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PubMed1993

Use of peer ratings to evaluate physician performance.

OBJECTIVE: To assess the feasibility and measurement characteristics of ratings completed by professional associates to evaluate the performance of practicing physicians. DESIGN: The clinical performance of physicians was evaluated using written questionnaires mailed to professional associates (physicians and nurses). Physician-associates were randomly selected from lists provided by both the subjects and medical supervisors, and detailed information was collected concerning the professional and social relationships between the associate and the subject. Responses were analyzed to determine factors that affect ratings and measurement characteristics of peer ratings. SETTING AND PARTICIPANTS: Physician-subjects were selected from among practicing internists in New York, New Jersey, and Pennsylvania who received American Board of Internal Medicine certification 5 to 15 years previously. MAIN OUTCOME MEASURE: Physician performance as assessed by peers. RESULTS: Peer ratings are not biased substantially by the method of selection of the peers or the relationship between the rater and the subject. Factor analyses suggest a two-dimensional conceptualization of clinical skills: one factor represents cognitive and clinical management skills and the other factor represents humanistic qualities and management of psychosocial aspects of illness. Ratings from 11 peer physicians are needed to provide a reliable assessment in these two areas. CONCLUSIONS: These findings suggest that it is feasible to obtain assessments from professional associates of practicing physicians in areas such as clinical skills, humanistic qualities, and communication skills. Using a shorter version of the questionnaire used in this study, peer ratings provide a practical method to assess clinical performance in areas such as humanistic qualities and communication skills that are difficult to assess with other measures.

Clinical Competence↗

PubMedDate not supplied

Pregnancy termination in relation to risk of breast cancer.

OBJECTIVE: To evaluate the association between pregnancy terminations and risk of breast cancer. DESIGN AND SETTING: Population-based case-control study in Wisconsin, Massachusetts, Maine, and New Hampshire. STUDY PARTICIPANTS: Cases were women younger than 75 years with a new diagnosis of breast cancer (n = 6888), identified from statewide tumor registries. Controls younger than 65 years (n = 9529) were randomly selected from lists of licensed drivers, or for older subjects, from lists of Medicare beneficiaries. EXPOSURES AND OUTCOMES: Breast cancer risk in relation to spontaneous or induced abortions. RESULTS: After adjustment for parity, age at first birth, and other risk factors, pregnancy termination (induced or spontaneous) was associated with a relative risk (RR) of breast cancer of 1.12 (95% confidence interval [CI], 1.04 to 1.21), compared with the risk among women who had never had a termination. Induced terminations were associated with a RR of 1.23 (95% CI, 1.00 to 1.51), which was somewhat greater than the risk associated with spontaneous terminations (RR, 1.11; 95% CI, 1.02 to 1.20). The association with induced abortions was stronger for those performed before legalization of abortion in 1973 (RR, 1.35; 95% CI, 1.01 to 1.80) than after this time (RR, 1.12; 95% CI, 0.84 to 1.49), suggesting a bias in reporting this sensitive procedure. CONCLUSIONS: A weak positive association was observed between abortion--whether induced or spontaneous--and risk of breast cancer. The increase in risk of breast cancer was somewhat greater among women with a history of induced terminations. However, this association may be due to reporting bias and was not significantly different than the slight risk for spontaneous terminations.

Abortion, Induced↗

PubMed1996

Links between mental health care professionals and general practices in England and Wales: the impact of GP fundholding.

BACKGROUND: Fundholding general practitioners are able to determine the type of contracts they place with providers of mental health care, and are able to employ some categories of mental health care professionals directly. The impact of this on the care of the mental health of patients in non-fundholding practices is not yet fully known. AIM: A survey was undertaken of 100 fundholding general practices and 100 similarly sized non-fundholding practices in order to investigate the changes in mental health provision made by general practitioners. METHODS: A sample of 100 fundholding general practices in England and Wales was randomly chosen from the list supplied by the Association of Fundholders and matched to a similarly randomly chosen sample of non-fundholding practices. Postal questionnaires were sent to the senior partner and to the practice manager in each practice. RESULTS: The number of mental health care professionals who are either employed by or attached to general practices, or who visit the general practice on a regular basis appears to have increased substantially since 1991. This increase was particularly marked in fundholding practices. The results suggest that general practitioners with specific links to particular mental health care providers were more satisfied with the service provided by the mental health care team, and more likely to increase referrals to that service in the last 2 years, than general practitioners without such links. There was little evidence to suggest that increasing the number of mental health care professionals in primary care had brought about a major reduction in referrals to psychiatrists. CONCLUSION: General practitioners, particularly fundholders, are increasing their links with mental health professionals, and community psychiatric nurses, psychiatrists, psychologists and counsellors are spending more time either based in general practice or visiting regularly. While the shift of resources to primary care, particularly to fundholders, may increase the treatment options available to patients with less severe illnesses, this may have the effect of reducing the services available for the long-term and severely mentally ill.

