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Perceptions and practice of concordance in nurses' prescribing consultations: findings from a national questionnaire survey and case studies of practice in England.

BACKGROUND: The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance-a partnership approach to medicine consultations-is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London]. OBJECTIVES: To investigate whether nurses were practising the principles of concordance within their prescribing interactions. DESIGN: Phase (i) postal questionnaire survey. Phase (ii): case studies of practice. SETTINGS: Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre. PARTICIPANTS: Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires. METHODS: Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires. RESULTS: 99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses' practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined 'compliance' agenda may still be partially operating in practice. CONCLUSIONS: Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses' prescribing consultations had not yet taken place.

Attitude of Health Personnel↗

Neurosensory disturbance after sagittal split and intraoral vertical ramus osteotomy: as reported in questionnaires and patients' records.

This retrospective study aimed at evaluating the long-term incidence of neurosensory disturbance (NSD) after sagittal split osteotomy (SSO) and intraoral vertical ramus osteotomy (IVRO). Furthermore, a comparison was made between the results obtained by questionnaires and information in the patient records in the evaluation of nerve function. Finally, the degree of discomfort caused by the NSD was evaluated. One hundred and twenty-nine patients, who underwent IVRO (79 patients) and SSO (50 patients), were included. Questionnaires were mailed to the patients at least one year after the operation. The records of all patients, who returned the questionnaires, were reviewed. The results of NSD obtained by questionnaires and records differed indicating a disagreement between the judgement of the surgeon and the patient's opinion. Long lasting NSD was underestimated by the surgeon as compared to the patient's subjective symptom. Long lasting NSD was reported in 7.5% (questionnaire), 3.8% (record) after IVRO and in 11.6% (questionnaire) and 8.1% (record) after SSO.

Adolescent↗

Parents and their cochlear implanted child: questionnaire development to assess parental views and experiences.

OBJECTIVES: To test the reliability of a validated closed-format questionnaire assessing parental views following cochlear implantation of their child. DESIGN: Parents were surveyed using a closed-format questionnaire developed in earlier work. The same parents were surveyed 1 month later and responses compared. Test-retest reliability was thereby assessed. SETTING: Tertiary referral Pediatric Cochlear Implant Centre in the UK. SUBJECTS AND METHODS: The parents of 20 children who had been born deaf or were deafened by age 3 years and who had been implanted for at least 2 years were drawn at random from patient lists. Parents were surveyed using a closed-format questionnaire whose validity had been previously assessed and re-surveyed 1 month later. Responses over time were compared. RESULTS: For the majority of items in the questionnaire, the replication of the item would lead to the same response on at least 95% of occasions. The text of the closed-format questionnaire is reproduced in full. CONCLUSION: This validated closed-format questionnaire appears to be unique in respect of cochlear implantation, being based explicitly on issues thought important by the parents. The high test-retest reliability indicates that it is capable of eliciting parental views in a meaningful manner. This information that is not currently available by other means can then be used as part of an overall assessment of outcomes, to inform efforts aimed at quality improvement as well as demonstrating accountability to purchasers and policymakers. Moreover, a wider use of this instrument can result in valid comparisons of outcomes among different cochlear implant centres.

Adult↗

A screening questionnaire for voice problems after treatment of early glottic cancer.

PURPOSE: After treatment for early glottic cancer, a considerable number of patients end up with voice problems interfering with daily life activities. A 5-item screening questionnaire was designed for detection of voice impairment. The purpose of this study is to assess psychometric properties of this questionnaire in clinical practice. METHODS AND MATERIALS: The questionnaire was completed by 110 controls without voice complaints and 177 patients after radiotherapy or laser surgery for early glottic cancer. RESULTS: Based on normative data of the controls, a score of 5 or less on at least 1 of the 5 questions was considered to state overall voice impairment. Reliability of the questionnaire proved to be good. Voice impairment was reported in 44% of the patients treated with radiotherapy vs. 29% of the patients treated with endoscopic laser surgery. CONCLUSIONS: The questionnaire proved to be a reliable, valid, and feasible method to detect voice impairment in daily life. The questionnaire is easy to fill in, and interpretation is straightforward. It is useful for both radiation oncologists and otorhinolaryngologists in their follow-up of patients treated for early glottic cancer.

Adult↗

In a mailed physician survey, questionnaire length had a threshold effect on response rate.

