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PubMed1982

Evaluating health education in asthma -- developing the methodology: preliminary communication.

The results are reported of a preliminary study to a controlled trial evaluating health education in asthma. A questionnaire designed to assess asthma morbidity in the previous twelve months and knowledge of the condition was administered to 50 asthma patients. An independent assessment of morbidity was made by the patient's general practitioners, utilizing case notes and their knowledge of the patients. For each aspect of morbidity, `severe' asthma as assessed by doctors tended to be associated with increasing disability on questionnaire assessment. Overall, questionnaire `morbidity scores' were significantly higher in the doctors' `severe' group. Patients' level of knowledge was low, but no significant correlation was found between patients' level of knowledge and level of morbidity.The findings suggest that there is a need for health education in asthma, and that the questionnaire used is a valid tool for measuring the impact of such education on patients' morbidity. An outline of the controlled trial for evaluation of health education is given.

Activities of Daily Living↗
PubMed2003

Evaluation of an oncology outpatient orientation program: patient satisfaction and outcomes.

A person's first visit to an outpatient cancer center is typically marked by considerable stress and negative emotion. Thus, innovative support interventions that aim to ameliorate such stress and emotion are warranted. This study evaluated one such intervention--a new-patient orientation program in a cancer center. The program is designed to: (1) provide patients with information about the center's facilities and procedures, (2) give them an opportunity to ask questions and discuss personal concerns, (3) provide them with detailed information concerning support services available in both the community and the cancer center, and (4) provide them with access to a support care practitioner for follow-up contact. Following the orientation program, 213 participants completed a mailed questionnaire designed to measure their level of satisfaction with various aspects of the orientation program and the effect of the program on their emotional state. The results showed that participants were extremely satisfied with the program, it helped them deal more effectively with their first visit to the center, and it increased their feelings of relaxation and comfort and reduced their feelings of fear and anxiety. These results support the use of informational and support interventions as an effective means of improving cancer care.

Ambulatory Care↗
PubMed2006

Follow-up of anorectal anomalies: the Italian parents' and patients' perspective.

BACKGROUND: Several studies addressed the long-term follow-up of anorectal anomalies (ARM) in relation to clinical issues (eg, continence) and quality of life. However, most of these studies are based upon questionnaires designed by physicians and/or health-care professionals, which may be sources of bias. METHODS: To investigate whether parents of children (patients themselves or older children or adults) who were born with ARM had the perception that they received appropriate care and follow-up, a survey was carried out in Italy, in 2003, among families with children with ARM. A 20-item questionnaire was mailed to 425 patients and parents listed in the AIMAR (Italian association for anorectal malformation) database and was returned by 209 families. The questionnaire covered different aspects of ARM: type of malformations and surgery, associated anomalies, fecal and urinary continence, as well as aspects about information given to the parents and satisfaction of care and follow-up received. RESULT: The patients and parents demonstrated a good understanding of distribution of malformations and their anatomical classification; nevertheless, 67% of responders had to travel outside their living area for surgery. Bowel management (BM) was commonly used among subjects; however, a significant percentage of patients using regular enemas were still soiling (58 patients were clean and 116 soiled). Urinary continence problems were mostly found in females with cloaca; nevertheless, 21 male patients reported occasional dribbling of difficult interpretation. Most subjects were provided with a good explanation about their or their child's malformation at time of reconstructive surgery, but the same level of information was missing about functional prognosis later in life when the need of an appropriate psychologic support was also felt. CONCLUSIONS: Patients and parents born with ARM are generally satisfied with the information received and with the short-term postreconstructive follow-up care. At longer follow-up, although more than a quarter of patients are completely clean, there is a significant percentage of subjects who still soil while following a BM program. This is explained by the small number of nurses and BM specialists who are involved in the rehabilitation process and by the lack of appropriate information about functional prognosis that are conveyed to the parents. In this respect, psychologic support in bridging the gap between cure and care may be critical.

Abnormalities, Multiple↗
PubMed1995

Health concerns of adolescent girls.

An anonymous self-report questionnaire designed to assess adolescent girls' health concerns was administered to 1,416 female students in grades 7-10 from 38 schools in northwestern Ontario. Results indicated that the future and items of appearance were of the highest level of concern in the sample. Factor analysis of the 27 concern items produced grouping of concerns into four factors: risk-taking behavior, appearance, health promotion/future orientation, and psychological functioning. Comparison of the four factors across grades revealed that concern about risk-taking behavior and psychological functioning did not change; concern about health promotion/future orientation issues decreased as the grade increased; and concern about appearance increased as the grade increased. It is anticipated that the grouping of concerns and differences by grade revealed in this study will assist in designing pertinent health programs to interest and motivate the teenage female population.

