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PubMed1999

Study of Hypertensive Prescribing Practices (SHyPP): A National Survey of Primary Care Physicians.

BACKGROUND: Approximately 50 million people in the U.S. have hypertension. The Joint National Committee (JNC V) guidelines provide treatment recommendations for hypertension. These guidelines promote initiating therapy with diuretics and Ã -blockers because these agents have been shown to reduce hypertension related morbidity and mortality. OBJECTIVES: To survey primary care physicians' antihypertensive prescribing practices, their perceptions about antihypertensive medication cost and safety, and their perceptions of the effects of managed care. DESIGN: A direct mail survey was distributed to a national random sample of 500 office based, primary care internists, family practitioners, and general practitioners. RESULTS: 72% of the physicians who responded reported being aware of the JNC V guidelines. Younger physicians claimed to be more aware of and more likely to follow JNC V guidelines than older physicians. Only 25% of physicians reported initiating treatment at systolic blood pressures greater than 140 mm Hg as recommended by the JNC V guidelines. Most physicians reported initiating treatment at higher pressures. Diuretics were selected for initial antihypertensive treatment by 36% of physicians, ACE inhibitors by 35%, Ã -blockers by 16%, and calcium channel blockers (CCBs) by 7%. Up to 27% of physicians admitted not knowing the cost of specific medications. Approximately half of the physicians reported that they and their patients were more concerned about medication cost and safety today than 18 months ago. A greater number of younger physicians reported that managed care formularies infringed upon their prescribing practices. CONCLUSIONS: Antihypertensive prescribing patterns are inconsistent with JNC V guidelines. Actual practice may deviate even more from these guidelines than reported in this survey. Also, physicians perceive that managed care is increasingly affecting their prescribing practices. (c)1999 by Le Jacq Communications, Inc.

Journal Article↗

PubMedDate not supplied

Injection rates for neuroangiography: results of a survey.

BACKGROUND AND PURPOSE: Injection rates have attracted scrutiny because of an incident of an aneurysm rupturing during arteriography. We sought to determine the current injection rates for neuroangiography in the setting of aneurysm evaluation. METHODS: An e-mail survey was distributed to 90 neuroradiology program directors within the United States and Canada. The injection rates and total volumes of contrast material injected for the common carotid, internal carotid, and vertebral arteries were provided for an "average" adult individual evaluated for intracranial aneurysms. RESULTS: Sixty-three (70.0%) program directors replied to the survey. Of these, five perform hand injections only and provided approximate values. The mean injection rates (SD) and total volumes (SD) for common carotid arteries were 7.2 cm(3)/s (1.8) and 9.9 cm(3) (2.0), respectively; for internal carotid arteries, 5.8 cm(3)/s (1.4) and 7.9 cm(3) (1.5); and for vertebral arteries, 5.4 cm(3)/s (1.2) and 7.8 cm(3) (1.7). The modes (rate/total) for the common carotid, internal carotid, and vertebral arteries were 7/12, 6/8, and 5/8, respectively. Forty-eight (81.4%) of 59 respondents did not believe a reduction in current injection rates would lead to a diminution in complications of arteriography. CONCLUSION: The rates of injection of contrast material in the United States for neuroradiologic studies show great variability. It does not seem that reducing arteriographic complications is an impetus to reduce injection rates. The values in this survey can provide "industry norms" for injections in the common carotid, internal carotid, and vertebral arteries if these rates are challenged.

Canada↗

PubMed2003

Follow-up of deaths among U.S. Postal Service workers potentially exposed to Bacillus anthracis--District of Columbia, 2001-2002.

