Questionnaire Replies Research Articles

Audit of referral patterns for hernia repair - are general practitioners aware of the changing face of herniorrhaphy?

The objective of this study was to examine referral patterns from general practitioners for groin hernia surgery and to assess their knowledge of services available to their patients. An anonymous postal questionnaire was sent to 120 general practitioners (GPs) in the South East Wales region who routinely refer patients for inguinal hernia surgery to the Royal Gwent Healthcare NHS Trust. A total of 86 questionnaire replies were returned. There was variation in referral patterns between the GPs with the majority (84%) referring their patients for groin hernia repair to either a general surgeon or as an open referral. Only 14% referred directly to a hernia specialist and none regularly referred to a laparoscopic surgeon. Referral patterns for inguinal hernia surgery do not reflect services provided in secondary care. Further education is required so that a patient's care can be optimised.

Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom

Routine metalwork removal, in asymptomatic patients, remains a controversial issue. Current literature emphasises the potential hazards of implant removal and the financial implications encountered from these procedures. However, there is little literature guidance and no published research on current practice. To estimate the current state of practice of orthopaedic surgeons in the United Kingdom regarding implant removal in asymptomatic patients. An analysis, by two independent observers, was performed on the postal questionnaire replies of 36% (500 out of 1390), randomly selected UK orthopaedic consultants. Four hundred and seven (81%) replies were received. A total of 345 (69%) were found to be suitable for analysis. The most significant results of our study (I) 92% of orthopaedic surgeons stated that they do not routinely remove metalwork in asymptomatic skeletally mature patients; (II) 60% of trauma surgeons stated that they do routinely remove metalwork in patients aged 16 years and under; (III) 87% of the practicing surgeons indicated that they believe it is reasonable to leave metalwork in for 10 years or more; (IV) only 7% of practicing trauma surgeons who replied to this questionnaire have departmental or unit policy. Our results demonstrate that most practicing trauma surgeons do comply with the evidence presented in the little literature available. However, we do believe that a general policy for metalwork removal is essential. Such a policy should include guidelines specific to age groups and level of surgeon who should be performing the removal procedure. Such a document would require further validated studies but would eventually serve to steer surgeons in achieving best practice.

Dialysis Discontinuation: Quo Vadis?

Approximately 1 in 4 deaths of patients maintained on dialysis in the United States is preceded by a decision to discontinue treatment. Once considered to be a form of suicide, dialysis discontinuation is now increasingly common in most countries that are fortunate enough to offer renal replacement therapies. Given an aging and progressively sicker chronic kidney disease patient population, the rate of terminating dialysis is likely to increase. The literature on dialysis discontinuation includes studies principally from Canada, the United Kingdom, and the United States. The research is reviewed, critiqued, and examined to determine its relevance to practice. Future issues include the need to explore variability in dialysis practice as well as employment of a more patient-centered approach that is consistent with modern palliative medicine.

Research for Better Performance of R & D Activities of Medical Equipment Industry in Japan

Based on 61 questionnaire replies, which were responded by engineers from 34 medical equipments' companies, technical aspects of the medical equipments industry were found as follows. When they carry out R & D, necessary information is mostly collected from related researchers or academic societies, and technologies used for development are mostly from inside of companies and outside procurement is quite seldom. Common ways of R & D joint works with medical researchers are advice base or contracted cooperation. Design specifications are often revised based on medical usage tests during R & D. They recognize that superiority of products is come from design technology or software technology. Most of R & D activities were initiated by such ways that medical researchers occasionally found out necessary technologies in sold products and they requested manufacturer of them to develop new medical equipment by using such technologies under cooperation. Based on this study, it is recognized that strategic point of view should be introduced in the fields of intellectual property rights or standards management in individual companies' level and also social systems should be developed to transfer technology from engineering side to medical researchers.