Adolescent↗
PubMed2004

Improving appropriateness of antibiotic therapy: randomized trial of an intervention to foster reassessment of prescription after 3 days.

OBJECTIVES: Reassessment of ongoing antibiotic therapy is an important step towards appropriate use of antibiotics. This study was conducted to evaluate the impact of a short questionnaire designed to encourage reassessment of intravenous antibiotic therapy after 3 days. PATIENTS AND METHODS: Patients hospitalized on the surgical and medical wards of a university hospital and treated with an intravenous antibiotic for 3-4 days were randomly allocated to either an intervention or control group. The intervention consisted of mailing to the physician in charge of the patient a three-item questionnaire referring to possible adaptation of the antibiotic therapy. The primary outcome was the time elapsed from randomization until a first modification of the initial intravenous antibiotic therapy. It was compared within both groups using Cox proportional-hazard modelling. RESULTS: One hundred and twenty-six eligible patients were randomized in the intervention group and 125 in the control group. Time to modification of intravenous antibiotic therapy was 14% shorter in the intervention group (adjusted hazard ratio for modification 1.28, 95% CI 0.99-1.67, P = 0.06). It was significantly shorter in the intervention group compared with a similar group of 151 patients observed during a 2 month period preceding the study (adjusted hazard ratio 1.17, 95% CI 1.03-1.32, P = 0.02). CONCLUSION: The results suggest that a short questionnaire, easily adaptable to automatization, has the potential to foster reassessment of antibiotic therapy.

Adult↗
PubMed2006

Self-esteem, confidence, and relationships in men treated with sildenafil citrate for erectile dysfunction: results of two double-blind, placebo-controlled trials.

BACKGROUND: Men with erectile dysfunction (ED) often have low self-esteem, confidence, and sexual relationship satisfaction. OBJECTIVE: We evaluated the impact of sildenafil citrate and its generalizability across cultures on self-esteem, confidence, and sexual relationship satisfaction in men with ED using the Self-Esteem And Relationship (SEAR) questionnaire. DESIGN: Pooled analysis of 2 double-blind, placebo-controlled, flexible-dose trials of sildenafil with identical protocols: 1 was conducted in the United States and the other in Mexico, Brazil, Australia, and Japan. PATIENTS: Men > or = 18 years old with ED. MEASUREMENTS: The impact of treatment on psychosocial factors associated with ED was determined by patient responses to the SEAR questionnaire. Erectile function was determined using the International Index of Erectile Function (IIEF) and a global efficacy question. Successful sexual intercourse attempts were derived from event logs of sexual activity. Treatment effect sizes were calculated for all study outcomes. RESULTS: Compared with patients who received placebo (n = 274), patients who received sildenafil (n = 279) reported significantly greater improvements (P < .0001) in self-esteem, confidence, sexual relationship satisfaction, and in all sexual function domains of the IIEF. Treatment effect sizes were large (range, 0.7 to 1.2) for all SEAR components, and improvement in psychosocial measures showed moderate to high correlations (range, 0.50 to 0.83, P < .0001) with improvement in erectile function, percentage of successful intercourse attempts, and global efficacy. CONCLUSIONS: In men with ED from 5 different nations, sildenafil produced substantial improvements in self-esteem, confidence, and sexual relationship satisfaction. Improvements in these psychosocial factors were observed crossculturally and correlated significantly and tangibly with improvements in erectile function.

Adult↗
PubMedDate not supplied

Factors related to career retention among dental hygienists.

PURPOSE: The purpose of this research was to investigate the reasons dental hygienists consider leaving or leave dental hygiene and to determine if the reasons vary by employment category. METHODS: In March 1988, mail questionnaires designed by the author were sent to a nationwide sample of 1,008 dental hygienists who graduated in 1982 and who had been surveyed every six months beginning in their senior year of dental hygiene school. Consideration of leaving dental hygiene was ascertained with an open-ended question. Responses to this question were categorized into five determinants of work change: economic, psychological, sociological, physiological, and environmental. Chi-square analysis was used to ascertain if determinants of work change were associated with employment. RESULTS: Responses were received from 812 dental hygienists--an 81% response rate overall and an 83% response rate from subjects with valid addresses. While 82% of the respondents were employed in dental hygiene, 7% were employed outside of dental hygiene, and 12% were not employed. Of the respondents, 57% had considered leaving dental hygiene within six years after graduation. Reasons for considering leaving varied by employment status. Dental hygienists currently employed in dental hygiene stated a wide variety of reasons for considering leaving, but most important were psychological factors. Environmental (family responsibility) factors were most important for unemployed dental hygienists, while economic factors were most important for dental hygienists employed outside dental hygiene. CONCLUSIONS: Factors identified in this research can be used to help understand, and to design efforts to enhance, career retention. Additional research is needed to determine whether the causative factors for job turnover and career turnover are different or essentially the same.

