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Management of acute coronary syndromes, a questionnaire survey of the clinical practice of cardiologists and other medical physicians belonging to west midland hospitals.

OBJECTIVE: To assess the management of acute coronary syndromes by cardiologists and other medical physicians in a clinical setting. DESIGN: Questionnaire survey consisting of 10 hypothetical clinical scenarios and four possible therapeutic options for each scenario. SETTING: Consultants and specialist registrars in Cardiology (with or without access to interventional facilities) and consultant physicians belonging to various hospitals in the west midland region of United Kingdom. MAIN OUTCOME MEASURES: Respondents' ability to recognise high risk patients and their management of the hypothetical clinical cases. To establish any differences in management strategy between cardiologists and general physicians, and whether these differences, if any, relate to access to interventional cardiac facilities. RESULTS: Overall no significant differences were found in the responses between cardiologists and general physicians with or without access to cardiac interventional facilities. However, cardiologists were more inclined to use percutaneous transluminal coronary angioplasty (PTCA) compared to other physicians (scenario 8, 18.4% vs. 6.7%, p = 0.05 and scenario 9, 44.9% vs. 26.7%, p = 0.01). In two other situations, physicians from institutions with access to interventional facilities were more inclined to use 'other' treatment strategies (intravenous nitrates, antiplatelet treatment, inotropes, Intra-aortic balloon pump) compared to their colleagues from non-tertiary hospitals with no interventional facility on site (scenario 3, 21.7% vs. 2.4%, p = 0.04) and more use of PTCA ( scenario 6, 52.2% vs. 26.8%, p = 0.04). CONCLUSIONS: The management of acute coronary syndromes in this questionnaire survey was satisfactory and evidence based. No real differences were found between the management strategies adopted by cardiologists or non-cardiologists. Physicians working in centres with interventional facilities were no more inclined towards using primary PTCA or rescue angioplasty than those working in centres without such facilities.

Acute Disease↗

The quality of spirometric examinations in Finland: results from a national questionnaire survey.

National treatment programmes for asthma and chronic obstructive pulmonary disease (COPD) have in the past few years increased the need for spirometry in Finland. The purpose of this study was to determine, by means of a national questionnaire survey, the quality and number of spirometric examinations performed in Finland in 1998, the year when the national COPD programme was initiated. We estimated that 395 000-425 000 spirometric examinations were performed in Finland in 1998. The mean quality of spirometry was evaluated as moderate, and the quality index developed for this study indicated an average of scores of 67 (max 100), ranging between 43 and 88 in the whole country. The most common qualitative insufficiencies in spirometric examinations were found in preparation of the subject for the examination, performance of the examination, recognition of a successful spirometric curve and evaluation of reproducibility of the examination. Furthermore, the time reserved in the reports for performing the examination was often very short. However, in comparison with the previous questionnaire survey in Finland (in 1990), the quality of spirometry had markedly improved.

Finland↗

[A questionnaire survey of surgical lung biopsy in patients with diffuse lung diseases].

A nationwide questionnaire survey was conducted to investigate the indications, diagnostic yield, complications, outcome, and benefit of surgical lung biopsy for diffuse lung diseases. Surgical lung biopsies were performed in 410 patients at 132 institutes in 1998, 94% of them as video-assisted thoracoscopic surgery (VATS). Interstitial lung diseases of unknown etiology formed the largest diagnostic group, and consisted of 194 patients. The clinical diagnosis prior to lung biopsy was inconsistent with the final diagnosis in 32.8%. Complications were seen in 32 patients, and mortality was 1.2%. Acute exacerbation of the underlying disease was seen in 9 patients, four of whom died. Patients with nonspecific interstitial pneumonia and even usual interstitial pneumonia who were treated following biopsy showed better outcomes than those untreated. The physician in charge judged that 82.2% of the patients received clinical benefits from the biopsy procedure. We concluded that VATS lung biopsies are indicated in more cases to confirm diagnoses and as a reference for treatments in patients with diffuse lung disease.