Endoscopy Continuous Evaluation of Patient Satisfaction in Endoscopy Centres

Background: A randomized sample of 14,000 men and women, aged 55-64 years, resident in the City of Oslo and Telemark County, were drawn from the population registry to be offered a flexible sigmoidoscopy (FS) screening examination. A questionnaire was designed to modify routines and evaluate patient satisfaction. Methods: Consecutive participants (4956) were given a questionnaire immediately after the FS to be filled in and returned by mail on the following day. Participants were asked questions about service, practical issues, and the level of pain during the FS and post-examination discomfort. They were also encouraged to give their comments in free text. Results: Questionnaire replies were received from 4574 (92%) out of 4956 participants. The vast majority reported to have experienced no (70%) or slight (21%) pain during the examination. Women reported pain and post-examination discomfort more often than men. Pain was also associated with age of the patient and length of bowel examined, but not with total examination time. The proportion of painless examinations varied between endoscopists from 62% to 81%. For all endoscopists collectively, this improved during the study period, irrespective of past experience, but trainees seemed to adopt the score of their masters. Conclusions: The study demonstrated that the use of feedback information in an endoscopy screening unit may be useful in improving standards, including the performance of endoscopists. It is possible that the introduction of similar feedback systems in routine endoscopy laboratories may in the long run improve the reputation of gastrointestinal endoscopy.

Endoscopy Continuous Evaluation of Patient Satisfaction in Endoscopy Centres

Background: A randomized sample of 14,000 men and women, aged 55-64 years, resident in the City of Oslo and Telemark County, were drawn from the population registry to be offered a flexible sigmoidoscopy (FS) screening examination. A questionnaire was designed to modify routines and evaluate patient satisfaction. Methods: Consecutive participants (4956) were given a questionnaire immediately after the FS to be filled in and returned by mail on the following day. Participants were asked questions about service, practical issues, and the level of pain during the FS and post-examination discomfort. They were also encouraged to give their comments in free text. Results: Questionnaire replies were received from 4574 (92%) out of 4956 participants. The vast majority reported to have experienced no (70%) or slight (21%) pain during the examination. Women reported pain and post-examination discomfort more often than men. Pain was also associated with age of the patient and length of bowel examined, but not with total examination time. The proportion of painless examinations varied between endoscopists from 62% to 81%. For all endoscopists collectively, this improved during the study period, irrespective of past experience, but trainees seemed to adopt the score of their masters. Conclusions: The study demonstrated that the use of feedback information in an endoscopy screening unit may be useful in improving standards, including the performance of endoscopists. It is possible that the introduction of similar feedback systems in routine endoscopy laboratories may in the long run improve the reputation of gastrointestinal endoscopy.

A Study on Skill Extraction in the Machine Operation. 2nd Report. Clarification of Cognition Ability in Machine Operation and a Proposal of Its Application Theory to Assist Operators.

In this paper, Clarification of cognition skill in actual machine operation is tried, and a theory to realize effective assist on the basis of the result is proposed. First, it is supposed what cognitive process operators operate machines through, by questionnaires to high skilled operators. Next, cognition skill of a subject in a certain work is clarified with a value named "Information Dependence", using a simulator system that is constructed on the basis of the questionnaire's replies. Finally, a theory to assist machine operators effectively is proposed on the basis of these studies on cognition skill, and the effect of the theory is validated. Also, the possibility to generalize the theory is shown by applying it to other works.

Allergic rhinoconjunctivitis, eczema, and sensitization in two areas with differing climates.

In this 5-year follow-up study we compared the prevalence of allergic rhinoconjunctivitis, eczema, and sensitization, in relation to several background factors, in two Swedish regions (Göteborg and Kiruna). In Göteborg, a city on the southwest coast, the climate is mild and humid. Kiruna is a town north of the Arctic Circle. Questionnaire replies and results of interviews were collected from all 412 7-8-year-old children of a population-based sample (203 in Göteborg and 209 in Kiruna); in addition, 192 children from Göteborg and 205 from Kiruna were skin-prick tested for sensitization to common aero-allergens. After 5 years, at 12-13 years of age, almost all of the initial study cohort were re-investigated. At follow-up the prevalence of allergic rhinoconjunctivitis was 17%, eczema 23%, and sensitization 32%. Allergic rhinoconjunctivitis and eczema were as common in Göteborg as in Kiruna, whereas sensitization was far more common in Kiruna. Children born during the pollen season had allergic rhinoconjunctivitis less often -- and were sensitized to pollen and animal protein less often -- than those born during the rest of the year. Sensitization to birch pollen, cat protein, and horse protein was less common in children living in Göteborg, the region with the highest frequency of cat ownership and horseback riding, and with the longest birch-pollen season. The girls were more commonly horseback riders but the boys were more often sensitized to horses. The results reinforce our previous findings: indoor climate may affect the development of sensitization and allergic diseases, to some extent independently; and if exposure to antigen is unavoidable, high doses might be better than low doses.

