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PubMed2004

An ongoing six-year innovative osteoporosis disease management program: challenges and success in an IPA physician group environment.

The goal of this ongoing comprehensive osteoporosis disease management initiative is to provide the adult primary care physicians' (PCPs) offices with a program enabling them to systematically identify and manage their population for osteoporosis. For over six years, Hill Physicians Medical Group (Hill Physicians) has implemented multiple strategies to develop a best practice for identifying and treating members who were candidates for osteoporosis therapy. Numerous tools were used to support this disease management effort, including: evidence-based clinical practice guidelines, patient education sessions, the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire tool, member specific reports for PCPs, targeted member mailings, office-based Peripheral Instantaneous X-ray Imaging (PIXI) test and counseling, dual x-ray absorptiometry (DEXA) scan guidelines, and web-based Electronic Simple Calculated Osteoporosis Risk Estimation (eSCORE) questionnaire tools. Hill Physicians tabulated results for patients who completed 2649 SCORE tests, screened 978 patients with PIXI tests, and identified 338 osteopenic and 124 osteoporotic patients. The preliminary results of this unique six-year ongoing educational initiative are slow but promising. New physician offices express interest in participating and those offices that have participated in the program continue to screen for osteoporosis. Hill Physicians' message is consistent and is communicated to the physicians repeatedly in different ways in accordance with the principles of educational outreach. Physicians who have conducted the program have positive feedback from their patients and office staff and have begun to communicate their experience to their peers.

Absorptiometry, Photon↗
PubMed2006

Regional variations in prenatal screening across Australia: stepping towards a national policy framework.

BACKGROUND: A relatively few centres across Australia provide screening tests for maternal serum markers or ultrasound measurement of fetal nuchal translucency to assess risk of fetal anomalies such as Down syndrome. While providers engage in external accreditation and quality assurance programs, state and federal governments have been slow to formulate relevant policies and standards. AIM: In this paper we review the current practices across Australian states and territories and propose recommendations for developing a national policy framework. METHODS: Data on the number and types of screening tests provided as well as state policies, where they are available, were obtained from government reports and supplemented by a mail survey to selected stakeholders in each state or territory. RESULTS: At a jurisdictional level, our results highlight the need to integrate the collection and monitoring of antenatal population-screening programs to assess clinical effectiveness and program performance (detection and screen-positive rates, uptake of diagnostic tests as a result of screening). Women's expectations and satisfaction with the information they are provided should be evaluated and used to adjust education resources. At a local level, collaboration between providers of the separate tests, both public and private, would enable the ascertainment of outcomes of integrated screening programs. To complete the cycle, these data should inform decisions to improve antenatal screening programs at a national level. CONCLUSIONS: A primary goal at a national level would be to develop a consensus on key performance indicators for programs that clarify best practice guidelines and establish optimal performance and accreditation standards.

Adult↗
PubMed1995

Comparing the performance of health status measures for healthy older adults.

OBJECTIVES: The specific goals of the study were to compare three health status measures among older adults for their correlations with similar scales and to examine whether extreme (positive) health states might lead to measurement problems. We also report on practical administration and response problems among older adults. DESIGN: Eligible and randomly selected health plan enrollees aged 65 and older were sent a baseline survey about their health. A random sample of persons who returned this survey was recruited to participate in the comparative study. Additional questionnaires were completed by mail and telephone interviews. Measures were repeated at a 1-year follow-up mailing. SETTING: This study was conducted at Group Health Co-operative (GHC) of Puget Sound, a large prepaid health maintenance organization. PARTICIPANTS: Subjects were 200 of the 283 older adults selected (68.2% response). Mean age was 72.5 years. MEASUREMENTS: The primary measures were the Sickness Impact Profile (SIP), the Quality of Well-being Scale (QWB), and three scales of the Medical Outcomes Study Short-Form 36 (SF-36). Also included were a stress scale, the Positive Affect Scale, and the Chronic Disease Score (CDS) computed from the automated pharmacy data. RESULTS: SIP scores showed a very strong skew toward low (good health) scores with a mean of 3.4% (+/- SD 4.4). The QWB scores ranged from .50 to .90 (mean .73 +/- .09). For the MOS SF-36 scales, scores of 100 (good health) were common for both of the physical health scales but not for general health. Analyses showed the SIP, QWB, and MOS SF-36 scales were moderately to strongly correlated with similar measurement scales and with the independent measure of chronic disease and psychosocial health. Scales repeated at 1 year were highly correlated: intraclass correlation coefficients between baseline and 1 year ranged from an r = .51 to .73. CONCLUSIONS: Our results suggest that the SIP is not a useful tool for rating healthy, community-dwelling older adults. Two MOS SF-36 measures used in this study showed some tendency for "ceiling" measurement effects. The QWB demonstrated an acceptable distribution of scale scores; however, it is the most complex of the three measures to administer. Among the broad range of older adults, no one tool appears to apply to every situation.

