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PubMed1985

A multi-hospital hepatitis B vaccine program: prevalence of antibody and acceptance of vaccination among high-risk hospital employees.

In July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients. Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies. Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.

Attitude of Health Personnel↗
PubMed2001

Inhalation treatment: errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children.

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.

Administration, Inhalation↗
PubMed2003

Relaxing intraoperative natural sound blunts haemodynamic change at the emergence from propofol general anaesthesia and increases the acceptability of anaesthesia to the patient.

BACKGROUND: It is known that auditory input, such as comforting music or sound, blunts the human response to surgical stress in conscious patients under regional anaesthesia. As auditory perception has been demonstrated to remain active under general anaesthesia, playing comforting sounds to patients under general anaesthesia might also modulate the response of these patients to surgical stress. METHODS: Fifty-nine patients scheduled for laparoscopic cholecystectomy were anaesthetized with propofol general anaesthesia in combination with epidural anaesthesia. Natural sounds, chosen preoperatively by each patient as being comforting, were played to 29 patients using headphones during surgery (S group) and the remainder of the patients (n = 30) were fitted with dummy open-type headphones (N group). We compared the haemodynamic change during anaesthesia and the acceptability of anaesthetic practice between the two groups in a randomized double-blind design. RESULTS: There were no differences in haemodynamics between the S and N groups during surgery. During the emergence from anaesthesia, the mean blood pressure and heart rate gradually increased; both parameters were significantly higher in the N group than in the S group. Postoperatively, patients in the S group perceived the experience of anaesthesia as significantly more acceptable than did those in the N group. CONCLUSION: These findings indicate that allowing patients comforting background sounds during general anaesthesia may blunt haemodynamic changes upon emergence from general anaesthesia and increase the acceptability of the experience of anaesthesia.

Aged↗
PubMed2003

Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction.

Oral implantology is an established subspecialty of restorative dental and oral surgery. While an extensive body of evidence on the fundamentals of osseointegration and associated factors has been published, marketing-oriented analyses based on representative public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction are scarce. In this study, an attempt was made to address these points by questioning a representative sample of 1000 adults in the household setting. The interviewees were presented with 14 questions. Of those familiar with implants as one of the treatment alternatives, 61% reported they would accept implants if the need arose. Implant acceptance was highest among males and interviewees below the age of 30 years. The interest in implants increased with increasing family incomes. Four percent of those questioned already had implants. Twenty-five percent knew someone who had undergone implant treatment. All those questioned found implant-supported rehabilitation to be very expensive. Many of them blamed the dentists for the high cost. One detail was particularly evident: satisfaction among implanted patients was clearly higher than satisfaction rates perceived by them from what they were told about implants by others. First-hand experiences with implants proved to be less biased than reported second-hand information.

Adolescent↗
PubMed1999

Admission rates, early readmission rates and patient acceptability of 142 cases of day case septoplasty.

Day case surgery should be confined to those procedures where less than 3% of patients require admission. The aim of this study was to establish the admission rates, early readmission rates and patient acceptability of 142 consecutive cases of day case septoplasty. Data acquisition was by retrospective postal questionnaire. One hundred and fifty-three patients were studied and data was acquired on 142. Ninety per cent (128/142) of patients had operations on afternoon lists. Admissions were 7/142 (5%), the early readmission rate (within 24 h) was 0% and 25/142 (17%) of patients felt they would rather have stayed in hospital for the first night after surgery. The conclusion of this work is that day case septoplasty is an acceptable practice in appropriately selected patients who are operated upon in the morning and when the technique described here is applied. An acceptably small proportion of planned day cases may require admission.

Adult↗
PubMed2003

Assessing limiting factors to the acceptance of antiretroviral therapy in a large cohort of injecting drug users.