In October 2001, two letters contaminated with Bacillus anthracis spores were processed by mechanical and manual methods at the U.S. Postal Service (USPS) Brentwood Mail Processing and Distribution Center in the District of Columbia. Four postal workers at the Brentwood facility became ill with what was diagnosed eventually as inhalational anthrax; two died. The facility was closed on October 21, and postexposure prophylaxis was recommended for approximately 2,500 workers and business visitors. Subsequent reports of deaths of facility workers prompted concern about whether mortality was unusually high among workers, perhaps related to the anthrax attacks. To evaluate the rates and causes of death among workers at the Brentwood facility during October 12, 2001-October 11, 2002, CDC, in collaboration with state and local health departments, analyzed death certificate data. In addition, these data were compared with aggregate mortality data from the five USPS facilities contaminated with B. anthracis during the fall 2001 anthrax attacks. This report summarizes the results of that analysis, which indicate that rates and causes of death among Brentwood workers during the 12 months after the anthrax attacks of 2001 were not different from rates and causes of deaths that occurred during the preceding 5 years.

Anthrax↗

PubMedDate not supplied

Development of a tool to measure subjective time experience.

Although variations in time experience in specific health-illness situations have been documented, the information has not been systematically described. This is due in part to lack of reliable and valid measurement of time experience. This article, which reports the development and testing of Time Experience Scales (TES) in a sample of healthy adults, represents preliminary work in the identification of temporal experience in ill persons. Subjective time experience was defined as thoughts and feelings about the temporal frame in which life events occur. Semantic differential and Likert scale items indicated four conceptual dimensions of subjective time experience. A mail questionnaire was distributed to a purposive sample of community-based healthy adults. Data were analyzed separately for men (n = 587) and women (n = 475). Factor analysis methods resulted in the emergence of six robust empirical factors: meaning, fast tempo, slow tempo, attention to death, future orientation, and past orientation. Product moment correlations between scales (.01 to .45) indicated the validity, and coefficient alpha (.68 to .88) the reliability of measurement, using the factors. Results suggest that at least six distinct temporal experiences help people assign order, rhythm, and meaning to life events, thereby creating a continuing and optimal life story. Further reliability and validity testing is suggested.

Adolescent↗

PubMed1983

Health educational aspects of preventive dental programs for school-age children in 34 countries--final results of an FDI international survey.

The survey was conducted as part of a project of the Working Group on Oral Health Promotion of CORE, in order to provide a basis for the FDI to plan ways to assist its member associations in developing successful preventive dental programs for school-age children. Mail questionnaires were distributed through national dental associations and completed by dental program directors. A total of 119 responses from 34 countries has been analysed. The programs reported tended to be young, supported by public funds, carried out in schools and part of ongoing agency or organizational programs. Instructional activities were the most frequently mentioned service provided routinely for all children, followed by early detection and treatment services. Primary preventive services appeared to be provided least frequently. About 60 per cent of programs served children drinking water from central sources, but only 16 per cent of programs served children drinking optimally fluoridated water. Water fluoridation was the most frequently mentioned procedure that respondents would have liked to see added or extended if additional resources were to be made available. Program organization was the most frequently mentioned reason for program success. The five most frequently mentioned barriers were insufficient financial resources (most often cited), manpower limitations, low public acceptance, non-supportive attitudes among policy makers and inadequate facilities. As a result of the survey three major needs were identified: (1) the need for more efficient application of known effective primary protective methods, especially against dental caries; (2) the need to improve the correspondence between program objectives, the types of services provided and the evaluation methods used to assess and evaluate program achievements; and (3) the need for greater understanding of the scope of community health educational aspects of oral health, prevention and dental treatment. Specification of these and similar problems should lead the FDI working group to recommend priorities on the type of assistance to provide to member nations and the manner of its provision, perhaps in concert with the World Health Organization and the International Association for Dental Research.

Child↗

PubMedDate not supplied

Community pharmacists' participation in health education and disease prevention activities.

Community pharmacists are faced with many opportunities to participate in health education and disease prevention activities. This study sought to determine the extent to which community pharmacists in British Columbia participate in such activities. A mail questionnaire was distributed to a systematic, stratified sample of 625 community pharmacists in B.C. (response rate = 83.6%). A five-point Likert-type scale was used to examine the frequencies of pharmacist involvement in 33 different health education/disease prevention activities. Results of the study indicate that pharmacists most frequently participate in health education/disease-preventing activities directly related to the dispensing or selling of medications. Activities exhibiting the lowest participation among pharmacists included speaking to community groups on health-related matters, participating in disease screening programs, querying clients on their level of occupational stress, counselling clients on AIDS prevention, and querying clients on their smoking status.

