Follow-up Questionnaire Survey Research Articles

Incidence of chemotherapy-induced amenorrhea in premenopausal patients with breast cancer following adjuvant anthracycline and taxane

The purpose of this study was to determine the incidence of amenorrhea among breast cancer patients aged 40years and younger following adjuvant chemotherapy. A follow-up questionnaire survey was conducted with premenopausal women with breast cancer who were treated with adjuvant anthracycline and taxane-based chemotherapy. In total, 66 women were retrospectively reviewed. Forty-nine patients were treated with a regimen containing anthracycline followed by taxane and 17 patients with anthracycline alone. Fifty-eight patients (87.9%) experienced amenorrhea during chemotherapy; 14 patients (21.2%) had persistent amenorrhea after chemotherapy. The incidence of amenorrhea during chemotherapy and persistent amenorrhea was higher in patients older than 36 than in younger patients (97.9 vs. 63.2%, 27.7 vs. 5.3%). Additional taxane resulted in a higher incidence of amenorrhea compared with anthracycline-containing regimen alone (93.9 vs. 70.6%). Multivariate analysis showed that age (≥36years) was independently associated with the incidences of amenorrhea during chemotherapy (p=0.007). Age was the strongest predictor of the incidence of amenorrhea during chemotherapy. It is unclear whether additional taxane may contribute to amenorrhea. This information could be useful in deciding whether to use adjuvant chemotherapy.

Results of 7302 stapled haemorrhoidectomy operations in a single centre: a seven-year review and follow-up questionnaire survey

This study aims to evaluate the results of all 7302 stapled haemorrhoidectomy operations performed in a single centre. A retrospective review of all 7302 patients who underwent stapled haemorrhoidectomy at our department over seven years was conducted. The hospital database was reviewed for subsequent readmissions and re-operations. A questionnaire survey was also sent out to all the patients. A total of 302 patients (4.1%) were admitted with post-operative bleeding and 281 stopped with conservative measures. Twenty one required surgical haemostasis. A total of 301 patients (4.1%) were admitted for an inability to void and 191 (2.6%) had true acute retention of urine, requiring catheterization. There were 124 patients (1.7%) admitted for pain, but all resolved with oral analgesia subsequently. Anal stricture requiring surgery occurred in only 86 patients (1.2%). Serious complications such as staple line dehiscence or anorectal sepsis occurred in seven patients. There were a total of 14 recurrences requiring readmission over this seven-year period, of which 12 were treated successfully with a second haemorrhoidectomy. A total of 1834 patients returned their questionnaire surveys and 95% of the patients reported complete resolution or improvement of their symptoms. Only 27 patients reported subsequent severe bleeding requiring medical attention. Stapled haemorrhoidectomy is safe, and most patients are satisfied with the long-term outcome.

Positive predictive values for self-reported fractures in an adult Japanese population

Self-reporting provides useful information for assessing the risk factors of osteoporotic fractures in large cohort studies. However, to data, no studies in Japan have confirmed the accuracy of this approach in this context. The aim of the study reported here was to determine the positive predictive value (PPV) for the self-reporting of fractures. A total of 133 participants of the Oguni cohort in the Japan Public Health Center-based Prospective Study who reported a vertebral, upper limb, or hip fracture on the 15-year follow-up questionnaire survey were evaluated. The accuracy of fractures was confirmed by cross-referencing medical records. The average age of the participants was 72.4 (standard deviation 7.9) years. The PPV for vertebral fracture in the last 15 years was 17/20 (85.0%) for women and 2/9 (22.2%) for men, for a total of 19/29 (65.5%). PPVs for upper limb and hip fractures were as low as 30/68 (44.1%) and 12/22 (54.5%), respectively. Female self-reporting provided PPVs suitable for symptomatic vertebral fracture over 15 years and can be used as an outcome measure in large cohort studies in Japan.

Efficacy of genotype notification to Japanese smokers on smoking cessation—An intervention study at workplace

Objectives: It is well-known that smoking causes many diseases including cancers. Informing smokers of their genotypes associated with the vulnerability to the harms of smoking may be effective measures for smoking cessation. The present study examined the effects of genotype notification of an oncogene (L-myc) genotype to smokers on their behavior to quit smoking. Methods: Subjects were 562 employees of a bank who answered to be a smoker for a questionnaire used at annual health checkup at workplace from July to December 2002. Those enrolled on August, October, and December were allocated into the genotype notification group (intervention group), and the rest into the controls. Among 286 smokers allocated into the intervention group, 257 participants (89.9%) agreed to genotype testing. One year after the enrollment, a follow-up questionnaire survey was conducted for all smokers including controls. Results: Those who stated to have quitted smoking were 22 (8.0%) among the 276 controls and 15 (5.8%) among the 257 genotype notified participants, providing that the odds ratio (OR) of cessation for the intervention was 0.64 (95% confidence interval, 0.32–1.28). No psychological problems associated with genotype notification were observed. Conclusion: The present study did not show positive effects of genotype notification on smoking cessation rate. To elevate the cessation rate, methods to explain and notify genotypes should be improved.

