Upgrading IEC strategy: the happy family coupon campaign.
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[Direct communication on the Internet. Uninet: the university link for Integrate Telematic Services].
The importance of Internet as a communication medium is clear due to the amount of information it distributes and the high number of potential recipients it has. The appearance of virtual user communities (CMV) focuses to information classification within subjects of interest for certain groups of people in order to facilitate its search and use. The UniNet project of Integrated Telematic Services for CMV through, as well as other subprojects, the 'propuesta RedUni' encourages the creation of CMV by mean of integration of various computer and Internet resources, such as distribution mailing list, web pages, Internet Relay Chat (IRC), etc. The current state of IRC in such context is presented and the utilities of the known as Scientific-IRC as a professional real time communication tool are discussed.
Communication↗
From the Centers for Disease Control and Prevention. Evaluation of Bacillus anthracis contamination inside the Brentwood mail processing and distribution center--District of Columbia, October 2001.
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Air Pollutants, Occupational↗
Impact of a child first aid wall calendar on lay people's skills and knowledge of infant CPR.
The aim of the study was to evaluate whether mass-mailing of a 12-month wall calendar which focused on child and infant safety and first aid treatment had any educational effect on lay people. The calendar included algorithms for removal of a foreign body from the airways and infant and child CPR. The knowledge and skills in these procedures were tested in two groups using a previously validated check-list before and after the introduction of the calendar. One group received the calendar by mass mailing, free-of-charge. Six months after calendar distribution the mean result for 52 persons tested was 18% correct, not different from the 19% correct for 65 persons tested before calendar distribution. The other group received the calendar as part of an internal company campaign focusing on infant and child safety with a possibility for borrowing a baby manikin, but with no instruction involved. In this group the mean result improved significantly from 27% precalendar (n = 57) to 47% (n = 125) (P < 0.001) 1 week after calendar distribution with a significant reduction to 38% (n = 52) (P = 0.004) 6 months later, still significantly better than precalendar (P = 0.004). Test persons younger than 50 years old scored better than those older than 50 years (39 vs. 22%, P < 0.001), and the test persons scored better if they had been tested previously (44 vs. 35%, P = 0.04) or had practised with a baby manikin (45 vs. 35%, P = 0.02). Whether the test persons had children 0-8 years old or not, did not affect the results. In conclusion the calendar had no educational effect when distributed by mail, but a safety campaign which included distribution of the calendar and a possibility to borrow a manikin had a positive influence on the first aid skills and knowledge of lay people. Mass mailing of CPR or other first aid material free-of-charge does not seem to further the goal of increasing the rate and proficiency of bystander interventions to save lives.
Adult↗
Characteristics of nephrology nurse researchers and their research.
OBJECTIVES: To identify the characteristics of nurses who are conducting research related to renal disease and the care of nephrology patients and to describe the investigations these researchers have conducted. DESIGN: Mailed survey using an investigator-adapted questionnaire, "ANNA Survey of Nephrology Nurse Researchers." SAMPLE/SETTING: Survey mailed to all 1991 members of ANNA's Research Special Interest Group and distributed via mail or at a nursing research conference to other nurses who were known to have conducted nephrology research. Ninety-six of the approximately 400 questionnaires that were distributed were returned; respondents described 147 research projects/programs of study. METHODS: Data were analyzed using descriptive statistics and chi-square analysis. RESULTS: Most respondents were master's prepared nurses who had completed one research study. Adults were the subjects in the majority of studies, and psychosocial phenomena and quality of life were the most frequently identified study foci. Descriptive and comparative studies were more common than experimental investigations. CONCLUSIONS: The findings indicate beginning exploration of a variety of patient care and administrative problems by nephrology nurses. Notably absent, however, was research on topics that present challenges to practicing nephrology nurses, including symptom management, care of diabetic and elderly renal patients, ethical issues, and cardiovascular complications of renal disease. Additional experimental research is needed, particularly to test nursing interventions aimed at alleviating common problems experienced by renal patients.
Humans↗
A pilot study to assess physician knowledge in transfusion medicine.
