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PubMed1993

An evaluation of clinical follow-up in women with early stage breast cancer among physician members of the American Society of Clinical Oncology.

Routine clinical follow-up for distant metastatic disease among women with early stage breast cancer is of uncertain clinical benefit. In order to evaluate current practice patterns, we administered a mailed survey to a stratified random sample of physician members of the American Society of Clinical Oncology (ASCO) (N = 435). The survey assessed the frequency and motivation for ordering follow-up medical tests in asymptomatic postmenopausal women with stage I or II breast cancer. The response rate was 55%, distributed as 39% radiation oncologists, 32% medical oncologists, and 29% surgeons. In the first year after treatment, physicians performed, on average, one physical examination every 3 months, one blood panel (CBC, alkaline phosphatase and liver function tests) every 4 months, and one chest radiograph every 9 months. In addition, 38% of the respondents ordered CEA and 21% ordered CA 15-3 levels, 28% ordered bone scans, and less than 4% ordered CT scans, bone surveys, or bone marrow biopsies in the first year after treatment. A logistic regression analysis controlling for physician age, gender, sub-specialty, practice type, years of experience, number of breast cancer patients treated annually, geographic region, and community size, showed that surgeons were less likely to order blood tests (p < 0.001) and tumor markers (p < 0.0029) than medical oncologists in years 3 and 5 of follow-up. Compared to physicians practicing in the northeast, those from the midwest were less likely to order chest radiographs in year 3 of follow-up (p = 0.0028). Other provider characteristics had no significant effect on test ordering behavior. The results of this survey suggest that relatively uniform practice patterns in regard to the follow-up of postmenopausal women with early stage breast cancer exist among ASCO physicians.

Adult↗
PubMed1987

The role of gender in an obstetrics and gynecology residency program.

A brief historical review of the role of female medical students and female physicians in American medicine is presented. The 1985-1986 Council on Resident Education in Obstetrics and Gynecology Residency Data Bank was analyzed for gender distribution. Questionnaire studies were undertaken to study the possible effect of the increasing number of female residents in an obstetrics and gynecology residency program. Queries were sent to current and former residents, the attending staff, and the nursing and anesthesiology staffs. In order to evaluate the national scene, letters were mailed to directors of programs with 20 or more residents. The overall results indicated female residents have a positive effect on residency training.

Female↗
PubMed2000

Complimentary journeys to the World Congress of Gastroenterology--an inquiry of potential sponsors and beneficiaries.

UNLABELLED: One of the most effective tools of pharmaceutical marketing is the distribution of gifts to physicians whose magnitude remains ill defined. This anonymous survey determines the frequency with which physicians receive travel awards from drug companies to attend International Medical Conventions and attempts to obtain the recipients' opinion on ethical and legal issues related to such sponsorships. METHODS: A questionnaire was mailed to all members of the German Gastroenterological Association who had attended the most recent World Congress of Gastroenterology and to 30 pharmaceutical companies. Questions concerned the physician's role at the congress, the mode of payment for travel, lodging and convention fees as well as the attendees' opinion on ethical and legal issues related to sponsoring by pharmaceutical companies. RESULTS: 78% of the contacted physicians returned the questionnaire. 67% (95% CI [55, 80]) of them received compensation for their travel expenses by industry, and the majority of them stated that they would not have attended the congress if such sponsoring had not occurred. More than two thirds believed that sponsoring by drug companies neither interferes with ethical and legal issues nor affects prescribing behavior. Such opinions were more frequently expressed by sponsored than nonsponsored attendees (p = 0.003). 20% of the contacted drug companies returned the questionnaire, one of whom expressed concerns regarding the ethics of sponsorships. CONCLUSIONS: International conventions would suffer from a significant deprivation of attendance if the attendees' expenses were not subsidized by industry. Recognition of ethical and legal issues related to such sponsoring appears to be limited and requires further discussion within the medical community.

Attitude of Health Personnel↗
PubMed2003

Stimulating adverse drug reaction reporting: effect of a drug safety bulletin and of including yellow cards in prescription pads.

