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PubMed1997

Patient attitudes to type specific serological tests in the diagnosis of genital herpes.

OBJECTIVE: To assess patient attitudes to HSV-2 serotesting and the effect of providing detailed information regarding genital herpes, the blood test, and its implications. METHODS: Consecutive genitourinary medicine clinic attenders were asked to complete an anonymous self administered questionnaire. Half received minimal additional information while the other half received a detailed information sheet. RESULTS: Overall, 200 clinic attenders with a median age of 27 years (range 15-57) completed the questionnaire, 92.4% wanted to know if they, and 90.8% if their partners, had been infected with genital herpes; 65% expected testing as part of screening without further discussion. Overall, on a scale of 1-10, 2% scored 1 (equivalent to definitely not wanting a test), while 45.5% scored 10 (equivalent to definitely wanting a test). The overall median score was 9 (95% confidence interval 8-10) suggesting a strong opinion in favour of testing. The desire to test in each of five described hypothetical situations increased significantly (p < 0.001) when compared with the general desire. CONCLUSIONS: Clinic attenders expressed a strong preference to be serotested for HSV-2 which was unaltered by the provision of information highlighting implications, although influenced significantly by the context in which they were asked. Should reliable tests become available the level of demand could have important implications on laboratory and counselling resources.

Adolescent↗
PubMed1998

The use of lumbar puncture and laboratory tests for sepsis by Australian neonatologists.

OBJECTIVE: To ascertain the current use of lumbar puncture (LP) and laboratory tests for possible or suspected sepsis by Australian neonatologists. METHODS: A self administered anonymous response questionnaire. RESULTS: Sixty-nine (73%) of 94 neonatologists responded. None performed LP routinely in preterm infants with respiratory distress syndrome (RDS) or asymptomatic term infants with maternal Group B streptococcus (GBS) colonisation. One (1.6%) performed LP in term infants with respiratory distress, and only 35 (51%) performed LP in preterm infants with suspected late-onset sepsis (LOS). Twenty-one percent did not perform LP on all preterm infants with RDS and septicaemia and 24% did not perform LP on all preterm infants with late-onset septicaemia. Sixty-six percent and 85% did not perform LP for laboratory evidence suggestive of sepsis in preterm infants with RDS and preterm infants with LOS, respectively. Forty-nine percent investigated asymptomatic term infants with maternal GBS colonisation. CONCLUSIONS: Lumbar puncture and laboratory tests for possible or suspected sepsis are not used uniformly by Australian neonatologists. The presently available information in the scientific literature is ambiguous and systematic review and further scientific study are required to determine best practice guidelines.

Australia↗
PubMed2002

Rationale and cost-efficiency compared for urine or saliva testing and behavioural inquiry among UK offender populations: injectors, arrestees and prisoners.

BACKGROUND: Costs, methodology and efficiency at obtaining behavioural information and biological sample to be tested for blood-borne viruses or illegal drugs are compared for UK surveys of offender populations: injectors in the community or attending drug agencies, arrestees and prisoners. METHODS: Arrestee surveys use extensive behavioural interview + urine sample and measure a key performance indicator in UK's Drugs Strategy. They have low efficiency (urine sample for drugs testing available from under 60% of eligible arrestees) at high cost (pound sterling 110-190 or 350 per urine sample and at least pound sterling 500-800 per injector). Random mandatory drugs testing of prisoners has the highest efficiency (because refusals are punishable), but the cost is high (pound sterling 110-120 per urine sample and pound sterling 300-500 per injector) and behavioural data are lacking. Prisoner surveys use self-completion questionnaire + saliva sample. They guarantee demonstrable anonymity in estimating the prevalence of blood-borne viruses and prisoners' associated risk behaviours, have high efficiency (saliva sample from over 80% of inmates) at low cost (pound sterling 30 per saliva and pound sterling 70-110 per injector), but behavioural data are limited to risk factors for blood-borne viruses. Low cost also characterises comprehensive interview + saliva sample from injectors in the community (pound sterling 90 per saliva sample, all from injectors) but efficiency cannot be assessed because the sampling frame of eligible injectors is not known. Voluntary unlinked anonymous surveys of injectors at drug agencies use self-completion questionnaire + saliva sample to be tested for blood-borne viruses. They are the least costly at pound sterling 43 per injector and moderately efficient with two-thirds volunteer rate by eligible injectors. DISCUSSION: For scientific added-value, we recommend co-location of survey types geographically and temporally; a common core set of behavioural questions; saliva sample as well as (and, eventually, instead of) the less acceptable urine sample. Survey methodologies for measuring key performance indicators should stand up to scrutiny in terms of openness, design credentials, statistical power, and costs. We examine how participation bias or inadequate survey size can compromise the effective monitoring of a key performance indicator.

