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PubMed2006

Touch-screen versus paper-and-pen questionnaires: effects on patients' evaluations of quality of care.

PURPOSE: The aim of the paper is to compare the computer administration method (touch-screen) with the original paper-and-pen approach when measuring patients' perceptions of care quality. DESIGN/METHODOLOGY/APPROACH: The study group consisted of 199 patients who responded to touch-screen and 219 who responded to paper-and-pen questionnaires, receiving care between January and March 2003 at two out-patient clinics in one county in Sweden. The response rate was 75 per cent. A modified version of the quality from the patient's perspective questionnaire was used. FINDINGS: Two main findings emerged: first, both methods yielded almost identical results in quality of care ratings, and second, the touch-screen method was perceived to be easier to use and to take less time to complete. ORIGINALITY/VALUE: The paper shows that both methods are acceptable, but the touch-screen method appears to be preferred by patients.

Adult↗

PubMed2001

The use of air-coupled ultrasound to test paper.

Capacitance transducers containing a thin polymer membrane have been used to transmit ultrasonic signals with frequencies in excess of 1 MHz through various paper products such as paper and cardboard. At normal incidence, a resonance was visible in thicker samples, the frequency of which could be correlated to parameters such as the thickness of the paper sample and the moisture content. It has also been demonstrated that images can be obtained of changes in structure across paper and card samples.

Journal Article↗

PubMed2006

Internet versus paper mode of health and health behavior questionnaires in elementary schools: asthma and fruit as examples.

The Internet has become an inevitable tool for collecting health and health behavior questionnaires. This study compared the feasibility, presence of score differences, and subjective evaluations by children between Internet and identical paper (asthma/fruit) questionnaires in elementary schools. A randomized crossover design was applied, with children starting with one administration mode before completing (5 minutes later) the other mode. Ten Dutch elementary schools with 270 school children (fifth grade, 10-12 years) were approached to participate. Response was 92%. The Internet mode had significantly less missing/nonunique answers than the paper mode (p < .01). The completion times did not differ significantly between the Internet and the paper mode. Except for perceived self-efficacy to eat sufficient fruit (p < .05), no differences in the asthma and fruit scores were found when comparing between the 2 modes. All variables showed strong intraclass correlation coefficients (166 >or= 0.64) between modes. Most items had good to very good agreement (kappa 0.61-0.95). The percentages for global and exact agreement ranged per item from 61.3 to 100. Most children preferred the Internet mode on "general preference" and "ease of use" aspects but rated no preference on "understandability." The majority rated the evaluation aspects of the Internet mode positively. Thus, Internet administration of a health and health behavior questionnaire is feasible at elementary schools, gives comparable responses, and is well accepted and preferred by children compared to the paper version. Therefore, it is recommended to use Internet as a tool in health and health behavior research among children.

Asthma↗

PubMed1995

Assessment of statistical procedures used in papers in the Australian Veterinary Journal.

One hundred and thirty-three papers (80 Original Articles and 53 Short Contributions) of 279 papers in 23 consecutive issues of the Australian Veterinary Journal were examined for their statistical content. Only 38 (29%) would have been acceptable to a statistical referee without revision, revision would have been indicated in 88 (66%), and the remaining 7 (5%) had major flaws. Weaknesses in design were found in 40 (30%), chiefly in respect to randomisation and to the size of the experiment. Deficiencies in analysis in 60 (45%) were in methods, application and calculation, and in the failure to use appropriate methods for multiple comparisons and repeated measures. Problems were detected in presentation in 44 (33%) of papers, with insufficient information about the data or its statistical analysis and presentation of statistics (appropriate missing or inappropriate shown) the main problems. Conclusions were considered to be inconsistent with the analysis in 35 (26%) of papers, due mainly to their interpretation of the results of significance testing. It is suggested that statistical refereeing, the publication of statistical guidelines for authors and statistical advice to Animal Experimentation Ethics Committees could all play a part in achieving improvement.

Analysis of Variance↗

PubMed1982

Evaluation of the rapid penicillinase paper strip test for detection of beta-lactamase.

