Intercomparisons of absorbed dose and dose distribution for x-irradiations using mailed LiF thermoluminescent dosemeters.
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Absorption↗
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Rapid assessment of agents of biological terrorism: defining the differential diagnosis of inhalational anthrax using electronic communication in a practice-based research network.
PURPOSE: Early detection of bioterrorism requires assessment of diagnoses assigned to cases of rare diseases with which clinicians have little experience. In this study, we evaluated the process of defining the differential diagnosis for inhalational anthrax using electronic communication within a practice-based research network (PBRN) and compared the results with those obtained from a nationwide random sample of family physicians with a mailed instrument. METHODS: We distributed survey instruments by e-mail to 55 physician members of the Wisconsin Research Network (WReN), a regional PBRN. The instruments consisted of 3 case vignettes randomly drawn from a set describing 11 patients with inhalational anthrax, 2 with influenza A, and 1 with Legionella pneumonia. Physicians provided their most likely nonanthrax diagnosis, along with their responses to 4 yes-or-no management questions for each case. Physicians who had not responded at 1 week received a second e-mail with the survey instrument. The comparison group consisted of the nationwide sample of physicians who completed mailed survey instruments. Primary outcome measures were response rate, median response time, and frequencies of diagnostic categories assigned to cases of inhalational anthrax. RESULTS: The PBRN response rate compared favorably with that of the national sample (47.3% vs 37.0%; P = not significant). The median response time for the PBRN was significantly shorter than that for the national sample (2 vs 28 days; P < .001). No significant differences were found between the PBRN and the Midwest subset of the national sample in the frequencies of major diagnostic categories or in case management. CONCLUSIONS: Electronic means of creating differential diagnoses for rare infectious diseases of national significance is feasible within PBRNs. Information is much more rapidly acquired and is consistent with that obtained by conventional methods.
Anthrax↗
Radiology Cases in Pediatric Emergency Medicine: amplifying the benefits of performance improvement by sharing a hospital performance improvement program with the world via the Internet.
A hospital performance improvement project to improve the quality of x-ray interpretations in the emergency department is described. To amplify the benefits of this project, a multimedia computer program containing this information was created and distributed via the mail and over the internet. Users are encouraged to copy the program disks and distribute them to others (no fees or royalties). The advantages of this method over conventional journals in print are described. Successful distribution of this program, known as Radiology Cases in Pediatric Emergency Medicine (RCPEM), and positive feedback from users, stimulated the continuation of this project, which has now released its fifth volume with two more volumes planned. RCPEM (a hospital performance improvement project) now continues to expand as the knowledge gained is disseminated over the internet to improve the quality of care rendered to children all over the world. Amplifying the benefits of other performance improvement projects can be done in a similar manner.
Computer Communication Networks↗
A survey of dental practitioners on their use of electronic mail.
OBJECTIVES: To assess the feasibility of using electronic-mail as a tool for surveying dental practitioners; to determine both response rates and response times for this method; and provide baseline information on e-mail usage. METHOD: Self-administered questionnaire distributed by e-mail to 309 practitioners on Monday morning, 1 June 1998. RESULTS: 53.4% response rate within 1 month; 10.2% of replies were sent within 2 hours; and nearly half the replies were sent within 48 hours. Qualified dentists were more likely to respond early than undergraduates. The most popular point of access for e-mail was home (69.1%). The majority of responders (56.8%) use e-mail every day with 1 in 7 (14.2%) using it at least four times a day. 72.4% stated that they found e-mail useful for communicating with professional bodies, while 41.3% used it to communicate with colleagues about patients and patient referrals. 34.0% found e-mail useful for ordering goods, and supplies and 14.6% were using electronic mail to make patient appointments at least some of the time. CONCLUSIONS: Responses can be obtained at much greater speed than conventional postal techniques will allow, but response rates were only 53.4%. E-mail is predominately used at home and for inter-professional communications, only a small proportion of responders use it for direct communication with patients.
Appointments and Schedules↗
Pharmaceutical services in nongovernmental hospitals on the West Coast.
