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At least 991 records · Page 55Linked to original sources
PubMed2005

A novel educational strategy to enhance internal medicine residents' familial colorectal cancer knowledge and risk assessment skills.

BACKGROUND: Internal medicine residents are deficient in their knowledge about familial colorectal cancer (CRC) and thus unable to comply with appropriate screening guidelines. The objective of this study was to evaluate the effectiveness of a mixed educational program that incorporates both a didactic lecture (DL) and interactive, case-based seminar (ICBS), plus distribution of a personal digital assistant (PDA)-based risk assessment tool. METHODS: Internal medicine resident continuity care teams were randomly assigned to an intervention (9 teams; 43 residents) or control (11 teams; 39 residents) arm. Both groups participated in a DL addressing the current status of CRC screening for average, moderate, and high-risk groups. Intervention teams also participated in a 1-h pre-clinic ICBS that included vignettes about patients at moderate or high risk of CRC because of family history, following which they received the risk assessment tool by e-mail. Knowledge and clinical risk assessment skills were evaluated using pre/posttests, patient exit interviews, and chart audits. RESULTS: Baseline test scores were similar for both groups (intervention, 51%vs control, 54%; p= 0.35). Immediate post-ICBS scores (intervention group only) significantly increased to 82% (p < 0.001). Six-month post-ICBS scores declined for the intervention group but remained significantly higher than 6-month control group scores (63%vs 56%, p= 0.002), which were unchanged from baseline. No significant differences were observed with respect to family history-taking or documentation skills. CONCLUSION: A mixed educational program that incorporates both a DL and ICBS is more effective that the DL alone for increasing knowledge about familial CRC risk but may have limited influence on clinical risk assessment skills.

Colorectal Neoplasms, Hereditary Nonpolyposis↗
PubMed1984

The Cordon study of weight reduction based on behaviour modification.

A behaviour modification programme for the treatment of obesity was offered to a population of obese women, aged 51-67, being screened for breast cancer. The programme was offered in two forms: (1) A series of ten small group sessions under the guidance of a non-medical leader, with three follow-up meetings after the course (10 S programme). (2). A series of ten mailed lessons with a pre- and post-course interview and three follow-up meetings after the course (10 L programme). The drop-out rate during the course was 12 per cent for the 10 S programme and 37 per cent for the 10 L programme. Follow-up in the 10 S programme revealed an average weight loss of 5.2 kg after 3 months, 4.1 kg after 17 months, and 3.0 kg after 36 months. Comparable figures in the 10 L programme were 3.0 kg, 3.0 kg and 1.6 kg, respectively. Percentile distributions of weight loss after these intervals are presented. Results are compared with those in other obese women in the cancer screening programme who either had no plans for weight reduction or said they had opted for other kinds of intervention. These comparisons clearly favour the behaviour treatment programme, but the picture may have been influenced by a possibly higher motivation of those who followed the course.

Aged↗
PubMed1993

Methods used by pharmacy departments to identify drug interactions.

The results of a survey evaluating the methods that pharmacy departments use to manage drug interactions, and their satisfaction with those methods, are reported. A random sample of 300 hospitals with more than 200 beds was selected, and a questionnaire was mailed in January 1991 to the directors of the pharmacy departments of these hospitals. Of the 300 questionnaires mailed, 167 were completed and returned. Thirty-seven percent of the hospitals offered pharmacy services through a central location only, whereas 63% offered such services through a combination of central and decentral locations. The majority of hospitals (83%) detected drug interactions through the knowledge of the pharmacist processing orders. Nearly all central pharmacies had AHFS Drug Information and Facts and Comparisons available for drug interaction information, but these resources were available in only slightly more than half of all decentral pharmacies surveyed. Fifty-four percent of the responding institutions had a computerized drug distribution system with a drug interaction component; 56% of these classified their system as "indispensable" or "helpful," while 44% classified their system as "somewhat helpful but sometimes a hindrance." Sixty-eight percent of all respondents believed that the availability of a drug interaction computer program increased the number of drug interactions identified. Sixty-eight percent of respondents perceived that pharmacists provided proper follow-up. Overall, 66% of respondents were not satisfied with their method for detection and follow-up of interactions. Of those who were satisfied, 79% had a computerized drug interaction program. Respondents who reported departmental audits or quality assessment procedures were also more likely to be satisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Information Services↗
PubMed1989

Mothers' benefit of a self-care booklet and a self-care educational session at child health centres.

