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Using the Delphi Technique, this study investigated the concept of acceptance and sought to identify behavioral indicators of patient acceptance of nurse practitioners. Thirty-four nurse practitioners participated in the study and came to consensus regarding 20 verbal and 16 nonverbal behaviors. This study was a step toward defining objective criteria of NP acceptance.
What is the best time after childbirth to accept contraception? The problem is to reduce overlap with postpartum anovulation, during which contraception is redundant, but simultaneously to reduce the proportion of women conceiving before contraception is inaugurated. Efficiencies of three classes of acceptance strategies at resolving this dilemma are investigated. Particular attention is paid to the postpartum acceptance rule because of its special administrative advantages. Its efficiency relative to those of other rules is found to be enhanced by conditions of short postpartum anovulation, a high proportion of ovulatory rather than anovulatory first menstrual cycles, a high level of natural fecundability, and, especially, a high level of contraceptive continuation.
The acceptance by individuals, institutions and communities of preventive measures for controlling the two most prevalent dental diseases, dental caries and periodontal disease, is limited. A wide gap exists between available preventive methods and their appropriate application. Adoption of preventive dental self-care (tooth brushing, flossing diet modification) is organized around five categories of determinants influencing oral health behaviours: psychological factors; face-to-face interactions between people; broad societal influences; information and the immediate surroundings; and reinforcement schemes. While each of these five categories of determinants influences adoption of the desired behaviours, altering any single factor does not usually result in sustained behaviour change. Institutions (e.g. schools and workplaces) and communities are sites where the determinants of individual behaviours can be altered and preventive services can be delivered. Very little research has been conducted to improve our understanding of the variables which explain why dental health prevention programmes are accepted or rejected by institutions or communities. When programmes are adopted, little is known about the accuracy of their administration or about barriers to, and problems in, their implementation and maintenance. To achieve optimal oral health throughout life, a combination of passive measures (e.g. water fluoridation, school-based fluoride programmes) and active personal behaviours (e.g. oral hygiene, diet control) is required. Therefore, it is essential that researchers and practitioners improve their understanding of the acceptance of passive measures by institutions and communities as well as their understanding of the adoption of active measures by individuals.
The therapeutic effect in application of n-CPAP therapy (nasal continuous positive airway pressure) is dependent on both the acute effect of this therapy and the long-term acceptance and consequent palliation respectively avoidance of sequelae. We present 50 patients (47 male, 3 female) treated with n-CPAP therapy because of severe sleep-related disorders of breathing. All patients had polysomnography, and in addition questionnaires were mailed to all 50 patients in order to get information concerning the symptoms of sleep-related disorders of breathing before and under n-CPAP therapy, mode of therapy and side-effects in application of n-CPAP therapy. Patients were treated for at least three to a maximum of 25 months with n-CPAP (average 10.5 months). Long-term acceptance with n-CPAP was defined as persistent use of n-CPAP during every night for at least five hours. On average continuous positive airway pressure of 8.6 mbar (range 4-18) was effective in normalizing formerly severe pathological respiratory parameters. Apnea-index decreased from 22.8 to 2.17/h on average. Regarding the symptoms of sleep-related disorders of breathing before and under n-CPAP therapy, we saw that almost 100% of our patients complained of the main symptoms of sleep-related disorders of breathing. By regular n-CPAP application a complete reduction of these symptoms could be achieved in nearly 80% of patients. Long-term acceptance of n-CPAP therapy was reported by 78% of our patients who used their n-CPAP device every night for at least five hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Norplant contraceptive implants are a relatively new acquisition onto the Kenyan family planning scene. The method seems highly acceptable to a wide cross-section of Kenyan women in government and non-governmental organisations (NGO) clinics. One thousand, six hundred and fifty four clients were recruited into the programme of the largest family planning NGO between 1991 and 1994. Most of the acceptors were young with an average number of 2.6 living children. Half-yearly acceptance rates have been rising. There were minimal serious side effects reported, but 72.0% of the clients complained of some menstrual disruption. Site infection rates were 0.2%, the same as capsule expulsion rates and benign ovarian cyst. Continuation rates were good at 91.0% over the first year and 80.0% over the second year. Client profile and user characteristics are presented. Norplant seems to be a well accepted contraceptive method by young low-parity Kenyan women seeking long-term, continuous yet reversible contraceptive options.