A survey of nongovernment, nonprofit and for-profit hospitals in Washington, Oregon and California was conducted to determine the incidence of selected hospital pharmacy services (1) directly related to drug distribution and (2) not directly related to drug distribution. Questionnaires were mailed to all qualifying hospitals in the three states; the return rate was 75.4%. Unit dose drug distribution was used in combination with other delivery systems by 58.3% of the respondents; 26.5% used unit dose exclusively. Over half of the respondents provided i.v. admixture programs, outpatient and inpatient discharge prescriptions, and inpatient medication profiles. Additionally, 77.9% provided pharmacy consultation to physicians. Nonprofit hospitals had significantly higher pharmacy staffing levels (both pharmacists and supportive personnel) than for-profit hospitals in the categories, "open seven days per week," "open nine to 16 hours per day," "open 17 to 24 hours per day, "101 to 200 beds" and "201 or more beds." Hospitals that provided the following services had significantly higher pharmacy staffing levels than those that did not provide the serices: unit dose drug distribution, i.v. admixture services, inpatient discharge prescriptions, inpatient medication profiles, drug therapy monitoring, and cardiopulmonary resuscitation team participation (difference of supportive staff only).
Hospitals, Proprietary↗
Physician knowledge and attitudes of Minnesota laws concerning adolescent health care.
STUDY OBJECTIVE: To determine physicians' knowledge and attitudes of medico-legal issues affecting adolescent health care. DESIGN, SETTING, PARTICIPANTS: A cross-sectional, mailed survey was distributed to 900 randomly selected primary care physicians in Minnesota, and all eligible physicians in Olmsted County. INTERVENTIONS: Physicians were mailed a survey with questions concerning Minnesota consent and confidentiality laws. MAIN OUTCOME MEASURES: Physician knowledge and attitudes of consent and confidentiality laws. RESULTS: A total of 317 (26%) surveys were returned. Olmsted county physicians achieved a median score of 37.5% and non-Olmsted physicians achieved a median score of 50% correct on a test of knowledge. Using a scoring scale where -1 signified "a bad law," 0 signified "neither a good nor bad law," and +1 signified "a good law," attitude regarding the laws was a median of +0.5 for both groups. In all, 41.1% of Olmsted physicians and 51.7% of non-Olmsted physicians felt that the laws had affected them or their practice. Olmsted physicians were compared to a cohort of Olmsted parents previously reported, with statistically significant differences noted. CONCLUSIONS: Results suggest that primary care physicians are not knowledgeable of Minnesota laws affecting adolescent health care. Opinion of these laws was positive, with notable exceptions. Physicians lack a sense of impact of laws affecting adolescent health care. Physicians were more knowledgeable and felt more positively about the laws than did parents of adolescents. Lack of knowledge and the presence of certain attitudes identify areas where physicians could benefit from greater understanding.
Adolescent↗
Knowledge of indications for EUS among gastroenterologists and non-gastroenterologists.
BACKGROUND: The level of awareness among non-gastroenterologists of the indications for EUS is unknown. This study assessed knowledge of the indications and the utility of EUS among gastroenterologists and non-gastroenterologists in a large multispecialty academic practice. METHODS: A questionnaire was designed that tested knowledge of the indications for EUS with respect to 4 organ systems: esophagus, gastroduodenum, hepatopancreatobiliary system and colorectum. The questionnaire was distributed by electronic mail to gastroenterologists, general internists, non-gastroenterologist subspecialists, and surgeons in a large multispecialty practice. RESULTS: The survey was distributed to 659 attending physicians of whom 227 (34%) replied: gastroenterologists (53%), internists (30%), non-gastroenterologist specialists (33%), and surgeons (28%). Knowledge of appropriate indications was highest among gastroenterologists (84.3%) compared with internists (68.9%), non-gastroenterologist specialists (65.4%), and surgeons (65.3%) (p < 0.0001). Among all non-gastroenterologists, knowledge of indications for hepatopancreatobiliary (mean 66.3% correct responses) and colorectal applications (64.0%) was inferior to knowledge of esophageal (71.5%) and gastroduodenal (83.5%) applications. CONCLUSIONS: Internists, non-gastroenterologist specialists, and surgeons in a large multispeciality practice have moderate knowledge of the indications and the utility of EUS. Knowledge was at the lowest level for hepatopancreatobiliary and colorectal applications of EUS for all 3 groups of non-gastroenterologists. Future studies should focus on the education of non-gastroenterologists regarding the role of EUS and assess the impact of such education on the appropriateness of EUS referral patterns.
Bile Ducts↗
Investigation of a ricin-containing envelope at a postal facility--South Carolina, 2003.
