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PubMed2004

Do the British Guidelines for Asthma Management facilitate concordance?

BACKGROUND: Asthma is an example of a common, chronic illness in which clinicians are encouraged to promote concordance and adhere to guidelines. Some existing research suggests that these aims may be incompatible. OBJECTIVES: To describe patient goals for life and for asthma management in order to inform concordance with people with asthma. DESIGN: A cross-sectional, qualitative survey. SETTING AND PARTICIPANTS: A purposive sample of 47 adults with asthma from Dundee, UK. The subjects were identified from general practice asthma registers and had a range of ages and asthma severity but no significant comorbidity. METHODS: Tape-recorded semi-structured interviews. The topic guide was based on the literature and had been piloted in a previous study. RESULTS: The participants focussed on improving their lives, only aiming to improve their asthma as a means of improving their lives. Three aspects of asthma were reported to help or hinder improving life: the use of asthma medication, trigger avoidance and exercise. People integrated these three aspects of asthma in order to maximize life. CONCLUSIONS: The study supports the more individualized goals of the recently revised British Guidelines for Asthma Management but highlights the need to develop this further in future revisions. It also provides an explanation for patients' acceptance of less than 'perfect' asthma control and it suggests that shared goals may be achieved in practice by considering the advantages and disadvantages of medication and allergen avoidance on everyday life rather than on asthma.

Adolescent↗
PubMed2006

The health information national trends survey: research from the baseline.

The decades surrounding the turn of the millennium will be remembered as a time of extraordinary opportunity in cancer communication. In 1990, the number of age-adjusted deaths due to cancer in the U.S. population began a slow steady decline after a century of disparaging increase. Reasons for this decline have been attributed to long-awaited successes in primary prevention, especially related to tobacco, and early detection for cervical, breast, prostate, and colorectal cancers, as well as advances in treatment. This was also a time of unparalleled change in the cancer communication environment. Scientific health discoveries escalated with the completion of the Human Genome project in 2003, and penetration of the Internet made health information available directly to consumers. To seize the opportunity afforded by these changes, the National Cancer Institute (NCI) launched the Health Information National Trends Survey (HINTS). Fielded for the first time in 2003, the HINTS is a nationally representative, general population survey of noninstitutionalized adults in the United States 18 years and older. This supplement contains a compilation of original research conducted using the data generated by the first administration of the HINTS telephone interviews. Covering topics in cancer knowledge, cancer cognition, risk perception, and information seeking, the articles represent an interdisciplinary view of cancer communication at the turn of the millennium and offer insight into the road ahead.

Computer Communication Networks↗
PubMed1992

Examination and communication: a study of first encounters between patients and physiotherapists.

What happens in first encounters between patients and physiotherapists? Videotaped encounters between two patients and their physiotherapists were analysed in depth to try to answer this question. It is advocated that attention must not be restricted to either clinical decision making or communication, but needs to be directed towards the relationship between communication and diagnostic approaches. In other words, in order to understand how a health problem is defined, the complexity and social organization of the process of interaction cannot be ignored. Therapies are chosen and cooperation is built on such socially and professionally constructed basis, and it is suggested that the nature of this construction needs to be grasped. To this end, the author analyses both the therapists' examination and the communication between patient and therapist. Focus is thereby shifted from the 'pure' diagnostic activity to the frame of reference underlying it. The analysis demonstrates differences in the two therapists' practice from the very moment patient and therapist greet one another till they say farewell. The therapists' actions mirror the dissimilar conceptual frameworks underlying their practice, and the therapists' conceptual lenses therefore need to be scrutinized further.

Attitude to Health↗
PubMed1980

Evaluation of a diet history questionnaire for epidemiologic studies.

This study was conducted to evaluate a detailed diet history questionnaire. Diet histories obtained from 16 men were compared with food records kept by their partners for a 30-day period. Mean estimates for all 13 nutrients calculated were higher with the diet history than with food records. Positive correlation coefficients were found between estimates from the two methods for all nutrients as well as food groups and six of the 13 nutrients gave a good fit for the corresponding regression equations. The questionnaire was also evaluated by repeating it after six months on 26 case-control pairs of an ongoing diet and cancer study. High correlation coefficients were obtained for most nutrients for the controls. However, cases showed lower correlations probably due to changes in their diet. The study found that the diet history method as an estimate of dietary patterns among groups shows sufficient validity and reliability to make it a useful instrument for epidemiologic studies.