Calculating the costs of work-based training: The case of NHS Cadet Schemes

Background The worldwide shortage of registered nurses [Buchan, J., Calman, L., 2004. The Global Shortage of Registered Nurses: An Overview of Issues And Actions. International Council of Nurses, Geneva] points to the need for initiatives which increase access to the profession, in particular, to those sections of the population who traditionally do not enter nursing. This paper reports findings on the costs associated with one such initiative, the British National Health Service (NHS) Cadet Scheme, designed to provide a mechanism for entry into nurse training for young people without conventional academic qualifications. The paper illustrates an approach to costing work-based learning interventions which offsets the value attributed to trainees’ work against their training costs. Objective To provide a preliminary evaluation of the cost of the NHS Cadet Scheme initiative. Data source Questionnaire survey of the leaders of all cadet schemes in England ( n=62, 100% response) in December 2002 to collect financial information and data on progression of cadets through the scheme, and a follow-up questionnaire survey of the same scheme leaders to improve the quality of information, which was completed in January 2004 ( n=56, 59% response). Principal findings The mean cost of producing a cadet to progress successfully through the scheme and onto a pre-registration nursing programme depends substantially on the value of their contribution to healthcare work during training and the progression rate of students through the scheme. The findings from this evaluation suggest that these factors varied very widely across the 62 schemes. Established schemes have, on average, lower attrition and higher progression rates than more recently established schemes. Using these rates, we estimate that on maturity, a cadet scheme will progress approximately 60% of students into pre-registration nurse training. Conclusions As comparative information was not available from similar initiatives that provide access to nurse training, it was not possible to calculate the cost effectiveness of NHS Cadet Schemes. However, this study does show that those cadet schemes which have the potential to offer better value for money, are those where the progression rates are good and where the practical training of cadets is organised such that cadets meet the needs of patients which might otherwise have to be met by non-professionally qualified staff.

Conflicting human interests over the re-introduction of endangered wild dogs in South Africa

In South Africa, a plan was launched to manage separate sub-populations of endangered African wild dogs (Lycaon pictus) in several small, geographically isolated, conservation areas as a single meta-population. This intensive management approach involves the re-introduction of wild dogs into suitable conservation areas and periodic translocations among them. To assess the attitudes towards re-introduced wild dogs, we conducted a questionnaire survey of multiple stakeholders—local community members, private landowners and tourists—in and around Hluhluwe-iMfolozi Park (HiP), one of the meta-population conservation areas. Here, we document conflicting human interests over the re-introduced wild dogs. Tourists in HiP, on the one hand, expressed overwhelmingly positive opinions about wild dogs across personal details of the respondents, but especially after having seen free-ranging wild dogs. On the other hand, we found misconceptions and perceptions that were more negative among the rural population around HiP, again largely independent of personal details of the participants, although educated respondents voiced more favourable views of wild dogs. These negative attitudes were in particular due to perceived and real threats of livestock losses. In a follow-up questionnaire survey, we also discovered apparent shortcomings of a previous short-lived conservation education programme among the local communities adjacent to HiP. Consequently, the mitigation of the conflict between wild dogs and rural people requires an understanding of the conditions under which livestock predation occurs, the encouragement of practices that prevent such predation, and increasing local tolerance of co-existence with wild dogs through both economic and non-monetary incentive schemes as well as continued conservation education.

Promoting safety

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The programme involved two-day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team-working skills would advantage the respective groups when conducting RCAs. Responses to a 2005 follow-up questionnaire survey of doctors (n = 53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs. Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar. Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting. There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed. Few longer-term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood.

Ensemble predictions and perceptions of risk, uncertainty, and error in flood forecasting

Under the auspices of the World Meteorological Organization, there are a number of international initiatives to promote the development and use of so-called ensemble prediction systems (EPS) for flood forecasting. The campaign to apply these meteorological techniques to flood forecasting raises important questions about how the probabilistic information these systems provide can be used for what in operational terms is typically a binary decision of whether or not to issue a flood warning. To explore these issues, we report on the results of a series of focus group discussions conducted with operational flood forecasters from across Europe on behalf of the European Flood Alert System. Working in small groups to simulate operational conditions, forecasters engaged in a series of carefully designed forecasting exercises using various different combinations of actual data from real events. Focus group data was supplemented by a follow-up questionnaire survey exploring how flood forecasters understand risk, uncertainty, and error. Results suggest that flood forecasters may not instinctively use ensemble predictions in the way that promoters of EPS perhaps think they should. The paper concludes by exploring the implications of these divergent ‘epistemic cultures’ for efforts to apply ensemble prediction techniques developed in the context of weather forecasting to the rather different one of flood forecasting.

