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PubMedDate not supplied

Evaluation of a "formal" endocrinology curbside consultation service: advice by means of internet, fax, and telephone.

OBJECTIVE: To describe the development, implementation, and assessment of an Internet- and fax-based endocrinology curbside consultation service. METHODS: An Internet- and fax-based endocrinology consultation service was designed by developing a simple Web site so that requesting physicians could complete a form about the patient. Community and academic-based primary-care physicians were invited to use the service. One month after each consultation, a follow-up questionnaire about the effectiveness and use of the Internet and fax consultation service was sent to each physician who had requested the consultation. RESULTS: During the 5-month period in which the service was offered, 67 physicians requested a total of 85 "formal" endocrinology curbside consultations. Of these 85 requests, 46 were by e-mail, 31 by fax, and 8 by telephone. Follow-up questionnaires were returned by 61 of the 67 physicians who used the service. One hundred percent of the physicians found the service to be useful, and about 33% noted formal consultation had been avoided. In approximately 55% of the consultations, physicians indicated that the response caused them to alter the treatment of their patient. Consultation questions encompassed the full spectrum of endocrinology. The issues were approximately equally distributed among test interpretation, medication, and management. CONCLUSION: We successfully designed and implemented an Internet- and fax-based endocrinology curbside consultation service. This form of consultation was used by physicians and brought about change in the management of their patients.

Attitude of Health Personnel↗
PubMed1995

Hereditary prostate cancer in Nova Scotia.

A case control study of 244 prostate cancer patients and 240 of their female partners was performed. The study sample was generated by the following methods: 1) an advertisement was placed in two newspapers with province-wide distribution 2) all Nova Scotia urologists were asked to identify patients with a positive family history and 3) consecutive patients treated for prostate cancer in an ambulatory setting were contacted by telephone. Seven men and 27 women did not know their family history. Patients with a positive family history (43/237, 18%) became case group. Wives who had family members affected by prostate cancer (16/213, 7.5%) comprised the control group. Both cases and controls completed a standardized questionnaire by mail or telephone. The heredity variant of prostate cancer accounted for 5 %, the familial 12% and the sporadic 83% of cases studied and 0%, 9% and 91%, respectively of the control group. The odds ratio calculated for first-and second-degree relatives was 2.73 (95% confidence interval, 1.49-5.01). The mean age at diagnosis of these cases was 68 years. There was not a statistically significant difference between the familial (69 years) and hereditary (67 years) subgroups' mean age at diagnosis (p=0.4). Most men with prostate cancer in the Nova Scotia population sample were affected by the sporadic variant. Small but important groups were affected by familial or hereditary types. Identification of these families will have important implications for screening and gene mapping studies.

Journal Article↗
PubMed2000

Personal and clinical skin cancer prevention practices of US women physicians.

OBJECTIVE: To document physician clinical and personal skin cancer prevention practices and associated characteristics. DESIGN: A cross-sectional questionnaire survey of a representative sample of US women physicians. SETTING: Mail survey. SUBJECTS: Three thousand thirty-two nondermatologists and 95 dermatologists. MAIN OUTCOME MEASURE: Personal and clinical practices. RESULTS: Twenty-seven percent of nondermatologists counseled or screened their typical patients on skin cancer or sunscreen use at least once a year, while 49% did so less frequently, and 24% never counseled or screened at all. Of the 95 dermatologists, two thirds reported counseling or screening their typical patients at every visit. In bivariate analysis of nondermatologists, the distribution of counseling or screening was significantly (P<.05) associated with the following personal and professional characteristics: frequent sunscreen use, recent (within 2 years) skin examination, good health status, a primary care specialty, self-confidence in counseling or screening, extensive training in counseling or screening, high perceived relevance to the practice of the counseling or screening, nonurban practice site, and nonhospital-based or non-medical school-based practice. We found that 48% of all physicians always or nearly always used sunscreen, and 25% had received a clinical skin examination in the previous 2 years. CONCLUSIONS: Although many primary care physicians report ever counseling or screening their typical patients about skin cancer and sunscreen use, increased professional education for primary care physicians could improve patient counseling about skin cancer prevention.