British Columbia↗

PubMedDate not supplied

How much do health care providers know about AIDS?

We sent a survey to more than 8,000 New Jersey health professionals to collect information on their knowledge level, attitudes, and prevention practices relating to the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS). The surveys were distributed through the mail in three separate waves with a postcard reminder. A total of 2,725 individuals provided completed questionnaires (34% response rate). We assessed the AIDS and HIV-related knowledge level of these health professionals, compared their knowledge levels, and identified variables that predict a high level of knowledge. The overall test scores indicate a definite need for AIDS education among these health professionals; on average, doctors answered 71% of the knowledge items correctly; dentists, 66%; and nurses, 65%. Doctors scored higher than the other health professionals on almost all of the 38 items relating to the epidemiological aspects of HIV, transmission, identification and reporting of HIV disease and AIDS, and assessment of HIV-associated risks. The multivariate regression model explained 24% of the variability in knowledge score (P = .0001) and identified the following independent variables as significant predictors of knowledge score: age, race, marital status, religious beliefs, political orientation, professional group, average number of hours worked each week, experience with HIV+/AIDS patients, knowledge self-assessment, and sources of AIDS information.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Quantitative and qualitative differences between handout and mailed patient satisfaction surveys.

BACKGROUND: Patient satisfaction surveys are widely used to measure patients' opinions of the quality of the health care they have received. There are a variety of methods for distributing patient satisfaction surveys. Different distribution methods may yield significantly different satisfaction ratings. OBJECTIVE: We sought to compare survey ratings obtained via 2 distribution methods: handout versus mailed. DESIGN: Patients were randomized to receive either a handout survey or a mailed survey. SUBJECTS: Patients who had an appointment with a family practice provider in one of the regional outpatient centers of a large medical clinic during a 3-week period. MEASURES: An 11-item visit-specific patient satisfaction survey was used to survey patient satisfaction. RESULTS: Handout surveys yielded higher satisfaction scores than mailed surveys. The response rate was higher with handout surveys than with mailed surveys. However, handout surveys were returned with more skipped questions, a lower variation in ratings, and fewer written comments than the mailed surveys. CONCLUSIONS: Both quantitative and qualitative differences between the 2 distribution methods were revealed. Attempts to compare data obtained from the 2 different distribution methods need to be approached with caution.

Adolescent↗

PubMed2001

A survey of patient-provider e-mail communication: what do patients think?

Communication between patients and providers forms the backbone of the patient-provider relationship. Often such communication is strained due to time and space limitations on the part of both patients and providers. Many healthcare organizations are developing secure e-mail communication facilities to allow patients to exchange e-mail messages with their providers. Providers are worried that opening such lines of communication will inundate them with vast quantities of e-mail from their patients. Patients are worried that their messages will be intercepted and read by unauthorized people. In an attempt to determine how a group of internet-active, e-mail-ready patients currently use, or potentially view, the ability to exchange e-mail messages with their health care providers, we distributed a survey via e-mail to over 9500 patients. After determining each patient's e-mail activity level (based on the number of messages sent each day), we asked questions such as: "Have you ever sent e-mail to your provider?" "What issues or concerns have prevented you from sending e-mail messages to your provider?" "If your provider were to tell you that someone in his/her office may screen, read or perhaps reply to your message before he/she sees it, to what extent would you be concerned about this?" and "How would you rate your overall satisfaction with the use of e-mail to communicate with your provider?" Results from the survey indicate that nearly 85% of the patients surveyed send at least one e-mail message per day, but that very few (i.e. 6%) of the patients have actually sent an e-mail message to their provider. Interestingly, over half of the patients indicated that they would like to send their providers e-mail, but that they do not know their provider's e-mail address.

Chi-Square Distribution↗

PubMed2003

Teaching operative dictation. A survey of obstetrics/gynecology residency program directors.