Adolescent↗

[The current managements and controversies of the clinical practice for patients with asthma. A questionnaire survey of asthma management for doctors professing internal medicine in Saitama prefecture].

A questionnaire survey of the current medical therapy in patients with mild persistent (step 2) asthma was conducted of doctors professing internal medicine in Saitama prefecture. Responses were obtained from 933 of those surveyed (response rate: 53%). Medications frequently prescribed for asthma control were theophylline (77%), inhaled corticosteroids (ICSs: 75%), and leukotriene modifiers (64%). Usage of theophylline in exacerbation reached 87% and was given priority over inhaled beta2-agonist, suggesting too much usage of theophylline among respondents. ICSs were used in 75% of respondents. Doctors specializing in respiratory or allergic medicine used ICSs more frequently than the others. They started ICSs at large doses initially (48%), followed by small doses, and they showed a trend of continuing ICSs after the asthma was under control (75%). Eighty-three percent of respondents used leukotriene modifiers, which were evaluated as easy to administer orally, having a synergistic effect with ICSs, and having fewer side effects compared with other asthma medications.

Administration, Inhalation↗

Survey of the present status of sleep-disordered breathing in children with achondroplasia Part I. A questionnaire survey.

An achondroplasia is known to be the inherited disease causing a growth impairment of limb bones. Recently, as a symptom of achondroplasia, a sleep-disordered breathing has been reported. Considering the scientific evidence that the sleep-disordered breathing in children such as that due to tonsillar hypertrophy inhibits somatotropin secretion and causes growth retardation, sleep-disordered breathing in children with achondroplasia may aggravate growth/developmental retardation in addition to the bone growth impairment. However, the present status of the development of sleep-disordered breathing in children with achondroplasia has been unknown. Therefore, in order to clarify the present status of sleep-disordered breathing in children with achondroplasia (AP group), we carried out a questionnaire survey of the breathing state during sleep, growth/development history and the oral state at preschool age and school age in the AP group, and compared the results with previously reported data in healthy children (control group). 1. Among the questionnaire items, the incidences of snoring, apnea, mouth breathing, anterior cross bite, and open bite at preschool age were significantly higher in the AP group than in the control group (P < 0.01) At school age, the AP group showed significantly higher incidences of mouth breathing and cross/open bite (P < 0.01) and snoring and apnea (P < 0.05) than the control group. 2. Height and weight at birth and at the ages of 1.5 and 3 years, excluding birth weight, were significantly lower in the AP group than in the control group (P < 0.01). 3. The chronological age at the initiation of eruption of the deciduous or permanent teeth did not significantly differ between the two groups. Thus, the AP group showed higher incidences of sleep-disordered breathing and malocclusion than the control group, and development of sleep-disordered breathing at preschool age.

Achondroplasia↗

[Questionnaire survey of dentists who made their own mouthguards].

PURPOSE: Most of the mouthguards on the market are inferior in fit and occlusion related to feeling and injury prevention capacity. Therefore, it is necessary to use appropriate custom-made mouth-guards. This research aimed to obtain data for the selection, improvement, and spread of mouthguards in the future. A questionnaire survey of dentists who had made four kinds of mouthguard was conducted in a mouthguard seminar. METHODS: The questionnaire survey concerning "feeling", "difficulty of production", and "selection when considering use and spread" was done for four kinds of mouthguard. The evaluations were made using a ten-point method with the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: Concerning the feeling: The laminated mouthguard was evaluated the highest, followed in order by improvement type, vacuum, and boil & bite. Concerning the production: The evaluation differed from other questionnaire items. No significant difference was found among all four kinds of mouthguard, so there was no difference in the fabrication difficulty. Concerning the selection and spread: The evaluation was almost the same as for the feeling. The laminated mouthguard was assessed to be the best mouthguard. CONCLUSIONS: The boil & bite mouthguard which is widespread was evaluated the lowest in all items except production. Therefore, it is necessary to encourage players to use an appropriate custom-made type in view of safety, wearing feeling, and dental occlusion.

Dentists↗

Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey.

