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At least 793 records · Page 44Linked to original sources
PubMed2003

Review of antenatal testing policies and practice for HIV and hepatitis C infection.

OBJECTIVE: To investigate antenatal HIV and HCV testing policy and practice in Australia. METHODS: A survey of private obstetricians and general practitioners (GPs) affiliated with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and directors of obstetric units in public hospitals was undertaken. Surveys were mailed to 40% and 20% random samples of private obstetricians and GPs, respectively, and all public hospital obstetric units. The questionnaires included information on type of antenatal policy, proportion of women tested for HIV and HCV, and number of HIV and HCV-positive women receiving antenatal care. RESULTS: Of the 995 surveys distributed, 847 (85%) were returned. Of these 847, 277 (33%) were returned from practitioners or hospitals no longer involved in antenatal care. The response rates from the remaining practitioners (n=570) included 87% from private obstetricians, 78% from GPs, and 71% from public hospitals. The proportion of private obstetricians, GPs and public hospitals with an antenatal testing policy for HIV was 62%, 42% and 44%, and for HCV 65%, 41% and 39%, respectively. Universal offer of antenatal testing among private obstetricians, GPs and public hospitals was 47%, 62% and 23% for HIV and 54%, 46% and 23% for HCV, respectively. During 1999, an estimated 33% of pregnant women were tested for HIV and 37% for HCV. Based on reported numbers of women in antenatal care, prevalence rates were estimated at 0.23 per 1,000 and 13 per 1,000, for HIV and HCV, respectively. CONCLUSIONS: Antenatal testing policy and practice varies widely in Australia. The lack of uniformity may reflect differing policies among clinical and public health bodies.

Adult↗
PubMed1997

Drug samples and family practice residents.

OBJECTIVE: To describe residents' knowledge, attitudes, and behaviors regarding sample medications and to determine the education provided in residency training regarding sample use. METHODS: A 6-item survey was sent to directors of US family practice residency programs. Residents of a sample of these programs were sent an anonymous, self-administered, 21-item questionnaire assessing knowledge, attitudes, and practices relating to sample use. Both surveys consisted of initial and follow-up mailings. RESULTS: The residency directors' survey was returned by 232 of the 436 residency directors (53%). Although 66% of the programs had a policy regarding samples, only 15% of the policies completely incorporated recommendations of the Society of Teachers of Family Medicine. After two mailings, 248 resident responses were received from 43 of 47 residencies (92%). Only 21% of respondents thought that they received adequate training about sample use in medical school; this number increased to 49% for residency training. Agreement with the adequate training statement was highest among respondents from residencies that had both a sample distribution policy and a pharmacist (p = 0.044). Fifty-five percent thought that samples influenced their prescribing and 70% thought that samples helped them to learn more about the sampled medication. CONCLUSIONS: Family practice residents value and use samples, although they are often unaware of the rules governing the labeling of samples. While reported distribution of samples by residents often is appropriate, education about effective sample use could be improved. Drug samples play a significant role in residency training.

Adult↗
PubMed2004

Online consumer surveys as a methodology for assessing the quality of the United States health care system.

BACKGROUND: Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly and inexpensively from large, representative samples of patients and consumers. These new information technologies also permit efficient, real-time assessment in such areas as health status, access to care, and other aspects of the care experience that impact health outcomes. OBJECTIVE: This study investigates the feasibility, validity, and generalizability of consumer online surveys to measure key aspects of health care quality in the United States. METHODS: Surveys about the health and health care experiences of a general adult population and of adults with diabetes were administered online and by telephone. The online survey drew from a sample frame of nearly 1 million consumers and used a single e-mail notification. The random-digit-dial methodology included 6 follow-up calls. Results from the online sample were compared to the telephone sample and to national benchmark data. RESULTS: Survey responses about quality of care collected using online and telephone methods were commensurate once they were weighted to represent the demographic distribution of the 2000 United States Census. Expected variations in health and health care quality across demographic and socioeconomic groups were largely observed, as were hypothesized associations among quality indicators and other variables. Fewer individuals were required to be contacted to achieve target sample sizes using online versus telephone methods. Neither method yielded representative cohorts of nonwhite individuals. CONCLUSIONS: Conclusions about the level and variations in health care quality in the United States are similar using data collected in this study compared to data collected using other telephone-based survey methods. As is typical for national telephone surveys conducted by the National Center for Health Statistics, stratified sampling and weighting of survey responses is necessary for results to be generalizable. Online methods are more appropriate for understanding health care quality than for conducting epidemiologic assessments of health in the United States.