The penicillin-starch paper strip method was compared with the acidometric and iodometric methods for assaying beta-lactamase production, using fresh isolates of clinically important bacteria. Results obtained by the three methods were compared for rapidity, accuracy, and stability of reagents. Of the 210 isolates tested by the paper strip method, 301 isolates tested by the acidometric method, and 117 isolates tested by the iodometric method, all were in perfect agreement with the disk diffusion susceptibility test except one strain each of Haemophilus influenzae, Staphylococcus aureus, and Staphylococcus epidermidis. The H. influenzae isolate was penicillin resistant and failed to give a positive test for beta-lactamase in all three tests. The staphylococci (intermediate and resistant in susceptibility, respectively) failed to give a positive test for beta-lactamase with the iodometric method. The results of the paper strip method, in which 3,241 strains representing nine species of bacteria were used, correlated completely with disk susceptibility tests except for 2 and 69 strains, respectively, of penicillin-resistant, beta-lactamase-negative H. influenzae and H. parainfluenzae. The results of this study indicate that the paper strip method is accurate, simple to perform, extremely economical, and uses materials that are stable when stored frozen. It is eminently suitable for routine laboratory use.

Bacteria↗

PubMed1991

Determination of genetic variation within Plasmodium falciparum by using enzymatically amplified DNA from filter paper disks impregnated with whole blood.

A new method which allows the enzymatic amplification of DNA extracted from whole blood dried on filter paper disks is presented. The method was used to study heterogeneity within an erythrocyte-binding antigen (EBA-175) of Plasmodium falciparum. Blood specimens from malaria-infected patients in Southeast Asia and Africa were spotted onto filter paper, dried, and transported for processing. P. falciparum DNA was extracted by boiling the filter paper disks in the presence of Chelex-100 ion-chelating resin, amplified by the polymerase chain reaction, and analyzed for the presence of genetic variation. In all cases examined, plasmodial DNA was successfully amplified and characterized from filter paper disks. Hybridization of the polymerase chain reaction products with internal probes demonstrated simultaneous infection with two strains of P. falciparum in two patients. This technique represents a sensitive and practical field method for the determination of genetic variation within P. falciparum and the study of molecular epidemiology.

Animals↗

PubMed2002

Triage decisions of prehospital emergency health care providers, using a multiple casualty scenario paper exercise.

OBJECTIVE: To examine the accuracy of theoretical triage decision making among emergency prehospital health care professionals, using a multiple casualty paper exercise. METHODS: A standardised 20 casualty paper exercise requiring each casualty to be prioritised for treatment was given to 100 doctors, 59 nurses, and 74 ambulance paramedics who could potentially be involved at the scene of a multiple casualty incident. Each paper was scored using the triage sieve algorithm. The paper contained descriptions of two casualties regarded as dead, six priority 1 casualties, six priority 2 casualties, and six priority 3 casualties. RESULTS: There was no significant difference in the scores received by both doctors and nurses, but paramedics did significantly less well than both nurses and doctors (p<0.05) However, the actual difference in mean scores is only just over 1; both doctors and nurses had a mean score of 13.03 and paramedics a mean score of 11.83. All professional groups tended to over triage patients. While there was no significant difference between doctors and nurses there was a significant difference (p<0.001) between paramedics and both doctors and nurses. CONCLUSIONS: There is little difference in the accuracy of triage decision making between the professional groups, with doctors and nurses scoring marginally better than paramedics. The rates of over triage are high posing the risk of overwhelming available resources further. Under triage rates are also high, with potentially life threatening conditions going unrecognised. However, some margin of error may be accounted for by the untested validity of the triage sieve methodology.

Adult↗

PubMed1994

Effect of condensed tannins from birdsfoot trefoil on endoglucanase activity and the digestion of cellulose filter paper by ruminal fungi.