Career Mobility↗
PubMed1999

Assessment of sports participation levels following knee injuries.

Although there are many published instruments designed to determine outcome following the treatment of knee injuries, only a few incorporate specific assessments of sports activity level and participation into the evaluation. This article reviews 3 of the most commonly used sports activity outcome instruments: the scales devised by Tegner and Lysholm, the Hospital for Special Surgery and the International Knee Documentation Committee. Problems and potential study biases that can arise with improper questionnaire design and data reduction techniques are reviewed, and recommendations are made to correct these problems. The problems identified include: (i) the failure to precisely define sports activity levels according to a specific sport and intensity of participation; (ii) the failure to sort populations according to overall intensity of athletic participation both before and after treatment; (iii) the failure to detect and sort from the population patients who return to sports and experience significant symptoms; (iv) the combination of work and sports activities into the same scale; and (v) the failure to detect alterations in sports participation caused by changes in lifestyle or non-knee-related factors. We have developed a sports assessment instrument, the Cincinnati Sports Activity Scale (CSAS). The methodology used to create this scale, its use in the assessment of return to or change in sports activities, and the assessment of specific functions of daily and sports activities, are briefly reviewed. The CSAS is based on 2 criteria: (i) the frequency of participation; and (ii) the general types of forces experienced by the lower extremity during the sport. The assessment of change in sports activities accounts for modifications in lifestyle and can also detect patients who have returned to sports but are experiencing significant symptoms and problems. Examples of data reduction and reporting are provided to represent practical situations from a prior investigation.

Activities of Daily Living↗
PubMed2003

Evaluation of sexual changes after stroke.

BACKGROUND: Sexual difficulties may arise after stroke. This study was aimed at evaluating and quantifying sexual changes 1 year after stroke. METHOD: Sixty-eight stroke patients, consecutively admitted to our rehabilitation unit, were enrolled in the study. Sixty-two patients were available for response after 1 year--46 men and 16 women with a mean age of 64 years (SD = 9.2). Time interval between stroke event and admission to rehabilitation unit was 15 days. None of the patients presented with lack of comprehension. Methods of data collection at admission were clinical examination, computed tomographic scan or magnetic resonance imaging, the Cumulative Illness Rating Scale, laboratory data, and data collection on sexual life from patients and, separately, from their partners. After 1 year, they were interviewed again to assess sexual performance; the Center for Epidemiologic Studies-Depression scale, Structured Clinical Interview for DSM-IV, and Functional Independence Measure were also performed. A questionnaire designed for this study was also administered for collecting data on patients' private lives. RESULTS: Sexual decline was common in the post-stroke period. Age (p =.009) and disability (p =.0059) were significant variables. There was no correlation between sexual decline and gender, nor injured hemisphere. There was also no correlation to marriage duration, education duration, or depression. Evaluation and analysis of the questionnaires revealed, however, that patients' partners played a substantial role in the decline of sexual activity. Many partners experienced fear of relapse, anguish, lack of excitation, or even horror, which withheld them from encouraging sexual activities. CONCLUSION: Data from this study demonstrated that sexual decline in the aftermath of stroke is pronounced. Patients suffer from their sexual impairment, but do not conceal that problem. Psychological, rather than medical, aspects account for discontinuity of sexual activity in stroke survivors, and proper counseling is clearly warranted.

Aged↗
PubMed1989

A pilot study of sexual lifestyle in a random sample of the population of Great Britain.

Rates of sexual-partner change and patterns of high-risk behaviour are important determinants of the spread of HIV. We carried out a survey to assess the feasibility of studying sexual lifestyle in a random sample of the British population, aged 16-64 years, in November 1987. Two thousand and seventy-seven households were selected using a multi-stage probability sampling procedure. Seven hundred and eight-five adults participated in a structured interview. The schedule included demographic details, attitudes to AIDS, numbers of sexual partners in different time periods, history of homosexuality and contact with prostitutes. An interview was obtained in 61% of households where contact was made, but the overall response rate was low (48%). There was marked variability between individuals in numbers of sexual partners in given time intervals. Men and women in younger cohorts had experienced first sexual intercourse earlier and had higher numbers of sexual partners than people in older cohorts. Surprisingly few reported high-risk behaviour such as homosexuality and use of prostitution. The methodological problems in trying to obtain unbiased and valid data on sexual behaviour are discussed. Further work is necessary to improve the response rate and questionnaire design.