INTRODUCTION: An assessment of transfusion medicine knowledge and practice in Canada was carried out over a 3-week period. METHODS: Fifty-five questions were posed to evaluate both basic information on blood and blood products and on clinical use. The form was distributed through the Canadian Society for Transfusion Medicine with designated individuals asked to handle regional distribution. Some used provincial mailing lists, others distributed within each hospital. Approximately, 2000 forms were sent, including 500 in French. RESULTS: A total of 294 forms were returned; answers were recorded as 'correct', 'incorrect', 'no answer' or with 'added comments'. Overall, 52% of the questions were answered correctly or were answered with qualifying comments. In clinical practice questions, 63% were answered correctly or with qualifying comments. Basic knowledge questions drew correct answers in 37% of the cases. Several issues were answered poorly. The volume of an apheresis plasma unit was correctly estimated by less than 10% of respondents with many understanding the volume (500-600 mL) by as much as 300-400 mL. Anaesthesiologists responded most often (21%); few haematologists participated (4%). Provincial response varied: most were received from Ontario (30%) and British Columbia (22%). CONCLUSIONS: The answers show that clinical application of transfusion is generally accompanied by a questioning process - it is not entirely by rote. Basic knowledge about products needs improvement.
Blood Transfusion↗
Impact of reminders and method of questionnaire distribution on patient response to mail-back satisfaction survey.
Nonresponse and methods of data collection could affect satisfaction measurement. The goal of this study was to estimate the impact of (1) nonresponse and (2) distribution method on evaluation of patient satisfaction in a mail-back study measuring patient opinion of medical and nursing care. The study was conducted in an adult hospital. Patients were pseudo-randomized according to the initial mode of questionnaire distribution (given at hospital or sent by mail). Three reminders were made at 1-week intervals to nonrespondents, regardless of the method of initial questionnaire distribution. Groups were distinguished according to the delay of response: initial (before any reminder), middle (after one or two mailed reminders), and late respondents (after mailed reminders plus telephone contact). The study included consecutively discharged patients to obtain 300 patients per arm. 482 patients returned the questionnaire (248 in the group receiving the questionnaire at the hospital and 234 in the other group). Groups were compared for satisfaction scores and delay of response. Early respondents were compared with middle and late respondents for patient characteristics, modality of hospital care, and satisfaction scores. Multivariate analyses were performed. Participation rate before any reminder was higher when the questionnaire was mailed than when it was given at the hospital (45% versus 39.7%, p = 0.03). The initial method of distribution did not influence patient satisfaction level. Satisfaction did not differ between respondents with or without reminders. Distributing questionnaires by mail may be preferred to distribution at discharge to optimize response rate. Reminders do not seem necessary to estimate satisfaction of overall potential respondents.
Adult↗
Internet-based interaction among brain tumour patients. Analysis of a medical mailing list.
Patients and their care providers are increasingly turning to the internet for information. Being faced with this information of very heterogeneous quality, the physician would do well to be informed about the common internet information sources. We investigated the e-mails of a mailing list (or "support group") serving about 380 brain tumour patients and their care providers. The mails were obtained from an archive and grouped according to their topic. Within 6 months, 3,272 e-mails were distributed to every group member. Alternative treatments were the most frequently discussed topics (15 %). These discussions dealt with serious new strategies as well as dubious drugs and methods. A critical attitude towards "quacks" was common, but not the rule. More than 10 % of the mails dealt with debates about therapeutic strategy and about symptoms. The individual course of the participants' illness was often reported very frankly. Emotional support between members played another great role in the support group. Criticism of physicians was rare compared to recommendations of specific therapists (3 % vs. 4 %) and included lack of empathy or sensibility and poor communication between physicians. The brain tumour mailing list is a communication medium for brain tumour patients and their care providers, which distributes and reproduces information of heterogeneous quality. The physician faced with this information should be unbiased but cautious.
Brain Neoplasms↗
Clinical e-mail in an academic dermatology setting.
BACKGROUND: Use of e-mail among patients and physicians is limited by reservations over issues such as medicolegal aspects, reimbursement, and time-management. OBJECTIVE: Our purpose was to identify the content of patient-related e-mails in an academic dermatology practice and determine whether clinical questions could be answered by e-mail. METHODS: The first 100 e-mails received each year that related to patients from January 1, 2000 to June 1, 2005 (plus any messages received in e-mail threads started in the original 100) were studied (N = 614). E-mails were sent by patients, potential patients, or physicians in reference to a patient. E-mails were divided into 8 categories on the basis of content. E-mails were subdivided as relating to new (patients who had never been seen in-person) or established patients. All clinical questions were categorized as to whether they were answered by e-mail. The average number of e-mails received per e-mail thread was tallied. RESULTS: E-mails were distributed as follows: clinical question from a physician (20%), clinical question from a patient (17%), appointment request (18%), request for referral to another physician (7%), prescription refill (3%), research inquiry (2%), thank-you correspondence (31%), other (17%). Percentages do not equal 100 because some e-mails contained more than one subject. Clinical questions were more likely to be answered when posed by physicians (100%) than patients (70%; P = .001), and when from established (79%) versus new patients (60%; P = .02). There were fewer e-mails per thread for queries from physicians (1.6 messages received) versus patients (2.2; P < .001) and for established (1.6) versus new patients (2.2; P < .001). LIMITATIONS: This study was limited to the experience of one dermatologist in an academic setting. CONCLUSION: E-mail broadens communication between patients and their dermatologist. E-mail may facilitate consultation with other physicians and management of patients with chronic disease. "Thank-you" responses engage a substantial amount of e-mail resources.