BACKGROUND: The effectiveness of voluntary reporting systems in pharmacovigilance highly depends on the number of assembled reports. AIM: The aim of this study was to measure the effect of the periodical distribution of a bulletin on drug safety issues and of including yellow cards in prescription pads on the rate of adverse drug reaction (ADR) reporting. STUDY DESIGN AND METHODS: The Catalan Centre of Pharmacovigilance began its activities at the end of 1982. Since 1985, an ADR bulletin (ADRB) has been mailed approximately quarterly to all physicians in its catchment area, with one yellow card enclosed. Additionally, from 1991-1994, a yellow card was included in the prescription pads of the Catalan Health Service. Time series methodology, with adjustment of the monthly number of reports to an Auto-Regressive Integrated Moving Average (ARIMA) model, was used to evaluate the effect of these two measures. RESULTS: From January 1983-October 1995, 6240 spontaneous ADR reports were received, and 41 issues of the ADRB were sent out. Initially, the mean monthly spontaneous ADR reporting rate was 34.4 (SD = 14.1; n = 106 months). After the inclusion of yellow cards in prescription pads, the mean monthly spontaneous ADR reporting rate increased to 53.9 (SD = 14.4; n = 48 months). According to an ARIMA model, when a bulletin was send out (MONTH1), a mean increase of 9.4 reports was produced in that month, plus 12.3 additional reports in the following month (MONTH2), and 6.3 in the second month after sending the ADRB (MONTH3). A yellow card in the prescription pads elicits a monthly mean increase of 19.8 in the number of reports. CONCLUSIONS: The present study suggests that ADRBs elicit a temporal increase of the ADR reporting rate. Including a yellow card in prescription pads was followed by an even greater increase in the reporting rate, possibly because it guarantees that yellow cards are available at the workplace.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Geographic distribution of hepatitis C virus genotypes in Brazil.

Brazil is a country of continental dimension with a population of different ethnic backgrounds. Thus, a wide variation in the frequencies of hepatitis C virus (HCV) genotypes is expected to occur. To address this point, 1,688 sequential samples from chronic HCV patients were analyzed. HCV-RNA was amplified by the RT-PCR from blood samples collected from 1995 to 2000 at different laboratories located in different cities from all Brazilian States. Samples were collected in tubes containing a gel separator, centrifuged in the site of collection and sent by express mail in a refrigerated container to Laboratório Bioquímico Jardim Paulista, São Paulo, SP, Brazil. HCV-RNA was extracted from serum and submitted to RT and nested PCR using standard procedures. Nested PCR products were submitted to cycle sequencing reactions without prior purification. Sequences were analyzed for genotype determination and the following frequencies were found: 64.9% (1,095) for genotype 1, 4.6% (78) for genotype 2, 30.2% (510) for genotype 3, 0.2% (3) for genotype 4, and 0.1% (2) for genotype 5. The frequencies of HCV genotypes were statistically different among Brazilian regions (P = 0.00017). In all regions, genotype 1 was the most frequent (51.7 to 74.1%), reaching the highest value in the North; genotype 2 was more prevalent in the Center-West region (11.4%), especially in Mato Grosso State (25.8%), while genotype 3 was more common in the South (43.2%). Genotypes 4 and 5 were rarely found and only in the Southeast, in São Paulo State. The present data indicate the need for careful epidemiological surveys throughout Brazil since knowing the frequency and distribution of the genotypes would provide key information for understanding the spread of HCV.

5' Untranslated Regions↗
PubMed2004

Physician response rates to a mail survey by specialty and timing of incentive.

