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At least 343 records · Page 19Linked to original sources
PubMed2004

Lateral retinacular release: a survey of the International Patellofemoral Study Group.

PURPOSE: The purpose of this investigation was to determine current views regarding lateral release among experienced knee surgeons with a specific interest in the patellofemoral joint. TYPE OF STUDY: Scientific survey. METHODS: A questionnaire was developed and mailed to all members of an international group with a specific interest in disorders of the patellofemoral joint. Frequencies and percentages of responses were calculated for each question to determine surgeon consensus. We measured agreement among responses using the kappa statistic. This provided an indication of consistency for each question as well as correlation among the responses to different questions. RESULTS: The survey response rate was 60%. Isolated lateral release was estimated to account for only 1 to 5 surgical cases per respondent per year, or 2% of cases performed annually. In the setting of arthroscopy or exploration, 74% of respondents believed that lateral release calls for specific informed consent. Strong consensus was found that objective evidence is needed to justify lateral release, but agreement was poor as to what clinical evidence provides the most appropriate indication for the procedure. CONCLUSIONS: Even among experienced knee surgeons with a special interest in diseases of the patellofemoral articulation, isolated lateral release is rarely performed. Strong consensus was found that isolated lateral release should not be undertaken without prior planning in the form of objective clinical indications and preoperative informed consent. LEVEL OF EVIDENCE: Level V.

Arthroscopy↗
PubMed2005

Cervical cancer screening continues to limit provision of contraception.

PURPOSE: Balancing needs for contraception and cervical cancer screening is challenging for clinicians. We assessed US obstetrician/gynecologists' practices regarding requirement of Pap testing before prescribing oral contraceptive or emergency contraceptive pills. METHODS: Questionnaires structured as clinical vignettes describing women desiring contraception with different risks of cervical dysplasia were mailed to a national sample of 355 obstetrician/gynecologists. RESULTS: A minority (3%) of the 185 obstetrician/gynecologists who responded would refill 12 months of oral contraceptives without requiring Pap testing. However, most would provide a limited supply of oral contraceptives until Pap testing could be performed. A substantial proportion (11-16%) would refuse to prescribe emergency contraception to women who they felt required Pap testing. Younger physicians, those practicing in academic settings and those who follow American Cancer Society guidelines were more willing to prescribe contraceptives without Pap testing. CONCLUSIONS: Cervical cancer screening continues to limit prescription of routine and emergency contraception by many US obstetrician/gynecologists.

Contraception↗
PubMed2005

Complementary therapies in pregnancy: midwives' and obstetricians' appreciation of risk.

Complementary medicine is increasingly being integrated into maternity care, primarily by midwives in response to mothers' demands. Midwives and obstetricians must, however, develop a comprehensive evidence-based knowledge of risks, as well as benefits, to ensure that any complementary therapies in pregnancy and childbirth are not only effective but also safe. This paper discusses the results of an evaluative audit of midwives' and obstetricians' knowledge of and attitudes to complementary therapies in pregnancy in an NHS antenatal clinic which revealed a generalised lack of knowledge and poor understanding of the possible risks to women.

Attitude of Health Personnel↗
PubMed2006

Actions speak louder than words: mainstream health providers' definitions and behaviour regarding complementary and alternative medicine.

The purpose of this paper is to explore how mainstream practitioners define and categorize complementary and alternative medicine (CAM) as one component of assessing their views. The following themes emerged from interviews with Canadian physicians, midwives and nurses: epistemological, evidence-based, medical domain, political-regulatory, funding-based, and role-based definitions of CAM. We also assess any possible links to their behaviour vis-à-vis CAM. We found that classifying something as CAM does not appear to inhibit most providers from recommending, referring for, or supporting their patients' use of these treatments. In conclusion, we highlight that despite their clear definitional boundaries around CAM, providers tend to evaluate each individual therapy on its own merits, taking other situational factors into consideration.

Attitude of Health Personnel↗
PubMed2005

Determinants of physician use of an ambulatory prescription expert system.

PURPOSE: To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system. METHODS: A prescription expert system was implemented in an academic internal medicine residency training clinic and physician utilization was tracked electronically. A physician attitude and behavior survey (response rate=89%) was conducted six months after implementation. RESULTS: There was wide variability in system adoption and degree of usage, though 72% of physicians reported predominant usage (> or =50% of prescriptions) of the expert system six months after implementation. Self-reported and measured technology usage were strongly correlated (r=0.70, p<0.0001). Variation in use was strongly associated with physician attitude toward issues of system efficiency and effect on quality, but not with prior computer experience, level of training, or satisfaction with their primary care practice. Non-adopters felt that electronic prescribing was more time consuming and also more likely to believe that their patients preferred hand-written prescriptions. CONCLUSION: A voluntary electronic prescription system was readily adopted by a majority of physicians who believed it would have a positive impact on the quality and efficiency of care. However, dissatisfaction with system capabilities among both adopters and non-adopters suggests the importance of user education and expectation management following system selection.