Mexico City physicians' awareness about cervical cancer prevention: implications for cancer screening.

In spite of an early cancer detection program (CCSP), Mexico has a mortality rate for cervical cancer of 16.5 per 100,000 women. A cross-sectional study of 330 physicians at the Mexico City General Hospital evaluated their knowledge of the CCSP, etiology, diagnostic alternatives, and treatment guidelines. Variance analysis was the statistical procedure used. Replies to a questionnaire about cervical cancer prevention awareness were scored on a scale from 1 to 9. According to the awareness scale, the global average classification was 4.4, with 50% of the physicians scoring 4 or less. There was no difference in the CCSP knowledge scores of gynecologists (mean 4.92, 95% CI 4.2-5.3), oncologists (mean 4.85, 95% CI 4.3-5.5), pathologists (mean 5.23, 95% CI 4.9-5.6), and those in other specialties (mean 4.29, 95% CI 4.2-5.0), p > 0.05. Many respondents attributed CCSP's lack of effectiveness to public apathy (68.12%). The effectiveness of the CCSP can be improved by educating health professionals if this education is combined with elimination of obstacles to its use. More information is needed to justify revising how doctors are educated in terms of not only quality of the training but also the contents of pre- and postgraduate training programs.

Lack of correlation between self-reported symptoms of dyspepsia and infection with Helicobacter pylori, in a general population sample.

To investigate any correlation between infection with Helicobacter pylori (H. pylori) and overall symptoms of dyspepsia, in a general population sample. Analysis of test results and questionnaire replies from a population screening study involving subjects registered at a single general practice in Market Harborough, UK. H. pylori status was established using a commercial enzyme-linked immunosorbent assay (ELISA), and frequent dyspepsia was assessed using a previously validated self-completion symptom questionnaire. Complete results for dyspepsia and H. pylori status were obtained and analysed for 1524 men and women aged 21-55 years at the start of the study. In those who attended for screening, the prevalence of dyspepsia was 39%, with a 15% prevalence of infection with H. pylori. No significant correlation was found between H. pylori status and frequent dyspepsia, upper abdominal pain or reflux-like symptoms. Adjustment for age, gender, smoking and alcohol consumption did not alter these findings. The analysis suggested that H. pylori infection does not play an important role in overall symptoms of non-ulcer dyspepsia in the community, nor is it important in protecting against acid reflux in patients without duodenal ulcer.

Social workers and significant others as collaterals of non‐responding alcoholics in follow‐up studies using mail questionnaires and telephone interviews

The subject of this study is non‐response to mail questionnaires and supplementary telephone interviews in evaluation of outcome of treatment for alcohol dependence. The study is based on two clinical populations (n= 121 and 603) from Runnagården, Sweden, a coercive care setting with both voluntary and compulsorily committed patients. The populations differed regarding size, treatment and background factors. Replies were obtained from two‐ and one‐third of the patients in the two populations respectively. Replies from social workers were obtained in 67% and 57% of the cases respectively, and from significant others in 59% of a smaller sub‐sample of the second population. With respect to the combination of patient and collaterals, we received at least one questionnaire reply concerning 96% and 79% of the two populations respectively. In this study we analysed non‐response and evaluated two methods to remedy this, i.e., prediction of the outcome in non‐responders from additional telephone follow‐up and questionnaires to collaterals. About two‐thirds of patients who replied had improved, compared with about one‐third of non‐responders. Significant others replied more often if patients had improved, while social workers replied more often if patients had not improved. Patients who did not reply to mail questionnaires, but answered the same questions in a telephone interview, differed in drinking outcome from non‐responders, but not from mail respondents. The method of using questionnaires addressed to social workers as an additional source of data can be used in countries with a general system of social welfare services and is better than the use of significant others as collaterals. In conclusion, replies obtained by additional telephone interviews were not representative for patients who did not return mail questionnaires. Non‐response groups were highly selected in each of the three questionnaires (addressed to patients, significant others and social workers). Since the selectivity had opposite tendencies, the combination of questionnaires to patients and to social workers seems to be the most representative.