BACKGROUND: There is a growing interest in the psychosocial work environment of health care staff since they are at high risk for burnout, role conflict and job dissatisfaction. Burnout, as a type of prolonged response to chronic job-related stressors, has a special significance in health care where staff experience both psychological-emotional and physical stress. Burnout and the other negative aspects of the job of health care staff have major behavioural and health implications. OBJECTIVES: The present study investigated the interrelationships among burnout, role conflict and job satisfaction in a sample of Hungarian health care staff. The study also investigated how these indicators of psychosocial work climate influence respondents' frequency of psychosomatic symptoms. DESIGN: A questionnaire survey (anonymous questionnaires) has been carried out to detect these interrelationships. SETTINGS: Two major hospitals in Szeged, Hungary. PARTICIPANTS: Questionnaires were distributed to 450 health care staff among whom 55.7% were registered nurses. All together, 201 questionnaires were returned and analyzed, giving a response rate of 44.6%. METHODS: Questionnaire contained items on work and health-related information (i.e., burnout, job satisfaction, role conflict, and psychosomatic symptoms) and on some basic sociodemographics. Beyond descriptive statistics, correlation and multiple regression analyses were computed. RESULTS: Findings show that emotional exhaustion and depersonalization scores were higher, while scores on personal accomplishment was lower as compared to Canadian, Norwegian or US samples. Burnout, particularly emotional exhaustion (p<.001), was found to be strongly related to job dissatisfaction. Schooling was inversely related to satisfaction with the job (p<.05). While job satisfaction was a negative predictor of each type of burnout subscale (p<.001), role conflict was a factor contributing positively to emotional exhaustion (p<.001) and depersonalization scores (p<.001). CONCLUSIONS: The study results underline the importance of the role of psychosocial work environment and the interrelationships among burnout, role conflict, job satisfaction and psychosomatic health among Hungarian health care staff.

Adult↗

Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment.

A retrospective questionnaire survey of a sample of 173 of the 360 cases of early congenital syphilis reported in 1972 revealed serious problems with diagnostic certainty, prevention, and treatment of congenital syphilis. Only 24 (13.9%) of the reported cases could be categorized as probably or definite cases based on criteria developed from a literature review. Forty percent of the mothers received no prenatal care and an additional 19% received no prenatal care until the third trimester. Initial and followup serologic testing was inadequate in those who received care. Eighty-three different penicillin treatment schedules were used in the treatment of 128 infants. Carefully reasoned diagnostic and therapeutic decision making about the management of congenital syphilis appears to be lacking.

Adolescent↗

[A questionnaire survey on the dissemination of personal exposure monitoring of organic solvents in Japan].

A questionnaire survey on the dissemination of personal exposure monitoring of hazardous chemicals, especially organic solvents, was conducted on 404 Japanese institutions for occupational health and environment, including enterprises, national and municipal institutes, universities and colleges. Responses were received from 236 organizations. The results can be summarized as follows: Of the 236 organizations which responded, 89 (37.7%) had some experience in measuring personal exposure in workers exposed to hazardous chemicals. In 74.2% of these 89 institutions, personal exposure monitoring of organic solvents was being made. Passive dosimeter method was far more commonly employed in Japan than charcoal tube method. Personal exposure measurement is predominantly regarded to be supplementary to the general air sampling and measurement method provided for in the Working Environment Measurement Law (1975). It is considered that personal exposure monitoring would be further disseminated in Japan than today with the aim of improving the health care system for industrial workers and of elucidating epidemiologically the relationship of chemical exposure to biological effects.

Air Pollutants, Occupational↗

[Questionnaire survey in the study of working conditions of machine operators in the agriculture].

A questionnaire survey was undertaken among machine operators in order to determine unfavourable occupational factors, fatigue degree, burden and intensity of labour, capacity for work and their health state. It was established that working conditions had certain influence on operators' organism. The relationship of their body effect on anthropometric data, age and length of service was demonstrated.

Adult↗

The reproducibility of reported height and body weight in repeated questionnaire surveys.