Ambulatory Care Information Systems↗
PubMed2005

Virtual reality simulators in orthopedic surgery: what do the surgeons think?

BACKGROUND: There is increasing pressure to develop virtual reality surgical simulation that can be used in surgical training. However, little is known of the attitudes of the surgical community toward such simulation, and which aspects of simulation are most important. MATERIALS AND METHODS: A postal survey on attitudes to surgical simulation was sent to all New Zealand orthopedic surgeons and advanced trainees. This comprised of 44 questions in 10 sections, using either a visual analogue scale (0 to 10) or free text box replies. Results were analyzed for two sub-groups; surgeons qualified before 1990 and those qualified in or after 1990 or still in training. RESULTS: Of the 208 possible responses, 142 were received, a response rate of 68%. Only four respondents had tried a surgical based simulator. Earlier qualified surgeons were more likely to agree that simulation was an effective way to practice surgical procedures, median score 7.7 versus 5.6 (P = 0.03). Both groups thought the most important task for simulation was practicing angulation/spatial orientation (median score 8.4/10), while a realistic view of the operation was the most important requirement (median score 9/10). Both groups were unconvinced that simulation would impact on their practice in the next 5 years, with this statement being scored lower by later qualified surgeons, median score 2.4 versus 4.1 (P = 0.04). CONCLUSIONS: Orthopedic surgeons in New Zealand are supportive of surgical simulation but do not expect simulation to have an impact in the near future. Intriguingly, later qualified surgeons and trainees are more skeptical than their earlier qualified colleagues.

Adult↗
PubMed2004

Influence of physicians' attitudes on under-notifying infectious diseases: a longitudinal study.

OBJECTIVES: To identify practitioners' demographic and professional characteristics associated with reporting of mandatory-reporting diseases (MRDs), and to identify attitudes associated with MRD reporting. DESIGN: Longitudinal study. SETTING: Regional Health Service of Galicia (North-western Spain). SUBJECTS: Random sample of 600 physicians. MAIN OUTCOME MEASURES: A postal questionnaire was used to measure the physicians' beliefs, knowledge and attitudes regarding MRDs. Associations between the independent variables and outcomes (notification or non-notification of MRDs every week during 1998) were modelled using the Andersen-Gill proportional hazards model. RESULTS: The response rate was 60.1%. The following beliefs, knowledge and attitudes were statistically associated with a smaller probability of reporting any given MRD: (1) I would only notify an MRD after confirming diagnosis; (2) the MRD reporting system interferes with my daily clinical practice; (3) besides the legal requirements, I would have to report MRDs as a medical professional; and (4) only the reporting of relevant or severe MRDs is necessary. Under-reporting was not associated with specialization (general or paediatric) or the type of contract (fixed or temporary), but was associated with gender. CONCLUSIONS: Some physicians' beliefs, knowledge and attitudes regarding MRDs are associated with under-reporting. This suggests that modification of certain attitudes and knowledge in physicians could greatly reduce the under-reporting of MRDs.

Attitude of Health Personnel↗
PubMed2004

Colorectal cancer screening: practices and opinions of primary care physicians.

BACKGROUND: The Canadian Task Force on Preventive Health Care (CTFPHC), in 2001, concluded that there is good evidence to include annual or biennial fecal occult blood testing (FOBT) and fair evidence to include flexible sigmoidoscopy in the periodic health examination of asymptomatic adults more than 50 years of age. METHODS: Mailed survey of Alberta primary care physicians to determine current colorectal cancer (CRC) screening practices, familiarity with the new guideline, and opinions about, and barriers to, screening average-risk patients. RESULTS: Response rate was 58.0% (n = 965). Less than half (41.9%) were familiar with the new Canadian guideline. The majority (74.7%) recommended that asymptomatic patients undergo screening; however, only 35.6% offered screening to at least 75% of average-risk patients. Few (9.4%) rated fecal occult blood as an "excellent or very good" screening test. Most (64.1%) physicians would choose colonoscopy if they themselves were to undergo screening. Concerns were raised about cost-effectiveness, inconsistencies of current recommendations, and resources. CONCLUSION: Although supportive of colorectal cancer screening of average-risk patients, few physicians recommend screening for the majority of their patients. Clarification of inconsistencies between guidelines, resource issues, and the availability of efficacious screening tests is required for wider acceptance of the new Canadian guideline.