OBJECTIVE: To examine the association between questionnaire length and response rate in a mailed survey of generalist physicians randomly selected from the American Medical Association master file. STUDY DESIGN AND SETTING: In a pilot study, otherwise similar questionnaires of 30 different lengths (849 to 1,867 words) were mailed to 192 physicians in April 1999. In the main study, questionnaires of 16 different lengths (564 to 988 words) were mailed to 1,700 physicians between June 1999 and January 2000. RESULTS: In the pilot study, response rate decreased from 60% for questionnaires 849 words in length to 16.7% for questionnaires over 1,800 words in length. Logistic regression revealed an odds ratio of 0.887 (95%CI 0.813, 0.968; p=0.006) for word count, expressed in units of 100 words. In the main study, response rate varied between 51.5% and 71.4%. Logistic regression showed no association between response and word count (OR 0.988; 95%CI 0.896, 1.090; p=0.81). CONCLUSION: There appears to have been a threshold in these studies of approximately 1,000 words. Questionnaires above the threshold had lower response rates than those below it (38.0% vs. 59.4%).

Health Care Surveys↗

Cross-cultural adaptation of the JPF-Questionnaire for German-speaking patients with functional temporomandibular joint disorders.

OBJECTIVES: Clinical research related to the management of the syndrome of temporomandibular joint pain and dysfunction would be facilitated enormously between researchers in different locations around the world if a small number of patient-oriented questionnaires were to achieve wide acceptance. It would make comparison of therapeutic results possible. For this reason, a cross-cultural version of the Jaw Pain and Function (JPF)-Questionnaire was developed and validated for use in German-speaking patients with functional temporomandibular disorders. MATERIAL AND METHODS: The scale was translated from the English into the German language and translated back into English again, pretested and reviewed by a committee. The German version of the JPF-Questionnaire was tested on 137 patients with temporomandibular disorders. Reliability and concurrent construct validity were assessed using Pearson's correlation coefficients. RESULTS: The concurrent validity was assessed by evaluating the relation of the questionnaire's summary score (the internal criterion) to data on maximum interincisal distance (the external criterion). Spearman's and correlation coefficients were statistically significant for the comparison of the summary score with maximal mouth opening (r=-0.213; p=0.036). Test-retest reliability for the JPF-Questionnaire was also assessed by Spearman's correlation coefficients: at first admission at the clinic (time a, mean=20.23+/-16.42, median=16), then at the time of administration 1 day later at home (time b, mean=17.98+/-16.29, median=13), and 7 days later at home (time c, mean=17.90+/-15.77, median=13). They were r=0.91 (p=0.0001) for the initial administration with the repetition 1 day later, r=0.90 (p=0.0001) for the initial administration with the repetition 1 week later, and r=0.93 (p=0.0001) for the correlation between the two repetitions. Test - retest reliability measured by mean-against-difference graphs was not satisfactory for time (a) versus time (b) and time (a) versus time (c) but there was a good test-retest reliability for time (b) versus time (c). CONCLUSION: The use of this instrument can be recommended in future clinical trials, as the German version of the JPF-Questionnaire seems to be valid and--under the same test-retest conditions--reliable for the assessment of temporomandibular joint disorders.

Adolescent↗

Culture, organization, and management in intensive care: construction and validation of a multidimensional questionnaire.

OBJECTIVE: The objective of this study is to develop and validate a questionnaire designed to assess the culture, organization, and management of intensive care units. DESIGN: This is a prospective multicenter study. SETTING: The study was conducted in 26 intensive care units located in Paris. PARTICIPANTS: All personnel were asked to complete the questionnaire. INTERVENTION: The questionnaire was developed in 2 steps: (1) development of a theoretical framework based on organizational theory and (2) testing of the reliability and validity of a comprehensive set of measures. METHOD: The internal consistency of the items composing each scale was tested by using the Cronbach alpha. Convergent, and discriminant validity was assessed by factor analysis with varimax rotation. RESULTS: The overall completion rate was 74% with 1000 respondents (750 nurses, 26 head nurses, 168 physicians, and 56 medical secretaries). Starting with a 220-item questionnaire, we constructed a short version-conserving metrological characteristics with good reliability and validity. The short questionnaire, entitled Culture, Organization, and Management in Intensive Care, consists of 106 items distributed in 9 dimensions and 22 scales: culture (n = 3), coordination and adaptation to uncertainty (n = 3), communication (n = 3), problem solving and conflict management (n = 2), organizational learning and organizational change (n = 2), skills developed in a patient-caregiver relationship (n = 1), subjective unit performance (n = 3), burnout (n = 3), and job satisfaction and intention to quit (n = 2). All the scales showed good-to-high reliability, with Cronbach alpha scores higher than .7 (with the exception of coordination [.6]). Team satisfaction-oriented culture is positively correlated with good managerial practices and individual well-being. CONCLUSIONS: The Culture, Organization, and Management in Intensive Care questionnaire enables staff and managers to assess the organizational performance of their intensive care unit.