Adolescent↗
PubMed2000

Treating chronic pain how do we measure success?

In this article, the practitioner is provided with information on common techniques to determine whether a particular treatment for a chronic temporomandibular disorder (TMD) is successful. Although most clinicians rely on patient reports of relief as the primary evidence for success, we have found that these reports are poorly correlated with changes in pain. Reports of relief may reflect other aspects of therapy, such as the patient's relationship with the health care provider or improved ability to cope. Therefore, in order to know if a treatment is truly efficacious, we suggest that the clinician measure the patient's pain before, during and after treatment. Questionnaires designed to measure pain and relief in the clinic, as well as instructions for their use, are included. These can be used to document progress and for medico-legal purposes.

Chronic Disease↗
PubMed2000

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↗
PubMed2002

Learning by computer simulation does not lead to better test performance than textbook study in the diagnosis and treatment of dysrhythmias.

STUDY OBJECTIVE: To compare computer-based learning with traditional learning methods in studying advanced cardiac life support (ACLS). DESIGN: Prospective, randomized study. SETTING: University hospital. MEASUREMENTS: Senior medical students were randomized to perform computer simulation and textbook study. Each group studied ACLS for 150 minutes. Tests were performed 1 week before, immediately after, and 1 week after the study period. Testing consisted of 20 questions. All questions were formulated in such a way that there was a single best answer. Each student also completed a questionnaire designed to assess computer skills, as well as satisfaction with and benefit from the study materials. MAIN RESULTS: Test scores improved after both textbook study and computer simulation study in both groups, although the improvement in scores was significantly higher for the textbook group only immediately after the study. There was no significant difference between groups in their computer skill and satisfaction with the study materials. The textbook group reported greater benefit from study materials than did the computer simulation group. CONCLUSIONS: Studying ACLS with a hard-copy textbook may be more effective than computer simulation for acquiring simple information during a brief period. However, the difference in effectiveness is likely transient.

Adult↗
PubMed1996

Dealing with a life-threatening diagnosis: the experience of people with the human immunodeficiency virus.

Different individuals demonstrate a variety of responses on learning that they have tested positive to the presence of antibodies to HIV. These responses range from rapid acceptance by some people, to a strong and persistent negative reaction in others. This paper reports a preliminary attempt to examine the possible nature and origin of coping responses. Twenty-three volunteer participants responding to newspaper advertisements were asked to complete two questionnaires designed for this study--one concerning their psychological state and one enquiring about their physical health. Following this a sample of high scores (n = 5) and a sample of low scorers (n = 5) were interviewed in depth. The results indicate that coping strategies may be influenced by: the time since diagnosis; the perceived physical health of the individual; and by social support. The construction of the psychological questionnaire is described and the results from this and the interviews are discussed with suggestions for further research.

Activities of Daily Living↗
PubMed2004

Information needs of recently diagnosed cancer patients in Brazil.

OBJECTIVE: The communication and disclosure of medical information to cancer patients has been an important issue in oncology, reflecting changes in the physicians' approach when dealing with the patients' ethical right to receive information. The aim of this study was to assess the general and specific information desired by cancer patients regarding their health conditions and to evaluate minor psychiatric symptoms. METHOD: Two-hundred and ninety-eight patients were examined at an oncological cancer center in São Paulo, Brazil, using a questionnaire designed to investigate patients' preferences about cancer information and evaluate minor psychiatric symptoms. RESULT: Ninety-five percent of the patients were interested in obtaining information on their health condition, with regard to whether they had cancer (95%), the chances of recovery (89%), and the side effects during treatment (94%). Younger patients tended to show more interest in obtaining information than the elderly. The Self-Reporting Questionnaire classified 25.8% of the sample as a probable psychiatric case, but no correlation was found between Self-Reporting Questionnaire scores and patients' desires for medical information. CONCLUSION: The majority of patients wished to be informed about their illness condition, and no correlation was found between psychiatric morbidity and desire for information.

Adult↗
PubMed2006

Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery.