Aged↗
PubMed1998

Longitudinal study of career plans and directions of veterinary students and recent graduates during the first five years after graduation.

OBJECTIVES: To determine the patterns of work undertaken by veterinarians during the first 5 years after graduation, and to study the background to career decisions. DESIGN: Longitudinal study. POPULATION: Veterinarians (119) who started the veterinary course at the University of Queensland in 1985 and 1986, and who responded to a mailed questionnaire 5 years after they graduated. PROCEDURE: Questionnaires were completed in the first and fifth year of the veterinary course, and in the second and after the fifth year after graduation. The data were coded numerically and analysed using the SAS System for Windows. RESULTS: Most respondents (61%) planned to work in mixed practice and 61% entered mixed practice initially, but only 39% of these (26% of the total) remained in mixed practice after 5 years. Those who had grown up on a farm which derived primary income from animals were more likely to enter mixed practice, but half of this group had left mixed practice after 5 years. Most decisions to change career direction involved a move away from negative factors including inadequate private time and/or rewards, issues involving other people including the practice principal and sometimes clients, or aspects of the work itself. However, some cited positive reasons, including opportunities to learn, to help others or to travel. There were no significant differences between males and females in the numbers entering mixed practice or leaving it, or entering small animal practice, or in attitudes to many issues involving veterinarians. However, more females than males found their remuneration too small, and females did receive significantly smaller incomes than males. CONCLUSIONS: Most graduating veterinarians, especially those from farms with animals, seek to enter mixed practice initially. Negative experiences are mainly responsible for moves to small animal practice. Gender does not affect the distribution of young veterinarians between mixed and small animal practice.

Animals↗
PubMedDate not supplied

The prevalence and risk factors of fluorosis among patients in a pediatric dental practice.

Seven hundred eight patients aged 5-19 years in a pediatric practice in North Carolina were selected using a random-start, systematic sampling procedure and enrolled in a case control study to determine risks for fluorosis. Subjects were examined by four trained examiners using the Tooth Surface Index of Fluorosis (TSIF). Information on fluoride exposures and other explanatory variables was obtained through parent interviews and mail questionnaires. Fluoride exposure was confirmed by fluoride assay of community drinking water samples. Bivariate associations for the entire sample were tested using MH chi2 statistic. A secondary analysis controlling for fluoride in drinking water was performed using logistic regression for 233 subjects (116 drinking fluoridated water; 117 drinking fluoride-deficient water) who were lifetime residents at the same address. Nearly 78% of subjects had a TSIF score of > 0; 36.3% > 1; and 18.9% > 2. Twenty-two variables found in bivariate analyses (P < 0.15) to be associated with fluorosis were included in multivariate analyses. For subjects drinking fluoride-deficient water, fluorosis (1 or more positive TSIF scores) was associated with dietary fluoride supplement frequency (OR = 6.5) and age of the child when brushing was initiated (OR = 3.0). For subjects drinking fluoridated water, fluorosis was associated with age of child when brushing was initiated (OR = 3.1).

Adolescent↗
PubMed1996

National survey of hospital-based pharmacokinetic services.

The status of pharmacokinetic services in the nation's hospitals was studied. A questionnaire was mailed in February 1995 to all 252 respondents to ASHP's 1994 national survey of hospital-based pharmaceutical services who indicated the provision of pharmacokinetic services in their institution. Ninety-eight completed questionnaires were returned (40.2% response rate). The pharmacokinetic services provided required an average of 19.1 person-hours per week, tended to be provided by staff pharmacists, were managed by the pharmacy department, tended to be most focused on aminoglycosides and vancomycin, required an average of 60 notes in patient charts per month, and relied on both computers and calculators for deriving values. There was little contact with patients during the consultation process. Drug concentration measurements tended to be scheduled by service providers, but confidence in the accuracy of the timing of dose administration and blood sampling was limited. Respondents believed that the services tended to be supported by other hospital personnel and that they were successful. There was very little expectation that the workload for providing pharmacokinetic services would increase in the near future. A national survey of hospital-based pharmacokinetic services showed that it took 19 hours per week on average to provide the services, that the focus was on aminoglycosides and vancomycin, and that the services were perceived to be supported by other departments.