Cost-Benefit Analysis↗
PubMed1998

The changing pattern of substance abuse in urban adolescents.

OBJECTIVES: To determine the prevalence of specific drug use in adolescents attending an adolescent health clinic and to compare current rates with a similar previous study. DESIGN: Blinded and anonymous urine samples obtained from patients presenting for routine health care were tested for the presence of cannabinoids, phencyclidine (PCP), amphetamines, opiates, and cocaine. SETTING: Adolescent medicine outpatient clinic. PATIENTS: Patients were between 12 and 21 years of age. Specimens from 1313 patients in 1995 to 1996 and 1312 patients in 1989 to 1990 were tested. MAIN OUTCOME MEASURES: Current drug use rates were compared with a similar screening of patients conducted in 1989 to 1990. Comparisons between studies were made on the basis of specific drug, age, and sex. RESULTS: For the most recent patient group, 14% were positive for 1 or more drugs and 13% were positive for cannabinoids. Males were significantly more likely to test positive for drug use than females. The oldest adolescents were more likely to test positive for drug use than younger adolescents. Comparing the 2 study year cohorts, patients tested recently were significantly more likely to have urine tests positive for at least 1 drug and cannabinoids in particular and less likely to have urine tests positive for cocaine. CONCLUSIONS: There has been an increase in positive urine tests in patients seen in our ambulatory clinic, with a strong shift toward cannabinoids and a shift away from cocaine. Practitioners need to be aware that drug use patterns in adolescents can shift relatively abruptly and counseling should be targeted to current drug use patterns.

Adolescent↗
PubMed2001

Smoking in Colombian medical schools: the hidden curriculum.

BACKGROUND: Tobacco companies are focusing their interest in less developed countries. In the absence of governmental opposition, physicians are expected to lead tobacco control efforts. We studied Colombian medical students' smoking prevalence and tobacco attitudes. METHODS: First- and fifth-year students from 11 medical schools in seven Colombian cities answered anonymous, self-administered, 38-item questionnaires. Additionally, smokers answered the Fagerström Test for Nicotine Dependence (FTND). RESULTS: Two thousand twenty-one students (males 50.6%; age 15-44, median 19) completed the survey; average response rate was 89.9%. Globally 25.9% of students were current smokers (males 27.9%, females 24.0%). Living at higher altitude and attending private universities were associated with higher prevalence (P < 0.001). Males had a higher chance of having given up smoking (P < 0.05); 91.3% of current smokers would like to quit; 67.3% of all smokers and 44.8% of daily smokers scored 0 in the FTND. Prevalence was similar among first- and fifth-years, but fifth-year students were more complacent with smoking in health centers and showed a lesser desire to quit. CONCLUSIONS: Medical students' smoking prevalence is similar to that of the general population. Tobacco control strategies need to be included in the curriculum. Nicotine addiction does not seem to be the main perpetuating factor.

Adolescent↗
PubMed1996

Cross-infection control: the role of "in-training" dental nurses.