Adolescent↗
PubMed2002

[Methodology of an epidemiologic prevalence study in rheumatology: the Chiavari study].

OBJECTIVES: Goals of epidemiological studies are the description of the measures of frequency of diseases, the attempt to clarify possible etiopathogenic mechanisms, and the provision of data to support health policy decisions. To increase the familiarity of rheumatologists toward epidemiology, we describe the methodology used in a prevalence study of musculoskeletal complaints performed in Chiavari, Italy. METHODS: A questionnaire, originally developed by the Epidemiology Unit of the Arthitis Research Council in Manchester, UK, to investigate the prevalence of rheumatoid arthritis, was used after translation and validation. 4456 subjects aged 16 years or more listed in four general practices were invited to participate in the study and to fill the ARC questionnaire. The 3294 responders reported a) any past occurrence of joint swelling lasting more than four weeks and the distribution of the swollen joints on a mannequin; b) any joint pain lasting more than four weeks; c) current joint pain or swelling; d) morning stiffness; e) whether they had been previously told by a doctor they had arthritis. RESULTS: Four steps were necessary to obtain a 74% response, i.e. direct contact, two mailings and a phone interview. The performance of the different questions was good. The prevalence of the most common conditions among patients answering positively to the questions regarding morning stiffness and symmetrical swelling of joints was as follows: osteoarthritis 2.60%, fibromyalgia 1.30%, carpal tunnel syndrome 1.14%, rheumatoid arthritis 0.31%, and psoriatic arthritis 0.10%. CONCLUSIONS: Methodological issues regarding the selection of the population and sample to study, the development of a questionnaire, and the problems in obtaining valid informations are discussed.

Adolescent↗
PubMed2001

Perceptions and use of Canada's Food Guide to Healthy Eating by grocery shoppers in London, Ontario.

Limited information exists on grocery shoppers' perceptions and use of Canada's Food Guide to Healthy Eating. The main objective of this study was to examine grocery shoppers' perceptions and use of the food guide in London, Ontario. The guide tearsheet and a self-administered questionnaire about food-buying practices were distributed to 2,000 food shoppers in ten London supermarkets. The response rate was 572 of 2,000 shoppers, or 29%; detailed results are reported in a separate paper. Four months later, a follow-up survey on the perceptions and use of the food guide was conducted through the use of a mailed questionnaire. (Both questionnaires had been pretested.) The response rate to the follow-up survey was 21% (118 of 572 participants). This survey revealed that 79% found the tearsheet useful or very useful. A majority indicated they would recommend its use to others. Over 75% reported awareness of the messages and almost two-thirds indicated that they had made some changes in their eating habits. About 40% provided helpful suggestions for revisions of the guide. The information obtained from this study will help health educators better understand shoppers' perceptions about the usefulness of Canada's Food Guide to Healthy Eating. The guide must be made more accessible, and shoppers' concerns about healthy food choices must be addressed.

Canada↗
PubMedDate not supplied

[Analysis of the management of the vaccination campaign in 1996-1997 against meningococcus C in Galicia].

This paper describes the process to design and plan a vaccination campaign against group C N. Meningitidis developed in the Autonomous Community of Galicia between December 9, 1996 and January 31, 1997. We also analyse the results of this process in terms of management results, vaccine coverage and preliminary estimates of effectiveness. A Work group was established, made up of professionals in charge of different intervention areas. A person was designated in charge of the whole campaign and a follow-up and information system was created. The work plan consisted of daily meetings for follow-up, co-ordination and task distribution; and periodical meetings with primary health care and peripheral public health coordinators. Strategies of implantation--in order to make sure the campaign accessibility and acceptability; of budget and of communication with health workers, inhabitants and mass media were developed. Up to 100 tasks were identified to develop the technical information and logistic activities: mailings, meetings, leaflets, ...; purchasing of 584.980 doses of vaccine, supplying to 715 vaccination points (1040 deliveries); problem solving and intervention recording. A vaccination coverage of 85% was achieved, with notification of 8 adverse reactions and 6 errors in the administration of the vaccine (34 children affected). The strategy chosen for the design and planning of the campaign has proven to be effective and valid and sufficient to achieve the final goals, in due time and without problems of misinformation, shortage of vaccine or lack of participation of professionals or people. Mistakes due to incorrect administration of the vaccine, management problems, rupture of the cold chain or recording failures were minimal and accidental.