Research on promotion of management of children with psychosomatic and psychosocial disorders in Japan

The number of children with psychosomatic and psychosocial disorders has been increasing in Japan. There are, however, few trained pediatricians who have adequate knowledge of the treatment needed. The Research Group on the Promotion of Management of Children with Psychosomatic and Psychosocial Disorders carried out the present study to (i) disseminate knowledge about psychosomatic and psychosocial disorders of children; and (ii) establish a community-based network model to ensure effective communication among relevant institutions. To disseminate knowledge of the psychosocial and psychosomatic disorders, the Research Group compiled the Handbook for Psychosomatic Disorders of Children and distributed it to pediatricians throughout Japan. A follow-up questionnaire survey was then carried out. Also, in order to examine the current status of the communication network between pediatricians and the related institutions, the Research Group conducted a questionnaire survey on general pediatricians. Sixty-five percent of the respondents indicated that they were actually using the Handbook. The topics in the Handbook that were most frequently referred to by the respondents were attention deficit hyperactivity disorders, school refusal, eating disorders, and orthostatic dysregulation. Thirty-seven percent of the participants indicated changes in their behavior towards psychosomatic and psychosocial problems. The results of the survey on communication networks found that the pediatricians generally collaborated with different institutions depending on the nature of the problems, such as school refusal and bullying, developmental disorders, child abuse and maltreatment, and others. Promotion of the Handbook would greatly contribute to improving the management of children with psychosomatic and psychosocial disorders, together with the construction of the basic network model for management of these children.

Initial Impact of a Dedicated Postgraduate Laparoscopic Mini-Residency on Clinical Practice Patterns

Laparoscopic surgical techniques are difficult to master, especially for surgeons who did not receive this type of training during their residencies. We have established a 5-day mentor-preceptor- proctor-guided postgraduate "mini-residency" (M-R) experience in minimally invasive surgery. The initial results from the first 16 participants in the laparoscopic M-R modules are presented. On the first and the last day of the M-R, all participants underwent surgical skills testing using an open-surgery, standard laparoscopic, and robot-assisted laparoscopic format. A written examination was also administered on the last day. The influence of M-R on the participants' practice pattern was then assessed by a follow-up questionnaire survey 1 to 7 months after their attendance. Data from the first 16 participants were analyzed. Of note, the score was significantly improved for only one of the four tested laparoscopic skills (i.e., threading a suture through loops). Nonetheless, on the follow-up survey, of the 15 respondents, two laparoscopically naïve participants had performed laparoscopic nephrectomy, and of the eight participants who had prior renal-ablative laparoscopic experience, four had performed advanced reconstructive laparoscopic cases. A 5-day dedicated postgraduate M-R in laparoscopy appears to be helpful for urologists wishing to incorporate this surgical approach into their practices. The "take rate" among participants is initially at the 40% level, similar to what has been previously reported after a 1 to 2-day hands-on didactic laparoscopy course.

Fibroid recurrence and symptom improvement in 127 patients having undergone abdominal myomectomy