OBJECTIVES: This paper reports the findings of a study on the roles of dental nurses in cross-infection control in general dental practices and who were undergoing training for their initial certificate. The research aimed to find out what factors in their vocation gave them satisfaction, what caused stress and the bearing of these factors on cross-infection control. The study complemented previous research on the same matters carried out face-to-face in dental practices and aimed to test the validity of this previous research. METHODS: The study was made anonymously by means of self-administered questionnaires completed by respondents attending evening classes. RESULTS: Sixty per cent of respondents reported suffering anxiety in their work, the list of causes being headed by lack of experience, language barriers and taking part in general anaesthetic sessions. A third thought their workload was too great and a third quoted lack of time as the reason for not always completing cross-infection control procedures. Half were worried about cross-infection control. Clinical work was the most, and adequate pay the least important of five factors that gave respondents satisfaction in their work. Respondents always welcomed a word of thanks from their dentists and relied on them for information about their tasks. CONCLUSIONS: In order to carry out their work thoroughly, uncertificated dental nurses need sufficient time. They benefit from support and encouragement from their dentist. These are important factors in cross-infection control so that stress is prevented and job satisfaction enhanced. Our two studies validate each other.

Adolescent↗
PubMed2005

Oxytocin is associated with human trustworthiness.

Human beings exhibit substantial interpersonal trust-even with strangers. The neuroactive hormone oxytocin facilitates social recognition in animals, and we examine if oxytocin is related to trustworthiness between humans. This paper reports the results of an experiment to test this hypothesis, where trust and trustworthiness are measured using the sequential anonymous "trust game" with monetary payoffs. We find that oxytocin levels are higher in subjects who receive a monetary transfer that reflects an intention of trust relative to an unintentional monetary transfer of the same amount. In addition, higher oxytocin levels are associated with trustworthy behavior (the reciprocation of trust). Absent intentionality, both the oxytocin and behavioral responses are extinguished. We conclude that perceptions of intentions of trust affect levels of circulating oxytocin.

Adult↗
PubMed1998

[Prevalence of smoking among adolescent students in Navarra].

This paper reports the prevalence of smoking among adolescent students in Navarra, analyzing the data by sex and geographic area. A sample representative of Navarran adolescent school children between 12 and 18 years old was identified. The prevalence of smoking was measured by way of an anonymous self-administered questionnaire filled out at school. A chi 2 test and analysis of variance were performed. Three hundred students (180 girls, 51.43%; 170 boys, 48.57%) were surveyed. Mean ages were 14.35 +/- 1.82 and 14.15 +/- 1.93 years, respectively. Smoking prevalence was 35% among girls in the Foral Community of Navarra and 28.82% among the boys. The age of initiation to smoking and frequency of smoking are analyzed for the five geographic areas of the Navarra province. The prevalence of smoking is higher among girls. Children are tending to start smoking at earlier ages (primary school). No differences in smoking frequency were observed for rural and urban areas.

Adolescent↗
PubMed2003

Recruitment of house staff into anesthesiology: a re-evaluation of factors responsible for house staff selecting anesthesiology as a career and individual training program.

STUDY OBJECTIVE: To reexamine, in a follow-up to our first study, those factors responsible for house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees. DESIGN: Survey questionnaire of 77 house staff at the Mayo Clinic during the 2000 to 2001 academic year. SETTING: Academic medical center. MEASUREMENTS: A cross-sectional analysis was conducted using a questionnaire to survey 77 house staff enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 2000 to 01 academic year. All responses were anonymous. Data were compared between time epochs using an f-exact test. A p-value <or=0.05 was considered statistically significant. MAIN RESULTS: Forty-five (58%) of those surveyed responded to the questionnaire. Responses were similar to those obtained in the original study that we conducted in 1995 to 96. The most frequently cited reasons for selecting anesthesiology as a career were: it is a "hands-on" specialty, it involves the clinical application of physiology and pharmacology, and there is adequate time off. The most frequently cited reasons for selecting our training program were: diversity of training experience, prestige associated with the institution, and house staff satisfaction (i.e., morale) observed at the time of interview. House staff continued to report a very high level of satisfaction with the training program (education, clinical practice, and research opportunities). Only 58% of respondents (vs. 92% in 1995-1996) felt that downsizing of anesthesiology training programs was a national trend, none (vs. 54% in 1995-1996) anticipated difficulty obtaining a job following training, and 91% (vs. 33% in 1995-1996) felt that they had future job security. Overall, 98% (vs. 98% in 1995-1996) were pleased with their career choice, and 93% (vs. 83% in 1995-1996) would choose anesthesiology as a career if they were now graduating from medical school. CONCLUSION: Data from one institution indicate that selection of an anesthesiology career and training program remain strongly associated with concerns regarding educational experiences and postgraduate employment opportunities. In contrast to our results from our 1995-1996 study, significantly fewer house staff had concerns about securing employment following training. Our observations-coupled with favorable National Resident Matching Program results during the past few years-bode well for the future recruitment of graduating American medical students into anesthesiology.