OBJECTIVE: To assess current efforts to teach operative dictation in obstetrics and gynecology residency programs. STUDY DESIGN: A survey detailing the didactics of operative dictation was distributed in a single mailing to all program directors listed in the roster of the Council on Residency Education in Obstetrics and Gynecology. RESULTS: Of 274 surveys distributed, 115 (42%) were returned. Ten percent of program directors reported defined curricula related to operative dictation. Using a combination of lectures, personal instruction and review of previous notes, attendings and senior residents share the responsibility for teaching operative dictation in the majority (78%) of programs. Sixty percent of program directors were in favor of more formal guidelines for residency education in the technique of operative dictation, 34% were opposed, and 6% offered no opinion. CONCLUSION: Obstetrics and gynecology residency programs rarely have a structured curriculum for teaching operative dictation, and the majority of program directors support the institution of more formal guidelines.

Clinical Competence↗

PubMed2004

An assessment of high school cheerleading: injury distribution, frequency, and associated factors.

STUDY DESIGN: Mail survey of cheerleading-related training and injuries. OBJECTIVE: To collect and describe injury frequency, distribution, and associated factors related to the activity of cheerleading. BACKGROUND: Estimates indicate that more than 1 million participants are involved in cheerleading at various levels; however, little information exists relative to injuries and training. Unlike most other sports, cheerleader injuries are not tracked in a central database. METHODS AND MEASURES: High school cheerleaders (mean age, 16.3 years) in 3 midwest states completed questionnaires mailed to their respective high schools. Of the surveys mailed to 104 schools, 425 (32.2%) were returned and sufficiently completed for analysis. RESULTS: Participants reported an average of 4.1 years of experience and 61.9% of the respondents had sustained 1 or more career injury. During the previous year, 41.3% had sustained 1 or more injuries (mean +/- SD, 1.7 +/- 1.9), resulting in an average of 3.4 reported missed practice or performance days. Of all injuries, the ankle (24.4%), back (16.1%), and wrist or hand (15.6%) were the most frequent sites of injury. CONCLUSION: The rates of injury in cheerleading are comparable to rates of other sports. To accurately provide safety guidelines for all levels of cheerleading, a nationwide injury tracking system is necessary.

Adolescent↗

PubMed1983

A comparison of the practices used for distribution of controlled substances in Massachusetts hospitals with those reported nationally.

A survey questionnaire concerning the procedures used to distribute controlled substances was mailed to 100 randomly selected Massachusetts hospital pharmacies. The tabulated results were compared to a similar study surveying 285 short-term medical and surgical hospitals nationwide. Of the 58 responding hospitals, 47 (81%) reported controlling either all or some Schedule III Controlled Substances in a manner similar to that used for the distribution and accountability of Schedule II drugs. A total of 42 (72%) reported maintaining the same systems for Schedule IV agents. In contrast, only 24 (42%) of those respondents reported controlling Schedule V drugs in a manner similar to Schedule II Controlled Substances. Similar to the findings of a nationwide study, many of the responding Massachusetts hospitals reported selective inclusion of those Schedule III, IV, and V drugs possessing an increased risk of illicit diversion into a more controlled distribution system. In conclusion, many Massachusetts hospitals distribute and account for controlled substances in a manner similar to that used nationwide.

Drug and Narcotic Control↗

PubMed2000

Formation and current results of a patient-organized registry for alpha(1)-antitrypsin deficiency.

