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PubMed2000

Creating cost-efficient initiatives in social work practice in the cardiac program of an acute care hospital.

All three cost-saving initiatives--the creation of a one-page application form to streamline the rehabilitation application process, the use of the resource specialist to assist with applications, and the development of an information package on cardiac rehabilitation--reflect a process whereby a creative idea, generating planning, activities, and follow-up resulted in a measurable effective change in practice. This process truly translated strategy into action (Kaplan, 1996) and is vital to the current rethinking in health care of how best to do our work (Coan, 1994). Because of this process, social workers in the cardiovascular surgical division of the cardiac program are better equipped to respond to the psychosocial needs of a growing cardiac population in a fiscally restrained environment.

Cardiac Surgical Procedures↗
PubMed1988

Reproducibility and validity of dietary assessment instruments. I. A self-administered food use questionnaire with a portion size picture booklet.

A self-administered food use questionnaire which included 276 food items and mixed dishes and a portion size picture booklet with 122 photographs was developed for a large lung cancer intervention trial among approximately 27,000 Finnish men aged 50-69 years. The reproducibility and validity of this questionnaire were studied from March to October 1984. In the reproducibility study, 121 men aged 55-69 years completed the questionnaire three times, at three-month intervals. The intraclass correlations varied from 0.56 for vitamin A to 0.88 for alcohol, with most falling between 0.60 and 0.70. In the validity study, 190 men of similar age kept food consumption records for 12 two-day periods, distributed evenly over a period of six months, and filled in the questionnaire both before and after this period. Correlations between nutrient intake values from the food records and the food use questionnaires ranged from 0.40 for selenium to 0.80 for alcohol. Among subjects who belonged to the lowest quintile on the basis of the food record measurement, an average of 51 per cent fell into the same quintile and 76 per cent fell into the lowest two quintiles when they were categorized on the basis of the food use questionnaire. Findings were similar for the upper tail of the distribution. These data indicate that the self-administered food use questionnaire is useful for measuring individual or group intakes for a variety of nutrients.

Aged↗
PubMed1996

The effect of brochure use versus therapist teaching on patients performing therapeutic exercise and on changes in impairment status.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate whether the mode of teaching exercises (use of brochures versus therapist teaching) affects whether patients correctly perform the exercises and whether it affects changes in impairment. SUBJECTS: Eighty-seven patients (33 women, 54 men) with neck pain and low back pain were examined. The average age was 48 years (SD = 12.7, range = 21-67). METHODS: Two groups of patients were analyzed. The supervised (physical therapist-instructed) group (n = 47) exercised under the supervision of a physical therapist, whereas the brochure group (n = 40) received their instructions only from one of three brochures. A rating scale was used to assess the correctness of exercise performance. Muscle status was registered using a standardized procedure for determination of muscle force and length. Pain severity was determined by means of a visual analogue scale. RESULTS: On the rating scale evaluating the correctness of exercise performance at follow-up, the patients in the supervised group performed better than the patients in the brochure group. In addition, there was a strong correlation between the quality of exercise performance and decrease in pain. CONCLUSION AND DISCUSSION: Exercises learned only from a brochure without being monitored by a physical therapist were done properly by only about half of the patients and appeared to result in fewer improvements in impairments.

Adult↗
PubMed2004

Do women read poster displays on breast cancer in waiting rooms?