Academic Medical Centers↗
PubMed2003

Medical staff's knowledge of pulse oximetry: a prospective survey conducted in a tertiary children's hospital.

OBJECTIVES: To assess the knowledge of pulse oximetry of senior (SMO) and junior medical officers (JMO) in a tertiary paediatric hospital. METHODS: A 16-item multiple choice questionnaire was administered to SMO and JMO without prior notice or instruction in the area. The questions were completed voluntarily and anonymously, then proctored and collated by the principal investigator. RESULTS: The mean test scores for SMO and JMO were 70 +/- 15% and 65 +/- 13%, respectively (P = 0.06). A significant negative correlation was found between the test scores and the years of paediatric experience with the SMO. CONCLUSIONS: The results of the survey showed there is an insufficiency of knowledge and understanding among medical staff concerning the principles, clinical applications and limitations of pulse oximetry. More emphasis needs to be placed on teaching these principles to ensure quality care for patients.

Australia↗
PubMed2000

Test method: GH.

The abuse of recombinant human growth hormone in sports is considered to be a widespread phenomenon, but until today all our knowledge thereof is based on rumor, anonymous surveys or accidental observations by customs officers. Although growth hormone (GH) is listed as a prohibited class E substance by the International Olympic Committee (IOC) no official test for the detection of GH abuse is implemented. Because of the high degree of identity in the amino acid sequence between recombinant and endogenous GH and because of the pulsatile nature of GH secretion, as well as inter-individual variations, it was believed to be undetectable. Recently, new proposals have been made to overcome this problem. On the basis of differential immunoassays it is possible to determine the relative content of GH isoforms in the circulation and thus to detect the application of recombinant GH. Furthermore, changes in GH dependent parameters after the administration of recombinant GH have been shown to be a possible indicator of GH abuse.

Biomarkers↗
PubMed2002

PCR diagnostics underestimate the prevalence of avian malaria (Plasmodium relictum) in experimentally-infected passerines.

Several polymerase chain reaction (PCR)-based methods have recently been developed for diagnosing malarial infections in both birds and reptiles, but a critical evaluation of their sensitivity in experimentally-infected hosts has not been done. This study compares the sensitivity of several PCR-based methods for diagnosing avian malaria (Plasmodium relictum) in captive Hawaiian honeycreepers using microscopy and a recently developed immunoblotting technique. Sequential blood samples were collected over periods of up to 4.4 yr after experimental infection and rechallenge to determine both the duration and detectability of chronic infections. Two new nested PCR approaches for detecting circulating parasites based on P. relictum 18S rRNA genes and the thrombospondin-related anonymous protein (TRAP) gene are described. The blood smear and the PCR tests were less sensitive than serological methods for detecting chronic malarial infections. Individually, none of the diagnostic methods was 100% accurate in detecting subpatent infections, although serological methods were significantly more sensitive (97%) than either nested PCR (61-84%) or microscopy (27%). Circulating parasites in chronically infected birds either disappear completely from circulation or to drop to intensities below detectability by nested PCR. Thus, the use of PCR as a sole means of detection of circulating parasites may significantly underestimate true prevalence.