Mothers' benefit of a mass-distributed self-care booklet and a self-care educational session about young children's minor illnesses were investigated. The following questions were studied: (1) Do mothers of infants read and benefit from a self-care booklet? (2) Is the mothers' knowledge about self-care improved more if the booklet is supplemented by a self-care educational session? 265 (92%) of 288 randomly sampled Swedish mothers whose first child was 6-12 months of age were interviewed regarding their knowledge about self-care. Shortly thereafter a self-care booklet was mailed to all households in Uppsala county and 6.5 months later a new group of 572 mothers was randomly sampled. Among the 572 mothers, 332 (58%) were randomized to a self-care session organized at child health centres and 240 (42%) were not invited to a session. Of the 572 mothers, 530 (93%) were later interviewed about the booklet, the session and their knowledge about self-care. 69% participated among the mothers randomized to the session. Among these mothers, 99% recalled the booklet and 96% had read the child care section. Among the mothers not invited to the session, 68% recalled the booklet and 60% had read the child care section. The mothers who had read the child care section would follow the recommendations about when to seek (and not to seek) medical care significantly better than those who had not read it (P less than 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Child Health Services↗
PubMed2004

Stages of change in smokers with schizophrenia or schizoaffective disorder and in the general population.

This study compared smoking behavior and motivation to quit smoking, assessed with a "stages of change" questionnaire, in outpatients with schizophrenia or schizoaffective disorder and in a representative sample of the general population. We conducted a mail survey in a representative sample of the general population of Geneva, Switzerland, in 1996 (n = 742); and a survey of 151 patients with schizophrenia (84%) or schizoaffective disorder (16%) who attended a Geneva ambulatory psychiatric clinic in 2000. There were more smokers (70% vs. 28%, p < 0.001) in patients with schizophrenia or schizoaffective disorder than in the general population, and fewer ex-smokers (15% vs. 52%, p < 0.001). Patients with schizophrenia or schizoaffective disorder smoked more than smokers in the general population (22 vs. 16 cigarettes per day, p < 0.001). Among current smokers, the distribution of stages of change was similar in patients with schizophrenia or schizoaffective disorder (precontemplation 79%, contemplation 18%, preparation 3%) and in the general population sample (74%, 22%, and 4%, p = 0.6). In both samples, similar proportions of smokers had made an attempt to quit in the previous year (27% vs. 22%, p = 0.3). These results suggest that a substantial minority of smokers with schizophrenia or schizoaffective disorder are motivated to quit smoking, try to quit, and succeed in quitting.

Adolescent↗
PubMed1975

The diagnostic process in outpatient endocrine care with special reference to screening. Further study of diagnostic patterns, their changes, total and diagnosis-specific resource consumption.

A screening procedure based on physical examination alone was used in the outpatient unit of a department of endocrinology and metabolism. The volume effectiveness and efficiency of this diagnostic process was evaluated by studying the case-records and by mail questionnaire. The case-records of 296 patients admitted to the clinic during 1968 were analyzed. It was found that 103 of these patients were immediately referred back after a brief physical examination only. The pattern of diagnosis, its changes during the screening procedure, and the outpatient-investigation were also studied. 50% of the patients subjected to outpatient-investigation ended up with a new diagnosis. It was also possible to construct a diagnosis-specific cost estimate for outpatient-investigation, starting from a non-confident and arriving at a confident diagnosis. The distribution of these costs was very skew. The cost for the physician performing the screening was estimated to represent only 2.6% of the costs saved by the introduction of the screening.

Adolescent↗
PubMed1989

Research productivity of allied health faculty in academic health centers.

As colleges of allied health become a more integral part of the academic community, faculty will increasingly be expected to contribute to the research mission of their respective institutions. The purpose of this study was to identify characteristics associated with research productivity of allied health faculty. A survey was mailed to 1444 full-time faculty members in 50 academic health centers nationwide, representing 10 of the most prevalent allied health fields. Research productivity was defined as the total number of publications produced by a faculty member over his/her academic career. Data from 579 respondents (40%) were analyzed. Results of the regression analysis showed that 44% of the variance in total publications was explained by an earned doctorate, hours spent in research, and salary. As a group, the study results showed that allied health faculty were not prolific researchers and did not publish extensively. Although faculty distributed their time among teaching, research, service, consulting, and practice, the greater percentage of faculty time was spent in teaching and service.

Adult↗
PubMed1997

An analysis of support groups for the mentally ill as a psychiatric intervention strategy in South Africa.