Drug Monitoring↗
PubMed1999

Use of the microscope in endodontics: a report based on a questionnaire.

A survey regarding operating microscope (OM) usage and training was mailed to 3356 active members of the American Association of Endodontists (AAE) in the United States. Data from 2061 questionnaires indicate that 52% of the endodontists surveyed have access to and use the OM in their practice. The frequency of use as a function of years since completing endodontic training was as follows: < 5 yr, 71%; 6 to 10 yr, 51%; and > 10 yr, 44%. The OM was used most often for retrieval of separated instruments, root-end preparations, and root-end fillings. Of the respondents who use the OM, 36% report they do not use it as often as anticipated. The most common reasons reported were positional difficulties, inconvenience, and increased treatment time. The information collected from the survey reveals that the more training the operator has on the microscope, the more likely he or she is to use it for all procedures.

Chi-Square Distribution↗
PubMed2006

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: a population-based study.

AIM: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. METHODS: Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. RESULTS: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. CONCLUSION: The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings.

Child↗
PubMed1999

Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study.

The aim of this study was to assess the accuracy and utility of administrative health data in identifying persons with inflammatory bowel disease on a population basis and to determine the incidence and prevalence of this disease in the Canadian province of Manitoba. The data from Manitoba Health (the province's single insurer) were used to identify residents with physician and/or hospital contacts for Crohn's disease or ulcerative colitis based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes between 1984 and 1995. Of 5,182 eligible individuals, 4,514 were mailed questionnaires and 2,725 responded. Cases were defined as individuals with five or more separate medical contacts with one of these diagnoses or three or more such contacts if they were resident for less than 2 years. The accuracy of the study case definitions was high when compared with either self-report or chart review. The 1989-1994 age- and sex-adjusted annual incidence was 14.6/100,000 for Crohn's disease and 14.3/100,000 for ulcerative colitis. The prevalence of Crohn's disease in 1994 was 198.5/100,000, and that of ulcerative colitis was 169.7/100,000. In conclusion, the authors have successfully established and validated a population-based database of inflammatory bowel disease based on administrative data. The high incidence rates and dynamic epidemiology of inflammatory bowel disease in Manitoba indicate the presence of important environmental risk factors, which warrants further investigation.

Adolescent↗
PubMed2001

Impact of first myocardial infarction on self-perceived health status.

Despite recent advances in the acute management of myocardial infarction (MI), few studies have evaluated self-perceived quality of life in the longer term after MI. We mailed a questionnaire incorporating the short form 12 (SF-12) and seeking information on symptoms, drug therapy, recent investigations and employment status, to 149 patients who had a first MI 2 years previously. The response rate was 82%. Mean physical and mental summary scores were significantly lower in patients than "normative" controls (physical summary score: 37.0+/-11.5 vs. 50.9+/-9.4; p<0.001 and mental summary score: 46.2+/-12.8 vs. 52.1+/-8.7; p<0.001, respectively). Physical and mental summary scores were closely associated with continuing chest pain at 2 years, level of limitation on daily activities and employment status. We found the SF-12 to be a useful tool for monitoring health status and believe it could be used to evaluate the impact of interventions on quality of life after acute MI. Self-perceived health status 2 years after a first MI remains poor despite advances in management.

Activities of Daily Living↗
PubMed2004

The Wisconsin Medical Society diabetes study.

PROBLEM: Diabetes is a chronic and costly disease affecting approximately 330,000 people in Wisconsin. This study examined the association between use of clinical practice guidelines and outcomes of care. METHODS: Fourteen physicians from 3 diverse sites volunteered to recruit their adult patients with type 1 and type 2 diabetes who were in continuous care in 1999 and 2000. Of 757 randomly selected patients, 492 (65%) completed a mailed survey and 471 (62%) also gave consent for medical record review. Measures included diabetes management indicators, SF-36 scores, and patient satisfaction. RESULTS: Respondent age averaged 63 years (range 22-90 years) and 55% were men. While most clinicians measured blood pressure, lipids, and hemoglobin (A1c), less than half of the patients were at goal for these indicators. The process indicators explained a significant amount of the variability in physical functioning after controlling for demographics, comorbidities, diabetes-related factors, and clinician type. Overall, most respondents rated their diabetes care as excellent or very good and would recommend their clinician to family and friends. CONCLUSIONS: Study patients with diabetes inconsistently met recommendations for diabetes self-management. While clinical care of study patients was often consistent with recommended guidelines, tremendous opportunities exist for achieving optimal blood pressure, A1c, and lipid levels.