BACKGROUND: This study reports data from a survey carried out in the Iranian Center for Breast Cancer (ICBC) to examine whether women read poster displays in waiting rooms and whether they would have any suggestions to improve posters and thus meet their informational needs. METHODS: Five specially designed posters were displayed in waiting rooms in the ICBC. The content of posters was related to risk factors, early detection, signs and symptoms, and prevention of breast cancer. During a 3 month period a self-administered questionnaire was distributed to all attendees and they were asked to complete the questionnaire. RESULTS: Overall, 850 women were given the questionnaire and 777 completed questionnaires (91 per cent) were returned. The mean age of the women was 37.0 years (SD = 10.7) and they mostly had secondary education (47 per cent). In all, 691 women (86 per cent) reported that they had seen the posters and 620 (80 per cent) said that they had read the displays. The vast majority of the women reported that posters were readable (89 per cent) and understandable (80 per cent). However, 25 per cent of the respondents indicated that materials on the displays created more questions rather than answering their questions and some reported that they became upset (26 per cent) or felt anxiety (42 per cent) while reading the posters. Finally, 218 women (28 per cent) had suggestions to improve posters, of whom 110 (50 per cent) believed that the posters should be simpler. CONCLUSION: The study findings suggest that despite the limitations of posters as a means of health communication, their use in public places may be useful but consideration should be given to the content of the poster displays to prevent anxiety.

Adult↗
PubMed2006

Informed choice in screening programmes: do leaflets help? A critical literature review.

BACKGROUND: Screening programmes aim to maximise population benefit by maximizing uptake but must also allow informed choice about participation. Many programmes provide potential participants with information leaflets. This article reviews studies of the effectiveness of leaflets in promoting informed choice in screening. METHODS: I searched 15 electronic databases and the websites of UK screening programmes, searched the bibliographies of identified studies and contacted experts in the field. Randomized controlled trials (RCTs) and controlled clinical trials where an attempt had been made to determine the contribution of leaflets to the exercise of informed choice in screening decisions were included. RESULTS: I identified nine trials from various screening programmes. Outcome measures included knowledge, attitudes to screening, intention to be screened, uptake, anxiety, satisfaction with decision-making, discussions about screening with care providers and agreement that enough information had been provided to allow informed choice. Most studies demonstrated that providing written information increased knowledge, but evidence that this promoted informed choice was poor. CONCLUSIONS: Research into informed choice in screening is hampered by the lack of agreement about its definition and measurement. The most effective way for screening programmes to achieve informed choice is unclear. Programmes should not rely solely on providing written information but should explore additional ways to promote informed choice.

Databases, Bibliographic↗
PubMed2004

Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Health's educational campaign.

BACKGROUND: In August 2002, the Department of Health (DH) wrote to all general practitioners (GPs) in England about hepatitis C, enclosing an educational booklet. AIM: To assess hepatitis C knowledge among East London GPs in June 2003. DESIGN: Postal questionnaire and face-to-face interviews. METHODS: A questionnaire was mailed to 250 (South-East) and 600 (North-East) London GPs, with reminders where needed. We randomly selected 10 GPs for face-to-face standardized interviews. RESULTS: Overall questionnaire response was 56% (South-East) and 57% (North-East), with little difference between the groups. Some 86% knew that hepatitis C was common in people who inject drugs, and that its prevalence was higher than HIV. However, 14% believed that antibodies to the virus indicated that the patient no longer had active disease. Some 49% thought that materno-fetal transmission was common, and 50% believed that blood transfusion in the 1990s carried a high risk of infection. Only 23% knew that 20% of patients develop cirrhosis after 20 years, and only 58% were aware that therapy was effective in > 50% of cases. Responses among the interviewed GPs were similar. DISCUSSION: Knowledge of hepatitis C among GPs remains poor. Every GP surveyed wished to be better informed. We hope the DH will produce and audit further educational campaigns.

Clinical Competence↗
PubMed1996

Single-blind randomized controlled trial of an educational booklet for patients with chronic arthritis.

Consecutive new attendees at a rheumatology clinic were randomly allocated to one of three groups. All groups received routine care, but one received no other intervention, one an educational booklet on arthritis and one the booklet plus instruction from a health professional. Prior to intervention, all groups had similar knowledge. Nottingham Health Profile (NHP) and Health Assessment Questionnaire (HAQ) score. After 6 weeks, the knowledge score was significantly increased in both groups given the booklet, but not in the control group. The group instructed by a health professional showed no greater increase than the group given the booklet alone. Increased knowledge was not associated with improved clinical status and no group showed a significant change in NHP or HAQ scores. Nearly all patients said they found the booklet useful.