Attitude of Health Personnel↗

Development and validation of a Breast Cancer Genetic Counseling Knowledge Questionnaire.

Women who undergo genetic counseling concerning their increased risk of developing breast cancer confront large quantities of complex information in a short period of time. Clinical reports have suggested that many women may not retain what they learned during counseling. A validated questionnaire to measure their knowledge, however, is lacking. In this study, we describe the development and validation of a questionnaire to assess knowledge of information typically included in genetic counseling for breast cancer. Items were empirically derived from detailed content analyses of actual genetic counseling sessions. The instrument's content validity was high, as evidenced by high levels of independent interrater agreement (0.93) on items. Subsequent data reduction and confirmatory factor analytic techniques yielded a highly reliable (alpha = 0.92) 27-item Breast Cancer Genetic Counseling Knowledge Questionnaire (BGKQ). Direct comparison of this questionnaire to a scale previously developed in the literature (BCHK; [Breast Cancer Res. Treat. 53 (1999) 69]) supported the utility of the new questionnaire for evaluation of knowledge after counseling. Compared to non-counseled groups (n = 45), women who had undergone genetic counseling (n = 28) scored significantly higher (P < 0.0001) on the BGKQ, but not on the other questionnaire, establishing the BGKQ's criterion validity. The BGKQ may, thus, provide a useful clinical and research tool for assessing knowledge of information provided during genetic counseling and exploring the potential impact of distress on knowledge, as well as the impact of knowledge on screening behaviors.

Adult↗

Development and validation of the Beliefs and Behaviour Questionnaire (BBQ).

OBJECTIVE: To develop and validate a questionnaire to screen for potential nonadherence in patients with chronic ailments. METHODS: Themes from qualitative interviews with chronic obstructive pulmonary disease patients were used in developing content of the questionnaire. The questionnaire was distributed to 525 ambulatory patients with chronic lung diseases. Principal components analysis was performed to identify the subscales in the questionnaire. Internal consistency, validity and stability of the subscales were also evaluated. RESULTS: The 30-item Beliefs and Behaviour Questionnaire (BBQ) measures beliefs, experiences and adherent behaviour on five-point Likert-type scales. Two hundred and eighty patients (53.3%) with a mean age of 71.1 years responded to the questionnaire. The 'beliefs' section had a two-factor solution-'confidence' and 'concerns' with internal consistencies of 0.82 and 0.45, respectively. The two domains identified from the section 'experiences'-satisfaction' and 'disappointment' had internal consistencies of 0.85 and 0.52, respectively. The 'behaviour' section, separately entitled the Tool for Adherence Behaviour Screening (TABS), had a two-factor solution--'adherence' and 'nonadherence', with internal consistencies of 0.80 and 0.59, respectively. All the domains demonstrated comparable reliabilities across two different patient populations. Their temporal stabilities ranged between 0.62 and 0.94. CONCLUSION: The validity, reliability and utility of the BBQ and the TABS, a sub-scale of the BBQ that screens both intentional and unintentional nonadherence to pharmacological and non-pharmacological disease management, have been established. PRACTICE IMPLICATIONS: The BBQ and the TABS have potential applications in screening adherence beliefs, experiences and behaviour in both clinical practice and research.

Aged↗

Validation of a chronic obstructive pulmonary disease screening questionnaire for population surveys.

The Confronting Chronic Obstructive Pulmonary Disease (COPD) Survey in North America and Europe conducted during 1999-2000 aimed to identify international differences in the clinical management of COPD and the patients' perspectives on their disease. Our aim was to validate the screening questionnaire used in this study in a sample of patients presenting at a respiratory clinic. Interviews were conducted at an outpatient clinic of the London Chest Hospital. Of the 136 patients contacted, 25 refused or were not able to participate. Questionnaire data were validated by comparison with medical records and spirometry on 104 patients. Overall, the questionnaire correctly identified 86.5% of patients with a diagnosis of COPD with a chance-corrected agreement (kappa = 0.66, SE 0.098), which indicates good agreement between the questionnaire alpha and the medical records. The questionnaire had a high sensitivity (92.0%) and specificity (72.4%) with respect to the diagnosis of COPD. The screening questionnaire used in The Confronting COPD Survey appears to be a valid screening tool to differentiate COPD from other respiratory diseases.