Adult↗
PubMedDate not supplied

Use of complementary therapies, adherence, and quality of life in lung transplant recipients.

PURPOSES: The purpose of this study was to describe complementary and alternative medicine (CAM) use by lung transplant patients and to determine whether CAM users differ from nonusers with respect to health status, quality of life, or medical adherence. METHODS: A mailed survey seeking CAM, quality of life, and adherence information was sent to 145 lung transplant recipients, and 99 responded. RESULTS: The majority (88%) used at least 1 form of CAM (median, 2; range, 0-17). Prayer (68%), support groups (43%), and relaxation techniques (31%) were the most common. Only 44% of users reported discussing CAM with their providers. CAM users were adherent to their transplant regimen. Few differences were found between CAM users and nonusers. Education, high symptom burden, female sex, and depression symptoms were associated with various types of CAM use. CONCLUSION: Most lung transplant recipients are using CAM. Providers must explore potential for interaction or enhancement between CAM and standard therapy to optimize care.

Adolescent↗
PubMed2002

The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century.

BACKGROUND: It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis (RA) for the UK were published. Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA, especially in women. OBJECTIVES: To estimate the age- and sex-specific point prevalence of RA (defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment). The estimate was made in the primary care setting in Norfolk, UK. METHODS: A stratified random sample was drawn from seven age and gender bands. The 7050 individuals selected were mailed a screening questionnaire. Positive responders were invited to attend for a clinical examination. The sample was matched against the names in the Norfolk Arthritis Register (NOAR), a register of incident cases of inflammatory polyarthritis which has been in existence since 1990. RESULTS: The overall response rate was 82%. Sixty-six cases of RA were identified. Extrapolated to the population of the UK, the overall minimum prevalence of RA is 1.16% in women and 0.44% in men. A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission. In addition, some cases who failed to attend for examination had significant disability. These prevalence figures are therefore an underestimate. CONCLUSIONS: The prevalence of RA in women, but not in men, in the UK may have fallen since the 1950s.

Adolescent↗
PubMed2002

Otolaryngology retirement profile in the southeastern United States.

OBJECTIVE: To document retirement-related issues and trends among otolaryngologists. STUDY DESIGN: Survey of 438 retired members in the Southern geographical region of the American Laryngological, Rhinological and Otological Society, Inc. METHODS: A questionnaire was mailed to retired members, completed anonymously, and returned to the author. RESULTS: A total of 138 (31.5%) surveys were received. Respondents' average age at retirement was 63.2 years; approximately half had retired in the last 5 years. Since 1995, most had left either a group practice (45%) or a solo practice (41%). The majority of respondents (40%) retired for previously planned or personal reasons. Two thirds of respondents reported that they were more satisfied with retirement than expected. This greater satisfaction was seen in those with a higher average income after retirement. The most common advice for colleagues still practicing was to save more money and invest more money. CONCLUSIONS: Although these results are biased because of a self-selected group of respondents, they illustrate that for this group of retired otolaryngologists, although retirement is being planned for, it is not occurring earlier than in previous years. The experience of retirement was largely positive for these respondents.

Age Distribution↗
PubMed2004

Does knowledge influence melanoma-prone behavior? Awareness, exposure, and sun protection among five social groups.

PURPOSE/OBJECTIVES: To examine melanoma-related knowledge, sun exposure, and sun protection to determine whether increased awareness is associated with a reduction in risk. DESIGN: Quantitative/empiricist study conducted by purpose- designed mailed questionnaire. PARTICIPANTS: Consultant oncologists at one teaching hospital in London, England; specialist registrars (oncologists in training) contacted through a London-based educational group; oncology-trained nursing staff from oncology departments at two London teaching hospitals; medical students; general (nononcology) nurses; and members of the lay public from one London teaching hospital. SETTING: Two teaching hospitals in London, both registered cancer centers that possess specialist departments of oncology and are staffed by clinical and medical oncologists. METHODS: Anonymous, self-completion, mailed questionnaire. RESEARCH VARIABLES: Sun exposure; use of sun protection and avoidance; knowledge of the biologic effects of sun exposure, moles, and malignant melanoma; melanoma-prone behavior. FINDINGS: No significant differences were found in sun exposure or melanoma-prone behavior across the five groups studied. No correlation existed between knowledge and melanoma-prone behavior. Differences in knowledge and protection scores were demonstrated across all groups and were statistically significant, but they did not translate into changes in exposure or behavior scores. CONCLUSIONS: Public health policy that seeks to reduce the incidence of melanoma is based on the false premise that increasing awareness of melanoma risk will reduce melanoma-prone behavior. Increasing awareness of the risks of sun exposure may improve the use of sun protection, but it does not reduce melanoma-prone behavior, even among specialist healthcare professionals. IMPLICATIONS FOR NURSING: This study provides a new epidemiologic tool for nurses working in the specialty.