Adult↗
PubMed2006

Critical care pharmacy services in United States hospitals.

BACKGROUND: Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated. OBJECTIVE: To characterize the type and level of pharmacy services provided to intensive care units (ICUs). METHODS: A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal. RESULTS: Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 +/- 1.5 days/wk, mean +/- SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting in-services (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories. CONCLUSIONS: Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.

Clinical Pharmacy Information Systems↗
PubMed2001

Expertise and estimating what other people know: the influence of professional experience and type of knowledge.

There is ample evidence that estimations of what other people know are often biased in the direction of one's own knowledge. Yet, it is still unclear if this bias is influenced by expertise. In Study 1, computer experts estimated the distribution of Internet concepts and general knowledge concepts among students. These estimations were compared with norm values and with estimations obtained from a sample of laypersons. Laypersons showed a stronger bias than experts. Study 2 revealed that knowledge estimations can be influenced by labeling knowledge items as specialist knowledge. The results are suggestive of ways in which communication between experts and laypersons could be enhanced. Especially in asynchronous communication situations, as for example in the use of e-mail based hot lines, if experts are to communicate effectively, they must make accurate assumptions about laypersons' knowledge of the topic.

Adult↗
PubMed2000

Effectiveness of monetary incentives for recruiting adolescents to an intervention trial to reduce smoking.

BACKGROUND: The study objective is to evaluate the effect of monetary incentives on response rates of adolescents to a smoking-related survey as the first step toward participation in an intervention trial. METHODS: A sample of 4,200 adolescent members of a managed care organization were randomized to one of four incentive groups: a $2 cash group, a $15 cash group, a $200 prize drawing group, or a no-incentive group. We compared group-specific response rates and willingness to be contacted about future study activities, as well as costs. RESULTS: Incentives increased survey response rates (55% response without incentive vs. a 69% response with incentive), with response of 74% in the $15 cash group, 69% in the token group, and 63% with a prize incentive. Incentives did not adversely affect willingness of adolescents to be contacted about a smoking intervention, (65% willing with incentives vs. 60% without, P = 0.03). In terms of cost per additional survey completed, token and prize groups were marginally more expensive than the no-incentive group ($0.40 and $1.42, respectively) while the large cash incentive was substantially more costly ($11.37). CONCLUSIONS: Monetary incentives improve response rates to a mailed survey, without adverse impact on willingness to further participate in intervention activities. However, a variety of issues must be considered when using incentives for recruitment to intervention studies.

Adolescent↗
PubMed1999

[Systematic home screening for Chlamydia trachomatis infections of asymptomatic men and women in family practice by means of mail-in urine samples].

OBJECTIVE: To determine the prevalence and determinants of Chlamydia trachomatis (CT) infections among asymptomatic men and women in general practice. To determine participation rates in a systematic screening programme in general practice, using home obtained mailed urine samples. DESIGN: Cross-sectional study. METHODS: In 15 general practices in Amsterdam, the Netherlands, a sample of 11,005 persons (5541 women and 5464 men), aged 15-40 were invited to send in a urine sample and a completed questionnaire by mail. The urine samples were tested using the ligase chain reaction for DNA amplification. Patients diagnosed with CT were treated and partner notification was performed. RESULTS: 33% of invited males (1809/5464) and 50% of females (2751/5541) sent in the study material. Older patients participated more frequently than younger patients. Participation rates among persons with a Dutch background were higher than rates among persons from other ethnic groups. In 42 men and 79 women a CT infection was identified (2.3% and 2.9% respectively). Infections were more prevalent in patients from Surinam and the Dutch Antilles and in the age category 21-25 years. Type of health insurance as a proxy measure of socioeconomic status was not an indicator of infection. CONCLUSION: The participation in this systematic screening using mail-sent urine samples was 33% in men and 50% in women. The CT prevalences among asymptomatic men and women were 2.3% and 2.9% respectively.

Adolescent↗
PubMedDate not supplied

Profile of Internet users: survey of the Surgical Section of the AAP.