OBJECTIVE: A comprehensive questionnaire was designed to assess the knowledge and understanding of injecting drug users (IDUs) regarding their HIV disease, and to determine any factors that may increase the acceptance of antiretroviral therapy (ART) by this group. RESULTS: Twenty percent of the total IDU cohort attending the GUIDE (GenitoUrinary Medicine and Infectious Diseases) clinic participated in the study. Fifty-two percent had been homeless in the past 5 years and 84% are unemployed. Seventy-two percent of patients did not complete second level education and 10% were illiterate. Fifty-one percent had siblings or parents with a history of injection drug misuse, and 25% had at least one sibling also HIV positive. Forty-seven percent started using drugs before the age of 13 years, and the most common initial drug was heroin (44%). Ninety-five percent had attended for methadone maintenance therapy (MMT), with 39% currently attending for daily therapy. The majority of patients were unable to simply explain or interpret CD4 cell counts (54%) and 'viral loads' (65%). Fifty-seven percent of patients were receiving highly active antiretroviral therapy (HAART). There was a statistically significant association between patients receiving HAART and both attendance at a primary care physician for methadone maintenance therapy (P = 0.005), and weekly take-outs of methadone (P = 0.005). There was also an association between adherence to HAART and attendance at a methadone maintenance clinic (P = 0.04). CONCLUSIONS: This study highlights the chaotic lifestyle and complex social background of the IDU. Such factors were not, however, associated with acceptance of HAART. The primary factor associated with both the acceptance of and adherence to HAART was regular and stable attendance for methadone therapy.

Adolescent↗
PubMed1997

Acceptability by patients of transvaginal sonography in the elective assessment of the first-trimester fetus.

The acceptability of transvaginal sonography (TVS) for visualization of first-trimester fetal anatomy was investigated in 160 women sequentially attending a routine dating scan clinic at 12-13 weeks' gestation. All women underwent transabdominal sonography (TAS) in the first instance to assess gestational age. Of these women, 88.1% agreed to undergo TVS. The main reasons for declining were fear of miscarriage (42.1%) and discomfort (36.8%). With TVS, 51.8% described no discomfort, 47.5% mild and 0.7% marked discomfort. Of the women who underwent TVS, 95% said that they would have no concerns about a further TVS in another pregnancy. Of those women who had previously had TVS (11.9%), all agreed to have TVS in this pregnancy and experienced significantly less concern about the procedure than did those who had never had TVS before. TAS was associated with discomfort and inconvenience only if women tried to fill their bladder prior to the scan. In conclusion, TVS is acceptable and well tolerated by an unselected pregnant population. Acceptability rates for TVS should improve as its use becomes more widespread.

Female↗
PubMed2000

Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy.

This paper reports on the reasons why patients agreed to or declined entry into randomized trials of cancer following discussions conducted by clinicians in both District General and University Hospitals. Two hundred and four patients completed a 16-item questionnaire following the consultation, of these 112 (55%) were women with breast cancer. Overall results showed that 147 (72.1%) patients accepted entry to a randomized clinical trial (RCT). The main reasons nominated for participating in a trial were that 'others will benefit' (23.1%) and 'trust in the doctor' (21.1%). One of the main reasons for declining trial entry was that patients were 'worried about randomization' (19.6%). There was a significantly higher acceptance rate for trials providing active treatment in every arm 98 (80.6%) compared with those trials with a no treatment arm 46 (60.5%), chi2 test P= 0.003. The study outlines a number of factors that appear to influence a patient's decision to accept or decline entry into an RCT of cancer therapy. An important factor is whether or not the trial offers active treatment in all arms of the study. Communication that promotes trust and confidence in the doctor is also a powerful motivating influence.

Adult↗
PubMed2001

Acceptance of pharmacotherapy for relapse prevention by chronic alcoholics.

The willingness to take medication is a major prerequisite for compliance with biological treatment approaches in psychiatric disorders. The aim of this study was to investigate the willingness of alcoholics to improve relapse prevention using drug therapy, since there has been little information about the acceptance of such a medication as yet. 261 chronic alcoholics consecutively referred for detoxification completed a newly developed questionnaire containing items on drinking history, recent treatments, and beliefs about drug therapy for relapse prevention. In order to draw comparisons, 67 self-help group attendees and 29 alcoholics consulting an outpatient advice service were also recruited. 67.8% of the recently detoxified alcoholics were prepared to take medication for relapse prevention, if prescribed, while 60% the self-help group attendees refused drug therapy. There was no correlation between the acceptance of drug treatment and duration of dependence. Subjects willing to take a medication more often believed their alcoholism to be curable, and they reported a higher craving frequency. 55% of those willing to take a medication were willing to pay for the drugs, but in most cases, at a level lower than the equivalent of 5 beers. As drug therapy acceptance is a crucial part of compliance with, and success of medical relapse prevention, our results underscore the necessity of a thorough exploration into the health beliefs of the patient and joint development of a treatment rationale prior to prescription.