Animals↗
PubMed2006

Audience response system technology improves accuracy and reliability of trauma outcome judgments.

BACKGROUND: Peer-review judgments are necessary for effective trauma performance improvement (PI), but may be influenced by peer pressure and the tendency to vote with the majority. Incorporation of Audience Response System (ARS) technology into trauma PI should result in improved outcome assessments. METHODS: We compared 30 months of nonanonymous trauma care judgments with 30 months of anonymous judgments obtained with the use of a keypad-based ARS. Statistical methods included the chi2 test and the Wilcoxon rank sum test. RESULTS: Use of the ARS resulted in a 28% reduction in deaths judged nonpreventable and a 24% reduction in trauma care judged to be appropriate (p < 0.0001). Unanimous outcome judgments were also significantly reduced (p < 0.0001). CONCLUSIONS: Outcome judgments obtained anonymously were significantly more divergent and less positive than those obtained nonanonymously. Anonymously derived outcome judgments may provide a better opportunity to identify adverse outcomes and thereby potentially improve trauma PI and trauma care.

Data Collection↗
PubMed1993

Responses of health care professionals to proposed mandatory HIV testing.

OBJECTIVE: to survey active health professionals to assess the response to and impact of a mandatory human immunodeficiency virus (HIV) testing policy on health care providers and the communities in which they practice. DESIGN AND SETTING: Anonymous four-page survey of active health professionals at 13 hospitals in northern and central New Jersey. PARTICIPANTS: 1557 physicians and nurses responded to the survey. Response rate was approximately 41%. INTERVENTION: Hypothetical intervention. MAIN OUTCOME MEASURES: Responses to a series of questions relating to a hypothetical mandatory HIV testing policy for health professionals. RESULTS: Approximately three fourths of all surveyed health professionals stated that a mandatory testing policy would persuade individuals in their profession not to work in high-prevalence areas. Among those who currently work in high-prevalence HIV/acquired immunodeficiency syndrome (AIDS) areas, only 51% said that they would definitely or probably remain in that area should such a policy be instituted. Among those practicing surgery or performing invasive procedures, 7% currently avoid HIV-positive patients, and an additional 34% said that they would do so under the proposed testing policy. Finally, 4% of these professionals currently advice others to stop working in high-prevalence areas, and an additional 22% state that they would definitely do so if the proposed policy were instituted. CONCLUSIONS: If physicians and nurses behaved in accordance with their survey responses, institution of a mandatory HIV testing policy would create a shortage of physicians and nurses in high-prevalence HIV/AIDS areas.

Adult↗
PubMedDate not supplied

HIV and interventional radiology: a national survey of physician attitudes and behaviors.

PURPOSE: The frequency of parenteral and cutaneous exposure to blood or body fluid during interventional radiologic procedures, current use of barrier precautions by interventional radiologists, and physician attitudes about testing for the human immunodeficiency virus (HIV) and related issues were assessed. MATERIALS AND METHODS: An anonymous survey of interventional radiologists was conducted by mail in November 1991. RESULTS: Of 1,530 surveys, 819 (54%) were returned and 806 (53%) were completed and evaluable. Ninety-six percent of respondents (763 of 794) perform procedures in patients infected with HIV. Sixty-nine percent oppose mandatory testing of physicians for HIV. Eighty-seven percent (693 of 797) reported at least one procedure-related injury (range, 0-99; mean, four). Fifty-eight percent of injuries occurred with use of a sharp instrument (381 of 662), 20% were due to needle recapping (133 of 662), and 7% (44 of 662), to improper disposal of a sharp instrument. Contact between a physician's blood and a patient was reported in only one case (0.2%). Eighty-five percent of respondents (671 of 789) changed their use of barrier precautions in the last 10 years; concerns about HIV were cited by 96% as a reason for change. Reported use of barrier measures was highly variable. CONCLUSION: Exposure to patients' blood or body fluid is not infrequent during interventional radiologic procedures. Exposure of patients to the blood or body fluid of health care workers is rare. Use of recommended precautions in interventional radiology is variable, and practices that could lead to preventable injury remain common. Strategies should be developed to reduce risks even further and to encourage universal compliance with government guidelines.