Community Mental Health Services↗

PubMed1996

Occupational exposure to 60-hertz magnetic fields and risk of breast cancer in women.

We used data from a large population-based case-control study to test the hypothesis that women whose "usual occupation" entailed exposure to higher than background 60-Hz magnetic fields had a higher risk of breast cancer than women without such exposure. Breast cancer cases were identified from four statewide tumor registries, and controls were randomly selected from lists of licensed drivers and Medicare beneficiaries. Information on usual occupation and breast cancer risk factors was obtained by telephone interview. We calculated adjusted odds ratios from logistic regression models for women holding occupations with potential for low, medium, or high magnetic field exposure, compared with background exposure. There was a modest increase in risk for women with potential for high exposure [odds ratio (OR) = 1.43; 95% confidence interval (CI) = 0.99-2.09], and no increase for women with potential for medium (OR = 1.09; 95% CI = 0.83-1.42) or low (OR = 1.02; 95% CI = 0.91-1.15) exposure The risk among premenopausal women in the highest-exposure category was higher (OR = 1.98; 95% CI = 1.04-3.78) than for postmenopausal women (OR = 1.33; 95% CI = 0.82-2.17).

Breast Neoplasms↗

PubMed1998

[Survey of medical specialists regarding bronchial asthma treatment].

A survey about asthma management was conducted in a group of 300 chest physicians randomized from a list of the whole country. This paper dealt with the questions about treatment in acute asthma and during maintenance therapy in adults and in children older than 6 years. Of the questionnaires mailed, 98 responses were obtained (32.7%)); 71% of the responders were respiratory medicine specialists (RM), 12% RM + Internal Medicine (IM), 6% in RM + Allergy (A), 5% in A, 4% in IM and 2% in IM + A. For the treatment of acute severe episodes 57.5% of the physicians chose nebulized or inhaled beta agonists (IBA) as the first choice for adults and 63.4% for children, parenteral steroids 26.3% in adults and 22.5% in children. For maintenance therapy, the first choice formulation was IBA for adults in 37.6% of the responders and inhaled steroid (IS) in 34.1% of them. In children, 34.7% of the responders choose IBA, 25.3% cromoglicate or nedocromil and 14.7% IS. IBA were prescribed more commonly for treating symptoms, secondly for preventing symptoms and in third place for continuous preventive treatment in adults and in children. The recommendation of IBA for treating and preventing symptoms were more commonly done in children. The average normal daily dose of IS was 297 and 254 micrograms for adults and children, respectively. The average maximal dose was 1176 and 618 micrograms for adults and children, respectively. The recommendation of hyposensitization for allergic asthma was, as mean score of frequency of use (from 0 = never to 3 = always), 0.96 for adults and 1.13 for children. Important drawbacks were detected in the treatment approach. In acute asthma episodes about 40% of the responders did not use IBA as the first choice of treatment. For maintenance treatment IS were rarely used, and their doses were less than the usually recommended by different guidelines. IBA were seldom recommended for prevention or treatment of symptoms. They are used moderately as continuous preventive treatment. Hyposensitization is commonly recommended and more frequently used than in other countries.

Administration, Inhalation↗

PubMedDate not supplied

[Evaluation of the psychological consequences of environmental catastrophes: a feasibility study based on the 1992 floods in the Vaucluse].