A survey on return to work and fitness for work in Japan: the systems provided in corporate regulations and their application

We conducted a survey to evaluate the current situation and the application of systems for return to work (RTW) and fitness for work (FFW) in Japanese companies. Self-administered questionnaires were mailed to 351 occupational health (OH) physicians listed in the membership directory of the Japan Society for Occupational Health published in 1990. The item of information sought were the size and industrial type of the company, the organization of OH staff, the process of assessment of RTW, the provision for sick leave in corporate regulations, the FFW criteria, and job training systems for RTW. Of the 145 companies from which questionnaire replies were received from OH physicians (response rate: 41%), 123 (85%) were manufacturing industries. When classified according to the number of employees, 41 (28%) had 3000 or more, 66 (46%) had between 1000 and 2999, 26 (18%) had 999 or fewer and 12 (8%) were unknown. 144 companies (99%) had provisions on temporary retirement in their corporate regulations. As for who makes compensation during temporary retirement, 66 (48%) and 61 (44%) companies answered "both company and health insurance society" and "health insurance society alone," respectively. 136 companies (94%) carried out assessment of RTW, and involved OH professionals and other related staff in the process of assessment. In the majority of cases, the OH physicians were in charge of the decision-making process on RTW and were authorized to make the final decision. In the companies with 3000 or more employees, the cases of longer-term sick leave were assessed in a more complete process than those of shorter-term sick leave. 119 companies (88%) conducted on additional health examination to assess the employee's FFW. Sixty-four companies (47%) had standardized criteria on FFW. One hundred and eighteen companies (83%) had job training systems for employees' RTW, and they mainly introduced restricting one's job and/or reducing one's work-load. It was suggested that complete systems for RTW and FFW were more available among companies with 3000 or more employees than among companies with 2999 or fewer employees.

Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul

In countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Sepcificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the K coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions.

The sexual abuse of children with visual impairments

Approximately ten per cent of children in the United Kingdom are sexually abused and research suggests that handicapped children are similarly being sexually exploited. Replies to a questionnaire from special teachers indicated that more than half of them had had to deal with the suspected abuse of visually impaired children. There is need for further research; raised awareness on the part of professional staff; and the development of preventive strategies.

Helicobacter pylori eradication in a clinical setting: success rates and the effect on the quality of life in peptic ulcer

Helicobacter pylori eradication for peptic ulcer has been widely taken up. Evidence for the efficacy of different regimens is often derived from small series in clinical trials but there is little reporting of everyday practice with unselected patients. Freedom from ulcer relapse has been demonstrated, but not whether this equates with clinical success. We report on a series of 706 patients with H. pylori infection who, between January 1991 and April 1995, received eradication therapy followed by assessment of H. pylori status. Two-hundred and seven of these patients were followed-up by postal questionnaire, validated by parallel questionnaires to their general practitioners, covering clinical outcome measures. The overall eradication rate was 81.7%, and a 1-week course of omeprazole plus two antibiotics was significantly better than a 2-week course of standard triple therapy (85.0% vs. 78.0%, P < 0.05). Amongst 21 first-time failures, a 7-day course of a clarithromycin-containing triple therapy succeeded in 18. The questionnaire replies indicate that, following successful H. pylori eradication, ulcer patients are less likely to consult with ulcer symptoms (P < 0.0005), take medication (P < 0.0005), require further prescription (P < 0.0005), or lose work-time because of their ulcer (P < 0.005). They are more likely to have a subjective sense of ulcer cure (P < 0.0005). In addition to clear cost savings, social benefits are now demonstrated when H. pylori is eradicated. A well-tolerated 1 week regimen is genuinely effective in everyday practice.