BACKGROUND: Significant challenges exist to investigating uncommon illnesses because too few patients are seen at any single clinical center to permit appropriate research studies. Recognizing this impediment to clinical research in alpha(1)-antitrypsin deficiency, the Alpha One Foundation, a patient-organized research foundation, has collaborated with clinician-scientists to organize a voluntary registry of individuals with alpha(1)-antitrypsin deficiency. PURPOSE: To facilitate clinical research in alpha(1)-antitrypsin deficiency by organizing a registry of affected individuals willing to be approached to participate in clinical studies. METHODS: Elements of the Alpha One Foundation Research Network Registry include a Medical and Scientific Advisory Committee, composed of physician-investigators and patient advocates, designated clinical resource centers at medical institutions with expertise in the management of individuals with alpha(1)-antitrypsin deficiency, and a data coordinating center with responsibility for database management and analysis. Questionnaires requesting information about demographic features, alpha(1)-antitrypsin phenotype, smoking history, and health-care utilization were distributed to prospective registrants through the following channels: mailings from the Alpha One Foundation; mailings from the clinical resource centers; and distribution by home-care and pharmaceutical companies. Information from this questionnaire formed the basis of the initial registry database. RESULTS: Between May 1997 and June 1999, 7,789 forms were distributed, and forms were returned by 712 unique registrants. Registrants have the following characteristics: mean (+/- SD) age, 49.3+/-13.2 years; women, 47.7%; white, 96.2%; PI*ZZ phenotype, 70.7%; ex-smokers, 73.3%; COPD patients, 87.2% (emphysema patients, 54.2%; chronic bronchitis patients, 33%); and self-reported liver disease, 6.4%. The mean number of physician visits reported by registrants in the preceding 12 months was 7.8+/-9.4, 59% reported currently receiving IV augmentation therapy, and 35% reported using supplemental oxygen at home. Examples of ongoing research studies using this unique database include: (1) a case-control study to evaluate occupational risk factors for obstructive lung disease in individuals with alpha(1)-antitrypsin deficiency and (2) a study to evaluate the health-care costs for affected individuals. CONCLUSIONS: A registry currently including 712 individuals with alpha(1)-antitrypsin deficiency has been organized through a collaboration between physician-investigators and a patient-organized research foundation. Use of the registry has already facilitated studies that were previously difficult because of the paucity of identifiable study subjects. The registry cohort promises to provide an important resource for future clinical and epidemiologic studies.

Clinical Trials as Topic↗

PubMed2005

Questionnaire study of canine neutering techniques taught in UK veterinary schools and those used in practice.

OBJECTIVES: To gather information about the different techniques employed in general practice and to compare this with current undergraduate teaching. This would provide an insight into any areas of discrepancy and influences on technique in practice. METHODS: A questionnaire was composed and distributed to 407 practices throughout the UK, using a commercial mailing list. Fifty further questionnaires were distributed by final-year students to their foster practices and five were sent to practices on request. A second questionnaire was composed and sent to the members of staff responsible for teaching surgical neutering techniques at each of the UK veterinary schools. RESULTS: Completed questionnaires were received from 183 respondents. These were compared with seven questionnaires from university teachers. Only areas in which the teachers reached a consensus of opinion were directly compared. CLINICAL SIGNIFICANCE: Several areas of discrepancy between current teaching and techniques in practice were identified. A study of complications compared with technique would provide further information. There is a lack of published material or an evidence base in many aspects of surgical neutering to support one technique over another.

Animals↗

PubMed1995

Factors promoting completion of advance directives in the hospital.

BACKGROUND: The 1991 Patient Self-Determination Act required health care providers to give patients information about advance directives. OBJECTIVES: To investigate whether the requirement to distribute information to hospital patients increased completion of the health care proxy. To also explore factors that might influence use of advance directives, including demographic variables and methods of informing patients about the directives. PATIENTS AND METHODS: We interviewed 419 randomly selected patients who were admitted for a planned admission to two tertiary care, teaching hospitals. Patients at one hospital received proxy information before the day of admission, at a pretesting visit, or by mail. The other hospital distributed the proxy information only on the day of admission. RESULTS: Before receiving hospital materials, 17% of all patients had completed proxies. After receiving hospital proxy forms, an additional 40% completed proxies at the hospital that distributed forms before the day of admission. Only 4% of the patients completed proxies at the hospital that distributed information only on the day of admission. The most frequently cited barrier to completion of a proxy was not seeing the form. Few patients said they did not want to think about the subject. CONCLUSIONS: Completion rates for advance directives may be markedly improved by altering the time for distributing information to patients admitted to the hospital for a planned admission. Patients were more likely to complete a proxy in the hospital that distributed the form in advance of the day of admission, a result that was unexplained by other variables in the study. Although many patients would prefer to receive information about advance directives during an office visit with a physician, hospitalization can provide a valuable opportunity for many patients to complete directives.