Objective: 1) To characterize preoperative and intraoperative risk factors for fibroid recurrence and requirement for subsequent surgical procedures, and 2) assess patient symptom improvement and satisfaction after having undergone abdominal myomectomy. Design: Retrospective cohort review with follow-up questionnaire survey. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Questionnaires were sent to these patients assessing the patient’s recurrence of fibroids, requirement for additional surgical procedures attributed to fibroid recurrence, symptom improvement, and general patient satisfaction with having chosen abdominal myomectomy as a modality to treat their fibroids. Potential parameters influencing outcome measures were collected from the medical record and included race, age, abdominal myomectomy: questionnaire response interval (number of years), number of fibroids, total fibroid weight, largest fibroid, prior abdominal myomectomy, uterine size, and patient weight. Results: A total of 331 questionnaires were mailed to patients. Forty questionnaires did not reach the intended patient and were returned to the author with insufficient address. A total of 291 questionnaires were assumed to have reached patients, and 127 were returned completed (43.6% response rate). Overall, 19.7% of patients had been told by their physician that their fibroids had returned, and 4.7% of patients underwent an additional procedure secondary to recurrence of their fibroids. Symptoms were noted as “much improved” in 90.6% of patients, and 86.6% of patients were “very satisfied” with having chosen abdominal myomectomy as a modality to treat their uterine fibroids. In order to determine statistical significance among risk factors and outcome measures, Fisher exact tests were applied to the data comparisons. Univariate analysis demonstrated that women greater than 40 years of age were more likely to report symptoms as much improved as compared to patients less than forty years of age (95% vs. 80%, p<0.01). The number of fibroids at abdominal myomectomy significantly impacted the risk of fibroid recurrence. Women with greater than 10 fibroids at abdominal myomectomy reported fibroid recurrence in 38% of cases versus only 12% of women with less than or equal to 10 fibroids (p<0.01). The incidence of fibroid recurrence was reported as 7% in the first two years after abdominal myomectomy, and the incidence sharply rose after two years to 29% (p<0.01). Conclusion: Abdominal myomectomy is an effective surgical treatment for women with symptomatic uterine fibroids. Significant symptom improvement is noted in women that have undergone abdominal myomectomy, most notably in women over the age of forty years. Fibroid recurrence is a concern for women that undergo a less than definitive procedure to treat their uterine fibroids. Women with less than ten fibroids at the time of initial abdominal myoemectomy have a reduced risk for recurrence as compared to women with greater than 10 fibroids.

Physical Therapists' Perceptions of Factors Influencing the Acquisition of Motor Abilities of Children With Cerebral Palsy: Implications for Clinical Reasoning

Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. The nominal group technique was used to conduct the focus groups. Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.

The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year.

To compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final-year medical students' attitudes towards psychiatry and mental illness. A 1-year follow-up questionnaire survey of two groups of medical students taught psychiatry in their fourth-year training by two different methods. One-year follow-up scores were compared with pre-attachment and post-attachment scores in the fourth year. 70 (68%) students completed both questionnaires at follow-up. The follow-up scores were significantly lower compared with both the fourth-year pre-attachment and post-attachment scores, suggesting that the positive change in attitudes following psychiatric training in the fourth year significantly decayed during the final year. The two teaching methods did not differ in the magnitude of this reduction. The positive change that occurs in medical students' attitude towards psychiatry, psychiatrists and mental illness after their fourth-year psychiatric training is transient and decays over the final year.

OUTPATIENT ADRENALECTOMY

To our knowledge we report the initial experience with outpatient, same day laparoscopic adrenalectomy. Nine select patients were entered into our ambulatory adrenalectomy protocol. Each patient fulfilled certain preoperative and postoperative inclusion criteria, including informed consent, age 70 years or older, body mass index 40 or less, adrenal tumor less than 5 cm., no pheochromocytoma, uncomplicated laparoscopic surgery that was completed by 12 p.m., perioperative hemodynamic stability and pain control by oral analgesics. All 9 patients successfully underwent outpatient laparoscopic adrenalectomy. Average patient age was 53 years and average adrenal tumor size was 2 cm. Mean surgical time was 2.3 hours and mean blood loss was 53 ml. The diagnosis was aldosteroma in 7 cases, enlarging adenoma in 1 and myelolipoma in 1. Average postoperative hospital stay was 416 minutes (range 300 to 570). Postoperative analgesia comprised 6 mg. morphine sulfate and 32 mg. ketorolac. The only complication was a local abscess requiring delayed drainage at 2 weeks. No other patient was rehospitalized for any reason. A followup questionnaire survey revealed excellent patient satisfaction. To our knowledge we report the initial series of outpatient laparoscopic excision of a solid organ, the adrenal gland. Ambulatory adrenalectomy is feasible and safe, and results in high patient satisfaction. However, ambulatory adrenalectomy should be restricted to highly select patients and performed by minimally invasive surgeons who have considerable experience with laparoscopic adrenal surgery.

Effect of a primary-care-based epilepsy specialist nurse service on quality of care from the patients' perspective: quasi-experimental evaluation