BACKGROUND: Historically, achieving a high response rate on physician surveys has been a challenging task. Given such concerns, understanding research strategies that facilitate adequate response rates is important. Primary care physician responses to a mail survey on smoking cessation are summarized by physician specialty and timing of incentive. METHODS: A stratified random-sample design, stratified by patient populations-adults, adolescents, and pregnant women-was used. The sampling frame included New Jersey internists, general practitioners, family physicians, pediatricians, and obstetrician-gynecologists. A total of 2100 physicians, 700 physicians from each patient strata, were sampled and mailed a smoking-cessation survey in summer 2002. The sample was randomized by incentive timing: Half received the incentive (i.e., 25 dollars gift card) with the first survey mailing, and half received the incentive on receipt of their completed survey. RESULTS: The promised-incentive group achieved a significantly lower response rate (56%) compared with the up-front-incentive group (71.5%). Response rates by medical specialty varied overall and within incentive groups. The difference between the incentive groups was greatest among obstetrician-gynecologists (i.e., 20.2 percentage points) and was least among pediatricians (i.e., 5.8 percentage points). CONCLUSIONS: Physician response rates to mail surveys are greatly improved, especially among certain medical specialties, by using up-front incentives.

Adolescent↗
PubMed1991

Primary prevention of malignant melanoma in a Swedish urban preschool sector.

Malignant melanoma is the most rapidly increasing tumor in Sweden. Sunburns in childhood are considered a major risk factor. In the spring of 1989, a health education program was therefore initiated in Stockholm County in cooperation with the local preschool authorities in the area. Lectures on malignant melanoma, hazards of sunburns in childhood, and the importance of sun awareness were arranged for the nursery school matrons in the preschool sector. Thirty-five of 42 authorities (83%) wanted a lecture for their nursery school matrons, whereas 17% of the authorities wanted to spread information on their own. Of 1,991 nursery schools, 1,783 (90%) took part in the information program. These, the Stockholm nonparticipants, and the rest of the country received written information from the Federation of Swedish Municipalities by initiative of the Department of Cancer Prevention. A questionnaire distributed to 574 randomly selected nursery schools in Stockholm county and to 100 in a reference area outside Stockholm showed that sun awareness was reported high in both places. Face-to-face information disseminated by an established organization was more effective in increasing sun awareness in the preschool sector than mailed information alone. In the areas where lectures were given, the message of sun awareness practice was passed on to nursery school staff and parents twice as effectively as in the reference area (p less than 0.01).

Child Day Care Centers↗
PubMed1995

Influenza and pneumococcal vaccination and tuberculin skin testing programs in long-term care facilities: where do we stand?

OBJECTIVE: 1) To compare policies and procedures for distribution of influenza and pneumococcal vaccines to long-term care facilities for the elderly in Canada, 2) to determine vaccination rates of residents and staff, and 3) to describe vaccination and tuberculin skin testing programs in these facilities. DESIGN: A cross-sectional survey consisting of telephone interviews and a mailed questionnaire was conducted in the spring of 1991. Telephone interviews were conducted with provincial/territorial epidemiologists. The questionnaire was sent to all (N = 1.520) Canadian long-term care facilities for the elderly with > or = 25 beds. RESULTS: There were 1,270 responding facilities (84%). The mean overall influenza vaccination rate for residents was 78.5%. The mean vaccination rate was higher in those provinces in which the vaccine was paid for by the government (79% versus 71%; P = 0.002). Only 19% of facilities reported staff vaccination rates > 25%; rates again were higher in those provinces in which vaccine for staff was provided by the government. Pneumococcal vaccine was offered to residents in 12% of the facilities. The proportions of facilities with > 10% and > 75% of residents vaccinated were significantly higher in the provinces where the pneumococcal vaccine was recommended and paid for as compared with those where it was not (P < 0.001 for both). Tuberculin skin testing programs for residents existed in 360 long-term care facilities (28%) across the country. CONCLUSION: In 1990, the number of residents living in Canadian long-term care facilities who were vaccinated against influenza and Streptococcus pneumoniae was suboptimal. Staff influenza vaccination rates were very low across the country. Most facilities did not have a baseline tuberculin skin test status for their residents. Vaccination rates are higher in jurisdictions in which governments provide the vaccine without charge.

Bacterial Vaccines↗
PubMed1990

Aplastic anemia associated with canthaxanthin ingested for 'tanning' purposes.