Support groups for the mentally ill in South Africa have functioned for more than ten years, and new ones are emerging, which shows that there is need for support groups in the community. Little is known about their structure, function and distribution. This study was an exploratory study which attempted to determine whether such groups could function as one of the intervention strategies in the community. The study investigated history, characteristics and activities of the existing support groups, and also examined failed support groups and areas where no support groups have been formed. A register of available support groups was compiled in the process. The sample consisted of fourteen functioning support groups, three unsuccessful support groups, one support group that had been recently initiated, and ten areas which had no support groups. Data collection was carried out by mailed questionnaires and telephonic questionnaires. The study shows that support groups have been in existence for a period ranging from four months to twenty years. The rendered assistance in advocacy and basic needs of their members, and also therapeutic intervention such as life skills teaching, crisis intervention, and counselling.

Community Mental Health Services↗
PubMedDate not supplied

The distribution of occupations in two populations with upper limb pain.

Occupations of two geographically distinct populations of patients with upper limb pain were examined. Relative risks for being in an occupation were calculated for subjects with epicondylitis, carpal tunnel syndrome, and pain syndromes in one population and nonspecific occupational overuse syndrome (OOS) in the other. Population A subjects (806 female, 154 male Auckland clinic referrals) with epicondylitis and carpal tunnel syndrome had higher rates of manual occupations compared with the Auckland employed population, consistent with previous research. Both Population A and Population B subjects (1,188 female, 499 male national notifications to the Department of Labour) with pain syndrome or nonspecific OOS had increased rates of clerical occupations. Relative risks ranged from 2.24 (95% CI 1.69,2.97) to 3.92 (3.50 ,4.40). Word processor operators, data-entry operators, and mail sorters were overrepresented in both populations. An unexplained association between nonspecific upper arm pain and being in some clerical occupations requires further research.

Arm↗
PubMed2001

Physician response to surveys. A review of the literature.

OBJECTIVE: Physician-specific surveys are a frequently used tool in health services research, but attempts at ensuring adequate response rates are rarely reported. We reviewed literature of survey methodology specific to physician surveys and report those found to be most effective. DATA SOURCES: Studies were identified by searching MEDLINE and PSYCHInfo from 1967 through February 1999. We included all English-language studies that randomized physician survey respondents to an experimental or control group. The authors independently extracted data from 24 studies examining survey methodology of physician-specific surveys. We included Mantel-Haenszel chi-squares comparing treatment groups, if present. If not, these were calculated from study data. RESULTS: Pre-notification of survey recipients, personalizing the survey mailout package, and nonmonetary incentives were not associated with increased response rates. Monetary incentives, the use of stamps on both outgoing and return envelopes, and short questionnaires did increase response rates. Few differences were reported in response rates of phone surveys compared with mail surveys and between the demographics and practice characteristics of early survey respondents and late respondents. CONCLUSIONS: We report some simple approaches that may significantly increase response rates of mail surveys. Surprisingly, the response rates of mail surveys of physicians compared favorably with those from telephone and personal interview surveys. Nonresponse bias may be of less concern in physician surveys than in surveys of the general public. Future research steps include specifically testing the more compelling results to allow for better control of confounders.

Adult↗
PubMed2003

Self-similar community structure in a network of human interactions.

We propose a procedure for analyzing and characterizing complex networks. We apply this to the social network as constructed from email communications within a medium sized university with about 1700 employees. Email networks provide an accurate and nonintrusive description of the flow of information within human organizations. Our results reveal the self-organization of the network into a state where the distribution of community sizes is self-similar. This suggests that a universal mechanism, responsible for emergence of scaling in other self-organized complex systems, as, for instance, river networks, could also be the underlying driving force in the formation and evolution of social networks.

Algorithms↗
PubMed1991

Determination of fees by professionals: an exploratory investigation of dentists.

Previous research has attempted to infer dentists' pricing practices from aggregate data, such as those derived from insurance claims. In a disaggregated analysis based on a mail survey of 327 dentists in private practice, the authors find the most important influence on dental fees to be cost, followed by fees charged by other dentists and perceptions of patient sensitivity to prices. The relative importance of the various influences on dentists' fees is related to several practice characteristics, including location and gross income.

Chi-Square Distribution↗
PubMed2007

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists.

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.

Adult↗
PubMed1976

Transfer dosemeters for fast neutron sources.

