset who are discordant for some suspected risk factor (for example, smoking), since such twins constitute a natural case-control pair. In such studies, questionnaires designed to identify the status of all twin pairs are sometimes error prone and can yield misleading estimates of the concordance-discordance ratios. Greater efforts to verify the characteristics of apparently discordant pairs than to verify those of apparently concordant pairs can result in the 'unequal ascertainment' fallacy. Using the results of a questionnaire with known error rates and the 'apparent' frequencies yielded, we present unbiased, maximum likelihood estimates of the 'true' proportions of concordant and discordant pairs. concordant and discordant pairs. We also present approximate covariances among these estimates.

Diseases in Twins↗

PubMed1994

Measures of socioeconomic status for child health research: comparative results from Bangladesh and Pakistan.

This paper examines the reliability and validity of several hypothesized indicators of socioeconomic status for use in epidemiologic research, particularly in studies of child health in the less developed world. Population-based surveys of child health and disability were completed in Bangladesh and Pakistan using standard questionnaires designed to measure four domains of household socioeconomic status: wealth, housing, parental education and occupation. Test-retest data indicate moderate to excellent reliability of most of the socioeconomic indicators in both countries. Loadings from factor analyses of the survey data provide further evidence of the reliability of the data, and confirm that the questionnaire measures housing and wealth as distinct domains in both countries. Parental education and occupation are correlated with housing and/or wealth in these data sets. Bivariate logistic regression analyses show that, although 11 of 12 dichotomous indicators of low socioeconomic status constructed from the data are predictive of child death in at least one of the four sub-populations studied (rural and urban Bangladesh, and rural and urban areas of Karachi, Pakistan), no single indicator is predictive of child death in all four sub-populations. These along with multivariate results demonstrate the importance of including multiple measures of distinct domains if the research aims include investigation and/or control of the effects of socioeconomic status on health in diverse populations.

Bangladesh↗

PubMed1999

Contact leukomelanosis induced by the leaves of Piper betle L. (Piperaceae): a clinical and histopathologic survey.

BACKGROUND: In April 1997, an unusual pigmentary disorder was noticed by dermatologists in Taiwan. All patients had a history of using facial dressings with steamed leaves of Piper betle L. (Piperaceae). OBJECTIVE: Our purpose was to clarify the evolution and the origin of this unique leukomelanosis. METHODS: Fifteen patients with an unusual pigmentary disorder, who visited our clinic in September and October 1997, were asked to complete a questionnaire designed to elicit the history related to the disorder. Eight of these 15 patients underwent skin biopsies: 6 on the mottled hyperpigmented area (group A) and 2 on the hypopigmented area (group B). All 8 specimens were prepared with hematoxylin-eosin, Masson-Fontana, and S-100 stains. RESULTS: The results of the questionnaire revealed that these patients had all experienced a temporary erythematous reaction in the first few days of the use of the facial dressing, and 9 of them also complained of an accompanying stinging sensation. A bleaching effect became noticeable approximately 1 week to 1 month later. Eight patients reported that the hyperpigmentation and confetti-like hypopigmentation occurred after overexposure to the sun. In both groups, histopathologic examination revealed some melanophages in the dermis. Masson-Fontana staining of specimens from group A showed local interspersed depigmentation and hyperpigmentation in the basal epidermis and pigmentary incontinence in the dermis. This picture was different from the homogeneous depigmentation within basal epidermis in specimens from group B. In both groups, S-100 staining was negative for melanocytes in the depigmented area. CONCLUSION: The clinical course and histopathologic findings suggest that the evolution of this pigmentary disorder can be divided into 3 stages. The first stage is the immediate bleaching stage, when an irritant reaction is usually conspicuous. The second stage consists of prominent hyperpigmentation visible both grossly and microscopically. The final stage is characterized by confetti-like depigmentation. It may be induced by chemicals in the betel leaves such as phenol, catechol, and benzene derivatives, perhaps through inhibition of melanin synthesis or melanocytotoxicity.

Adult↗

PubMed2002

A post-discharge functional outcome measure for lower limb amputees: test-retest reliability with trans-tibial amputees.

There are approximately 700 lower limb amputations performed throughout Scotland each year. A national system of survey and analysis conducted by the Scottish Physiotherapy Amputee Research Group (SPARG) provides information on these patients up until discharge from hospital. However, there has been no method of collecting long-term functional and prosthetic use information following discharge. The Functional Measure for Amputees (FMA) has, therefore, been developed from the Prosthetic Profile of the Amputee (PPA) questionnaire, designed by Gauthier-Gagnon and colleagues in Canada (Grisé et al, 1993). Modifications to the PPA were carried out to make it more appropriate for the Scottish amputee population; these changes were approved by the original authors. The test-retest reliability of the 14-question FMA was assessed using a repeat postal questionnaire study. One hundred and thirty-three (133) from a possible 390 trans-tibial amputees were returned. Comparing sociodemographic and clinical variables between consenters and non-consenters showed no evidence to support sample bias. Continuous data items on the FMA analysed using an intraclass correlation coefficient showed ICC values of 0.74, 0.85, 0.96 and 0.64. Categorical data items analysed using percentage agreements showed reliability of over 70% for seven items, between 40% and 70% for three items and between 20% and 40% for the remaining three items. The FMA questionnaire was found to be reliable on the majority of its questions and moderately reliable on the remaining questions during successive follow-up postal administrations.