Scientific studies of environmental disasters, whether human or natural in origin, have shown that the psychological impact of such events may be considerable and long-lasting. Several natural disasters have occurred in France, but their impact on public psychological health has not been assessed. In September 1992, there was a major flood in southeast France (Vaucluse), which caused 38 deaths. Four years later, we performed a pilot cross-sectional study to assess the feasibility of a larger epidemiological study to assess the psychological impact of this flood. Two affected towns were chosen for this study: Vaison-la-Romaine (VLR), where the flood was very sudden and 29 people were killed, and Bédarrides, where the water level rose more slowly. In Bédarrides, households were randomly selected from a list of victims (n = 100) and in Vaison-la-Romaine, households were randomly selected from the telephone directory (n = 140). Exposure to the flood was assessed by a series of questions, the answers to which were used to calculate an exposure score. The questionnaire also included psychometric scales for post-traumatic stress disorder (QE-PTSD), anxiety (Spielberger State-Trait Anxiety Inventory) and depression (Beck Depression Inventory). In Bédarrides, the participation rate was high: 69% of the selected households were successfully contacted and found to be eligible for inclusion and 74% agreed to a face-to-face interview. In Vaison-la-Romaine, 51% of the selected households were contacted and eligible and 50% agreed to the face-to-face interview. Our survey showed that exposure was multidimensional and that it was possible to calculate an exposure score suitable for the analysis of exposure-effect relationships. The PTSD scale was completed well by the interviewees, several of whom did not fill in the depression and anxiety scales correctly. However, analysis of the responses obtained showed that these tools had a high level of internal consistency. Cross-correlations between the various psychological scales used in this study were highly significant (p < 10-4). There was some degree of association between some psychometric scales and exposure. This pilot study shows that a cross-sectional study of the long-term psychological consequences of an environmental disaster could be carried out several years after the event but that the feasibility of such a study depends ultimately on its acceptance by the public and the relevant authorities. It underlines the need to collect exposure data immediately after the event and enabled us to identify and to adapt the tools required for this kind of evaluation. It should encourage public health decision-makers to support such evaluation and to improve the psychological and social support available to people exposed to floods.

Anxiety↗

PubMed2000

Inositol for respiratory distress syndrome in preterm infants.

BACKGROUND: Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. OBJECTIVES: To assess the effectiveness/safety of supplementary inositol in preterm infants with RDS in reducing adverse neonatal outcomes. SEARCH STRATEGY: Medline, Embase, and Reference Update Databases were searched in August 1997 using key words: inositol and infant-newborn and random allocation or controlled trial or randomized trial (RCT). The reference lists of identified RCTs, personal files and Science Citation Index were searched. Unpublished additional information was obtained from the authors of one RCT published in abstract form. SELECTION CRITERIA: All randomized controlled trials of inositol supplementation to preterm infants with a control group that received a placebo or no intervention were included. Outcomes of interest were bronchopulmonary dysplasia (BPD), death, BPD or death, retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and sepsis. DATA COLLECTION AND ANALYSIS: Data on neonatal outcomes were abstracted independently by the two researchers and any discrepancy was resolved through consensus. Revman was used for analysis of the data. MAIN RESULTS: Four reports of three RCTs were identified. One report was a duplicate publication. The outcome of death or bronchopulmonary dysplasia was reported in two trials, and was found to be significantly reduced (RR 0.56, 95% CI 0.42, 0.77; RD -0.215, 95% CI -0.323, -0.107). The outcome of death was reported in two trials and was found to be significantly reduced (RR 0.48, 95% CI 0.28, 0.80; RD -0.131, 95% CI -0.218, -0.043). Retinopathy of prematurity, stage 4 or needing therapy, was reported in two trials, and was found to be significantly reduced (RR 0.09, 95% CI 0.01, 0.67; RD -0.078, 95% CI -0.128, -0.027). Intraventricular hemorrhage, grade III-IV, was significantly decreased (RR 0.55, 95% CI 0.32, 0.95; RD -0.090, 95% CI -0.170, -0.010). Neither sepsis nor necrotizing enterocolitis outcomes were increased. When a secondary analysis was done excluding a study published in abstract form, the results differed only in that there was a significant reduction in retinopathy of prematurity, any stage (RR 0.53, 95% CI 0.29, 0.97; RD -0.082, 95% CI -0.159,-0.005). REVIEWER'S CONCLUSIONS: Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A multi-center RCT of appropriate size is justified to confirm these findings.

Dietary Supplements↗

PubMed2006

Dissociating the influence of familiarity and meaningfulness from word frequency in naming and lexical decision performance.

Performance in two experiments was compared on a list of words of high and low frequency in which familiarity/meaningfulness (FM) was balanced and on a list of high- and low-frequency words in which FM was confounded with frequency (i.e., high frequency--high familiarity vs. low frequency--low familiarity). Both repetition and task (lexical decision and naming) were investigated. In the lexical decision task of Experiment 1, both frequency and repetition effects were larger in the list with FM confounded than in the list with FM matched. In the naming task, frequency and repetition effects and their interaction were significant, but there was no influence of FM list context. In Experiment 2, in which the repetitions occurred across blocks, as opposed to randomly intermixed within a list, similar results were found; however, there was no interaction between list and repetition. The results suggest that an evaluation of items in terms of their meaning and familiarity explains a large part of the variance, only in lexical decision. These dimensions may be cued both by subjective feelings of familiarity and the extent to which semantic information is available and by episodic traces due to recent encounters with the item.