On October 15, 2003, an envelope with a threatening note and a sealed container was processed at a mail processing and distribution facility in Greenville, South Carolina. The note threatened to poison water supplies if demands were not met. The envelope was isolated from workers and other mail and removed from the facility, and an investigation was begun. On October 21, laboratory testing at CDC confirmed that ricin was present in the container. To assess the human health effects related to possible ricin exposure, the South Carolina Department of Health and Environmental Control (SCDHEC) and CDC interviewed all workers at the postal facility and initiated statewide surveillance for illness consistent with ricin exposure during October 15-29. On October 22, the facility was closed for a detailed epidemiologic and environmental investigation. This report summarizes the results of the investigation, which found no evidence of environmental contamination and no cases of ricin-associated illness. Clinicians and public health officials should be vigilant for illnesses suggestive of ricin exposure.
Environmental Exposure↗
A national survey of jail diversion programs for mentally ill detainees.
OBJECTIVES: The authors sought information on the number, structure, and effectiveness of programs aimed at diverting mentally ill inmates from the criminal justice system into the mental health treatment system. METHODS: A working definition of a jail diversion program was developed. Mail surveys were distributed to 1,263 U.S. jails with a capacity of 50 or more detainees to ascertain the presence or absence of diversion programs. Telephone interviews with samples of respondents and nonrespondents to the mail survey yielded additional information about the programs' operation, funding, staffing, and directors' perceptions of their effectiveness. RESULTS: Information obtained from the mail and telephone surveys indicated that only 52 U.S. jails with a capacity of 50 or more detainees had formal mental health diversion programs that fit the definition developed by the authors. Programs in larger jails served fewer violent felons than did those in smaller jails. Three-fourths of the programs were located in mental health agencies. Two-thirds of program directors considered the programs to be moderately or very effective. CONCLUSIONS: Only a small number of U.S. jails have diversion programs for mentally ill detainees, and objective data on their effectiveness are lacking. Systematic evaluations are needed to determine what types of programs work best for which types of detainees.
Data Collection↗
Prospective comparison of endoscopy patient satisfaction surveys: e-mail versus standard mail versus telephone.
OBJECTIVES: The dramatic growth of the Internet holds potential for use in survey distribution. Comparisons of electronic mail (e-mail) to traditional survey techniques are lacking. We compared standard mail, telephone, and e-mail modes of endoscopy satisfaction survey administration with respect to response rate, timeliness of response, response content, and cost-efficiency of responses. METHODS: An endoscopy satisfaction questionnaire consisting of seven core items from the modified Group Health Association of America-9 survey was distributed to patients after routine outpatient endoscopy. Patients were randomized to receive the questionnaire by standard mail, telephone, or e-mail. Response rates and findings in the three groups were compared. The "nonresponders" to the standard mail and e-mail surveys were subsequently contacted by telephone to determine their level of satisfaction. RESULTS: The phone survey response rate (90%) was higher than e-mail (70%) or standard mail (85%), although e-mail was the most cost-efficient mode of survey delivery. There was no significant difference in satisfaction scores among the three groups. Nonresponders were significantly more satisfied than "responders." CONCLUSIONS: A survey technique utilizing e-mail with subsequent follow-up by telephone to nonresponders appears to be the most cost-efficient way to deliver a questionnaire. The satisfaction levels of the responders may underestimate the overall satisfaction of the population being surveyed.
Colonoscopy↗
A survey of Canadian practitioners regarding the management of the hypertensive disorders of pregnancy.
BACKGROUND: How Canadian practitioners are managing the hypertensive disorders of pregnancy (HDP) is not known, particularly in relation to the 1997 guidelines published by the Canadian Hypertension Society (CHS). METHODS: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferroni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. RESULTS: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. For all types of HDP, most internists, family doctors, and midwives initiate nonpharmacological therapy (most common advice to quit work) at dBP 80-89 mmHg (i.e., primary prevention). Only for preeclampsia do obstetricians most frequently use this threshold; otherwise, dBP 90-99 mmHg is usually chosen. For nonsevere hypertension, antihypertensive drug therapy (most commonly methyldopa or labetalol) is started by most practitioners at dBP 90-99 mmHg, although obstetricians are more likely to choose a higher threshold (p < 0.0001). There is little agreement about dBP treatment goal; most internists and family doctors normalize dBP, whereas obstetricians appear to be divided on dBP goals of 80-89 (46-51%) vs. 90-99 mmHg (41-44%) for all HDP (p = 0.66). Severe hypertension is commonly treated with parenteral hydralazine, labetalol, or magnesium sulphate. Short-acting or sustained release nifedipine is used rarely/never by most practitioners. Approximately one-third of obstetricians and family doctors use diazepam to treat eclampsia. The vast majority use MgSO4 prophylactically in women with preeclampsia. INTERPRETATION: This survey has clarified current stated management of women with HDP, and identified the need for both research into the dBP treatment goal that optimizes pregnancy outcomes among women with HDP, and translation of definitive studies into clinical practice.