Adult↗
PubMed2000

Survival of children with AIDS: experience in a university hospital in northeast Thailand.

The survival experience of pediatric AIDS patients from three points: birth, age at first symptom and age at AIDS diagnosis (by the WHO definition) was studied. We had 90 subjects, 46 males and 44 females. They were under 15 years of age and were diagnosed as having perinatally-acquired pediatric AIDS. The children came to Srinagarind Hospital between January, 1989 and December, 1997. They were followed-up until April 30, 1998. Patients who did not come to the hospital were traced by confidential mail. The two most common first symptoms were chronic diarrhea (36.7%) and persistent lower respiratory tract infection (34.4%). The median age at the first symptom was four months (95% CI = 3 to 5 months) and the median age at diagnosis was 13 months (95% CI = 11 to 15 months). Thirty-nine cases received antiretroviral treatment, either AZT, ddI or both. Forty-five cases died, 18 cases lived to the end of the study, 27 could not be followed-up. A survival curve was calculated according to the Kaplan and Meier method using SPSS version 6.0. The 1- and 2-year survival rates from the time of the first symptom were 75.3 per cent (95% CI = 65.8% to 84.7%) and 60.3 per cent (95% CI = 49.0% to 71.6%). The corresponding survival rates from AIDS diagnosis were 59.7 per cent (95% CI = 48.4% to 71.1%) and 42.8% (95% CI = 30.3% to 55.3%), respectively.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Orthodontic treatment provided by pediatric dentists.

The purposes of this study were to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. A 25-item survey was mailed to 492 diplomates of the American Board of Pediatric Dentistry. Surveys returned within 16 weeks were included for statistical analysis. The response rate was 73%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Practitioners who were dual trained in pediatric dentistry and orthodontics spent more time providing orthodontic treatment, although nearly half spent at least 50% of their time providing traditional pediatric dental treatment. Most pediatric dentists provided orthodontic treatment in the primary or early mixed dentition stages. The most common conditions treated were anterior crossbite, ectopic eruption, habits, posterior crossbite, and space maintenance. The most common orthodontic appliances used were fixed rapid palatal expanders and removable Hawley appliances with finger springs. Orthodontic treatment provided by pediatric dentists has decreased since it was last surveyed in 1983 and is not expected to change in the next 5 years.

Chi-Square Distribution↗
PubMed2005

Burnout in clinical research coordinators in the United States.

PURPOSE/OBJECTIVES: To assess burnout among clinical research coordinators (CRCs) and to determine which personal and job-related factors are associated with burnout. DESIGN: Random, stratified, cross-sectional mail survey. SETTING: CRCs from membership lists of clinical research organizations. SAMPLE: 252 CRCs in the United States. To be included in the study, participants must have been in their current position longer than six months and involved in clinical trial coordination or data management. Of 2,770 records, 900 CRCs were mailed questionnaires; 35% (316) responded, and 252 of those were eligible for analysis. Eligible respondents were Caucasian (86%), female (94%), and employed full-time (92%) in an oncology setting (71%). METHODS: Respondents completed mailed self-administered questionnaires measuring burnout, job satisfaction, personality characteristics, perceived work overload, and selected personal- and employment-related data. Data analyses included descriptive, univariate, and multivariate statistics. MAIN RESEARCH VARIABLE: Burnout. FINDINGS: About 70% of respondents were satisfied with their job, and 74% would still choose the clinical research profession. Approximately 44% reported high emotional exhaustion, a component of burnout. Factors independently associated with high emotional exhaustion burnout were low satisfaction with job (p 0.0001), high perceived daily workload (p 0.0001), and low endurance personality (p = 0.002). CONCLUSIONS: Burnout is prevalent in CRCs. Job dissatisfaction, perceived daily work overload, low endurance, and nurturance personality traits were associated with high burnout. IMPLICATIONS FOR NURSING: Nurses are involved significantly in clinical trial coordination. High burnout rates have potentially negative implications for data quality and productivity in clinical trial data management-important values for nursing and the clinical research profession.

Administrative Personnel↗