Adult↗
PubMed2003

[Stereotactic vacuum-assisted breast biopsy--success, histologic accuracy, patient acceptance and optimizing the BI-RADSTM-correlated indication].

PURPOSE: To evaluate success, histologic accuracy, patient acceptance and BI-RADS TM-correlated malignancy rate of stereotactic vacuum-assisted breast biopsies in order to optimize the indication. MATERIALS AND METHODS: In 132 patients with mammographically detected breast lesions 166 stereotactic vacuum- assisted 11 gauge core biopsies were performed. All lesions were classified according to the BI-RADS TM categories of the ACR. Removal of the lesion was radiographically assessed as complete, representative or not representative. Patient acceptance was evaluated. RESULTS: Of the 166 lesions, 54 (32.5 %) lesions were judged completely removed, 110 (66.3 %) representatively removed and 2 (1.2 %) not representatively removed. Malignancy was found in 38 (22.9 %) lesions. The rate of malignancy increased from 6.3 % (2/32) for BI-RADS TM category 3 to 16.7 % (19/114) for BI-RADS TM category 4 and increased further to 85 % (17/20) for BI-RADS TM category 5 (p < 0.001). The histology of a sufficient vacuum-assisted biopsy was underestimated in 6 (15 %) of the 40 lesions that were subsequently excised surgically. Most patients (98.5 %; 130/132) stated they would undergo a vacuum-assisted biopsy again. CONCLUSION: Vacuum-assisted breast biopsy is accurate, has a justifiable rate of histologic underestimation and is well accepted by patients. Patients with BI-RADS TM category 4 microcalcification benefit the most. Lesions of BI-RADS TM category 3 and BI-RADS TM category 5 should be biopsied only under special circumstances (family risk of breast cancer; assessment of lesions extension).

Adult↗
PubMed1997

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). I: Long-term acceptance of nasal CPAP].

BACKGROUND: Nocturnal ventilation with nCPAP has been established as the safest and most efficient nonsurgical treatment for OSAS. Long-term results, however, are determined by the patients' compliance with therapy. The aim of this study was the objective measurement of long-term acceptability of nCPAP therapy in all patients receiving this treatment in our sleep laboratory between January 1990 and March 1995. METHODS: We prospectively investigated 41 patients (36 male, 5 female) with moderate to severe OSAS who received nCPAP therapy. Mean time of follow-up was 20.6 months, ranging from 1.2 to 53.5 months. Therapy was indicated when OSAS was confirmed by cardiorespiratory polygraphy and either (1) the patient complained of daytime sleepiness or (2) the patient possessed an apnea-hypopnea index greater than 30/h or when the mean oxygen desaturation was below 80% regardless of the presenting symptoms. The compliance with treatment was defined as a mean rate of use of over 5 hours per night calculated from the time counter on the nCPAP machine. RESULTS: 33 patients (88.5%) have continued using nCPAP until the present time but only 24 patients (59%) met our criteria for long-term acceptance and this group was identified as responders. We found no significant differences in age, body mass index, apnea-hypopnea index, and nCPAP-pressure between responders and non-responders. CONCLUSION: Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not efficiently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical approaches have to be considered as an alternative therapy.

Adult↗
PubMed1997

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). II: Side-effects of nCPAP therapy. Effect on long-term acceptance].