Health Education↗
PubMed2002

A Quebec survey of issues in cancer pain management.

We report the results of a cancer pain survey mailed to Quebec hematologist-oncologists and palliative care physicians in 1999. The survey was designed to sample views on the current status of pain management and on obstacles to the provision of adequate pain relief for patients. The survey, formulated by an ethics network centered at the Clinical Research Institute of Montreal, was distributed to all members of the Association of Hematologist-Oncologists of Quebec and to all physician members of the Quebec Palliative Care Association. Responses were obtained from 138 Palliative Care Association members (response rate 61%) and 76 hematologist-oncologists (response rate 45%). Major obstacles reported included inadequate assessment of both contributory psychosocial issues and severity of pain, patient reluctance to take opioids, and inadequate access to non-drug techniques for pain relief. Access to opioids was not regarded as a problem. Both groups felt generally competent in their ability to manage various aspects of cancer pain therapy. They gave little credit to their formal medical school or residency training. Fifty-six percent of the palliative care group and 57% of the hemato-oncologists rated their medical school experience as only "poor" or "fair" on a 4-point scale. Residency ratings were modestly better. We conclude that medical faculties should assign a high priority to teaching health professionals patient assessment techniques. Simple symptom assessment scales should be routinely used in oncology/palliative care practice. Medical school training in pain management is not highly regarded and should be enhanced. We also note that, based on response to the scenario of a patient presenting with severe pain, many physicians, while feeling competent in the use of opioids, may be overly conservative in their initial use.

Attitude of Health Personnel↗
PubMed2001

Efficacy of patient letter reminders on cervical cancer screening: a meta-analysis.

OBJECTIVE: To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears. METHODS: A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed. RESULTS: Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity (chi2 = 31, 9 df, P <.001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity (chi2 = 5.2, 8 df, P =.75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80). CONCLUSIONS: Patient reminders in the form of mailed letters increase the rate of cervical cancer screening. Patient letter reminders have less efficacy in lower socioeconomic groups.

Adolescent↗
PubMed2003

Data-driven graduate curriculum redesign: a case study.

This article discusses the use of Knowles' adult learning theory as the framework for a curriculum redesign within the leadership and management track of a master's of science in nursing program. Health care executives within the university service area were surveyed regarding their organizational needs for advanced practice nurses. A second survey was mailed to a sampling of all RNs in the university service area. In response to perceived community needs, the curriculum of the leadership and management track was redesigned to allow for role specialization within the program. In addition, the university has an infrastructure to support distance learning and an experienced staff able to support distributive learning, providing wide geographical access to students in distant locations.

Adult↗
PubMed1988

Comparison of practice patterns and job satisfaction of entry level PharmD and BS level graduates in hospital and community practice.

Controversy has and continues to exist over whether schools of pharmacy should make the PharmD the universal entry level pharmacy degree. Proponents argue that doctorate status would enhance pharmacy's professional image and society would benefit from doctoral-level training. Opponents counter that, given the present health care system, society can place only a small percentage of pharmacists in positions requiring training at the doctorate level and, further, placing pharmacists with highly developed clinical skills in positions not requiring such skills will lead to both frustration and loss of clinical skills. The present study investigated the following research questions with regard to community and hospital pharmacy practice: (i) do job activities of entry level PharmD graduates differ from those of BS graduates; and (ii) does the job satisfaction of entry level PharmD and BS graduates differ? Questionnaires were mailed to randomly selected California entry level PharmD graduates and Georgia BS graduates to elicit responses regarding practice patterns and job satisfaction. Response rates were 68 percent for PharmD and 62.5 percent for BS respondents. The subsequent data revealed that both PharmD and BS respondents devoted the greatest portion of their time to drug distribution in both practice settings. Minimal differences were noted in other work activities in either on practice setting. No differences in job satisfaction were found.

California↗
PubMed1992

Dental hygiene practice: international profile and future directions.