PURPOSE: This study was designed to test the hypothesis that removal of lower third molars below the occlusal plane and in close proximity to the inferior alveolar canal (IAC) delays recovery after surgery as compared with lower third molars below the occlusal plane yet not close to the IAC. PATIENTS AND METHODS: Recovery data were available for 579 patients enrolled in an institutional review board-approved clinical trial. After surgery a questionnaire designed to assess health-related quality of life (HRQOL) recovery was given to the patient to be completed each day for 14 days. At each postsurgery visit, clinical data were collected detailing healing and treatment. Based on radiographic findings, patients with at least 1 mandibular third molar below the occlusal plane were identified. Outcomes for patients with at least 1 radiographic sign indicating proximity of a lower third molar to the IAC were compared with those with none. Clinical and HRQOL outcomes were compared with Cochran-Mantel-Haensel statistics (P < .05). RESULTS: No significant differences were found between groups for delayed clinical recovery. If radiographic signs for a patient at presurgery evaluation indicated close proximity of a lower third molar to the IAC, odds were significantly increased for delayed HRQOL recovery for worst pain, lifestyle, and oral function. CONCLUSION: Our findings support the hypothesis that a presurgery finding of a lower third molar below the occlusal plane and in close proximity to the IAC is associated with patients' prolonged HRQOL recovery, but not a significant delay in clinical recovery.

Adolescent↗
PubMed2005

Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study.

BACKGROUND: Questionnaires completed respectively by doctor and patient may give conflicting views of what actions the doctor took during a consultation in primary care. This disagreement will affect an assessment of whether patient expectations of care were met, and may itself be influenced by fulfillment of expectations. OBJECTIVE: To investigate how patient expectations, and patient and doctor reports of doctor's actions in a primary care setting are associated. DESIGN: Questionnaire survey. SETTING: Fifty Royal Navy, Army and Royal Air Force medical centres. PARTICIPANTS: A total of 117 members of the British Armed Forces with a health problem identified by a screening questionnaire, and their medical officers. MAIN OUTCOME MEASURES: Patient and doctor reports following a consultation indicating whether the doctor gave a prescription, made a referral or did tests, and patient expectations of these outcomes. RESULTS: Agreement between patient and doctor (kappa) was 0.81 for prescribing, 0.69 for referral and 0.54 for tests. The prevalence of unmet expectations was higher when estimated from doctors' reports than from patients' reports (prescription P=0.016; referral P=0.065; tests P=0.092; difference of 6% in each case). Patient and doctor were more likely to disagree on what happened if the action reported by the doctor did not match the patient's expectations (all P<0.01, except for when doctor reported doing tests P=0.058). CONCLUSION: Whether or not a doctor's actions appear to fulfil patient expectations in a primary care consultation depends on whether those actions are reported by the doctor or the patient.

Adult↗
PubMed2003

Evaluation of quality of life in patients with cataract in Hong Kong.

PURPOSE: To evaluate the quality of life in patients in a public hospital in Hong Kong before and after cataract surgery using a new questionnaire. SETTING: Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China. METHODS: One hundred ten Chinese patients having cataract extraction were evaluated for surgical outcomes and quality of life using a questionnaire modified to reflect the local culture and environment in Hong Kong. The questionnaire consisted of 20 questions divided into 4 domains: distance vision, near vision, social function, and cataract-related symptoms. The test-retest reliability of the questionnaire was assessed in another 15 patients by weighted kappa and internal consistency tested with the Cronbach alpha. Construct validity was tested by correlating visual acuity with quality of life and subjective visual improvement and satisfaction with quality-of-life improvement. The preoperative and 4-month postoperative quality of life were evaluated, and the association with the patients' characteristics, type of surgery performed, presence of systemic or ocular diseases, and subjective patient satisfaction was analyzed. RESULTS: The preoperative visual acuity in the operated eye had a low correlation (0.11) with the quality-of-life score; visual acuity in the better eye had a higher correlation (0.29). Quality-of-life improvement was moderately correlated with visual acuity improvement and patient satisfaction. Overall, quality-of-life scoring improved in all domains after surgery, with an overall effect size of 0.68. Quality-of-life scores improved postoperatively in 83.6% of patients, did not change in 3.6%, and were worse in 12.7%. Visual acuity improved in 94.5%, remained the same in 2.7%, and was worse in 2.7%. There was no difference in quality-of-life improvement between extracapsular cataract extraction and phacoemulsification at 4 months. Patients with systemic or ocular diseases and those who were phakic in the fellow eye had lower quality-of-life improvement; however, this was statistically significant for systemic diseases only. Age and sex did not affect quality of life or its improvement. CONCLUSIONS: The quality of life and surgical outcomes in cataract patients were assessed by a simple questionnaire. The local culture and environment should be taken into consideration in the questionnaire design.

Aged↗