Adult↗
PubMed1987

A comparison of patient, family, and nurse evaluations of the usefulness of intensive care.

As patient advocates, critical care nurses need to be cognizant of which treatments the patients and their families prefer. Therefore, we conducted a study to compare how nurses, their critically ill patients, and their families evaluate the usefulness of intensive care. A group of former medical intensive care patients (n = 72), or their family members if the patient had died, were asked how willing they would be to undergo (or to subject their relative to) intensive care again, if necessary. All nurses (n = 15) caring for these patients were asked a parallel, hypothetical question about the usefulness of intensive care to these patients and to themselves, were they to become sick. Analysis of matched pairs of patient (or family member) and nurse questionnaires (n = 38) revealed that: nurses underestimate the usefulness of intensive care as evaluated by their patients and families; and patients believe that quality of life is a less important factor in judging the usefulness of intensive care than do their nurses.

Attitude↗
PubMed2000

Intelligent database generated occupational questionnaire system.

Obtaining an adequate occupational history requires special expertise to "ask the right questions" that are relevant to a particular patient's specific health conditions and potential exposures. This article describes a way to systematically accomplish this by means of a computer system that can overcome limited availability of necessary clinical occupational health expertise. The Intelligent Questionnaire system is a computer-based system for generating case-specific questionnaires about the influence of work on respiratory disease. Intelligent Questionnaire includes three databases: Questions, Responses, and Calls (clues to identify questions). The Questionnaire also arranges questions in a logical manner and provides a customized data entry screen for each subject. This approach provides primary practitioners with expertise on a case-by-case basis. It also facilitates occupational health surveillance because it allows acquiring detailed case-specific information in a systematic fashion. A computer-based system can facilitate obtaining occupational histories with high specificity and consistency without depending on general availability of a human occupational health clinical expertise.

Artificial Intelligence↗
PubMed2005

The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study.

BACKGROUND: Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions. OBJECTIVE: To explore information needs and decisional role-preferences of parents caring for infants with AD. METHODS: Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts. RESULTS: Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor. CONCLUSIONS: Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.

Adult↗
PubMedDate not supplied

Health-related quality of life and other patient-reported outcomes in the European centralized drug regulatory process: a review of guidance documents and performed authorizations of medicinal products 1995 to 2003.

OBJECTIVES: The objective of this study was to review and analyze the use of health-related quality of life (HRQL) and other patient-reported outcome (PRO) evaluations for the approval of new pharmaceutical products by the European Medicines Agency (EMEA). METHODS: All published EMEA guidance documents and regulatory information for products authorized at the EMEA and appearing in the European Public Assessment Report (EPAR) database between 1995 and 2003 were examined for reference to HRQL and other PROs. RESULTS: More than half of the guidance documents for clinical investigation of pharmaceutical products in specific disease areas included reference to HRQL or other PROs. Guidance notes for 10 conditions indicated PROs can serve as primary endpoints in clinical trials, among which three included HRQL outcomes. The review of EPAR documentation uncovered HRQL and other PRO data for 34% of the drugs registered during the period of the review, with cancer-related treatments most frequently including PRO data. There was a trend toward increasing HRQL and other PRO claims in regulatory documents of pharmaceutical products in recent years, with the proportion exceeding 30% from 1999 to 2003. CONCLUSIONS: There is further scope for health outcomes researchers and regulatory decision-makers to contribute to the more efficient utilization of PROs and HRQL outcomes. Health researchers need to better justify the inclusion of these outcomes in clinical trials and highlight the added value of PRO data; while the regulators should develop harmonized procedures and capacities to adequately appraise the submitted information.

Chronic Disease↗
PubMed1975

Anxiety and ritualized speech.