BACKGROUND: Communication through electronic networks is becoming a most useful resource of health care providers. PURPOSE: Establish the demographic and professional profile and identify the internet service provider of members of the Surgery Section of the American Academy of Pediatrics (AAP). MATERIALS: A short survey questionnaire including variables of age, gender, years of experience, type of practice and internet service provider was mailed to all members of the Surgical Section of the AAP. Two-hundred and six responses of 588 (35%) were received and analyzed. RESULTS: Mean age of the group was 52 years of which 88% were male and 12% female (7.5:1). The group had an average of eighteen years of practice; 185 members (90%) have access to Internet and 188 (92%) use it mainly for e-mailing from either home (25%), hospital/office setting (30%) or both (42%). Twenty-three percent of member were willing to receive section news and correspondence by electronic means, by print-mail 34% and both 44%. Overall type of practice was private 21%, University 54% or combined 23%. No access to internet means an older member (57 yrs, p = 0.02) sharing solo (private) practice (p = 0.006). Two-third of internet service providers were university-based (-edu) or hospital organizations (-org) with a younger age group (48 yrs, p = 0.000001). CONCLUSIONS: E-mailing is becoming the preferred method of communication among many members of the Section of Surgery of the AAP. Net accessibility through University or Children Hospital servers account for the high number of young members in this practice setting.

Demography↗
PubMedDate not supplied

Factors associated with the geographic variation of reported Chlamydia infection in Minnesota.

BACKGROUND AND OBJECTIVES: In Minnesota, physicians have been required to report cases of Chlamydia trachomatis infection since 1985. The distribution of reported cases suggests that there is substantial geographic variation in the rate of chlamydia infection. GOAL OF THIS STUDY: We conducted chlamydia screening at selected sites and a survey of primary care physicians in counties with high and low rates of reported chlamydia infection. We hypothesized that chlamydia infections are uniformly distributed in nonmetropolitan areas, and the geographic differences in reported cases can be attributed to variable testing and reporting practices by physicians. STUDY DESIGN: The number of reported female chlamydia cases per 1,000 women was calculated for each rural Minnesota county in 1990. Fourteen counties with high and low rates of reporting were selected for further investigation. From September to December 1991, universal chlamydia screening was carried out at 11 clinics serving patients in these counties. A questionnaire was mailed to all primary care physicians in these counties. RESULTS: In 1990, the rate of reported chlamydia cases was 4.7/100,000 and 0.1/100,000 for women living in the high-reporting and low-reporting counties, respectively. Chlamydia infection was present in 5.5% and 9.7% of women screened at selected clinics in high- and low-reporting counties, respectively. Physicians in high- and low-reporting counties did not differ significantly in terms of age, gender, number of pelvic exams, or frequency of chlamydia testing. However, physicians in high-reporting counties were significantly more likely to test for chlamydia when evaluating mucopurulent cervicitis or salpingitis, and they were more likely to test a woman whose sex partner had urethritis. Physicians in high-reporting counties were also more likely to have reported a case of chlamydia.

Adolescent↗
PubMedDate not supplied

Estimating non-response bias in a survey on alcohol consumption: comparison of response waves.

AIMS: According to 'the continuum of resistance model' late respondents can be used as a proxy for non-respondents in estimating non-response bias. In the present study, the validity of this model was explored and tested in three surveys on alcohol consumption. METHODS: The three studies collected their data by means of mailed questionnaires on alcohol consumption whereby two studies also performed a non-response follow-up. RESULTS: Comparisons of early respondents, late respondents and non-respondents in one study showed some support for 'the continuum of resistance model', although another study could not confirm this result. Comparison of alcohol consumption between three time response groups showed no significant linear pattern of differences between response waves. CONCLUSIONS: The hypothesis that late respondents are more similar to non-respondents than early respondents, could not be confirmed or rejected. Repeated mailings are effective in obtaining a greater sample size, but seem ineffective in improving the representativeness of alcohol consumption surveys.

Adolescent↗
PubMed1983

Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981.

The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.

Analysis of Variance↗
PubMedDate not supplied

Clinical study of hearing instruments: a cross-sectional longitudinal audit based on consumer experiences.