Initiatives to improve epilepsy care have emphasized the role of specialist nurses. Formal evaluation of these initiatives are scarce. Further evaluative studies are required to ascertain the optimal means of providing epilepsy care. This study aimed to assess the effect of a primary-care-based epilepsy specialist nurse service on patients' reported health status, perceived quality of life, health care use, attitudes to health care, and provision of information. A quasi-experimental follow-up questionnaire survey was sent to all 574 patients aged 16 years or over and receiving antiepileptic drugs for epilepsy, registered in 14 general practices in north-west Bristol. Patients in seven practices who received the new service (intervention patients) were compared with patients in seven practices who did not (control patients). Follow-up comparisons between intervention and control patients were adjusted for baseline differences. Response rates to the first, second and both surveys were 66.2%, 68.6% and 50.9%, respectively. Intervention patients were more likely than control patients to have discussed most epilepsy topics with general practitioners and/or hospital doctors, and were significantly more likely to have categorized general practitioner care as excellent (odds ratio (OR) 2.30, 95% confidence intervals (CI) 1.12–4.70). Intervention patients were significantly less likely than controls to have reported never missing taking their anti-epileptic drugs (OR 0.48, 95% CI 0.24–0.94). There were no significant changes in measures of health status, use of other health care services, and perceived quality of life between intervention and control patients. This study provides evidence of an improvement, after 1 year, in communication and satisfaction but not health status resulting from the introduction of a primary-care-based epilepsy service.

Responses to unsolicited patient e-mail requests for medical advice on the World Wide Web.

The Internet is increasingly used by consumers to seek health and medical information, but online medical advice has not been explored systematically. To explore the attitude of physicians and other providers of medical information on the Internet toward unsolicited e-mail from patients and their reaction to a fictitious acute medical problem described in such an e-mail. E-mail in December 1997 and January 1998 to Web sites from a fictitious patient describing an acute dermatological problem. Follow-up questionnaire survey to the same sites. World Wide Web. Fifty-eight physicians and Web masters. Response rate and types of responses. Twenty-nine (50%) responded to the fictitious patient request; 9 respondents (31%) refused to give advice without having seen the lesion, 27 (93%) recommended that the patient see a physician, and 17 (59%) explicitly mentioned the correct "diagnosis" in their reply. In response to the questionnaire, 8 (28%) of the 29 respondents said that they tended not to answer any patient e-mail, 7 (24%) said they usually reply with a standard e-mail message, and 7 (24%) said they answer each request individually. Responses of physicians and Web masters to e-mail requests for medical advice vary as do approaches to handling unsolicited e-mail. Standards for physician response to unsolicited patient e-mail are needed.

The impact of a food and health education programme on the dietary habits of young Scottish adolescents

A food and health education programme aimed at pupils, staff and parents was launched at a Scottish secondary school in 1993. The effect of this project was evaluated by means of a baseline and follow-up questionnaire survey of pupils' eating habits at age 11–12 years and 13–14 years respectively in the intervention and a control school. During the period of the intervention (1993–95) there was an increase in the percentage of boys consuming non-chipped potatoes and in the percentage of girls taking vegetables and diet drinks, but a decrease in the percentage of boys consuming all soft drinks. Compared to girls proportionally more boys were frequent consumers of breakfast cereals, chips, cakes and biscuits, and meat products and these differences were maintained in the follow-up evaluation.The results demonstrate the limitations of the curriculum approach to nutrition education and suggest a need for additional approaches to be employed in order to promote changes in dietary behaviour.

Social support in pregnancy: Methodology and findings of a 1-year follow-up study

Abstract This paper describes the methodology and findings of a follow-up postal questionnaire survey carried out 1 year after delivery in a sample of women who took part in a randomized controlled trial of a social support intervention in pregnancy. Analysis of data 6 weeks after delivery had shown a range of beneficial health outcomes for women and children allocated to be offered the social support intervention; data from the 1-year follow up provide evidence for the continuation of some of these beneficial effects of the pregnancy intervention 1 year later. Mothers' perceptions of the value of the intervention also remained significantly positive at this point, suggesting that additional social support during pregnancy may significantly enhance the experience of motherhood over the first year of the child's life. From a methodological point of view, the paper argues that postal questionnaires represent an appropriate low-cost strategy for monitoring the short and long-term effects of research interventions.

875 Cases of bacterial meningitis: Diagnostic procedures and the impact of preadmission antibiotic therapy Part III of a three-part series

Data on the bacteriological findings, diagnostic measures and clinical course of 875 patients with bacterial meningitis are presented. Findings from the medical records and from a follow-up questionnaire survey of 667 of these cases revealed no significant difference between patients treated with antibiotics before admission (pretreated) and those who were not treated before admission (non-pretreated) with respect to clinical condition on admission, mortality and late sequelae. Pretreatment was, however, associated with a longer duration of symptoms. Apart from cases due to Neisseria meningitidis, there were no significant differences in diagnostic findings between pretreated and non-pretreated cases. In the group of pretreated meningococcal patients, however, positive blood cultures, pleiocytosis in the cerebrospinal fluid (CSF) and positive cultures from sites other than blood and CSF were less frequent than in the non-pretreated cases.