Dermatology↗
Pharmacist computer skills and needs assessment survey.
BACKGROUND: To use technology effectively for the advancement of patient care, pharmacists must possess a variety of computer skills. We recently introduced a novel applied informatics program in this Canadian hospital clinical service unit to enhance the informatics skills of our members. OBJECTIVE: This study was conducted to gain a better understanding of the baseline computer skills and needs of our hospital pharmacists immediately prior to the implementation of an applied informatics program. METHODS: In May 2001, an 84-question written survey was distributed by mail to 106 practicing hospital pharmacists in our multi-site, 1500-bed, acute-adult-tertiary care Canadian teaching hospital in Vancouver, British Columbia. RESULTS: Fifty-eight surveys (55% of total) were returned within the two-week study period. The survey responses reflected the opinions of licensed BSc and PharmD hospital pharmacists with a broad range of pharmacy practice experience. Most respondents had home access to personal computers, and regularly used computers in the work environment for drug distribution, information management, and communication purposes. Few respondents reported experience with handheld computers. Software use experience varied according to application. Although patient-care information software and e-mail were commonly used, experience with spreadsheet, statistical, and presentation software was negligible. The respondents were familiar with Internet search engines, and these were reported to be the most common method of seeking clinical information online. Although many respondents rated themselves as being generally computer literate and not particularly anxious about using computers, the majority believed they required more training to reach their desired level of computer literacy. Lack of familiarity with computer-related terms was prevalent. Self-reported basic computer skill was typically at a moderate level, and varied depending on the task. Specifically, respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. CONCLUSIONS: Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness.
Adult↗
Pediatric residency training in the normal newborn nursery. A national survey.
OBJECTIVE: To determine how and what pediatric residency programs are teaching residents about normal newborn care in the nursery. DESIGN: A mailed survey distributed in 1994. PARTICIPANTS: All 237 known pediatric residency programs in the United States, Canada, and Puerto Rico. RESULTS: Survey response rate was 77% (184 of 237 questionnaires were returned and completed). In 40% of the programs, neonatologists were primarily responsible or co-responsible for teaching residents about management of normal newborns. A normal newborn nursery curriculum had been developed and implemented in 56% of the programs, 30% of programs were developing one, and 13% reported no curriculum. Specific instruction about breast-feeding was not offered in 16% of programs. Circumcisions were most commonly performed by obstetricians; anesthetic use was low (overall median use, 10%) but was more common (P < .002) when circumcisions were performed by pediatricians. The hospital environment and lack of faculty time were cited as the main barriers to teaching residents about normal newborn care. CONCLUSIONS: Although general pediatricians spend a substantial amount of practice time on newborn care, neonatologists were responsible for this teaching in almost half of the pediatric residency programs. Many programs have not developed a curriculum. Instruction about breast-feeding was not universal. Most pediatric residents do not learn to perform circumcisions. General pediatricians should be more involved in the development, implementation, and evaluation of comprehensive newborn nursery curricula to improve training in this important aspect of general pediatric practice.
Canada↗
Water supplementation of infants in the first month of life.
OBJECTIVE: To describe the prevalence of and risk factors associated with regular water supplementation of neonates. DESIGN: Evaluation of data from the Food and Drug Administration's Infant Feeding Practices Study, a panel study of US women of fairly high socioeconomic status who were followed up from late pregnancy through their infants' first year of life. The sample was drawn from a nationally distributed consumer mail panel. Each mother was asked whether she gave her neonate water at least 3 times per week. PARTICIPANTS: A total of 1677 mothers of infants who were neonates in April through November 1993. MAIN OUTCOME MEASURES: Percentages of mothers who gave their neonates water at least 3 times a week, considering infant feeding status, mother's education, and family income. RESULTS: About one fourth (24.7%) of the mothers reported giving their neonates water at least 3 times per week. Stratification by feeding practices and socioeconomic factors revealed that 41.6% of mothers who formula-fed their neonates, 47.4% of mothers with less than a high school education, and 35.4% of mothers with an annual family income less than $22,500 gave their neonates water at least 3 times per week. CONCLUSIONS: Water supplementation of neonates was a prevalent practice in this cohort of women. Feeding practices, maternal education, and family income were all significant risk factors associated with this behavior.