Adult↗
PubMed1995

Protocol therapy for acute asthma: therapeutic benefits and cost savings.

BACKGROUND: To evaluate the therapeutic and financial benefits of protocol therapy for acute asthma using standard medications. MATERIALS AND METHODS: This study employed a sequential design in which the influence of an asthma care path on hospital admissions, length of stay (LOS) in the emergency department, and return visits were evaluated for 1 year. This information was contrasted with similar data obtained from the 8 months immediately before the protocol was implemented (preprotocol) and a 12-month period after strict adherence to it had declined (admixture). RESULTS: In all, 526 acute exacerbations of asthma were treated with the care path, and 429 and 558 episodes were evaluated during the preprotocol and admixture periods, respectively. There were no significant differences between the presenting clinical or physiologic features of any group. With the protocol, 77% of the patients resolved their symptoms within 1:47 +/- 0.02 hours:minutes of arrival in the emergency department with a 2% return rate within 24 hours. The algorithms used quickly identified those needing hospitalization. Patients not meeting the criteria for discharge after receiving the treatments employed typically did not resolve their symptoms for days (average hospital stay 4.1 +/- 0.2 days). Compared with the preprotocol period, the care path significantly reduced the LOS by 50 minutes, the number of urgent and intensive care unit admissions by 27% and 41%, respectively, and the frequency of return visits within 24 hours by 66%. Charges to patients and third-party payors decreased $395,000. When adherence to the protocol diminished, LOS, admissions, and returns rose significantly toward preprotocol values and the financial benefits were lost. CONCLUSIONS: Asthma protocol therapy, based primarily upon aggressive use of sympathomimetics in association with serial monitoring of key indices of improvement, provides prompt and efficient relief for acute exacerbations of asthma. Such an approach yields significant financial benefit while quickly identifying individuals who require hospitalization, and it also detects physician practice patterns that can have potentially detrimental impacts on patient care.

Acute Disease↗
PubMed2005

Do physician attitudes and practices limit use of EUS in the staging and the treatment of esophageal carcinoma?

BACKGROUND: Although EUS provides superior local staging of esophageal carcinoma when compared with other tests, EUS seems to be underused by physicians. We designed this prospective study to determine whether EUS is ordered in the evaluation of esophageal cancer and whether staging information obtained would change management. METHODS: A total of 114 physicians were mailed a questionnaire that surveyed which tests are used in evaluating patients with esophageal cancer, the order in which they are requested, and their estimated cost. Physicians were asked to estimate prognosis and to indicate which therapy would be used for each specific TNM cancer stage. RESULTS: Of 114 physicians, 71 (62.3%) physicians from 4 disciplines responded. Only 47.3% of physicians would use EUS in the patient workup for esophageal cancer. Physicians would only order EUS after first obtaining an endoscopy, then a barium swallow, and then a CT scan ( p < 0.0001). A significantly greater number of internists (78.9%, p = 0.055) would not order EUS, and 31.6% of internists would not use any staging data before referral to another physician for definitive management. Physicians were accurate in their assessment of the prognosis for each cancer stage and the cost of each test. There was no difference in the use of surgery between disciplines for stages O, I, IIA, and IV. However, significantly more surgeons than nonsurgeons would use surgery for stage IIB (100.0% vs. 71.3%, p = 0.019), with a trend toward greater use by surgeons for stage III (64.3% vs. 34.1%, p = 0.11). Except for significantly greater use of chemotherapy by surgeons and oncologists for stage IIA than internists and gastroenterologists (36.6% vs. 3.1%, p = 0.0006), there were no differences between subspecialties with use of chemotherapy for all other stages or use of radiation therapy for any stage. CONCLUSIONS: Clinicians have an adequate understanding of patient survival based on cancer stage and a reasonable appreciation of cost for diagnostic tests regarding esophageal carcinoma. Specific data on cancer staging does impact treatment choices and management decisions. EUS is grossly underused by clinicians for staging esophageal cancer. Although internists may serve as gatekeepers, they fail to order EUS, order EUS only after less accurate tests, or fail to use staging data in management (especially referral) decisions. The ultimate modality of treatment may be more related to the type of physician that the patient is referred to, instead of the specific cancer stage. Education of primary care clinicians may be needed before the full impact of EUS on patient care can be appreciated.