Attention↗

PubMed2002

An effective workplace stress management intervention: Chicken Soup for the Soul at Work Employee Groups.

Stress is a costly and significant source of health problems and mental distress--with work cited as a primary stressor. This pilot study supports the effectiveness of a new workplace stress intervention: Chicken Soup for the Soul at Work Employee Groups. In this program, employee-participants met during nine weekly meetings to read inspirational workplace stories, comment, and share their own stories. A leader, chosen from and by the group, guided meetings. Utilizing a wait-list control group design, participants were randomly assigned to an experimental or wait-list group. Participants completed pretests and posttests (Coping Resources Inventory, Occupational Stress Inventory-Revised, Job Descriptive Index, Pressure Management Indicator, survey). Statistical interaction effect for subtests was evaluated using a two-way repeated measures analysis of variance. Participants exhibited improved total coping resources, cognitive/rational coping, state of mind, confidence and home/work balance. Participant comments and their continued participation in a similar company-sponsored program bolster these empirical results.

Humans↗

PubMed1989

Randomized controlled trial of small group education on the outcome of chronic asthma in general practice.

The effectiveness of small group education of general practitioners in the management of asthma was evaluated by randomized controlled trial. The outcome measure was the asthma morbidity of the general practitioners' own patients. Following random selection from the list of one family practitioner committee in suburban London, the 27 participating general practitioners were allocated randomly to one of two educational groups or to a control group. The educational intervention comprised eight meetings at which the management of chronic asthma was discussed and attempts made to devise agreed strategies for care. The two educational groups devised different strategies. Asthma morbidity was assessed by postal questionnaires to patients before the intervention and on five further occasions at six-monthly intervals over two and a half years. Of 454 patients who entered the study 338 completed the sixth and final assessment. The degree of morbidity experienced by the patients and their reported use of asthma specific drugs was considerable and was notably constant over the period of study. There was no difference in morbidity between the three groups at the outset and no effect of the intervention could be demonstrated. In this educational intervention the participating general practitioners were not informed about the morbidity and drug use reported by their patients. This information may be crucial if small groups are to be used to design and implement effective strategies for care. It would appear that small group education of general practitioners in the form reported here is not effective in reducing morbidity from chronic asthma.

Adolescent↗

PubMed1985

Behavioral profiles of dog breeds.

Breed behavior profiles were obtained by a method that was quantitative and free of personal biases. The profiles concerned 13 traits, eg, excitability, snapping at children, watchdog barking, and affection demand, which are of interest to people wanting dogs as pets. Authorities for the development of the profiles were 48 small animal veterinarians and 48 obedience judges, randomly selected from directories so as to represent equally men and women, and eastern, central, and western geographic regions of the United States. Each authority was asked to rank on each of the behavioral traits a list of 7 breeds chosen randomly from a list of 56 breeds. The data were analyzed in a custom-designed computer program that pooled the data and then ranked all 56 breeds on the basis of the 13 traits. The results indicated that some behavioral traits discriminate between breeds better than others. An examination of sample profiles indicated the feasibility of developing a statistically meaningful behavioral profile that integrates comparative rankings of several authorities balanced as to representation of geographic location, sex, and type of experience with dogs.

Analysis of Variance↗

PubMed2006

The association between quality of care and the intensity of diabetes disease management programs.