The acceptance of vaccinations depends on the quality of information on effects and side effects. This publication deals with the results of three questionnaire studies: Questionnaire 1 was directed to the general population and contained questions on vaccination history and acceptance of vaccinations, questionnaire two and three were addressed to practitioners (general medicine/paediatrics/internal medicine) with additional questions on the number of vaccinations performed per year. An average of 50% of the persons taking part in the questionnaire study had been vaccinated within the last 10 years against diphtheria, tetanus, polio and/or influenza. The acceptance of these vaccinations was quite satisfactory whereas opinions on mumps and measles vaccinations were quite negative. In the course of the questionnaire study with practitioners it could be demonstrated that vaccinations against diphtheria, tetanus, polio and influenza were regarded as useful while immunisation against mumps, measles, tuberculosis, pertussis and chicken-pox were not regarded as useful. Information programes on vaccinations and the need for further investigations are discussed as well as the problem of mandatory vaccinations.
BACKGROUND AND OBJECTIVES: We sought to evaluate the HIV seropositivity of patients who refused or accepted human immunodeficiency virus (HIV) testing in a South Carolina sexually transmitted diseases (STD) clinic, and the patients' reasons for refusing or accepting testing. STUDY DESIGN: A serologic and self-administered survey done Jan. 9 through June 1, 1989. For those who refused HIV testing, a routine syphilis serology sample was tested blindly for HIV. RESULTS: Of 1,929 patients in the study, 398 (21%) refused HIV testing. HIV test refusers were 2.2 times more likely to be HIV antibody positive than HIV test acceptors (3.0% versus 1.4%, prevalence ratio = 2.2, CI95 1.1-4.4), with this difference mainly occurring among males. Seven of eight patients reporting that they refused testing because they were HIV positive were found to be HIV negative. The principal reason indicated for test refusal was not feeling at risk for HIV infection. The principal reasons indicated for test acceptance were wanting to know the results for their own health status and wishing to prevent spread of the virus to partners. CONCLUSION: We conclude that: (1) a higher seropositivity exists among HIV test refusers than acceptors; (2) patient reporting HIV seropositivity should be viewed with caution; (3) many STD patients deny their risk for HIV; and (4) STD patients are concerned about transmission of HIV to their partners.
Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.s.) accepted a sigmoidoscopy. Of 658 (m = 403, f = 255) patients with complete investigation, 153 (23%) (m = 104, 26%; f = 49, 19%; n.s.) had a total of 272 neoplastic polyps, including 1 carcinoma. Adenomas = /> 10 mm were found exclusively in male patients (n = 25, p < 0.001). In comparing patients aged 50-55 years (n = 386) with those aged 56-60 years (n = 272), prevalences of neoplasia were found to be 19%/29% (p < 0.01), and prevalences of adenomas = /> 10 mm were 2%/10% (p < 0.05). The acceptance of a colonoscopy in patients with neoplastic polyps at sigmoidoscopy was 116/153 (m = 78, 75%; f = 38, 78%; n.s.). In 39 of these patients (34%) (m = 31, 40%; f = 8, 21%; p < 0.05), 68 further adenomas were detected but no carcinoma or adenoma with severe dysplasia. Multiple adenomas in the proximal colon were seen in 17 cases (15%) (m = 16, 21%; f = 1.3%; p < 0.01). The FOBT was positive in 10/658 patients, including the case with a carcinoma, but only in 4/25 with adenomas = /> 10 mm. In 5 cases with positive FOBT sigmoidoscopy and complementary colonoscopy did not reveal any pathology.
The wearing of even technically perfect full dentures is associated with a significant deterioration of most, if not all, oral functions. The fact that between 85 and 90 per cent of patients receiving new and technically well made dentures and between 65 and 75 per cent of patients with older dentures are generally satisfied with the treatment result is therefore more of a tribute to human adaptation than to prosthodontic skill. Research has shown that variables claimed to play an important role in patient acceptance of full dentures, such as the quality of the dentures, the oral condition, the patient-dentist relationship, the patients' attitude toward dentures, the patients' personality, socio-economic factors, demographic variables, previous denture experience and oral stereognosis, have in fact no or negligible effects in this respect. Nor has the degree of prediction been appreciably improved by combining the effects of such variables. Variables of theoretical importance for acceptance of dentures such as the patients' motory ability and the quality and quantity of saliva have still to be studied. At the present time research has yet failed to furnish the clinician with a practical method whereby patients who are unlikely to accept full dentures can be identified with any degree of certainty. The clinician has therefore still no option but to base his prediction on an individual estimate of his patient's adaptive ability.