Adenocarcinoma↗
PubMed2003

Depression screening attitudes and practices among obstetrician-gynecologists.

OBJECTIVE: To assess obstetrician-gynecologists' attitudes and practices related to depression screening. METHOD: A total of 282 obstetrician-gynecologists completed a 36-question mail survey that assessed attitudes regarding depression screening, training to treat depression, psychosocial concern, professional influence, and ease of screening. RESULT: Depression screening (employed regardless of signs or symptoms) was reported by 44% of physicians. Positive attitudes toward depression screening, high psychosocial concern, high ease of screening, and adequate training to treat depression were significant independent predictors of depression screening practices. CONCLUSION: The majority of obstetrician-gynecologists are concerned about depression, believe depression screening is effective, and perform some degree of depression screening with their patients. However, they perceive depression screening as difficult to carry out in everyday practice, and some question whether screening improves outcomes.

Attitude of Health Personnel↗
PubMed1999

Physicians' knowledge and practices regarding natural family planning.

OBJECTIVE: To assess physicians' knowledge and practices of modern methods of natural family planning. METHODS: A questionnaire was mailed to 840 physicians selected randomly from Missouri state licensing records for obstetrics-gynecology, family practice, general practice, and general internal medicine. RESULTS: The response rate was 65%. A total of 375 physicians (69% of respondents) saw women for reproductive issues. About half (46%) of physicians reported that they mentioned natural family planning to at least some women when discussing family planning issues. Observing vaginal discharge of cervical mucus was discussed by 40% of physicians in the context of avoiding pregnancy and by 36% of physicians in the context of helping a couple achieve pregnancy. Twenty-two percent of physicians estimated the best possible effectiveness of natural family planning to avoid pregnancy to be greater than 90%, and 35% estimated the actual effectiveness to avoid pregnancy to be greater than 70%. (The threshold rates of 90% best possible effectiveness and 70% actual effectiveness were chosen to be somewhat less than those reported in medical literature.) Physicians who gave higher estimates of effectiveness of natural family planning and physicians who were aware of an instructor in their community were more likely to provide women with relevant information about natural family planning. CONCLUSION: Most physicians, especially those unaware of availability of instructors in their areas, underestimate the effectiveness of natural family planning and do not give information about modern methods to women.

Family Planning Services↗
PubMed2003

Home electrical stimulation for urinary incontinence: a study of the diffusion ofa new technology.

The objective of this study was to investigate the extent to which physicians requested home electrical stimulation (ES) treatment for patients with urinary incontinence (UI). Home ES was requested by 429 general practitioners (GPs) and 147 gynecologists within 2 years (1992 to 1994) after the Norwegian National Insurance Service offered reimbursement for the procedure. For first-time requesters, cumulative plots of time to request were compared for GPs versus gynecologists. Characteristics of requesting GPs were compared with those of a randomly selected control sample of nonrequesting GPs, collected by postal questionnaire. A greater proportion of gynecologists than GPs prescribed home ES during the 2-year study period (42% vs 14%, P <0.001). Median time to request for ES was 5.8 months for gynecologists versus 8.6 months for GPs (P <0.01). A greater proportion of female GPs than male GPs requested the treatment (17% vs 13%, P <0.01). Sufficient information about and/or knowledge of treatment indications were claimed by 71% of requesting GPs versus 21% of controls (P <0.001). Altogether, 91% of requesters versus 62% of controls judged that home ES was effective or a good treatment alternative (P <0.001). Requesters (versus controls) prescribed more bladder training and estrogen for urge UI, more pelvic floor exercises and estrogen to treat stress UI, and more ES to treat both types of UI (all P <0.05). Gynecologists prescribed ES more often and earlier than GPs. Prescribers of ES were more proactive in treating UI in their practices than those who were not prescribers.

Adult↗
PubMedDate not supplied

What accounts for physician opinions about midwifery in Canada?

The objective of this study was to identify the characteristics of physicians practicing obstetrics in the province of Quebec, Canada and relate these to their opinions about midwifery practice. A self-administered questionnaire was sent to a systematic random sample of 844 physicians; 597 physicians answered (response rate = 71%). Results show that physicians who were more open to midwives had a more client-centered approach to maternity care. They had attended premed school outside Canada but received their specialty training in Canada. They also had often collaborated with midwives since they had begun practicing. Physicians who were more open to midwives were less demanding in terms of level of midwife training. They agreed that midwives should be self-regulating. It is concluded that greater knowledge of midwives' practice, gained through collaboration in the workplace and interdisciplinary education, could help physicians to better understand the significant contributions that midwives can make to the health care system.

Adult↗