Reproducibility of reported height and weight were studied via repeated questionnaire surveys distributed to subjects within a year. Effects of the factors which might influence the reproducibility of these values were investigated. Although only about half of the subjects reported the same height and 30% the same weight on the second questionnaire, no change was found in average height and weight after a one year interval for both male and female subjects. The reproducibility decreased with age for both height and weight. Smokers tended to have lower reproducibility for height than non-smokers. The shorter subjects had lower height reproducibility than their taller counterparts, while heavier subjects had lower weight reproducibility than light subjects. It was observed that the lower the weight reproducibility, the lower the height reproducibility and vice versa. Reported height or weight figures ending in zero or five were more frequent than the expected 10% with low reproducibility.

Adult↗

[Pediculosis capitis: a questionnaire survey in 4 schools of the Bordeaux Academy 1990-1991].

A questionnaire survey of head lice treatment was conducted in four schools--each including a nursery and an elementary school--in the Bordeaux area. Two schools were situated in the centre of the city, one in a suburban area and one in a rural area (50 km from the city). Four-page questionnaires were filled in anonymously by the parents in April 1991; 840 answers were obtained (80 p. 100 response rate). Between January 1990 and March 1991, 48.7 p. 100 of children had at least one episode of head lice infestation (infestation rates varied from 38.8 to 62.6 p. 100 depending on the schools); 30.5 p. 100 of children were contaminated for the first time during that period. Lice were detected by the parents in 95 p. 100 of the cases. The prevalence of lice was higher in females (60 p. 100) than in males (40 p. 100). The highest prevalence was noted in the suburban school where 17 p. 100 of the parents were unemployed at the time of the survey. The peak age for head lice was 7, but 19.4 p. 100 of nursery school children aged 2-4 years had been contaminated at least once. Impetigo was rare (1.2 p. 100), and pruritus was noted in only 14.2 p. 100 of the cases. Most children had been contaminated at school. Curative treatment was counselled by a chemist in 87 p. 100 of the cases. Pyrethrins were used in 81 p. 100, and the shampoo (Hegor) plus spray (Paraspecial Poux) association was the most frequent, totalling two-thirds of prescriptions.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

Auditing patient experience and satisfaction with neurosurgical care: results of a questionnaire survey.

The objective of this study was to determine the current level of patient satisfaction with neurosurgical services from the time of initial referral to hospital discharge. The survey was camed out by a self-administered postal questionnaire survey from the National Hospital for Neurology and Neurosurgery, London, UK. The participants were 364 patients discharged from the unit within one calendar year. The main outcome measures were level of satisfaction with various aspects of care, as measured by fixed response and free text style questions. Most patients are happy with the waiting time to see a neurosurgeon and the wait for subsequent admission acceptable, but many would have preferred it to be shorter. Twenty-seven had their original admission date cancelled, but most were happy with the explanation offered. Weaknesses in the management of outpatient clinics were highlighted, 35% of patients waiting more than half an hour to be seen. The great majority were happy with various aspects of communication with the neurosurgical team. Few patients were given the opportunity to follow up their visit with literature provided or a visit to a specialist nurse (17 and 9%, respectively). However, both were considered very useful, in particular, 93% highly valued a meeting with the specialist nurse. There was a dichotomy of opinion over the course of the inpatient stay. While most aspects of care received 70-80% satisfaction, the management of discharge received the most criticism. This was thought to represent a pooling of resources around the most needy patients. The majority of patients were discharged home (76%), only a third feeling that staff did everything possible to help this process. Very few received printed information. Again, those who had seen the specialty nurse had much higher levels of satisfaction. Patient satisfaction audit gives useful data on patients' perception and satisfaction with care that may not be apparent on more traditional audit measures such as length of stay, which focus more on a unit's efficiency. This study shows generally high levels of patient satisfaction with neurosurgical practice but highlights areas needing attention and expansion, such as access to a specialist nurse and relevant literature. Dissatisfaction with various administrative arrangements are clearly shown and provide an opportunity for patient centred improvements.