A pilot project to train and deploy low-level rural health auxiliaries is being carried out in southern Iran. This first group of 16 village health workers (VHW) went to work in the initial 16 project villages early in 1974. The group consisted of 11 men and 5 women ranging in age from 15 to 45. These workers are taught to treat simple medical conditions, to practice preventive health measures, and to conduct health education and visit programs. Six months after initial deployment to the villages, a sample survey of 226 villagers was carried out to determine what characteristics of the VHW and of the consumers were associated with greater acceptance of the VHW's work and his or her role in the village. The results indicated that both male and female health workers are accepted in an equivalent role, and that workers returning to their own villages are no more or no less likely to have difficulties in gaining acceptance than are those returning to a different village. It was found that experience with a VHW of a particular sex could significantly alter attitudes toward the preferred for the VHW. The age of the worker was the only variable closely associated with the villagers' confidence in the worker--the older the VHW, the higher the villagers tended to rate his or her knowledge. In Iran, as in many developing countries, the rural village tends to be a closed, male-dominated group. The experience of the VHWs in Iran makes it apparent that the health worker, regardless of sex, age, or village of origin, can gain the confidence and respect of the villagers.
BACKGROUND: In 1989, the gene for cystic fibrosis was cloned and it became possible to detect carriers of the gene among the general population, including pregnant women. AIM: The aim of the pilot study was to assess the acceptability of integrating cystic fibrosis carrier testing into antenatal care by general practitioners at the first booking appointment. METHOD: Between 1 September 1991 and 31 August 1992, inclusive, all patients receiving routine antenatal care in a two-partner training practice in south Manchester were offered carrier testing for cystic fibrosis using a computer protocol for antenatal care developed by the practice. A questionnaire including a Spielberger state-trait anxiety inventory was sent to patients 2 weeks after they received the results of their carrier test, and interviews with the patients in their home were carried out 4 weeks and one year after they received the result. RESULTS: All but one patient (75 out of 76) booking before 14 weeks of pregnancy accepted the offer of cystic fibrosis carrier testing, and 96% (72 out of 75) felt that they had made the right decision and that they had enough time for discussion with their general practitioner before testing. CONCLUSIONS: Cystic fibrosis carrier testing can be successfully integrated into the antenatal booking appointment in general practice and is acceptable to patients. This is a model for other genetic screening opportunities resulting from advances in medical genetics.
Primary health-care providers have been encouraged to counsel their patients about regular physical activity, but there are significant barriers to effective counseling. In this study a program of training and materials was tested for acceptability to providers, office staff, and patients. Primary care providers and office staff were trained to use the Physician-based Assessment and Counseling for Exercise (PACE) materials in four geographical sites in the United States. The program was tested in a variety of settings and with diverse patient populations. The acceptability of the program during a five-month study period was evaluated through structured interviews. The training was effective in preparing the providers to counsel, and the program was generally acceptable to providers, office staff, and patients. Counseling was provided in less than five minutes by 70% of providers, and most patients reported following the recommendations given. The PACE program assists providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an important part of a national effort to enhance the adoption and maintenance of physical activity among adults.
Non-acceptance of prosthetic appliances is not only a clinical problem; it also gives rise to legal proceedings. Not every case of non-acceptance is psychogenically induced, there are often somatic and even iatrogenic causes. Objective treatment deficiencies are subject to forensic sanctions irrespective of any underlying psychosomatic illness. If the dentist is to manage non-acceptance in a responsible way not open to forensic consequences, competent clinical and psychological skills are needed.
OBJECTIVE: to compare the acceptability of a new estradiol gel TX 11323 (A) and a transdermal matrix system. METHOD: this randomised open crossed study was conducted on 80 healthy menopausal female volunteers treated successively with 1.5 mg of estradiol per day in gel form (Estreva Gel, Theramex, Monaco) and by a transdermal matrix twice-weekly system delivering 50 micrograms/24 h of estradiol (Oesclim 50, Fournier, Dijon-France). The treatment was applied for 25 days with an interval of 6 days between the 2 administration cycles. Acceptability was evaluated and compared by a self-questionnaire given on D1 and D25 of each therapeutic cycle. RESULTS: the 2 treatments, after 25 days of use, were judged convenient, easy and fast to use by more than 90% of subjects. There was, nevertheless, a significant difference in favour of the gel in respect of the estimation of the "visual aspect" of the treatment, reported skin problems, problems with application technique, as well as discomfort during intimacy found in 11% of cases using the transdermal system. It is noted that 80% of the women consider the gel treatment more feminine (p < 0.001) and that 61.3% prefer this treatment compared to 32.5% preferring the transdermal system studied (p = 0.005). CONCLUSION: this study shows a better acceptability of the estradiol gel TX 11323 (A) compared to that of the transdermal matrix system studied.