The ruminal fungi Neocallimastix frontalis RE1, Neocallimastix patriciarum 27, Piromyces communis 22, and Orpinomyces joyonii 19-2 were examined for their ability to digest filter paper in the presence of condensed tannins from birdsfoot trefoil (Lotus corniculatus L.). For all four fungi, inhibition of endoglucanases was evident at 100 micrograms condensed tannins.mL-1 with nearly complete inhibition at 300 micrograms condensed tannins.mL-1. At 100 and 200 micrograms condensed tannins.mL-1, the endoglucanase activity of N. frontalis RE1 was greater (P < 0.01) than that of the other three fungal species. Exposure to 100 micrograms condensed tannins.mL-1 did not affect the ability of N. frontalis RE1 or N. patriciarum 27 to digest filter paper, and although digestion was reduced, N. frontalis RE1 and P. communis 22 solubilized more than 20% of the filter paper at 500 micrograms condensed tannins.mL-1. In contrast, O. joyonii 19-2 was virtually unable to digest filter paper at 300 micrograms condensed tannins.L-1. Mycelia of fungi grown with condensed tannins were covered by filamentous material, which may have arisen from the formation of condensed tannin-protein complexes. Less than 86% of the condensed tannins (as measured by the H2SO4 method) were recovered after 120 h of incubation with N. frontalis RE1, P. communis 22, and N. patriciarum 27. The need for detailed studies to examine the ability of ruminal fungi to metabolize condensed tannins is evident.

Animals↗

PubMed1986

Simple screening methods for hypoxanthine-guanine phosphoribosyltransferase and adenine phosphoribosyltransferase deficiencies using dried blood spots on filter paper.

Simple methods for the detection of hypoxanthine-guanine phosphoribosyltransferase and/or adenine phosphoribosyltransferase deficiencies using dried filter paper blood spots were studied. Enzyme activities in the eluate from dried filter paper blood spots stored for 4 weeks at room conditions were shown to be quite stable. Autoradiographs prepared from dried filter paper blood spots and DE-81 papers soaked with enzyme reaction mixtures containing 14C-hypoxanthine and/or 14C-adenine showed sharp radioactive spots in normal subjects. No activity was evident in the cases of the Lesch-Nyhan syndrome and/or adenine phosphoribosyltransferase deficiency. The methods seem to be suitable for screening.

Adenine Phosphoribosyltransferase↗

PubMed2005

Paper and voice MAYSI-2: format comparability and concordance with the voice DISC-IV.

The authors examine the comparability of paper and voice formats of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) as well as each format's concordance with the Voice Diagnostic Interview Schedule for Children (DISC) among adjudicated youth. Comparability is assessed among 248 youths admitted to a South Carolina Assessment Center. Mean scores and alpha coefficients are calculated, and area under the curve and positive and negative predictive values are used to compare concordance to the DISC. Paper and voice formats are significantly correlated, have similar alpha coefficients, and have comparable concordance with the DISC, suggesting that the MAYSI-2 paper and voice formats are comparable instruments. The voice format may be preferable to the paper format for screening justice youth for mental health problems because it may reduce incomplete data and increase reporting of stigmatized behaviors and because of its ability to automatically generate scored reports and aggregate data.

Adolescent↗

PubMed2003

Putting thought to paper: a microARCS protease screen.

In micro-arrayed compound screening (microARCS), an agarose gel is used as a reaction vessel that maintains humidity and compound location as well as being a handling system for reagent addition. Two or more agarose gels may be used to bring test compounds, targets, and reagents together, relying on the pore size of the gel matrix to regulate diffusion of reactants. It is in the microenvironment of the agarose matrix that all the components of an enzymatic reaction interact and result in inhibitable catalytic activity. In an effort to increase the throughput of microARCS-based screens, reduce the effort involved in manipulating agarose gels, and reduce costs, blotter paper was used rather than a second agarose gel to introduce a substrate to a gel containing a target enzyme. In this assay, the matrix of the blotter paper did not prevent the substrate from diffusing into the enzyme gel. The compound density of the microARCS format, the ease of manipulating sheets of paper for reagent addition, and a scheduled protocol for running multiple gels allowed for a throughput capacity of more than 200,000 tests per hour. A protease assay was developed and run in the microARCS format at a rate of 200,000 tests per hour using blotter paper to introduce the substrate. Picks in the primary screen were retested in the microARCS format at a density of 384 compounds per sheet. IC(50) values were confirmed in a 96-well plate format. The screen identified several small molecule inhibitors of the enzyme. The details of the screening format and the analysis of the hits from the screen are presented.

Caco-2 Cells↗

PubMed2004

Incongruence between test statistics and P values in medical papers.