Aged↗

The Lung Information Needs Questionnaire: Development, preliminary validation and findings.

STUDY OBJECTIVES: Many chronic obstructive pulmonary disease (COPD) patients are dissatisfied with the information they are given. A brief questionnaire completed prior to the clinical encounter would assist health professionals identify areas of information need. DESIGN: Ten focus groups of 59 patients assisted in the process of questionnaire construction. Three hundred and four patients (return rate 63%) responded to a postal questionnaire. RESULTS: Twenty-one per cent did not know the name of their disease, 3% reported medication non-compliance and 8% were confused with medicines. Fifty-five per cent of patients were exercising inappropriately, 8% did not know what to do when breathing worsened and 36% did not know when to call an ambulance. All six of the Lung Information Needs Questionnaire domains discriminated significantly as a function of health professional contact. Retest reliability for the six domains varied between .66 and .98, and for the total score was .89. alpha was .62. CONCLUSIONS: Patients can act as experts during the process of questionnaire construction. Information needs vary between patients but tend to be high for non-drug related aspects of self-management COPD. This questionnaire can be used to guide the clinical encounter.

Adult↗

The Lumbar Spine Outcomes Questionnaire: its development and psychometric properties.

BACKGROUND CONTENT: There are currently a number of generic and disease-specific instruments for assessing complaints of low back pain (LBP). None provide the comprehensive coverage of the wide range of factors that are considered essential in evaluating treatment outcomes. PURPOSE: To develop and evaluate the psychometric properties of a comprehensive, disease-specific questionnaire for characterizing complaints of LBP and evaluating the outcomes of treatments for these complaints. STUDY DESIGN: A clinical-cohort study of a large, convenience sample of LBP patients. METHODS: We have developed a comprehensive, disease-specific questionnaire for characterizing complaints of LBP and evaluating the outcomes of treatments for these complaints. A large group of patients who sought treatment for LBP (n=2539) completed the Lumbar Spine Outcomes Questionnaire (LSOQ) before treatment, and at 12 and 24 months after treatment. For each subject and for each evaluation period, scores on six composite measures were derived from the subjects' responses to the questionnaire: a LBP severity score, a leg pain severity score, a functional disability score, a psychological distress score, a physical symptoms score, and a health-care utilization score. These scores were used to evaluate the reliability, validity, and responsiveness of the questionnaire. RESULTS: Test-retest reliability of the LSOQ was evaluated by correlating the subject's 12-month scores on each composite measure with the corresponding 24-month scores. Intraclass coefficients of correlation were used. The obtained coefficients of correlation [(a) LBP severity, 0.87; (b) leg pain severity, 0.85; (c) functional disability, 0.87; (d) psychological distress, 0.88; (e) physical symptoms other than pain, 0.82; and (f) health-care utilization, 0.76] indicate good test-retest reliability for the LSOQ. Construct validity was evaluated by correlating scores on the composite measures derived from the LSOQ with scores on measures of the same constructs derived from the Oswestry Low Back Pain Disability Questionnaire and the Short Form 36-Item Health Survey. The coefficients of correlation were relatively high (mostly between .7 and .9), indicating good construct validity. Construct validity was also evaluated by comparing the scores of groups of subjects who were known to differ or not to differ on the composite measures, using multivariate analyses of variance. Significant multivariate and univariate differences were obtained between groups who were expected to differ (ie, surgically and nonsurgically treated patients). No significant differences were found for groups who were not expected to differ (ie, patients with similar diagnosis, but different surgical treatments). Responsiveness was assessed by evaluating differences in the 24-month change scores between improved and unimproved subjects. Large and significant differences were obtained between improved and unimproved subjects for all composite measures derived from the LSOQ. The observed effect sizes ranged from .68 to 1.17 indicating that the LSOQ is highly responsive. CONCLUSION: The LSOQ appears to be acceptable to patients, easy to administer, highly reliable, valid, and responsive. It provides information on demographics, pain severity, functional disability, psychological distress, physical symptoms, health-care utilization, and satisfaction. It should be considered for use in both clinical and research applications as well as regulatory review involving patients with LBP complaints.

Cohort Studies↗

Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis.