It is often difficult to achieve adequate acceptance of nasal continuous positive airway pressure (CPAP) therapy by patients with OSA. Many patients find it particularly inconvenient to expire against the treatment pressure. With this in mind, we have attempted to improve acceptance of CPAP therapy by using a bilevel system that reduces the treatment pressure during expiration. 52 patients were randomized either to initial treatment with CPAP therapy followed by bilevel treatment, or to treatment in reversed order. During bilevel therapy the ratio of inspiratory to expiratory pressure was fixed at 1:0.6. After each treatment the patients were interviewed on the basis of visual analogue scales to establish their subjective evaluation of such parameters as general well-being, quality of sleep, comparison of the respective treatment pressures, and possible preference for one of the two systems for long-term treatment. The minimal effective inspiratory treatment pressure during bilevel therapy (IPAP) and the minimal effective CPAP pressure were closely correlated (r = 0.89). There was no difference between the apnoea hypopnoea indices during CPAP therapy as compared with bilevel therapy. Most patients (57%) felt the treatment pressure with the bilevel system to be lower (p = 0.048). There were no differences in patients' well-being early in the morning, or in their assessment of sleep quality. The majority of patients (52%) preferred bilevel therapy for long term treatment, while 38% preferred CPAP therapy (n.s.). In a subgroup of 13 patients with a treatment pressure of > or = 10 mbar during CPAP therapy 10 patients (77%) gave preference to the bilevel system (n.s.). In a considerable number of patients the acceptance of treatment can be improved by using a bilevel system for initiation of nasal positive pressure therapy.
The acceptance of transtracheal catheters (TTC) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxaemia was analysed and the adverse events associated with this system of oxygenation described. Once the TTC (Oxycat) was inserted, each patient was monitored on an outpatient basis and information about the associated adverse events was collected. In a group of 70 patients that met the inclusion criteria, only 14 (20%) accepted TTC insertion. The observed adverse events were: haemorrhage through the stoma (3); ejection of the TTC in a cough reflex (2); subcutaneous emphysema (2); mucous plugging (1); and haemoptysis (1). Removal of the TTC was necessary in 29% of the cases, and was associated with the onset of an adverse event in all cases except one. Despite the proven benefits of oxygen therapy performance and the improvement in effort tolerance, transtracheal catheter has a low level of acceptance among patients with extremely disabling diseases. The adverse events observed were frequent, but could have been corrected and in no case worsened our patients' prognosis.
OBJECTIVE: To examine patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry. DESIGN: A random-digit dialing telephone survey. SETTING AND PARTICIPANTS: A sample of 649 adults (> or = 18 years old) living in Kentucky. MAIN OUTCOME MEASURES: Patient awareness of office-use gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. RESULTS: The survey had a response rate of 55%. Eighty-two percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quality (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2.4 times as likely to believe that personal gifts have a negative effect on the cost of health care and 2.3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. CONCLUSIONS: These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the pharmaceutical industry.
OBJECTIVE: To determine the clinical acceptability of various levels of video compression for remote proctoring of laparoscopic surgical procedures. DESIGN: Observational, controlled study. SETTING: Community-based teaching hospital. PARTICIPANTS: Physician and nurse observers. INTERVENTIONS: Controlled surgical video scenes were subjected to various levels of data compression for digital transmission and display and shown to participant observers. MAIN OUTCOME MEASURES: Clinical acceptability of video scenes after application of video compression. RESULTS: Clinically acceptable video compression was achieved with a 1.25-megabit/second data rate, with the use of odd-screen 43.3:1 Joint Photographic Expert Group compression and a small screen for remote viewing. CONCLUSION: With proper video compression, remote proctoring of laparoscopic procedures may be performed with standard 1.5-megabit/second telecommunication data lines and services.