Results of an international survey on dental hygiene are reported. The survey was conducted in 1988 through the International Dental Hygienists' Federation as part of a project to establish and maintain an international database on the profession. Information was collected by mail from national dental hygienist associations, using a 40-item questionnaire developed for the purpose; preliminary tabulations were validated by the associations. Information is presented for 13 countries-Australia, Canada, Denmark, Italy, Japan, Korea, The Netherlands, Nigeria, Norway, Sweden, Switzerland, the United States and the United Kingdom. Characteristics include historical development, numbers and distribution, education, regulation, scope of practice, employment settings and conditions, professional organisation, and perceived oral health and professional issues. The profiles and issues are examined in the light of broader socio-economic, demographic, epidemiological, technological and policy-related trends and changes. Implications for future health and organisational planning are noted.

Australia↗
PubMed2005

Overview of recruitment for the osteoporotic fractures in men study (MrOS).

Large, long term research studies present recruitment challenges that can be met with collaborative approaches to identify and enroll participants. The Osteoporotic Fractures in Men Study (MrOS), a multi-center observational study designed to determine risk factors for osteoporosis, fractures and prostate cancer in older men, recruited 5995 participants over a 25-month period. Enrolling a cohort that represented the race and age distribution of each community, and developing interest in an older male cohort about a condition commonly thought of as a "women's disease," were major recruitment challenges. During the start-up phase, recruitment challenges and strategies were analyzed and collective approaches were developed to address ways to motivate the target population. Key methods included mailings using community and provider contact lists; regional and senior newspaper advertisements; and presentations targeted to seniors. Sites used a centrally developed recruitment brochure. Response to mass mailings at some sites surpassed 10-15% and appointment show rates averaged above 85%. The final number enrolled in MrOS was 5% more than the original recruitment goal of 5700. Minority recruitment was enhanced through the use of the Health Care Financing Administration and other databases that allowed for targeted recruitment. Overall, minority enrollment was approximately 10.56% of the cohort (244 African American, 191 Asian). Men age>80 were enthusiastic and represent about 18% of enrollees. Through a coordinated approach of developing and refining recruitment strategies and materials, sites were able to adapt their original strategies and complete recruitment ahead of schedule.

Aged↗
PubMed2002

Guideline adherence rates and interprofessional variation in a vignette study of depression.

OBJECTIVE: To assess the appropriateness of and variation in intention-to-treat decisions in the management of depression in the Netherlands. DESIGN: Mailed survey with 22 paper cases (vignettes) based on a population study. SETTING: A random sample from four professional groups in the Dutch mental healthcare system. SUBJECTS: 264 general practitioners, psychiatrists, psychotherapists, and clinical psychologists. MAIN OUTCOME MEASURES: Each vignette contained information on a number of patient characteristics taken from three national depression guidelines. The distribution of patient characteristics was based on data from a population study. Respondents were asked to choose the best treatment option and the best treatment setting. For each vignette we examined which of the selected treatments was appropriate according to the recommendations of the three published Dutch clinical guidelines and a panel of experts. RESULTS: 31% of all intention-to-treat decisions were not consistent with the guidelines. Overall, less severe depression, alcohol abuse, psychotic features, and lack of social resources were related to more inappropriate judgements. There was considerable variation between the professional groups: psychiatrists made more appropriate choices than the other professions although they had the highest rate of overtreatment. CONCLUSIONS: There is sufficient variation in the intentions to treat depression to give it priority in quality assessment and guideline development. Efforts to achieve appropriate care should focus on treatment indications, referral patterns, and overtreatment.

Antidepressive Agents↗
PubMed1989

[Questionnaire survey of full-time occupational health physicians in Japan].

In August 1987 the University of Occupational and Environmental Health conducted a mail questionnaire survey on occupational health physicians (OHPs) located throughout Japan. The objective was to obtain preliminary information concerning the actual situation of OHPs together with their opinions on post-graduate training in this field. A summary of the results based on 187 valid responses (valid response rate = 59.4%) is as follows: 1. Age distribution of the respondents was in excess of 55 years of age (mean age of 61.4 yr), suggesting aging of the work force. 2. Comparison of the present age with period in present position revealed that a significant proportion of the respondents assumed their current position following retirement from clinical service. 3. Routine work schedules such as clinical activities and making site visits within factory tended to be influenced by the number of employees. 4. Conduct of special physical examinations on workers in hazardous environments was rated the highest among the necessary abilities of OHPs. 5. It was found that 30-34 years of age and 2-5 years of clinical experience were the minimal qualifications for a full time OHP.