The experiment examines the effects on a number of words that seem irrevelant to semantic communication. The Units of Ritualized Speech (URSs) considered are: 'I mean', 'in fact', 'really', 'sort of', 'well', and 'you know'. Two hypotheses are tested: (i) that URS rate will increase with anxiety; and (ii) that the speaker's preferred URS will increase with anxiety. Subjects were interviewed on topics they had previously rated as anxiety-provoking and non-anxiety-provoking. Hypothesis (i) was supported, but hypothesis (ii) was not. More specifically, the use of 'I mean' and 'well' increases when the speaker is anxious. Explanation for this is sought in the grammatical location of these two units. Sex differences in the use of URSs, correlations between URSs and their relationship to other forms of disfluency are also considered.

Anxiety↗
PubMed1999

Medical cover at Scottish football matches: have the recommendations of the Gibson Report been met?

OBJECTIVES: To determine if doctors providing medical care at Scottish football stadiums meet the standards recommended by the Gibson Report. METHODS: A postal questionnaire and telephone follow up of doctors involved with the 40 Scottish League teams. RESULTS: 47% of the doctors had not attended any relevant resuscitation courses and 72% had no training in major incident management. CONCLUSIONS: The recommendations of the Gibson Report with regard to medical cover at football stadiums have not been fully implemented in Scotland.

Disaster Planning↗
PubMed1999

Design and reliability of pediatric HealthQuiz: preliminary report of a comprehensive, computerized, self-administered child health assessment.

The time available for pediatric ambulatory visits is rarely sufficient to permit a truly comprehensive health assessment. We hypothesized that a reliable, computerized, self-administered questionnaire could be designed to screen for a full range of pediatric health issues and provide a comprehensive health database for pediatric patients. An age- and gender-specific pediatric questionnaire of 478 questions was formatted to elicit only a "Yes," "No," or "Not Sure" response and structured in a branched, decision-tree format. The initial draft was reviewed for content by pediatric experts in Canada and the United States and revised in accordance with their suggestions. The questionnaire was divided into two modules, Medical Peds, covering biomedical issues and Prevent Peds, covering prevention, psychosocial, educational, and safety topics. Cognitive interviews were carried out with 132 parents in pediatric ambulatory care centers in Chicago and Halifax, with use of scripted and nonscripted probe questions, to ensure comprehensibility among patients with widely varying educational levels and health knowledge. Reliability was tested in 100 parents of children aged 1 month to 12 years, through use of five different test-retest sequences. Respondents' impressions were surveyed on completion of the procedure. Following content reviews, and cognitive and reliability testing, the total bank of questions was reduced to 375. As a result of the use of branching logic, individual parents answered an average of 111 Prevent Peds and 144 Medical Peds questions. Average time required to complete the entire questionnaire was 13 minutes for Prevent Peds and 19 minutes for Med Peds. Retesting within 36 hours showed an overall 97% concordance of response pairs in the Medical Peds and Prevent Peds questionnaires. There were no statistically significant differences in test-retest reliability between different sequence formats used, (e.g., HealthQuiz followed by personal interview, or HealthQuiz vs. HealthQuiz). A few questions that frequently elicited "Not Sure" responses were eliminated. As a result, the majority of questions elicited either a "Yes" or "No" response. Pediatric HealthQuiz identified a wide spectrum of child health problems that are often overlooked in routine health visits. Parents completing Pediatric HealthQuiz indicated a high degree of satisfaction with the procedure. Most reported that they believed the information would improve their child's health care.

Canada↗
PubMed2002

Autonomy in practice: a qualitative study of school nurses' perceptions.

Many who enter the specialty of school nursing find themselves faced with the challenge of practicing as the sole professional responsible for the health care of large numbers of students and school employees. In addition, the transition from the more familiar medical or nursing setting into the unknown territory of the educational environment can be daunting. This qualitative study examined the perceptions of 6 new and 6 experienced school nurses regarding the autonomy of their practices. Results identified sharp contrasts in the areas of role perception, comfort, and confidence between the two groups. It is imperative that the specialty initiate changes to nurture and support the novice during this transitional period.

Adult↗