Adult↗
PubMed1998

Knowledge in patients with rheumatoid arthritis: a longer term follow-up of a randomized controlled study of patient education leaflets.

Despite the wide availability of disease-related leaflets, their impact on patients' knowledge and well-being has rarely been evaluated. A randomized controlled study of a 'Rheumatoid Arthritis' leaflet revealed increased knowledge among the intervention group after 3 weeks. In addition, the leaflet was viewed as a source of reassurance. The purpose of the follow-up study was to determine whether the increase in knowledge was maintained in the longer term and to examine psychological well-being. Eighty-four patients (42 intervention and 42 control) completed the 6 month follow-up. There were no significant changes (P > 0.01) in mean outcome measures over the period 3 weeks-6 months for either the intervention or control groups. Patients in the intervention group retained the increase in knowledge observed at 3 weeks. Moreover, there was no evidence of adverse reactions to the leaflet in terms of psychological distress. Leaflets can be effective in promoting longer term increases in knowledge.

Adult↗
PubMed2003

The development and evaluation of a drug information leaflet for patients with rheumatoid arthritis.

OBJECTIVES: To develop and assess the effectiveness of a drug information leaflet (DIL) for D-penicillamine (DPA) and determine whether additional verbal information provides enhanced benefit. METHODS: Three preliminary studies were undertaken: a reading age study; the development of a DIL for DPA; and a DPA knowledge questionnaire. The primary study assessed the effect of the DIL on the knowledge of 30 patients at weeks 0 and 24 after commencing DPA. A follow-up study of 100 patients randomly assigned to receive the DIL alone (control group) or with additional verbal backup (experimental group) determined the effects of additional verbal information by comparison of DPA knowledge questionnaire scores at weeks 0 and 24. RESULTS: The reading study showed that 12% of the sample had difficulty reading and so the DPA DIL was designed to be easy to read using the Flesch Reading Index. An assessment of knowledge of DPA prior to reading the DIL resulted in scores ranging from 0 to 13 with a median of 2 (maximum possible 14). By week 24 the median score was 10 (range 6-14), which was significant at P < 0.0001. The assessment of additional verbal backup showed that both the control group and the experimental group knew little about DPA on study entry, with a median score 2 in each group. On study exit, both groups knew significantly more (P < 0.001) about the drug; the control group scored 9 and the experimental group 11 (not significantly different; P=0.109). CONCLUSIONS: A large minority of patients have poor reading skills, but when a DIL is designed to be easy to read patients gain significant amounts of knowledge from it. Providing additional verbal explanations did bring about increases in knowledge but these were not significant.

Adolescent↗
PubMed2006

Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management.

OBJECTIVES: Interventions that take psychosocial factors into account are recommended for patients with persistent back or neck pain. We compared the effectiveness of a brief physiotherapy pain management approach using cognitive-behavioural principles (Solution-Finding Approach-SFA) with a commonly used method of physical therapy (McKenzie Approach-McK). METHODS: Eligible patients referred by GPs to physiotherapy departments with neck or back pain lasting at least 2 weeks were randomized to McK (n= 161) or to SFA (n= 154). They were further randomized to receive an educational booklet or not. The primary outcome was the Tampa Scale of Kinesiophobia (TSK) (Activity-Avoidance scale used as a proxy for coping) at 6 weeks, and 6 and 12 months. RESULTS: Of 649 patients assessed for eligibility, 315 were recruited (219 with back pain, 96 with neck pain). There were no statistically significant differences in outcomes between the groups, except that at any time point SFA patients supported by a booklet reported less reliance on health professionals (Multidimensional Health Locus of Control Powerful Others Scale), while at 6 months McK patients showed slightly more improvement on activity-avoidance (TSK). At 6 weeks, patient satisfaction was greater for McK (median 90% compared with 70% for SFA). Both interventions resulted in modest but clinically important improvements over time on the Roland Disability Questionnaire Scores and Northwick Park Neck Pain Scores. CONCLUSIONS: The McK approach resulted in higher patient satisfaction overall but the SFA could be more cost-effective, as fewer (three vs four) sessions were needed.