AIDS Serodiagnosis↗
PubMed2006

Storage and use of residual dried blood spots from state newborn screening programs.

OBJECTIVES: To provide current data for policy discussions and to assess future needs among newborn screening programs regarding the storage and use of residual dried blood spots (DBS) in the United States. STUDY DESIGN: An electronic questionnaire was administered to U.S. state health department laboratory directors in 2003. RESULTS: Responses were received from 49 of the 50 states. Approximately half of them stored residual DBS for more than 6 months, 57% did not have a written policy that determines how residual DBS can or cannot be used, and 16% informed parents that DBS might be retained. Residual DBS were used by 74% of respondents for evaluation of newborn screening tests, by 52% for clinical or forensic testing, and by 28% for epidemiologic studies. Use of DBS was reported more frequently by states with extended storage. When asked if they might participate in an anonymous multistate epidemiologic study by contributing unlinked DBS, 41% responded affirmatively. CONCLUSIONS: More states have used residual DBS for evaluating newborn screening tests than for epidemiologic studies. There is potential interest among states in using unlinked DBS for multistate studies and a need for written policies addressing all uses of residual DBS.

Blood Specimen Collection↗
PubMed2000

Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence.

OBJECTIVE: To describe pediatric housestaff knowledge, experience, confidence in pediatric resuscitations and their ability to perform important resuscitation procedures during the usual training experience. DESIGN AND PARTICIPANTS: Cohort study of PGY-3 level residents in a ACGME accredited pediatric residency training program at a large, tertiary care children's hospital. METHODS: Fund of knowledge was assessed by administering the standardized test from the Pediatric Advanced Life Support (PALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. Procedural skills were evaluated through observation of the resident performing four procedures during a skills workshop using a weighted step-wise grading sheet. Resident experience and confidence was quantified using an anonymous survey. RESULTS: Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2%+/-5.5), but performed less well when answering more complicated questions (60.0%+/-9.9) on the short answer test. No resident was able to successfully perform both basic and advanced airway skills, and only 11% successfully completed both vascular skills. Although residents were overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. For example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedback on their performance less than half of the time. Over 89% of them felt that resuscitation knowledge and skill were important for their future chosen career. CONCLUSION: Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessary resuscitation skills, few residents performed critical components of these skills correctly. Current pediatric residency training may not provide sufficient experience to develop adequate skills, fund of knowledge, or confidence needed for resuscitation.

Attitude of Health Personnel↗
PubMed2002

Knowledge about and attitude towards science of first year medical students.

AIM: To assess the knowledge about and attitude towards science of students entering medical school, and to find out whether these parameters are influenced by their high school education, sex, place of residence, and rank achieved on the admission test. METHODS: A total of 193 (82%) students who enrolled at the Zagreb University School of Medicine in 2001 filled out an anonymous questionnaire at their first lecture. The questionnaire consisted of demographic data, 20 statements on science adapted to a 1-5 Likert scale, and 8 multiple-choice test questions on knowledge of scientific research. RESULTS: The students knowledge of scientific research was poor (out of 8 answers, 2.2 +/- 1.2 were correct) in spite of their positive attitude towards science (75 +/- 11 on a 20-100 scale). Higher ranking students at the admission test showed more positive attitude (Spearmans rho=-0.157, p=0.003). There was no interdependence between other personal data (sex, high school, and place of residence) and opinion/knowledge about science. CONCLUSION: In Croatia, first-year medical students are not familiar with basic facts about the scientific methods and communication in medicine, but they have positive attitude towards scientific research. The only factor associated with more positive attitude towards science is higher rank at the admission test.

Attitude↗