BACKGROUND: Given an observed test statistic and its degrees of freedom, one may compute the observed P value with most statistical packages. It is unknown to what extent test statistics and P values are congruent in published medical papers. METHODS: We checked the congruence of statistical results reported in all the papers of volumes 409-412 of Nature (2001) and a random sample of 63 results from volumes 322-323 of BMJ (2001). We also tested whether the frequencies of the last digit of a sample of 610 test statistics deviated from a uniform distribution (i.e., equally probable digits). RESULTS: 11.6% (21 of 181) and 11.1% (7 of 63) of the statistical results published in Nature and BMJ respectively during 2001 were incongruent, probably mostly due to rounding, transcription, or type-setting errors. At least one such error appeared in 38% and 25% of the papers of Nature and BMJ, respectively. In 12% of the cases, the significance level might change one or more orders of magnitude. The frequencies of the last digit of statistics deviated from the uniform distribution and suggested digit preference in rounding and reporting. CONCLUSIONS: This incongruence of test statistics and P values is another example that statistical practice is generally poor, even in the most renowned scientific journals, and that quality of papers should be more controlled and valued.

Confidence Intervals↗

PubMed2003

Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.

OBJECTIVE: It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. DESIGN: Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. MEASUREMENTS: The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. RESULTS: The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. CONCLUSION: Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

Attitude to Computers↗

PubMed1999

Investigation of seroprevalence of respiratory virus infections in an infant population with a multiantigen fluorescence immunoassay using heel-prick blood samples collected on filter paper.

Respiratory viruses are an extremely common cause of childhood morbidity. However, the current seroprevalence of viruses in infant populations is difficult to establish because invasive venipuncture may be technically and ethically unacceptable. This prospective study aimed to establish the seroprevalence of respiratory viruses in an infant population by use of a novel multiantigen fluorescence immunoassay against common respiratory viruses, using heel-prick blood samples collected on filter paper. Mothers and babies were recruited in the immediate peripartum period in the Royal Maternity Hospital, Belfast. Cord blood samples at birth and heel-prick filter paper blood samples at 7 mo were collected for measurement of virus-specific IgG to respiratory syncytial virus, influenza A virus, adenovirus, and parainfluenza virus type 1, type 2, and type 3 by indirect immunofluorescence using a multiviral assay developed for this purpose. Of 386 mothers approached, 325 (84%) permitted follow-up at 7 mo, and of these, 256 (79%) agreed to the heel prick. From 234 paired samples, 125 infections were documented. Adenovirus infections were commonest, 53 (22.6%), followed by respiratory syncytial virus, 32 (13.7%); influenza A virus, 22 (9.4%); parainfluenza virus type 3, 14 (6%); parainfluenza virus type 1, 2 (0.85%); and parainfluenza virus type 2, 2 (0.85%). These results demonstrate the seroprevalence of a range of respiratory viruses in an infant population, using a novel multiviral immunoassay. The filter paper collection of blood samples and multiantigen assay format has implications for easy, widespread viral serodiagnosis in both seroepidemiology studies and in the diagnosis of pediatric viral illnesses. Filter paper permits recovery of respiratory virus-specific IgG and can be used as a simple and acceptable epidemiologic and diagnostic tool.

Antigens, Viral↗

PubMed1998

Filter paper blood spot assay of human insulin-like growth factor I (IGF-I) and IGF-binding protein-3 and preliminary application in the evaluation of growth hormone status.

To facilitate broader applications of insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) analysis, we developed procedures for their measurements in extracts of whole blood dried on filter paper. A single 8-mm diameter filter paper disc containing about 13 microL blood was used. IGFBP-3 was efficiently extracted in a buffer within 1 h of incubation. IGF-I extraction involved incubation in buffer followed by acidification and neutralization steps. Blood spot assays showed intra- and interassay coefficients of variation (including interspot variations) of 5.4-16.7% for IGF-I and 6.6-11.7% for IGFBP-3; recoveries were 97 +/- 7.1% and 101 +/- 8.7%, respectively. Recoveries of IGF-I and IGFBP-3 in response to 4- to 8-fold variations in extraction buffer volume were 97 +/- 8.2% and 107 +/- 6.1%, respectively. Dried blood spot IGF-I and IGFBP-3 showed greater than 1-month stability at -20 C, 4 C, and room temperature and retained more than 65% of the immunoreactivity after approximately 1 month at 37 C. Both IGF-I and IGFBP-3 were contained within the plasma fraction of whole blood, and variations (mean +/- SD) in IGF-I (204 +/- 29 micrograms/L) and IGFBP-3 (4.4 +/- 0.48 mg/L) measured in extracts of dried blood spot with adjusted hematocrit of 0.2-0.62 were acceptable. IGF-I and IGFBP-3 in paired plasma and dried blood spot extracts of random samples (n = 46) showed excellent correlation (r > 0.94) with slopes of near unity. Compared to conventional methods, the filter paper procedures were equally effective in distinguishing IGF-I and IGFBP-3 levels in untreated GH receptor-deficient (n = 11) and age-matched normal controls (n = 16). We conclude that blood collected on filter paper is ideal for IGF-I and IGFBP-3 analysis and may find applications in pediatric and large scale infant screening programs.