Aged↗

PubMedDate not supplied

Cost benefit analysis of neurostimulation for chronic pain.

OBJECTIVES: To assess the healthcare utilization of patients with intractable chronic neuropathic pain treated with spinal cord stimulation and peripheral nerve stimulation and to provide a cost-benefit analysis. METHODS: The case records of 222 consecutive patients who received spinal cord stimulation or peripheral nerve stimulation implants at the Cleveland Clinic Foundation between 1990 and 1998 were reviewed retrospectively. Patients were asked to complete a Neurostimulation Outcome Questionnaire designed to gather data on utilization of healthcare resources starting 1 year before surgical implantation. These data were pooled and net differences in events per patient per year, before and after device implantation were calculated and modeled to 2000 cost data obtained from the Medicare Fee Schedule and Healthcare Financing Administration. RESULTS: Neurostimulation Outcome Questionnaires were returned by 128 patients. The mean patient age was 46 +/- 12.5 years (range 21-71 years) and the mean implant duration was 3.1 +/- 2.3 years (range 0.5-8.9 years). The mean per patient total reimbursement of spinal cord stimulation/peripheral nerve stimulation absent pharmacotherapy was $38,187. Patients treated with spinal cord stimulation/peripheral nerve stimulation for pain management achieved reductions in physician office visits, nerve blocks, radiologic imaging, emergency department visits, hospitalizations, and surgical procedures, which translated into a net annual savings of approximately $30,221 and a savings of $93,685 over the 3.1-year implant duration. The large reduction in healthcare utilization following spinal cord stimulation/peripheral nerve stimulation implantation resulted in a net per patient per year cost savings of approximately $17,903. DISCUSSION: The reduced demand for healthcare resources by patients receiving neurostimulation suggests that peripheral nerve stimulation and spinal cord stimulation treatment, although associated with relatively high initial costs, demonstrates substantial long-term economic benefits. Thus, neurostimulation should be considered as a viable option for the early treatment of patients with intractable chronic neuropathic pain.

Adult↗

PubMed1987

The relationship between burnout and job satisfaction in nurses.

Nursing is a stressful occupation. This study, carried out on two groups of nurses, confirms the thesis that job satisfaction as measured by the Job Satisfaction Questionnaire designed for this study was a reliable indicator of burnout. It was expected that an inverse relationship between job satisfaction and burnout would be found. The hypothesis was that high job satisfaction would be associated with low burnout. It was found that a relationship exists between job satisfaction as measured by the Job Satisfaction Questionnaire and burnout as measured by the Maslach Burnout Inventory.

Administrative Personnel↗

PubMed1993

The quality of survey data obtained from elderly adults.

The quality of survey data obtained from elderly adults has important implications for nutrition status assessment, policy decisions and program development. Self-reported information by adults of all ages is subject to inaccuracies. Accuracy of data obtained from older respondents may be lower than that of younger respondents. Errors made by older adults are largely due to misinterpretation of the questions asked, motivations related to participation and reporting of information, and changes in memory associated with aging and other factors which may impact respondent accuracy. Cooperative efforts by cognitive psychologists, survey researchers and nutritionists are necessary for improving both questionnaire design and the accuracy of information obtained.

Age Factors↗

PubMed1991

The impact of curriculum-based suicide prevention programs for teenagers: an 18-month follow-up.

In a long-term follow-up of a study designed to assess the impact of school-based suicide prevention curricula on high school students, a group of 174 students from two high schools who were exposed to a prevention program were compared with a group of 207 control students from two additional high schools who were not exposed to the curriculum. A questionnaire, designed to measure the effects of the prevention program on actual help-seeking behaviors and suicide morbidity during the follow-up period, was administered 18 months after delivery of the program. The study failed to find convincing evidence of any program effect.

Adolescent↗

PubMedDate not supplied

[Multicenter study of prescription-indication of antacids and antiulcer agents in primary care].

OBJECTIVES: To analyse the prevalence in primary care of use of drugs to treat acidity and ulcers, and to study how prescription of these medicines matches up with indication. DESIGN: Crossover study of 1213 clinical histories selected according to simple random sampling. SETTING: 6 health centres in Navarra. PATIENTS: 370 histories with a record of use of one of the drugs under study were chosen. MEASUREMENTS AND MAIN RESULTS: Between March and June 1997, third-year family and community medicine interns collected data based on a questionnaire designed by the Pharmaceutical Provision Service of the Navarra Health Service-Osasunbidea, where the information was subsequently processed. The prevalence of patients in treatment with the drugs being studied was 30.5%. On the use of these medicines as prophylactics (n = 206), 74.3% were indicated as gastro-protection by NSAIDs (n = 153). The risk factors recorded in these cases were described, by which at least 39.9% of the prescriptions were unjustified. In general the proton pump inhibitors were prescribed more by specialists (43.7% vs. 16.4%, p < 0.001), whereas primary care doctors used more drugs for acidity (40.8% vs 21.8%, p < 0.001) and zinc acexamate (7.7% vs. 0.7%, p = 0.002). The main differences between PC and specialists was seen in duodenal ulcer treatment and prevention with NSAIDs of gastropathy. CONCLUSION: These results suggest it would be appropriate to establish mixed protocols (primary/specialist care) in order to tackle peptic ulcers better.

Adult↗