Adult↗
PubMed1980

Pharmacy and health planning: a national survey of health planners.

The extent of pharmacy involvement in area health planning, and the perception of health planners on pharmacy and drug-related issues, were assessed. Health Systems Agencies (HSAs) (135, or 66%) and State Health Planning and Development Agencies (SHPDAs) (25, or 45%) responded to a 34-item mail questionnaire on pharmacy planning issues. Pharmacists were involved in developing health plans in 39% of the HSAs and 18% of the SHPDAs. Pharmaceutical services were mentioned in 50% of the local and 58% of the state plans. Thirty-two percent of the HSAs and 42% of the SHPDAs believed there was a poor distribution of pharmacies in health service areas. The respondents also answered questions on the need for pharmaceutical services in given areas and among special populations, drug reimbursement procedures, and the kinds of data health planners need when planning pharmaceutical services. Numerous respondents noted that increased participation by pharmacy groups in health planning would be desirable and welcomed.

Health Planning↗
PubMed2000

Clinical impact of dosimetry quality assurance programmes assessed by radiobiological modelling of data from the thermoluminescent dosimetry study of the European Organization for Research and Treatment of Cancer.

The European Organization for Research and Treatment of Cancer (EORTC) Radiotherapy Group initiated its mailed thermoluminescence dosimetry (TLD) programme in 1986. The aim of the present study was to evaluate the clinical relevance of variations in beam output detected in the period 1993 to 1996. A total of 140 beam outputs were checked (26 for cobalt-60 units and 114 for linear accelerators) in 35 centres. Clinical dose-response data for tumour control and normal tissue morbidity were used to assess the variation in clinical outcome resulting from variability in beam output. For 75 checked beams with nominal accelerating potentials (n. a.p.) of 6 MV or less the mean ratio, +/- standard deviation (S.D.) of measured to stated output was 1.004+/-0.020. For 65 beams with n. a.p. of 8 MV or more, the ratio was 1.009+/-0.021. Even with this relatively high level of precision, broad distributions of estimated tumour control or normal tissue morbidity were found. In the 10% of the beams with the most pronounced underdosage, the loss in tumour control probability was estimated at 7-8 percentage points. Likewise, in the 10% of the beams with the most pronounced overdosage, the increase in mild/moderate morbidity was 19-22 percentage points. For severe morbidity the same beams raised the estimated incidence of severe complications from 5% to 9-10%. An estimation of the loss of uncomplicated cure probability was about 1% for both high and low energy beams. Sequential mailings considerably improved the uniformity of clinical outcome. We conclude that small deviations in beam output may lead to clinically important variations in outcome. Substantial reductions in the variation between measured and stated output can be achieved by sequential mailings. Mailed TLD checks should be an integral part of a continuously ongoing quality assurance activity in radiotherapy.

Dose-Response Relationship, Radiation↗
PubMed1999

Practical methods to increase use of advance medical directives.

OBJECTIVE: To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN: Population-based, randomized controlled trial with 3-month follow up. SETTING: Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS: A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS: All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS: The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference -0.04, 0.04, p =.952). CONCLUSIONS: In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives.

Advance Directives↗
PubMed1998

The influence of clinical symptoms on quality of life in patients with narcolepsy.

Quality of life is a multidimensional construct involving subjective well-being, health, and welfare. For the patient with narcolepsy, as for any patient with a chronic illness, clinical symptoms have a major impact on physical and psychosocial function and hence on quality of life. This article briefly reviews selected effects of narcolepsy and describes the results of studies undertaken by researchers at the Sleep-Wake Disorders Center of Montefiore Medical Center in New York City. The goal of these studies was to determine the social characteristics and perceived needs of patients and to document the prevalence of the clinical features of narcolepsy and their impact on quality of life. Using a combination of methodologies--mail survey, record review, and personal interviews--the researchers found that clinical symptoms of narcolepsy have a profound impact on the physical, mental, and social health of those affected with the disorder.

Adolescent↗