Adult↗

Questionnaire survey and prevalence of intestinal helminthic infections in Barru, Sulawesi, Indonesia.

A questionnaire survey with parasitological study was carried out on the inhabitants of 4 villages in Barru district, Sulawesi, Indonesia from 1994 to 1995. The questionnaire dealt with life style and sanitary conditions. In 482 houses in the 4 villages, interviews for the items of the questionnaire were conducted with the owner, housekeeper and children of the same family. In Pancana and Lalolang, 37.7% and 50% respectively of man inhabitants surveyed were fishermen, while in Lompo Riaja and Pattappa, 38.6% and 65.5% respectively were farmers. The highest proportion of official workers was 33.7% in Lompo Riaja. Educational level was low; 88.4% in Pancana, 90.4% in Lalolang, 62.1% in Lompo Riaja and 91.2% in Pattappa had elementary or below elementary school education. In Lompo Riaja, 30.8% of the inhabitants graduated from senior high school or university. The percentage of families having their own latrine was 30.3% in Pancana, 13.2% in Lalolang, 31.9% in Pattapa and 60% in Lompo Riaja. The people without latrines usually defecated in rice fields, seaside or riverside. A total of 654 fecal samples was examined by the modified Kato-Katz thick smear method. Five nematode species, Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Strongyloides stercoralis and unidentified Rhabditoids of free-living nature were detected. Cestode, Hymenolepis nana infection was confirmed. All the hookworms examined by the modified Harada-Mori culture technic were Necator americanus. Trichuris infection was most common, followed by hookworm and Ascaris infections, both in young (aged 4-14) and older (aged over 15) age groups. The prevalence of hookworm infection was significantly higher in males than in females of older age. Among the older age group, the prevalence of Trichuris infection was significantly lower in Lompo Riaja, while hookworm infection was the highest in Pattappa. Among all the inhabitants examined for parasite infection, 17.4% had 3 kinds of nematode, Ascaris, Trichuris and hookworm. However, egg counts revealed that most of the inhabitants with Trichuris or hookworm had light infections. The inhabitants with higher education background had significantly lower infection rates of Ascaris and Trichuris. The prevalence of hookworm infection was not significantly different between the inhabitants owning latrine and without it, but the prevalence of Ascaris and Trichuris, differed significantly.

Adolescent↗

A questionnaire survey of nematode parasite control practices on goat farms in Denmark.

A questionnaire survey to examine worm control practices on angora and other goat farms in Denmark was undertaken in 1993. Questionnaires were inserted in the July, 1993 issue of the official journal of the angora goat farmers in Denmark (Mohair News) and 72 questionnaires posted directly to other goat farms selected from a list of 150 farms registered with the Goat Breeders Association. Data from 51 angora and 41 other goat farms indicated that anthelmintics were used on more than 80% of the farms. On 51% of the farms, no predetermined drenching programmes were followed. On 72% and 64% of the farms, kids (< 1 year of age) and adult goats (> 1 year old) were drenched 1-3, and two or three times per year, respectively. Only 9% of the farmers used the recommended weight of the heaviest animal in a herd to determine anthelmintic doses for groups of both kids and adult goats. Visual perception which may result in underdosing was used to determine weights for drenching on 41% and 69% of the farms for kids and adult goats, respectively. From 1986 to 1993, Class I anthelmintics (benzimidazoles) were the most commonly used. Anthelmintic classes were not alternated annually on the majority of farms, which would enhance selection for resistance. While the majority of farmers (58%) rotated goats regularly between paddocks, only 21% drenched the goats when being moved. Anthelmintic treatment for newly introduced goats was not carried out on 45% of 55 respondent farms, nine of which had imported stock. This increases the likelihood of introducing resistant worms to the farms.

Administration, Oral↗

Night driving curfews in New York and Louisiana: results of a questionnaire survey.