Antihypertensive Agents↗
A survey of canadian practitioners regarding diagnosis and evaluation of the hypertensive disorders of pregnancy.
BACKGROUND: How Canadian practitioners are diagnosing and managing the hypertensive disorders of pregnancy (HDP), particularly in relation to the 1997 recommendations published by the Canadian Hypertension Society (CHS), is not known. METHODS: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferonni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. RESULTS: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. Most (609, 84.5% of) respondents take blood pressure (BP) with women in the sitting position, and use a mercury sphygmomanometer (79%) and the 5th Korotkoff (61%) sound to designate diastolic BP (dBP). To monitor pregnancies complicated by preeclampsia, most clinicians use the proposed laboratory tests of maternal well-being (usually at least once/week), fetal well-being [nonstress test (NST, at least once/week), and ultrasonographic studies (once weekly to every two weeks)]. There is general agreement that women with preeclampsia should be delivered for uncontrolled hypertension, end-organ dysfunction, or fetal compromise (nonreassuring NST, severe oligohydramnios, biophysical profile < 4, estimated fetal weight < 5th centile, and reversed end-diastolic flow by umbilical artery Doppler velocimetry). Less consensus was seen for delivery for preeclampsia at > 34 weeks, mild asymptomatic HELLP syndrome, hyperreflexia, and absent end-diastolic flow by umbilical artery Doppler velocimetry. INTERPRETATION: This survey has clarified the current state of practice with respect to the diagnosis and evaluation of women with all types of HDP. In particular, we have identified areas of potential variability in BP measurement, and provided data on the feasibility of enrolling women with sub types of preeclampsia into intervention studies aimed at prolonging pregnancy.
Biomarkers↗
Responding to a bioterrorist attack: environmental investigation of anthrax in New Jersey.
A bioterrorism attack using the United States postal system to deliver a hazardous biological agent to specific targets created multiple environmental and occupational exposure risks along the path of the anthrax-containing letters. On October 18, 2001, a suspected case of cutaneous anthrax was confirmed in a postal worker from the Trenton Processing and Distribution Center where at least four suspect letters were postmarked. Over the next three weeks, a team of investigators collected samples at 57 workplaces in New Jersey as part of a comprehensive environmental investigation to assess anthrax contamination as a result of this bioterrorist attack. A total of 1369 samples were collected with positive sample results found in two mail processing and distribution centers, six municipal post offices, and one private company. This large-scale epidemiological and public health investigation conducted by state and federal agencies included environmental evaluations utilizing general industrial hygiene principles. Issues of sampling strategy, methods, agency cooperation and communication, and site assessment coordination are discussed.
Anthrax↗
Differences between Internet samples and conventional samples of men who have sex with men: implications for research and HIV interventions.
The Internet is becoming a new erotic oasis for obtaining sex online or in person. We reviewed the literature on cybersex and compared differences in data from samples of homosexually active men obtained on identical questionnaires from a conventional written questionnaire, distributed through the mailing and contact lists of a large national gay organization in Sweden, and through the same organization's website and chat room. A total of 716 written questionnaires and 678 Internet questionnaires were obtained. The Internet sample was younger, more likely to live in small towns or cities, live with parents or a girlfriend, and have lower formal education. They are less likely to have previous sexual experience solely with other men (one in three of the Internet sample vs. 1 in 14 of the written sample defined themselves as bisexual) and more likely to visit erotic oases such as bathhouses, video clubs and erotic movie houses. They also visited Internet chat rooms more frequently (86% of the Internet sample vs. 50% of the written sample). One third of the Internet sample wanted the opportunity to talk with an expert about HIV compared with a quarter of the written sample. Sexual practices between the two samples were generally similar, although the Internet sample reported significantly less body contact, kissing, hugging, mutual masturbation, and more condom use for anal intercourse with steady partners. Over four times as many of the Internet samples reported sex with women in the past year as the written sample. These data indicate that Internet data collection is feasible and that this mode of data collection, despite the nonrandom and self-selected nature of both types of samples, is likely to be more significantly oriented toward the young, geographically more isolated, and more behaviorally and self-identified bisexual respondent than conventionally distributed written questionnaires.