The objective of the present audit was to document improvements/changes in hearing instrument (HI) benefit in terms of use and satisfaction throughout the 1990s and compare the benefit in consumers fitted with analogue (A), programmable (P), and digital signal processing (DSP) HIs. The audit data are based on a questionnaire mailed to subjects fitted with HIs 3 to 4 months after the fitting, including questions concerning satisfaction with the HI, use of the HI, ability to manage the HI, and satisfaction with the overall services in the department. Information was obtained from 32,694 subjects (i.e., 71.2 per cent of those fitted with HIs throughout the last decade), with a median age at fitting of 78 years (range, 18-102), with a preponderance of females. No significant differences in age, gender distribution, and hearing instrument distribution were found between the respondents and non-respondents. The audit shows that there are no significant differences in any of the benefit parameters throughout the decade, irrespective of the introduction of P-HIs in 1995 and of the DSP-HIs in 1998. Thus, from the consumers' perspective, no changes have appeared in the last decade. A comparative analysis of the A-HIs, P-HIs, and DSP-HIs shows that among those provided with P-HIs and DSP-HIs, only 69.6 per cent (CI 68.1-71.0) and 65.5 per cent (CI 60.2-78.8), respectively, were very satisfied/satisfied with the HI, which is significantly less than the 73.5 per cent (CI 72.4-74.5) in those fitted with A-HIs. The daily/weekly use of all three types of HIs was similar. However, the group fitted with DSP-HIs was significantly less satisfied with the general services compared with those fitted with A-HIs and P-HIs, respectively. Based on these audit data, it is concluded that, according to the consumers, the outcome from HIs has not changed over the last decade, and a comparison between the traditional A-HIs with both P-HIs and DSP-HIs is in favour of the traditional A-HIs.

Aged↗
PubMed1978

Survey of clinical pharmaceutical services in Florida hospitals.

A survey of clinical pharmaceutical services in Florida hospitals is described. Questionnaires were mailed to the pharmacy departments of 210 hospitals containing 50 or more beds; 172 (82%) responded. Data were collected concerning the extent and types of clinical services provided; the reasons for not implementing the services were also obtained. Twenty (12%) hospitals employed a full-time clinical pharmacist. Inservice drug education, formalized drug information, cardiopulmonary resuscitation and patient medication histories were provided by 78%, 47%, 19% and 6% of the hospitals, respectively. Hospitals with a total or partial unit dose drug distribution system seemed more likely to provide clinical services than those with other types of distribution systems. Hospitals employing a clinical pharmacist were engaged in a wider range of clinical services and provided these services to a larger portion of their patient population. The reason most frequently cited for not implementing clinical services was inadequate staff.

Florida↗
PubMed2005

The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey.

BACKGROUND: Lower reimbursements for endoscopic procedures and increasing demand for screening endoscopy over the past decade have spurred efforts to increase efficiency in the performance of endoscopic procedures. Two dichotomous approaches have emerged: (1) unsedated endoscopy and (2) propofol sedation. The aim was to determine national practice patterns of unsedated endoscopy and propofol sedation, and to assess endoscopists' attitudes toward unsedated screening with an electronic survey. METHODS: A short survey was developed and then was converted to a Web-based format. All national members of the American Society for Gastrointestinal Endoscopy (ASGE) were invited via electronic mail (e-mail) to participate. Survey data were collected electronically. RESULTS: Two e-mails elicited responses to the Web survey from 18% (724) of national ASGE members contacted, within 2 weeks. Of the respondents, 45% do not routinely offer unsedated EGD and colonoscopy, and only 15% of those respondents plan to incorporate unsedated endoscopy into their practice in the next year. Of the 55% who currently perform unsedated endoscopy, 85% do no more than 25 unsedated procedures per year. Lack of patient acceptance was the most common reason cited for not offering unsedated endoscopy. Most endoscopists felt that the availability of unsedated esophagoscopy or colonoscopy would not significantly increase screening for Barrett's esophagus or colonic polyps/colorectal cancer, respectively. Routine use of propofol sedation for EGD, colonoscopy, and ERCP/EUS was reported by 19%, 22%, and 19%, respectively. Community practitioners were more likely to use propofol than those at academic centers (p < 0.0002 for all). Of those not currently using propofol, 43% plan to incorporate it into their practice within the next year. Over 70% of respondents would themselves choose to be sedated for routine endoscopic procedures. CONCLUSIONS: Electronic surveys allow for rapid distribution and data collection but suffer from a limited response rate. The survey suggests that unsedated endoscopy has limited acceptance in the United States, and, without a major intervention that affects endoscopists' attitudes, its use is not likely to increase significantly. Unsedated endoscopy will not have a great impact on endoscopic screening. In contrast, propofol sedation has already gained acceptance in the community, and the routine use of propofol in endoscopy units will likely increase in the future.