Anticoagulant resistance in Europe: Appraisal of the data from the 1992 EPPO questionnaire

AbstractResistance to the first successful anticoagulant rodenticide, warfarin, was detected in the Norway rat (Rattus norvegicus Berk.) in 1958, and it has since expanded to cover other commensal rodent species (R. rattus L., Mus musculus L.) and the majority of later‐developed anticoagulant compounds. The purpose of this paper is to give an up‐to‐date picture of the current distribution of anticoagulant resistance in Europe, as revealed by the questionnaire dispatched by EPPO (European and Mediterranean Plant Protection Organization) to its member countries in 1992. Replies were received from 13 countries (43% of EPPO members), and it was found that broad‐spectrum resistance occurred in practically all those countries that reported testing activity. A likely conclusion based on this finding is that true distribution of resistance is certainly more extensive than documented by the questionnaire replies. Another conclusion drawn by the EPPO Rodent Control Panel was that the existing resistance detection protocols were no longer adequate to cover the whole array of existing anticoagulant rodenticides. Consequently, a new guideline including novel methods particularly for detecting resistance to single‐dose anticoagulant compounds was urgently needed. This guideline is currently under review.

Using the mass-observation archive as a source for women's studies

The Mass-Observation Archive at the University of Sussex (UK) is a rich source of material on and by women. The Archive holds the papers which resulted from the work carried out by 'Mass-Observation', a pioneering British social research organisation, between 1937 and the early 1950s. These papers include personal diaries and detailed questionnaire replies as well as reports and surveys focusing on aspects of everyday life. The Archive is also the base for a contemporary writing project which invites volunteer mass-observers to record in diaries, and in response to open ended prompts and questions their opinions and experiences for the 1980s and 1990s. In this paper, the archivist describes which parts of the collections might appeal to the Women's Studies scholar.

Spinal cord injuries in Japan: a nationwide epidemiological survey in 1990

To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide. Using the statistical method of the nationwide epidemiological survey described by Hashimoto et al,1 the annual estimated incidence was obtained from the number of patients registered, and from the questionnaire reply rate at each prefecture. The number of registered patients in 1990 was 3465 and the mean reply rate was 56.6%. There were 2665 registered patients with a neurological deficit (Frankel A-D) and the annual SCI incidence was 39.4 per million. The male:female ratio was 4.3:1 and the ratio of cervical cord injures to those caudal to the cervical cord was 2.9:1. The mean age at the time of injury was 48.5 years. The cause most frequently seen was traffic accidents, the second most frequent being falls from a height. Besides those two, sports injuries and falls on level ground were the third most frequent causes of SCI in the young generation and in elderly people respectively.

Writing to the Archive: Mass-Observation as Autobiography

The social research organisation, Mass-Observation, which operated between 1937 and 1950, recruited volunteer writers to join a `panel' to record aspects of their everyday life in Britain during those years. In 1981, the Archive which houses that material (diaries, detailed questionnaire replies) initiated a revival of the panel. This article describes this revival and argues that the contemporary writing for the Archive can be considered a form of autobiography, providing the definition of autobiography is broadly defined to include a wide variety of forms of self-expression and writings about self in a social context. Furthermore, the desire to be a contemporary Mass-Observer demands that a new genre be forged which draws on the writer's experience of other similar forms of written expression and which evolves as a result of a process of negotiation within a specific relationship with the Archive.

Survey of oral anticoagulant treatment in children.

To find out which children are treated with oral anticoagulants and how their treatment is controlled in the United Kingdom. Two questionnaires were used. The first was sent to general haematologists and the other to paediatric cardiologists and cardiac surgeons. There were 273 (58%) replies to the first questionnaire. Most children were treated because of artificial cardiac valve replacement. The mean target International Normalised Ratio (INR) used was 2.73 to 4.0 for children with heart valves and 2.1 to 3.25 for children with venous thrombosis. The second questionnaire elicited replies from 11 of 22 cardiac centres. The mean target INR used for children with cardiac valves ranged from 2.59-3.77. Of 68 children covered in the survey, there have been two major bleeds and two thrombotic episodes: 78.8% of children were controlled with a venous prothrombin time and 21.2% with a capillary test. There was no consistency in the dose regimens used for the induction of oral anticoagulant treatment with warfarin. The levels of anticoagulation used for maintenance are similar to those recommended by the British Society for Haematology for adults (3.0 to 4.5). They seem to be safe for children too.