BACKGROUND: nCPAP is a well established method for the management of OSAS. The aim of this study was to evaluate long-term side effects and complications of nCPAP therapy and their influence on the patients compliance with treatment. PATIENTS AND METHODS: Forty-one patients with OSAS were interviewed by questionnaire to elucidate the problems and adverse effects of their nCPAP therapy. The patients were divided into responders and non-responders. Non-responding OSAS patients were using their nCPAP devices less then 5 hours each night by definition. RESULTS: The number of side effects and type of complication during nCPAP therapy were the same in both the responding and non-responding groups. The most frequently reported problems were a tender region on the bridge of the nose and discomfort associated with a dry nasal mucosa. Although nCPAP treatment was initially accepted by most patients, adverse effects and other difficulties decreased patient compliance, with time, in many cases. CONCLUSIONS: Despite there being no difference between responders and non-responders with respect to the number and severity of complications, it should not be presumed that these side effects do not influence long-term patient compliance with nCPAP therapy. Patients who suffer from symptoms of OSAS tend to accept these adverse effects, while those who do not feel limited by their disease are less persistent in their use of this treatment modality. Identification and elimination of the problems associated with the use of nCPAP equipment may increase longterm patient compliance. Close monitoring in the outpatient department combined with intermittent inpatient assessment in the sleep laboratory will also help to improve acceptance of nCPAP therapy.

Adult↗
PubMed1981

Posttranslational processing of methyl-accepting chemotaxis proteins in Escherichia coli.

Methyl-accepting chemotaxis proteins (MCPs) of Escherichia coli undergo changes in methylation state in response to chemical stimuli. The addition of methyl groups to MCP is dependent on cheR function; their removal is dependent on cheB function. This MCP methylation system is instrumental in establishing the unstimulated swimming pattern of E. coli and in enabling the cell to carry out sensory adaptation after a chemotactic response. We employed electrophoresis in sodium dodecyl sulfate-containing polyacrylamide gels to analyze MCP molecules synthesized in cheR deletion mutants lacking MCP-specific methyltransferase activity. MCP made under these conditions proved to be completely devoid of methyl groups. In the absence of cheB function as well, this unmethylated MCP is made in a form, designated 2(*), that exhibits several properties characteristic of methylated MCP. In the presence of cheB function, MCP 2(*) is processed to a form, designated 1(*), that no longer resembles methylated MCP. The rate of this conversion process is modulated by chemotactic stimuli. Both MCP 1(*) and MCP 2(*) are capable of initiating changes in flagellar rotation in response to stimuli, and, in the presence of cheR function, both forms can accept methyl groups. We suggest that MCP 2(*) is a normal intermediate in MCP synthesis in which one or more of the methyl-accepting glutamic acid residues carry a methyl-ester-like modification, which, like glutamic acid methyl esters, can be removed by cheB function. This cheB-dependent processing event does not appear to be reversible, but nevertheless it may play an important role in modulating the signaling behavior of newly synthesized MCP molecules.

Bacterial Proteins↗
PubMed1991

Treatment acceptability of alternative sex therapies: a comparative analysis.

Eighty female subjects rated therapy descriptions of a case involving the treatment of inhibited female orgasm in group and individual formats. Half of the treatment descriptions described the patient's husband participating in some of the homework exercises. After each treatment description, subjects completed a series of treatment acceptability ratings (Treatment Evaluation Inventory, Semantic Differential, Credibility Rating Scale) designed to evaluate the alternative treatment dimensions. A case history of primary anorgasmia, representative of actual clients and problems typically seen in sex therapy clinics, was presented to subjects via written material and audiotape players. A clear preference for individual format over group format was consistently found in credibility and acceptability ratings. Inclusion of the identified patient's partner in therapy was not a salient factor in acceptability ratings for the female subjects. Implications of this research paradigm are discussed in light of the current state of the art in sex therapy, and future research needs are identified.

Adolescent↗
PubMed1992

Marital therapy formats: an analysis of acceptability ratings with married spouses.

One hundred thirty-five married individuals evaluated the acceptability of alternative therapeutic formats commonly employed in marital therapy. Distressed and nondistressed spouses were randomly assigned to experimental conditions including two types of educational information (descriptive and group-oriented) presented across three treatment formats (i.e., individual, conjoint, and group). Primary dependent variables included the Treatment Evaluation Inventory and the Semantic Differential. Results revealed that conjoint format was most acceptable, followed by group and individual, respectively. However, distressed spouses rated the group and conjoint formats as equal in acceptability. Group-oriented information increased nondistressed subjects' ratings of group format. The implications of these results for clinicians and researchers offering marital therapy are discussed.