Anesthetics, Intravenous↗
PubMed1989

Case-control study of hydrocarbon exposures in patients with renal cell carcinoma.

A retrospective case-control study tested the hypothesis that exposure to hydrocarbon combustion products is associated with the development of renal cell carcinoma. One control per case, matched for sex, date of birth (within 5 years) and urologist, was chosen. Controls were patients who presented with hematuria and were shown not to have a urinary tract tumour. A total of 164 cases and 161 controls responded to mailed questionnaires and telephone interviews. Smoking more than 20 cigarettes per day was associated with the presence of metastatic renal cell carcinoma (p less than 0.001). Exposure to burning coal was associated with an increased relative risk of the disease but only when the exposure occurred between the ages of 10 and 24 years (p less than 0.05). Dose-response relations were demonstrated for intensity of exposure (p less than 0.025) and duration of occupational exposure (p less than 0.05). The distribution of latent periods from first exposure to diagnosis was bimodal, with one mode at 21 to 30 years and another at 41 to 50 years. Occupational exposure to tar or pitch or both was also associated with an increased relative risk of renal cell carcinoma (p less than 0.05).

Adolescent↗
PubMed1983

Pharmaceutical services in family practice medical residency training programs.

The extent and nature of pharmacists' involvement in family practice medical residency training programs was assessed using a national survey. Department chairmen of all 386 approved family practice residency training programs in the United States were contacted and asked to provide the names and addresses of pharmacists in charge of pharmaceutical services in the centers. A 46-item, six-page questionnaire was mailed to each pharmacist with a follow-up mailing, then a telephone call, to nonresponders. Department chairmen of 68 (18%) of the programs reported having at least one pharmacist in the center. Responses to the questionnaire were obtained from 53 (78%) of the pharmacists, four of whom were no longer involved with family practice centers. Most of the remaining 49 pharmacists were men (76%) between 30 and 40 years old (59%) with an academic appointment (67%) and a doctor of pharmacy degree or some type of postgraduate training. Drug-distribution services were provided in 37% of the centers. All pharmacies offered clinical services. Almost all pharmacies (92%) offered educational services to both medical and nursing staffs, and pharmacists in 74% of the centers were involved in research. Few family practice medical residency training centers have pharmaceutical services conducted by a pharmacist; centers with pharmacists have a wide variety of distributive and clinical services.

Family Practice↗
PubMed1990

Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs.

Tobacco-related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco-related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco-related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed1993

Maxillofacial prosthetics: vital signs.

A maxillofacial prosthetics survey was designed to record the response rate of prosthodontists regarding the frequency of maxillofacial procedures and insurance coverage in 1991. The survey explored variability with respect to membership in professional organizations, region, education, primary activity, and age of the prosthodontist. A total of 342 survey instruments were received from a total of 690 mailed. A total of 18,410 maxillofacial procedures were performed by the survey population. Members of the American Academy of Maxillofacial Prosthetics performed procedures at a significantly higher rate than did the members of the American College of Prosthodontists. A greater procedure rate was observed for prosthodontists in the South Midwest and Southwestern regions; the hospital setting; with 2 plus 1 year additional postgraduate maxillofacial training; and the 45- to 54-year age group. Insurance covered most maxillofacial procedures, but was not uniformly distributed within predictor variables nor between procedures.

Adult↗