The increasing use of fast neutron sources in radiobiology, radiotherapy, etc. makes dosimetry intercomparisons (intercalibrations) by mail desirable. After comparing the relative advantages and disadvantages of the various available integrating fast neutron detectors, fission fragment track etching was chosen because such detectors can be made sufficiently small, rugged, fading resistant, inexpensive and accurate. Using several combinations of 232Th or 237Np as fissile materials, and organic and inorganic track detectors, it was established that both automatic spark counting and visual track counting techniques can be developed to cover the desirable dose range (approximately 50-500 rad) with sufficient accuracy (sigma less than or equal to 5%). One possible source of errors is the overlapping size distributions of fission fragment and recoil particle tracks in organic foils exposed at high neutron energies. Several approaches to reduce this problem are discussed.

Fast Neutrons↗
PubMed1995

Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women's Health Study: how many kinds of breast cancer are there?

Characterization of breast tumors on both estrogen receptor (ER) and progesterone receptor (PR) status suggests distinct biological and clinical profiles. We hypothesized that these tumor subtypes might also show specific differences in their relations with epidemiologic risk factors. Risk factors were assessed via a questionnaire mailed in January 1986 to 37,105 cancer-free women, ages 55-69 years: the Iowa Women's Health Study. To the end of 1992 (241,627 person-years of follow-up), 939 incident breast cancers were ascertained by the Iowa population-based Surveillance, Epidemiology, and End Results Cancer Registry. Joint ER and PR status was determined on a total of 610 (65%) tumors. Three patterns of association were seen in relation to epidemiologic risk factors. Endogenous hormone exposure variables--parity, age at first birth, age at menarche, body mass index, and body fat distribution as defined by waist-to-hip ratio--showed their expected pattern of associations only with PR+ breast cancers. In age- adjusted and polychotomous logistic regression analyses, both ER-PR- and ER+PR- breast cancers showed evidence of an inverted pattern of associations with several risk factors compared with that seen for ER+PR+ cancers [including parity (ER-PR-), waist-to-hip ratio (ER-PR-), body mass index (both), body mass index at age 18 years (ER-PR-), history of bilateral oophorectomy (ER+PR-), and oral contraceptive use (ER+PR-)]. Family history was not associated with ER+PR- cancers; only 8 (8%) of 99 patients with this subtype had a family history of breast cancer compared with 16% of all other types combined.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1999

Musculoskeletal chronic pain in general practice. Studies of health care utilisation in comparison with pain prevalence.

OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

Adult↗
PubMed2002

Factors affecting response rates to the Consumer Assessment of Health Plans Study survey.

OBJECTIVES: Assess the determinants of nonresponse to a consumer health care survey. METHODS: The first (1997; CAHPS 1.0) and third (1999; CAHPS 2.0) Medicare managed care (MMC) CAHPS surveys collected data on 215 and 365 health plan reporting units, respectively. Data indicated which beneficiaries responded by mail, responded by phone, could not be located, and did not respond. InterStudy data described plan characteristics. chi2 tests and logistic regression models, adjusted for clustering by plan, were used to test associations of individual and plan characteristics with availability of good contact information and response given good contact information. RESULTS: Response rates in the 1997 and 1999 surveys were 75% and 80%, respectively. Older and disabled beneficiaries, women, nonwhite beneficiaries, and persons living in areas with more residents who were nonwhite, on public assistance, and less educated had lower response rates. These associations were partly explained by the distribution of bad contact information, but even among beneficiaries who could be located plan response rates varied greatly. For-profit plans are significantly more likely to have high rates of bad contact information and lower response rates. Telephone follow-up improved the sociodemographic representativeness of the sample, for both high and low response rate plans. CONCLUSION: CAHPS-MMC survey procedures, in particular telephone follow-up, have resulted in high response rates, and current case-mix strategies compensate for some of the remaining effects of differing response rates on comparisons among plans. Further efforts to explore the determinants of response rates are warranted.

Age Distribution↗
PubMed1994

Desiccated thyroid in a nutritional supplement.

Nutritional or vitamin supplements, which are largely unregulated by the Food and Drug Administration (FDA) and are sold in health food stores and through mail-order catalogs, may contain various combinations and doses of vitamins, minerals, herbs, chemicals, and animal tissues. Some of the products marketed as nutritional supplements contain desiccated porcine or bovine thyroid. A patient came to our family practice center with resting tachycardia, amenorrhea, and weight loss. She had been taking a nutritional supplement containing desiccated thyroid for 3 months. Laboratory studies confirmed the presence of hyperthyroidism. The daily recommended and consumed dose of the product she had been taking exceeded the normal replacement dose by two to three times. There is potential for harm in the unregulated availability and distribution of desiccated thyroid to the public.

Adult↗