OBJECTIVES: To compare the validity of detecting panic disorder using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), a screening question, and physicians' diagnosis, and to test whether modified evaluation algorithms improve the operating characteristics of these questionnaires. Additionally, patient and physician acceptability of the screening questionnaires was investigated. METHODS: The total sample of 499 patients comprised 348 medical outpatients and 151 psychosomatic outpatients. The Structured Clinical Interview for DSM-IV (SCID) was the criterion standard for the presence of a panic disorder. Sensitivity, specificity, predictive values, and overall accuracy were compared for the different measures. The conditional test characteristics were calculated based on the observed prevalence of panic disorder in the medical and psychosomatic subsample, respectively. RESULTS: Panic disorder was diagnosed in 4.3% of the medical outpatients and in 19.2% of the psychosomatic outpatients. The HADS, PHQ, and screening question achieved good operating characteristics. In contrast, physicians detected only 15% of cases with panic disorder. Modified evaluation algorithms of the questionnaires lead to an improvement of test characteristics. Of all measures, the PHQ had the best operating characteristics. The use of screening questionnaires was accepted by 96% of the patients and 97% of the physicians. CONCLUSIONS: The questionnaires as well as the screening question performed well in detecting panic disorder. Thus, the integration of these highly accepted measures into clinical evaluation is suggested. Recommendations for the selection of specific evaluation algorithms are given.

Adult↗

[Screening ability of a questionnaire designed for the detection of diabetes mellitus in hospital outpatients clinic].

BACKGROUND AND OBJECTIVE: The socio-economical burden of type 2 diabetes mellitus (DM2) recommends its screening when the disease is suspected. In the present study we aimed to evaluate: the results of the oral glucose tolerance test (OGTT) normally indicated in hospital outpatient clinics when diabetes is suspected, and the efficacy of the American Diabetes Association (ADA) diabetes risk questionnaire to detect glucose tolerance abnormalities. PATIENTS AND METHOD: All subjects with an indication of OGTT were included consecutively. Individuals filled up a questionnaire including the ADA items. The sensitivity and specificity of the questionnaire were calculated. RESULTS: Two hundred and twenty nine subjects were studied (62.9% women): 44.1% had normal glucose tolerance (NGT) with normal fasting glucose. Moreover, 6.5%, 25.8% and 23.6% showed an impaired fasting glucose, impaired glucose tolerance and diabetes, respectively. According to the questionnaire, 45.8% of subjects undergoing the OGTT had a positive risk of diabetes. The questionnaire revealed a sensitivity = 72.2%, specificity = 60.6% and a positive predictive value = 37.1%. Age was the only variable that increased the risk of DM (odds ratio = 3.48, p = 0.0001). CONCLUSIONS: The important proportion of patients with NGT found in our study suggests the need to improve the indication of a diagnosis test when diabetes is suspected. One possibility would be to validate a questionnaire to detect the risk of diabetes in our own area.

Adult↗

The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.

OBJECTIVE: To create and validate a questionnaire for assessing symptom severity and symptom impact on health-related quality of life for women with leiomyomata. METHODS: The questionnaire was derived from focus groups of women with leiomyomata. Content validity was established through cognitive debriefings of women with leiomyomata and review by expert clinicians. Patients for the validation study were recruited from five gynecologists' offices, an interventional radiology department, and a University campus. Instruments used for validation were the Short Form-36, Menorrhagia Questionnaire, the Revicki-Wu Sexual Function Scale, and a physician and a patient assessment of severity. Item and exploratory factor analysis were performed to assess the subscale structure of the questionnaire. Psychometric evaluation was conducted to assess reliability and validity. Test-retest was performed on a random subset of the sample within 2 weeks of the initial visit. RESULTS: A total of 110 patients with confirmed leiomyomata and 29 normal subjects participated in the validation. The final questionnaire consists of eight symptom questions and 29 health-related quality of life questions with six subscales. Subscale Cronbach's alpha ranged from 0.83 to 0.95, with the overall health-related quality of life score alpha = 0.97. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire subscales discriminated not only from normal controls but also among leiomyomata patients with varying degrees of symptom severity. Test-retest reliability was good with intraclass correlation coefficients of 0.76-0.93. CONCLUSION: The UFS-QOL appears to be a useful new tool for detecting differences in symptom severity and health-related quality of life among patients with uterine leiomyomata. Additional study is underway to determine the responsiveness of the UFS-QOL to therapies for leiomyomata.

Adult↗

Perceived learning needs of patients with coronary artery disease using a questionnaire assessment tool.