Adaptation, Psychological↗
PubMed2003

It ain't over till it's over: the case for offering relapse-prevention interventions to former smokers.

Most people who attempt to quit tobacco smoking eventually relapse. Although treatment strategies have been developed to prevent smoking relapse, they tend to be available only to the small proportion of smokers who enroll in intensive smoking cessation treatments. It is argued that freestanding relapse-prevention interventions could be offered to persons who recently ceased smoking, whether they used a formal treatment program or quit on their own. A line of research is described demonstrating that a series of relapse-prevention booklets mailed to recent quitters significantly reduces smoking relapse. Moreover, the intervention seems to be highly cost-effective. If disseminated widely, such an approach has the potential to make a significant public health impact.

Clinical Trials as Topic↗
PubMed2003

A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial.

OBJECTIVE: To evaluate the efficacy of a theory-based tailored minimal self-help intervention to increase condom use among young women at risk for HIV/sexually transmitted disease (STD). DESIGN: Randomized controlled trial on an intent-to-treat basis in two managed care plans, in Washington state and North Carolina, with follow-up at 3 and 6 months. PARTICIPANTS: A proactively recruited sample of 1210 heterosexually active, non-monogamous, non-pregnant women, aged 18-24 years recruited June 1999-April 2000; 85% completed the 6-month follow-up. METHOD: Arm 1 received usual care. Arm 2 received a mailed computer-generated self-help magazine, individually tailored on survey items including stage of readiness to use condoms, barriers to condom use, partner type; condom samples and a condom-carrying case were included in the packet; this was followed 3 months later by a tailored 'booster' newsletter. The a priori 6-month main outcomes were percentage of women using condoms during the previous 3 months (overall and by partner type) and proportion of total episodes of intercourse during which condoms were used in the previous 3 months. RESULTS: Relative to usual care, intervention group women reported significantly more condom use overall [adjusted odds ratio (OR), 1.86; 95% confidence interval (CI), 1.32-2.65; P = 0.0005] and with recent primary partners (OR, 1.97; 95% CI, 1.37-2.86; P = 0.0003). They also reported using condoms for a higher proportion of intercourse episodes (52.7% versus 47.9%; P = 0.05). Significantly more intervention women carried condoms, discussed condoms with partners, and had higher self-efficacy to use condoms with primary partners. CONCLUSIONS: Tailored cognitive/behavioral minimal self-help interventions hold promise as HIV/STD prevention strategies for diverse populations of young at-risk women.

Adult↗
PubMedDate not supplied

What every patient should know...pretransplantation and posttransplantation.

This article addresses an overview of patient education required for the postoperative heart transplant patient. The overall purpose of patient education is to insure the patient and, when appropriate, his or her significant other(s) are provided with education to enhance knowledge, skills, and behavior change. Patient education needs are to be continually assessed, identified, and addressed. Education includes instruction in the specific knowledge and skills needed by the patient and his or her significant other(s) to meet the patient's needs. Health education of the postoperative heart transplant patients may add significant and sustained benefits to their recovery and compliance with regime while reducing costs.

Adaptation, Psychological↗
PubMed1998

Suitability of patient education materials for cardiac catheterization.

Changes in healthcare delivery for such diagnostic procedures as cardiac catheterization have resulted in an emphasis on patient self-study, using booklets and videotapes given to them before the procedure. This transition mandates an evaluation of the appropriateness and effectiveness of these materials. The purpose of this study was to systematically assess the suitability of materials used to prepare patients for cardiac catheterization. Three videotapes and four booklets were evaluated using the Suitability Assessment of Materials instrument. Concrete objective information (procedural and sensation information) was also evaluated. Scores revealed only one video and two booklets suitable for patient education. None received a superior rating. These results suggest that some patient educational materials used to prepare patients for cardiac catheterization are unsuitable. Clinicians should augment current suitable materials to enhance their effectiveness.

Cardiac Catheterization↗