Adult↗
A surgical Internet discussion list (Surginet): a novel venue for international communication among surgeons.
BACKGROUND: Internet discussion lists, also known as mailing lists, are subject-specific groups that are participated in and distributed by e-mail. Medical mailing lists have not been warmly received by the peer-reviewed medical literature. OBJECTIVE: To demonstrate the potential value of medical discussion lists on the Internet through a description of Surginet, the largest such mailing list dealing with general surgery, and a survey of its participants. Our hypothesis is that Internet discussion lists fill a unique niche in dissemination of medical information. DESIGN: A retrospective review of the electronic activities of one medical mailing list, and an e-mail questionnaire survey of its membership's demographics and practice patterns. PARTICIPANTS: Four hundred eighty-nine subscribers to Surginet from 46 countries. MAIN OUTCOME MEASURES: Electronic activity of the list, subscribers' demographics, and subscribers' perceptions concerning the list's activities and its value. RESULTS: Surginet currently has 489 subscribers from 46 countries. During 1997 an average of 12.5 messages per day and 375 per month were posted, all dealing with topics in general surgery. Completed questionnaires were received from 190 subscribers (39%), of which 93% are men and 73% are between the ages of 30 and 50 years practicing in 38 countries; 84% are practicing surgeons and 13% are surgical residents. Most (59%) are "passive" members who read, but do not actively participate in, the discussions. Improving knowledge base, interaction with other surgeons, and obtaining consults were the most common reasons given for list subscription. CONCLUSIONS: Groups such as Surginet fill a niche involving the free exchange of ideas, methods, and attitudes relevant to the current practice of general surgery, which is different from the way medical information is disseminated by published literature and organized medical meetings. There is a perception among list subscribers that this is a valuable and useful modality for continuing education.
Communication↗
Ethanol fixation of bladder irrigation specimens for flow cytometric analysis. A multiinstitutional study from the bladder cancer flow cytometry network.
Ethanol preservation of voided and catheterized urine has long been the standard for urinary cytologic study. In this report ethanol preservation of bladder irrigation specimens was evaluated for flow cytometric analysis in a multiinstitutional study requiring specimen transport. Specimens from ten patients obtained at one center were preserved for varying periods of time in 50% ethanol, then distributed by express mail to four other participating centers, up to 3000 miles distant. On receipt, from 1 to 3 weeks after collection, the samples were processed and examined by flow cytometric study using propidium iodide as the fluorochrome. Forty-six of the 50 (92%) analyzed specimens gave satisfactory histograms. In 41 of the 46 adequate samples (89%), an aneuploid peak in the alcohol preserved (propidium iodide stained) specimen correlated well with the fresh (acridine orange stained) specimen. However, there was variable loss of DNA stainability with a broadening of the coefficient of variation in some alcohol-preserved specimens and an increase in cellular debris so that measurements of DNA index and percent hyperdiploid cells were considered unreliable. The authors conclude that ethanol preservation of bladder irrigation specimens for short periods of time may be a feasible alternative when flow cytometric analysis cannot be carried out on fresh specimens, but that this is not optimal fixation for specimens that must be transported and further studies of other fixatives are recommended.
Aneuploidy↗
Ergonomic investigation of letter-carrier satchels: part II. Biomechanical laboratory study.
A biomechanical investigation of four satchels designed for the purposes of manually carrying and delivering mail was conducted. Twenty United States Postal Service carriers participated in the study. The satchels differed primarily in the presence/absence of a waist belt, the number and design of the shoulder straps, and the number of pouches. The biomechanical analyses were comprised of postural (shoulder and hip) deviation measurements, estimated compressive forces at the L5/S1 joint, soft tissue pressure on the shoulder, spinal torsion during mail retrieval, force distribution between the feet, and an anthropometric evaluation. The results indicated that a satchel with two shoulder straps and two pouches was more desirable than the single-pouch satchels from a biomechanics standpoint.
Journal Article↗
Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.
OBJECTIVE: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. METHOD: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). RESULTS: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. CONCLUSIONS: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.
Adult↗