BACKGROUND: Although disease management programs are widely implemented, little is known about their effectiveness. OBJECTIVE: To determine whether disease management by physician groups is associated with diabetes care processes, control of intermediate outcomes, or the amount of medication used when intermediate outcomes are above target levels. DESIGN: Cross-sectional study. SETTING: Patients were randomly sampled from 63 physician groups nested in 7 health plans sponsored by Translating Research into Action for Diabetes (87%) and from 4 health plans with individual physician contracts (13%). PATIENTS: 8661 adults with diabetes who completed a survey (2000-2001) and had medical record data. MEASUREMENTS: Physician group and health plan directors described their organizations' use of physician reminders, performance feedback, and structured care management on a survey; their responses were used to determine measures of intensity of disease management. The current study measured 8 processes of care, including most recent hemoglobin A1c level, systolic blood pressure, serum low-density lipoprotein cholesterol level, and several measures of medication use. RESULTS: Increased use of any of 3 disease management strategies was significantly associated with higher adjusted rates of retinal screening, nephropathy screening, foot examinations, and measurement of hemoglobin A1c levels. Serum lipid level testing and influenza vaccine administration were associated with greater use of structured care management and performance feedback. Greater use of performance feedback correlated with an increased rate of foot examinations (difference, 5 percentage points [95% CI, 1 to 8 percentage points]), and greater use of physician reminders was associated with an increased rate of nephropathy screening (difference, 15 percentage points [CI, 6 to 23 percentage points]). No strategies were associated with intermediate outcome levels or level of medication management. LIMITATIONS: Physician groups were not randomly sampled from population-based listings, and disease management strategies were not randomly allocated across groups. CONCLUSIONS: Disease management strategies were associated with better processes of diabetes care but not with improved intermediate outcomes or level of medication management. A greater focus on direct measurement, feedback, and reporting of intermediate outcome levels or of level of medication management may enhance the effectiveness of these programs.

Aged↗

PubMed1996

Random paired scenarios--a method for investigating attitudes to prioritisation in medicine.

OBJECTIVE: This article describes a method for investigating attitudes towards prioritisation in medicine. SETTING: University of Kuopio, Finland. DESIGN: The method consisted of a set of 24 paired scenarios, which were imaginary patient cases, each containing three different ethical indicators randomly selected from a list of indicators (for example, child, rich patient, severe disease etc.). The scenarios were grouped into 12 random pairs and the procedure was repeated four times, resulting in 12 scenario pairs arranged randomly in five different sets. SURVEY: This method was tested with four groups of subjects (n = 8, n = 47, n = 104 and n = 36). RESULTS: Children and patients with a severe disease were prioritised in all groups. The aged, patients with a mild disease and patients with a self-acquired disease were negatively prioritised in all groups. Poor or rich patients were prioritised in some groups but negatively prioritised in others. CONCLUSIONS: The validity and reliability of this method are good and it is suitable for investigating attitudes towards medical prioritisation.

Aged↗

PubMed2005

Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders.

BACKGROUND: Although many evidences suggest the presence of specific therapeutic factors in brief dynamic therapy (BDT), few studies have investigated its efficacy in the treatment of depressive disorders in comparison to other psychotherapies. The aim of this study was to determine whether BDT is more effective than brief supportive psychotherapy (BSP) and waiting list condition in the treatment of minor depressive disorders. METHOD: Thirty patients with primary DSM-IV dysthymic disorder, depressive disorder not otherwise specified or adjustment disorder with depressed mood completed a randomized controlled trial with three treatment groups (BDT, BSP, waiting list condition). A 6-month follow-up was performed for patients treated with both psychotherapeutic approaches. Other psychiatric treatments were not permitted throughout the treatment period and the 6-month follow-up. Symptoms were assessed at baseline, at the end of treatment, and after 6 months of follow-up. RESULTS: Patients treated with both psychotherapeutic approaches showed a significant improvement after treatment in comparison to non-treated controls, but BDT was more effective at follow-up evaluation. CONCLUSIONS: BDT is a promising treatment for minor depressive disorders. This study also suggests that BDT is more effective than supportive psychotherapy in improving the long-term outcome of depressive disorders.

Adolescent↗

PubMed1997

The effect of health maintenance organization vs commercial insurance status on obstetrical management and outcome.

OBJECTIVE: To compare obstetrical management and birth outcomes between patients with health maintenance organization (HMO) insurance and those with private commercial insurance. DESIGN: Retrospective population-based cohort study. SETTING: King County, Washington. PATIENTS: Among newborns delivered in 1992 and 1993, a random sample of 4000 birth records listing HMO insurance for prenatal care was compared with a random sample of 4000 birth records listing private commercial insurance as the primary coverage. MAIN OUTCOME MEASURES: Use of ultrasonography and amniocentesis; rate of primary cesarean section performed; adequacy of prenatal care; incidence of maternal medical complications, low birth weight, and congenital malformations; and length of hospital stay. RESULTS: Women covered by HMO compared with commercial insurance were more likely to undergo ultrasonography (relative risk [RR], 1.4; 95% confidence interval [CI], 1.3-1.4). Inadequate prenatal care was less frequent among HMO-insured patients (RR, 0.6; 95% CI, 0.5-0.7), as was the incidence of birth weight below 2500 g (RR, 0.7; 95% CI, 0.6-0.9). No differences in rates of cesarean section and congenital anomalies were observed. Among women without obstetrical risk factors, HMO-insured mothers were at an increased risk of labor and delivery complications (RR, 1.4; 95% CI, 1.3-1.5); their infants were at an increased risk of infant distress (RR, 1.8; 95% CI, 1.5-2.2). CONCLUSIONS: Patients with HMO insurance have improved access to prenatal care and screening when compared with privately insured patients. The reasons for increased risks of abnormal maternal and infant outcomes observed among a subset of HMO-insured patients are unclear. A study with more detailed prospective data collection is warranted.