Aplastic anemia with a fatal outcome occurred in a previously healthy young woman after ingesting canthaxanthin taken for the purpose of skin "tanning" and provided to her by a commercial tanning salon. Canthaxanthin is a synthetic, non-provitamin A carotenoid that is highly lipid-soluble; it colors the skin by deposition in the epidermis and subcutaneous fat. It is readily available through commercial tanning salons and mail advertisements, but despite advertising claims that it is harmless, investigation regarding the safety of oral doses of canthaxanthin in humans has not been conducted. It is not approved as a prescription or an over-the-counter preparation by the Food and Drug Administration. The drug's present means of distribution makes monitoring for toxic effects difficult. Thus, the frequency of adverse effects associated with canthaxanthin use, such as bone marrow suppression, is unknown. Even if there is only a small risk of these toxic effects, the use of the drug for cosmetic purposes does not justify this risk.

Administration, Oral↗
PubMed2006

Who uses decision aids? Subgroup analyses from a randomized controlled effectiveness trial of two prostate cancer screening decision support interventions.

OBJECTIVE: To examine who reported using unsolicited prostate cancer screening decision aids distributed as part of a randomized controlled trial, whether reported use varied by type of aid (video or pamphlet), and what affect reported use had on study outcomes. METHODS: A total of 1,152 men aged 50 and older from four medical facilities in the United States were randomly assigned to pamphlet, video or usual care (control). Materials were mailed 2 weeks prior to clinic appointments in general internal medicine. Outcomes were assessed by phone survey 1 week after appointments. Analyses examined the reported use of materials by study group, the association between patient characteristics and reported use, and the impact of reported use (adjusting for patient characteristics) on a 10-item knowledge index. RESULTS: Fifty-six percent of those randomized to receive the video and 50% of those randomized to receive the pamphlet reported using the materials. Reported use of the video was higher for patients who had greater than a high school education (OR 1.73), were married (OR 2.20), and reported no prior abnormal prostate cancer screening test results (OR 3.39). Reported use of the pamphlet did not vary by patient characteristics. In intent-to-treat analyses (ignoring reported use), individuals randomized to the video and pamphlet groups had significantly higher knowledge scores relative to the control group (7.44, 7.26 and 6.90 respectively). Adjusting for reported use modestly increased the estimated differences across treatment groups but did not substantially change conclusions about the relative effects of these aids on knowledge. CONCLUSIONS: Only half of men receiving unsolicited prostate cancer screening decision aids before a visit reported using the aids, and who reported using them varied by type of aid. Efforts to broadly implement decision aids may need to offer a variety of approaches, and incorporate creative strategies to enhance reaching all population subgroups.

Aged↗
PubMed1997

Auto-faxing imaging reports to referring physicians.

One of the major service issues within Medical Imaging is delivering reports quickly to referring physicians. As an effort to improve service, Mount Sinai Hospital's Department of Medical Imaging implemented Auto-Fax to distribute imaging reports to physicians instead of the postal service. When a report is transcribed and then verified by the dictating radiologist, the radiology information system will automatically fax the result report to the referring physicians if subscribed to the Auto-Fax service. If not, the report will be printed and mailed out manually. A transmission log is kept recording the requisition number, time, date, fax number, number of pages, and transmission status of all reports faxed. The system will try three times to fax the report. If unsuccessful at all attempts, the report will be printed and sent out by mail. Referring physicians are required to sign an agreement that the receiving parties are responsible to ensure transmitted reports are kept confidential. Over 150 referring physicians have signed on for the service. Initial problems with missing cover pages, missing report pages, and reports not being received by physicians have been resolved. A recent survey of physicians receiving reports by Auto-Fax indicate that the service is very popular and has increased the speed with which transcribed report are received. Suggestions for improvement included faxing reports in batches, at specific times of the day, and directly to personal computers. Challenges reported included photocopying thermal paper faxes and sorting reports (for those offices with shared fax machines).

Diagnostic Imaging↗
PubMed2001

Adoption of the AHCPR Clinical Practice Guideline for Smoking Cessation: a survey of California's HMOs.