Adult↗
PubMedDate not supplied

Age and medication acceptance.

Patients' willingness to take a newly prescribed medication is an important, but little studied, part of the medication process. The authors studied the impact of patient age on the perceived importance and interaction of three factors known to influence young people: severity of their medical condition, extent of possible medication side effects, and level of trust in their physician. A convenience sample of 170 French adults aged 18 to 93 rated their likelihood of taking a medication intended to alleviate physical suffering in 27 scenarios in which three levels (low, moderate, and high) of each of the above three factors were combined in an orthogonal factorial design. Among younger participants, high trust in the physician was not considered a sufficient reason for high acceptance of a new medication; it had to be accompanied by low side effects. Among very elderly participants, high trust led to high acceptance almost irrespective of the severity of possible side effects. Among the middle aged, trust and side effects had largely independent effects. To promote patients' acceptance of newly prescribed medications, physicians need to establish trust, but not abuse its power in elderly patients.

Adolescent↗
PubMed2006

Pediatric HIV type 1 vaccine trial acceptability among mothers in Kenya.

Vaccination of infants against human immunodeficiency virus type 1 (HIV-1) may prevent mother-to-child HIV-1 transmission. Successful trials and immunization efforts will depend on the willingness of individuals to participate in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-sectional study, pregnant women presenting to a Nairobi antenatal clinic for routine care were interviewed regarding their attitudes toward participation in research studies and HIV-1 vaccine acceptability for their infants. Among 805 women, 782 (97%) reported they would vaccinate their infant against HIV-1 and 729 (91%) reported willingness to enroll their infant in a research study. However, only 644 (80%) would enroll their infants if HIV- 1 testing was required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial included concerns about side effects (75%), partner objection (34%), and fear of discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results (5%). The strongest correlate of pediatric vaccine trial participation was maternal willingness to be a vaccine trial participant herself; in univariate and multivariate models this was associated with a 17-fold increased likelihood of participation (HR 17.1; 95% CI 11.7-25; p < 0.001). We conclude from these results that immunizing infants against HIV-1 and participation in pediatric vaccine trials are generally acceptable to women at high risk for HIV-1 infection. It will be important to address barriers identified in this study and to include male partners when mobilizing communities for pediatric HIV-1 vaccine trials and immunization programs.

AIDS Vaccines↗
PubMed2005

Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: a study of rapid versus standard testing.

Patients of unknown HIV status who were admitted to the inpatient unit or who were undergoing evaluation in the outpatient clinic of a public health hospital were randomized to receive either the standard HIV test or a rapid HIV test. Patients ranged from 21-71 years of age, and 71% were male. Eleven percent were Hispanic, 36% black, and 48% Caucasian. 35% were injection drug users (IVDU) and 3% men who have sex with men (MSM). The waiting period for the standard test was 2 weeks, and that for rapid testing was approximately 20 minutes. Patients were provided with a telephone number and told to call and schedule a follow-up appointment to receive their standard test results. We found no statistical difference in the acceptance rates of either testing modality overall or with respect to age or gender. We did find a significantly greater percentage of Hispanic patients accepting rapid testing over standard testing (p = 0.04). The overall acceptance rates of rapid and standard testing were 60% and 41%, respectively. This was far lower than expected, and was due in part to the 40% of patients who refused testing because of their having a previous HIV test. All patients who had received previous testing had tested HIV negative, and we did not discover any new cases of HIV in the 103 patients tested during the study. Of those we tested, 95% of those receiving the rapid test and 43% of those receiving the standard test were informed of their status (p < 0.001). Failure of patients to return for follow-up visits accounts for the low percentage of individuals successfully informed of their standard test results. The study suggests that rapid HIV testing is at least as palatable as standard testing in our population. In addition, a far greater percentage of patients are informed of their status using the rapid HIV test. HIV testing programs at our hospital may not be cost effective as our population appears to have been heavily tested previously. Prior to initiating an HIV testing program within a hospital setting, it is imperative to determine the percentage of patients previously tested for HIV.

AIDS Serodiagnosis↗