Adolescent↗

PubMed2005

A comparison of paper with electronic patient-completed questionnaires in a preoperative clinic.

UNLABELLED: In this unblinded randomized control trial we compared electronic self-administered Pre-Admission Adult Anesthetic Questionnaires (PAAQ) using touchscreen technology with pen and paper. Patients were recruited in the Pre-assessment Clinic if they had completed a PAAQ in the surgeon's office. Patients were randomized to study PAAQ using paper, hand-held computer (PDA), touchscreen desktop computer (kiosk), or tablet. Patients also completed a preference and satisfaction survey. The main outcome measures were percent agreement between the prestudy and study PAAQ and time to completion. Only six of the 366 patients approached refused to participate. The median time to completion of the PAAQ was shortest on the kiosk (2.3 min) and longest on the PDA (3.2 min) (chi2 = 14.5; P = 0.002). The mean agreement between the prestudy and the study PAAQ was approximately 94% across all study arms. The proportion of participants expressing comfort before and after completing the PAAQ increased from 10% to 97% on the computerized arms and from 60% to 64% on the paper arm. Touchscreen computer technology is an accurate, efficient platform for patient-administered PAAQ. Patients expressed comfort using the technology and preference for computerized versus paper for future questionnaires. IMPLICATIONS: Self-administered electronic health questionnaires using touchscreen computer technology are an accurate means of collecting patient information in the preoperative setting and can provide a valuable basis for an electronic perioperative patient record. Patients expressed comfort and satisfaction with this method of questionnaire completion.

Adolescent↗

PubMed1997

Reporting animal use in scientific papers.

This paper reports the results of an examination of the 'methods' sections of a range of experimental research papers in biomedical science, focusing on the descriptions of animal use and housing. Detailed descriptions in the methods should enable replication, and also enable readers to judge scientific quality. Relatively few papers sampled gave adequate descriptions of housing conditions and many failed to give details of physiologically relevant variables such as weight of animals. Thirty per cent of papers omitted the number of animals used, and the deaths of animals (whether as part of the protocol, or accidental death) were not always recorded. Adequate reporting of the conditions of animal maintenance and use are important, both in relation to the quality of the science produced, and also because of public concerns about the ethics of animal experiments.

Animal Husbandry↗

PubMedDate not supplied

Validity of serology for American trypanosomiasis with eluates from filter paper.

This study evaluates whether blood collected on filter paper kept at 4 degrees C and tested at different intervals of time (1, 7, 15, 30 and 60 days after collection) would present similar results when compared to the serum samples and whether the type of filter paper influences the results. Eluates from filter paper samples were tested for Trypanosoma cruzi antibodies using indirect immunofluorescence antibody test (IFAT), indirect haemagglutination (IHA) and enzyme-linked immunosorbent assay (ELISA) as reference, the antibody titer in sera. Analysis of data showed that results obtained with IFAT, IHA (cut off point = 1:40) and ELISA in sera had similar sensitivity and good concordance among reactions. The use of a multiple linear regression model indicated that titer fall in eluates occurs up to the 7th day after the collection, and it is more marked for samples with lower antibodies titers. However, no significant differences were observed by IFAT, IHA (cut off point = 1:20) and ELISA in the proportion of positive reactions between sera and eluates. The results also showed that Melitta, Klabin or Whatman (reference) filter papers could be indicated for surveys, since they have shown similar capacity of maintenance of anti-T. cruzi immunoglobulins.

Animals↗