Adult↗

PubMed1977

Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners.

A mailed survey questionnaire was distributed to the North Carolina Academy of Family Physicians to assess their orthopedic training and their opinions of the orthopedic training of resident physicians in family practice. Approximately 300 questionnaires were analyzed and the spectrum of orthopedic activities in office, hospital, and community were tabulated. There was no significant geographic variation in practice within the state for these variables, but there were statistis in their management and referral practice of several patient problems. Seventy percent of respondents thought that their training in orthopedics was appropriate to their present practice, but half felt that their training was inadequate. Most of the respondents (57 percent) had less than one month of postgraduate training in orthopedics. The majority (68 percent) recommended some postgraduate training in orthopedics, with about 50 percent recommending one to three months of postgraduate training. The mail survey questionnaire is proposed as a useful aid in curricular design in family practice.

Education, Medical↗

PubMedDate not supplied

Attitudes and expectations about music therapy for premature infants among staff in a neonatal intensive care unit.

BACKGROUND: Music appears to reduce stress in premature infants, but little is known about the attitudes and expectations about music among clinicians caring for these infants. The study questions were: a) would staff like to have music played in the Neonatal Intensive Care Unit (NICU), b) would they prefer live to recorded music, and c) how would their attitudes be affected by their profession and experience? DESIGN: Cross sectional survey of NICU staff in the winter of 2003. METHODS: Eligible subjects were 37 physicians and 150 nurses and other clinical staff in the NICU. After pilot testing and revision, the self-administered questionnaires contained 57 Likert type or multiple choice items. They were distributed by e-mail and in staff mailboxes with two reminders. Data were analyzed using simple descriptive statistics, Chi-square, and logistic regression. RESULTS: The response rate was 75%. Most were nurses and 27 were MD's. Most (84%) were female and most (70%) reported some previous musical training. The majority (68%) agreed that they would like to have music played in the NICU. Most agreed that music could reduce stress (86%) and crying (79%) and improve sleep (79%) in premature infants. Recorded was preferred to live music by more than 2:1. Attitudes were significantly associated with prior musical training, experience, and profession. CONCLUSIONS: NICU staff holds favorable attitudes toward music for premature infants. Music's effects on caregiver attitudes, mood and behavior may contribute to its impact on infants. Evaluation of the effects of music on infants needs to account for caregiver's expectations and behavior as well as direct effects on infants' physiology.

Adult↗

PubMed2005

Treatment of pediatric febrile neutropenia in the era of vancomycin-resistant microbes.

PURPOSE: The increasing frequency of Gm(+) infections in febrile neutropenic (FN) patients has resulted in increased use of vancomycin (VN). Likely as a result, VN-resistant Enterococcus (VRE) has become a significant concern in FN patients. We sought to understand how the emergence of VN resistant microbes has changed the antibiotic management of pediatric FN. METHODS: A questionnaire was distributed by e-mail to responsible investigators of the Children's Oncology Group. RESULTS: One hundred and thirty responses were analyzed. Forty-four percent initially used monotherapy, with 82% of those using ceftazidime. Twenty-seven used VN with another agent, generally ceftazidime. After the emergence of VRE and VN-resistant staphylococcus (VRS), monotherapy increased to 58%. Ceftazidime continued to be most frequently used. There was a 57% reduction in the use of VN with 88% of centers not currently using VN in their initial treatment of FN. Forty-seven percent of the centers that continue to use VN have VRE, while 90% that have discontinued its use have VRE/VRS. CONCLUSIONS: Ours is the first study to survey current practices in the treatment of pediatric FN and to document changes in practice patterns due to emerging antibiotic resistance patterns. We demonstrate increased use of monotherapy for FN, and a 57% decrease in the use of VN. Local considerations influence antibiotic choices with a significant difference in VRE prevalence between those centers that continue to use VN as compared to those that have discontinued it.

Anti-Bacterial Agents↗