OBJECTIVE: To determine the perceived learning needs and their level of importance in patients with angina pectoris or myocardial infarction at hospitalization and follow-up clinic visit and to assess the reliability of a self-administered questionnaire. DESIGN: Longitudinal, exploratory. SETTING: West Coast university-affiliated medical center and clinics that serve primarily a veteran population. PATIENTS: Twenty-eight adults who were admitted with a diagnosis of angina pectoris or myocardial infarction. Age range was 31 to 80 years (mean 61 years). OUTCOME MEASURES: Learning needs, questionnaire. INTERVENTION: Data collection was initiated at hospitalization and continued at the first clinic visit after discharge. A self-administered questionnaire and personal data sheet were completed by the patients. RESULTS: Matched-pair t-tests and Pearson's correlation were used for data analysis. No statistical differences were demonstrated between learning needs at hospitalization and clinic visit. Three content areas including symptom recognition, cardiac anatomy and physiology, and medications were ranked as the most important learning needs of patients at hospitalization and follow-up clinic visit. The least important learning needs at both times were content areas of smoking, work, and sex. No correlation was found between the importance of perceived learning needs and age, occupation, smoking, and marital status. The questionnaire contains 38 items and is self-administered. It was developed on the basis of a previous tool and preliminary study results. Content and validity were supported by clinical experts. The internal consistency reliability alpha coefficients of the questionnaire were 0.96 at hospitalization and 0.93 at the clinic visit. CONCLUSIONS: The findings of this study suggest that the most important perceived learning needs of patients at hospitalization and follow-up clinic visit are those that affect survival. A self-administered questionnaire can be used as a practical and reliable tool to determine the perceived learning needs of patients with coronary artery disease during the recovery phase of illness. Cardiac educational programs for patients with coronary artery disease can focus on the content areas that patients consider most important.

Adult↗

Issues associated with the application to veterinarians of a mailed questionnaire regarding lower respiratory-tract disease in racehorses.

This study evaluated a questionnaire investigating the attitudes and behaviours of veterinarians regarding the cause, diagnosis and treatment of lower respiratory-tract disease in racehorses. The questionnaire was sent to all non-student members (648) of the Australian Equine Veterinary Association: two mailings and a single telephone contact (each separated by four weeks). Subsequent phases were only administered to those who had not responded to earlier phases. In total, 467 (72.1%) of the 648 mailed questionnaires were returned. Of these, 354 were usable. The remaining 113 respondents gave various reasons for not completing the questionnaire; the most common (68%) was that horses were not a component of their practice. Those respondents working primarily with horses required fewer phases to return the questionnaire. Although deviating from previously described questionnaire designs, the described protocol provided a reasonable response rate.

Animals↗

[Metric characteristics of the Professional Quality of Life Questionnaire [QPL-35] in primary care professionals].

OBJECTIVE: To assess the internal consistency, discriminative capacity and factorial composition of the Professional Quality of Life Questionnaire (QPL-35) in a population of primary care professionals. METHODS: We performed a cross-sectional analytical study in a primary care area in Madrid from 2001 to 2003. Random sampling of 450 healthcare professionals was performed on 2 occasions. The sample was stratified into 3 groups: group I (clinicians, pharmacologists, psychologists), group II (nurses, midwives, physiotherapists, social workers) and group III (administrative staff, porters, auxiliary nurses). The self-administered questionnaire QPL-35 was sent in January 2001 and January 2003 and on each occasion the questionnaire was sent again 1 month later. The percentages of total responses and responses per item were studied. We also studied the distribution of each answer by examining the floor effect and ceiling effect, as well as the factorial composition based on a previous validation study. RESULTS: Five hundred sixty-three questionnaires (62.6%) were returned. All the questions had a response rate of more than 96%. At least one unanswered question was found in 22.0% of the questionnaires, and at least 2 were unanswered in 7.1%. The distribution of the answers did not fit normal distribution in any of the cases. The floor effect was present in questions related to management support and the ceiling effect was found in those related to motivation. The factorial analysis found 3 factors that explained 39.6% of the variance in the total number of questions. These factors were very similar to those of the previous validation study: management support, perception of workload and intrinsic motivation explained 17.0%, 13.2% and 9.4% of the variance, respectively. Internal consistency was high for each factor (Cronbach's alpha > 0.7) and for the total score (Cronbach's alpha = 0.81). CONCLUSIONS: The metric properties of the QPL-35 are maintained in different environments. This questionnaire can be recommended as a tool to measure and compare quality of professional life in primary care.

Adult↗