Female↗

PubMedDate not supplied

Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial.

OBJECTIVES: To evaluate the effects of early access (EA) to physical therapy treatment for patients with subacute low back pain compared to access with a 4-week waiting list. DESIGN: A prospective, randomized clinical trial. SETTING: Primary health care. PATIENTS: Sixty consecutive patients with subacute low back pain. INTERVENTIONS: Patients were randomized either to EA within 2 days for physical examination and individualized physical therapy treatment (n=32) or a control group with a 4-week waiting list (n=28). OUTCOME MEASURES: Self-administrated questionnaires were used for assessment at inclusion, at discharge, and at 6 months. Primary outcome measure was pain intensity assessed by Borg category scale for ratings of perceived pain. Secondary outcomes included the Orebro musculoskeletal pain screening questionnaire, the Roland and Morris disability questionnaire, sick-leave, visits to health care, and physical therapy. RESULTS: The results showed no significant differences in pain between the groups at discharge. At 6 months, the reduction of pain was significantly greater in the EA group compared to the control group (P=0.025). Changes in secondary outcome measures were not significantly different between groups. CONCLUSIONS: This study indicated that EA to physical therapy resulted in greater improvement in perceived pain at 6 months compared to later access. In this study, EA to physical therapy could be introduced by reorganization without additional resources.

Adolescent↗

PubMed1999

[Sick-listed persons think job adjustments might reduce sick-leave].

In the 1990's, improving the follow-up of sick-listed patients with a focus on job adjustments has been a priority in Norwegian social policy. In a study of 1,000 consecutive sick-listed patients (14 days or more) with a musculoskeletal or mental disorder as primary diagnosis, we asked 499 randomly selected sick-listed patients about their opinion on whether adjustments in their job situation might reduce their need for sick-leave in the current episode or in the future. 161 useful questionnaires were returned. Nearly 30% replied that job adjustments might bring down his or her current sick-leave, and 40% thought that job adjustments might reduce future needs for sick-leaves. One in four were of the opinion that they might return to work immediately if job adjustments were made. Among those who knew about job adjustments which had in fact been implemented at their place of work, there were no significant differences in the estimates of potential reductions by age, sex, diagnosis or occupation, with the exception that young women who worked in places where such adjustments had been made, had little belief in the potential of such adjustments. We may conclude that in the sick-listed patients' own opinion, job adjustments have a considerable potential for cutting down the number of working days lost by sickness. The Norwegian "active sick-leave" scheme is suitable and might be used more.

Adult↗

PubMed2005

[Risk estimation in aesthetic surgery: a national study in French].

AIM: The aim of this study was to establish the status of the means of information and to search for the variability in risk estimation. MATERIALS AND METHODS: A questionnaire has been mailed to a hundred plastic surgeons randomly sorted among the habilitation list to be returned in an anonymous enclosed envelope. This random sample comprised 50 liberal practioners and 50 plastic surgeons working at hospital. The first part of this questionnaire dealed with basic data such as the type of activity (reconstructive or aesthetic), years of experience and means of information. The second part dealed in seven items with the most important preoperative information to be given to the patient and the most feared complications according to each surgeon before a reduction mammaplasty and abdominoplasty. RESULTS: A total of 50 (50%) of the 100 questionnaires were returned. Years of experience influenced significantly the importance given to information and the way of transmitting it. Important variability existed between the surgeons' answers. Moreover, current complications were in many cases never mentioned. Risk estimation depended on the experience of the surgeon and the information procedures were influenced by the surgeon's type of activity. CONCLUSION: Important variability in risk estimation exists among the plastic surgeons leading to an important variability in the kind and way of delivering information.

Abdomen↗