New York and Louisiana, two states having night driving curfews, were included in a questionnaire survey of high school students conducted in 1983. Most students in these states knew about their curfew law. In both states the majority of licensed drivers said they had violated the curfew, but the majority claimed to have violated the curfew no more than twice. Students do not believe that the police enforce curfew restrictions vigorously, but many parents require their children to obey the law. New York students were more knowledgeable than Louisiana students about the restrictions, and there was more evidence in New York than Louisiana of reduced driving resulting from the curfew. These findings are consistent with results of an earlier study that found curfews in both of these states reduced crashes but estimated crash reductions during curfew hours were greater in New York than in Louisiana.

Accidents, Traffic↗

Oral chemotherapy safety practices at US cancer centres: questionnaire survey.

OBJECTIVE: To characterise current safety practices for the use of oral chemotherapy. DESIGN: Written questionnaire survey of pharmacy directors of cancer centres. SETTING: Comprehensive cancer centres in the United States. RESULTS: Respondents from 42 (78%) of 54 eligible centres completed the survey, after consulting with 89 colleagues. Clinicians at 29 centres used handwritten prescriptions, two used preprinted paper prescriptions, and six used electronic systems for most oral chemotherapy prescribing. For six commonly used oral chemotherapies, on average 10 centres required a diagnosis on the prescription, 11 required the protocol number, four required the cycle number, nine required double checking by a second clinician, 14 required a calculation of body surface area, and 14 required a calculation of dose per square metre of body surface area. Only a third of centres requested patients' written informed consent when oral chemotherapy was given off protocol. Nearly a quarter (10) of centres had no formal process for monitoring patients' adherence. In the past year respondents at 10 centres reported at least one serious adverse drug event related to oral chemotherapy, and respondents at 13 centres reported a serious near miss. CONCLUSION: Few of the safeguards routinely used for infusion chemotherapy have been adopted for oral chemotherapy at US cancer centres. There is currently no consensus at these centres about safe medication practices for oral chemotherapy.

Administration, Oral↗

[Analyses of work-relatedness of health problems among truck drivers by questionnaire survey].

In order to estimate occupational risk factors for health problems among truck drivers, a questionnaire survey of working conditions, job content in truck transportation, subjective symptoms and present illnesses was carried out among 541 truck transportation workers in 1997. The valid response rate was 85.7%, and 134 local truck drivers, 199 long-distance truck drivers and 71 clerical workers were analyzed. First, to examine occupational risk factors and health problems among the three groups, the authors analyzed working conditions, job content in truck transportation, subjective symptoms and present illnesses. Second, to estimate the work-relatedness of health problems among local truck drivers and long-distance truck drivers, logistic regression analyses were conducted, and odds ratios and 95% confidence intervals were computed. The prevalence rates of working factors affecting health problems of truck drivers were significantly higher than those of clerical workers in the items on irregular shift work, working environment, working posture, handling heavy materials, job stress due to overloading and long working time and limited time off. The prevalence rates for subjective symptoms (ringing in the ears, neck pain and low back pain) and present illnesses (hypertension, ulcers in the digestive tract, back injuries, whiplash injuries and hemorrhoids) among truck drivers were significantly higher than those of clerical workers. In logistic regression analyses, many work-related items except age, BMI and smoking habit showed significantly higher odds ratios for subjective symptoms and present illnesses of truck drivers. Odds ratios for hypertension, heart diseases and related subjective symptoms among local truck drivers were significantly increased by job career, twisting posture, vibration and driving stress. Odds ratios for gastro-duodenal diseases and related subjective symptoms were significantly increased by narrow working space, sleeping in the truck, driving distance, squatting posture and driving stress. Odds ratios for ringing in the ears among local truck drivers were significantly increased by job career, long working time, narrow working space, sleeping in the truck and driving stress. Odds ratios for musculo-skeletal diseases and related subjective symptoms were significantly increased by overwork, vibration, narrow working space, sitting posture and shortage of recess. Odds ratios for fatigue symptoms were significantly increased by the shortage of recess, vibration and driving stress. In order to cope with the health problems of truck drivers, it is recommended that working conditions and work loads for among truck drivers as described above be improved.

Automobile Driving↗