OBJECTIVE: Our objective was to assess the degree to which health maintenance organizations (HMOs) and Medicaid managed care (MMC) plans in California have adopted the 1996 AHCPR Clinical Practice Guideline for Smoking Cessation. (AHCPR [U.S. Agency for Health Care Policy and Research] was renamed AHRQ [Agency for Healthcare Research and Quality] in 1999.) METHODS: A fax survey of 13 licensed HMOs and 21 MMC plans operating in California in 1999 with up to 10 follow-up contacts by telephone, mail, fax, and/or electronic mail. RESULTS: Awareness of the AHCPR guideline is widespread, and all HMOs in California in 1999 offered coverage for at least one treatment for smoking cessation. We found that 77% of the HMOs in California were aware of the AHCPR guideline, but less than half had used it to design benefits or distribute treatment guidelines to medical care providers in their networks. While only 23% of California HMOs covered the nicotine patch or gum, 69% covered at least one form of the pharmacotherapy and one type of counseling to treat tobacco dependence. In addition, a majority of the HMOs and MMC plans inform their members about coverage for smoking cessation treatments and inform providers about their role in helping smokers to quit. CONCLUSION: Considerable progress has been made in increasing access to effective smoking cessation treatments in California's managed care organizations over the last 10 years. Future efforts and research must concentrate on: (1) adopting the 2000 Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence, (2) increasing purchaser demand for coverage of tobacco dependence treatments, (3) increasing health plan documentation and monitoring of member smoking status, and (4) increasing provider provision of effective tobacco dependence treatments.

California↗
PubMed1999

Reducing inappropriate restraint use in Colorado's long-term care facilities.

BACKGROUND: Many physical and psychosocial complications arise from the use of physical restraints. Restraints in nursing homes have been estimated to cause approximately 1 in every 1,000 nursing home deaths. When restraints are removed, quality of life and functional status improve; there does not appear to be an increase in serious falls, and serious injuries may even decline. METHODS: To assess the current status in Colorado nursing homes, in 1997 the Colorado Foundation for Medical Care mailed a questionnaire to 214 nursing homes to identify remaining barriers to restraint reduction. Results were used to plan interventions to further reduce inappropriate use that met most providers' needs. Given providers' need for greater family and public awareness of the risks associated with restraints, the project team developed educational tools for distribution to families and a media campaign for the public. In addition, an assessment tool and educational materials were created to facilitate appropriate use of devices and implementation of least-restrictive interventions. Data were collected before and after the intervention phase on remaining barriers, frequency of assessment, and perceived level of success of restraint reduction. RESULTS: Most of the 175 (82%) of Colorado's 214 long-term care providers who received educational materials found them very useful and recommended expansion to other states. Facilities indicated a higher perceived level of success in reducing restraints, an increase in the frequency of assessments, and a decrease in barriers to restraint reduction. The public awareness campaign, performed in tandem with the state health department, reached more than a half-million people in Colorado, using the slogan, "Restraints Have Risks!"

Aged↗
PubMed2003

Familial aggregation of irritable bowel syndrome: a prospective study.

BACKGROUND: Patients with irritable bowel syndrome (IBS) often report family members with similar symptoms, but family studies are lacking. We hypothesised that if there is familial aggregation, there would be an increased frequency of IBS in first degree relatives of IBS patients compared with relatives of controls (the patient's spouse). METHODS: A valid self report bowel disease questionnaire (BDQ) that recorded symptoms, the somatic symptom checklist (a measure of somatisation), and a family information form (FIF) to collect the names and addresses of all first degree relatives were mailed to two groups of patients and their spouses (patients attending an IBS educational programme and residents of Olmsted County, Minnesota, who had been coded as IBS on a database). A BDQ was then mailed to all first degree relatives of subjects identified from the FIF. IBS diagnosis in the relatives was based on the Manning criteria. RESULTS: The BDQ was sent to a total of 355 eligible relatives; 71% responded (73% relatives of patients, 67% relatives of spouses). Relatives were comparable in mean age, sex distribution, and somatisation score. IBS prevalence was 17% in patients' relatives versus 7% in spouses' relatives (odds ratio adjusted for age and sex 2.7 (95% confidence interval (CI) 1.2, 6.3)). When also adjusted for somatisation score, the odds ratio was reduced to 2.5 (95% CI 0.9, 6.7). CONCLUSIONS: Familial aggregation of IBS occurs, supporting a genetic or intrafamilial environment component, but this may be explained in part by familial aggregation of somatisation.