Bottle Feeding↗
Impact of taking antiepileptic drugs at school in a group of children and adolescents.
The impact of epilepsy on the quality of life can be significant. Peer acceptance is important for the social adjustment of children. Even children with controlled seizures may appear different from their peers if they are required to leave the classroom to take antiepileptic drugs. The objective of this pilot study was to determine if there is a measurable effect on peer relationships in children having to leave the classroom or recess time to take antiepileptic medications in a school setting. Results of surveys mailed or distributed by a pharmacist were obtained from 47 children, aged 6 to 18 years. Children who reported poor seizure control were significantly more likely to have trouble making friends compared with those with seizures controlled (70% vs 27%, P = 0.02). Even though the majority reported good seizure control (7/8), the children who left the classroom to take medications reported that they had significantly more trouble making friends than those who did not leave the classroom (63% vs 21%, P = 0.03). Therefore, the effect of taking medication at school may be associated with a significant decrease in social and peer relationships, even in children with self-reported good seizure control.
Journal Article↗
Perceived susceptibility to and knowledge of malignant melanoma: screening participants vs the general population.
BACKGROUND: The incidence of and mortality from melanoma are increasing and no effective treatment for disseminated disease exists. Studies of factors influencing participation in prevention and early detection of melanoma are therefore warranted. In the present study, participants in public melanoma screening were compared with a sample of the Swedish population with respect to concern for nevi, perceived risk for melanoma, knowledge about melanoma, and sources of information. Gender differences were studied. METHOD: Consecutive participants in public melanoma screening (Participants) received questionnaires at registration for skin examination; 235 (96%) responded. Questionnaires were distributed by mail to a random sample of the Swedish population (Public); 1,070 (63%) responded. RESULTS: Participants were more concerned about nevi, and a higher proportion had previously consulted physicians for suspected lesions compared with the Public. Participants were better informed in terms of the number of sources of information and knowledge of melanoma and risk factors. There were no differences regarding perceived risk and there was a mixed picture concerning knowledge of sun effects and sun protection. Gender differences were found for perceived susceptibility to, knowledge of, and number of sources of information about melanoma, favoring women. CONCLUSION: The preventive aspects of screening as well as the good prognosis of melanoma detected early should be stressed in invitations to skin cancer screening. New approaches for reaching men are warranted.
Adolescent↗
Knowledge of sleep apnea in a sample grouping of primary care physicians.
UNLABELLED: The purpose of this pilot study was to examine four groups of primary care physicians' knowledge of sleep apnea. METHODS: Using a 36-item questionnaire, we investigated how cognizant primary care physicians in Ontario, Canada, were of sleep apnea and its different symptoms. The questions covered incidence, diagnosis, treatment, and medical and social ramifications of sleep apnea. Sleep apnea surveys were administered to small groups of primary care physicians attending educational conferences or were distributed by mail to physicians who had previously referred patients to the sleep clinic. RESULTS: A total of 151 physicians responded to the survey. An overall average score of 69% was obtained on the questionnaire. CONCLUSIONS: This score suggests that the physicians sampled in this pilot study are relatively under-informed about the clinical features and medical and social ramifications associated with sleep apnea.
Humans↗
Predictors of prescriptions for management of fatigue among veterans with multiple sclerosis.
OBJECTIVE: To determine predictors of fatigue-modifying medication use. DESIGN: Cross-sectional cohort. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: Veterans with multiple sclerosis (MS) in the VHA in the northwestern United States from 1995 to 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A self-administered survey distributed by mail sought information from veterans with MS about demographics, symptoms, barriers to care, and disease characteristics. The variables were compared with prescriptions for fatigue-modifying medications during the study period. RESULTS: Of 1032 patients, 451 (44%) completed the survey, and 306 (68%) reported moderate or high fatigue levels. Only 40% of the 306 were prescribed fatigue-modifying medications. Those using specialized fatigue services or who received care at tertiary centers were more likely to receive fatigue treatments. Patient-perceived barriers to accessing care and other patient characteristics were not associated with prescription rates. CONCLUSIONS: Fatigue is undertreated among veterans with MS. However, there is considerable variability in the provision of fatigue care. Interventions to improve the quality and uniformity of fatigue care are warranted.
Adult↗
The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan.
PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.
Diffusion of Innovation↗