Adolescent↗
PubMed2002

Pediatric physiatry in 2000: a survey of practitioners and training programs.

OBJECTIVES: To assess the current status and future prospects of the field of pediatric rehabilitation medicine (PRM) physiatry by detailing the demographics, training, research interests, and other characteristics of physicians currently practicing in that field and to determine the availability of training programs in PRM. DESIGN: A printed survey of members of the American Academy of Physical Medicine and Rehabilitation Pediatric Rehabilitation Special Interest Group (PRSIG) and a separate questionnaire directed to departments of physical medicine and rehabilitation (PM&R) concerning their PRM training programs. SETTING: Not applicable. PARTICIPANTS: PRSIG members and PM&R training programs listed by the American Board of Physical Medicine and Rehabilitation. INTERVENTION: Between July 1998 and April 2000, a survey was sent to PRSIG members, with follow-up mailings to nonresponding members. Between April and July 2000, a survey on PRM training practices was sent to 82 PM&R departments with fax and telephone follow-up to nonresponders and to those departments that had discontinued their training program. MAIN OUTCOME MEASURES: Instrument measures of physicians practicing PRM, including demographics, geographic distribution, practice sites, training, academic participation, special interests, and research interests along with willingness to participate in collaborative research, association in other organizations, and communication preferences. Data on training requirements as well as availability of PRM fellowships and combined pediatric and PM&R residencies indicate that the number and scope of these training opportunities are declining. RESULTS: There is little uniformity in the amount of exposure to pediatric rehabilitation required by PM&R residency training programs. There are discrepancies in the reported numbers of PRM fellowships and/or combined pediatric and PRM training programs. Projecting the number of physicians who will be practicing in this subspecialty in the future is difficult because there are no reliable data about the number of graduates or trainees in the field. CONCLUSIONS: The rehabilitation needs of children are met by physiatrists with specialized pediatric training. Our survey provided a demographic overview of the PRSIG membership. Given the decline in PRM training programs, it is imperative that the remaining programs be strengthened through communication and organization among physiatrists who practice PRM. We believe that a national database and an interactive Web site are feasible means with which to facilitate this goal.

Child↗
PubMed1996

Gender and interest in academic careers among first- and third-year residents.

BACKGROUND: While increasing proportions of medical students and residents are women, the proportion of women in the advanced ranks of medicine remains small. This study describes gender differences among residents concerning interest in academic medicine and related influences. METHOD: A survey instrument was mailed to all 308 first- and third-year residents at the University of Washington School of Medicine in the late summer of 1993. The survey assessed interest in academic careers, values, psychological traits, exposure to mentoring, and perceived role stress. Frequency analysis and chi-square analysis were performed to compare the distribution responses by gender within the entire respondent group and within the first-year and third-year subgroups. RESULTS: A total of 180 (58%) of all first- and third-year residents responded; 99 (55%) were men. Although the level of interest in academic careers was similar among first-year male and female residents, the level of interest was greater among third-year men than among third-year women. Women overall were less likely to consider it personally important to achieve national recognition. Women in the third (but not the first) year of residency were significantly less likely than men to agree that leading others was personally important to them. Women reported feeling less confident, were less likely to have identified a faculty member who had successfully balanced career and personal life, and were significantly more likely to feel under stress and to have interrupted their careers for childbearing. CONCLUSION: The interest in academic careers appeared to be lower among third-year female residents than among third-year male residents, despite the similar interests in academic medicine among male and female first-year residents. Increasing role stress among women in training may explain the reduced interest in leadership and academic careers among women at more advanced levels of training.

Attitude of Health Personnel↗
PubMed2001

Rural residence and migration for specialty physician care.

This article describes why rural residents migrate or travel outside their local market area for specialty physician care. Data were collected through a random mail survey of persons residing in Iowa's rural counties. The results imply that migration for specialty care is not simply a function of a low perceived availability of local specialty physicians. Managers of rural and urban health care systems may need to rethink the extent to which specialty physician services should be distributed across rural markets.

Catchment Area, Health↗