Stamped Return Envelope Research Articles

Electronic 1 year follow up after ablation

Abstract Background Several studies have shown that phone calls are an effective but resource intensive Follow-up (FU) method to collect patient reported data (PROM) after discharge from hospital. Regarding patient preference for FU, who has been ablated for atrial fibrillation (AF), most of the AF patients favoured a questionnaire with a stamped return envelope. In 2019 the National registry for ablation and electrophysiology in Norway (AblaNor) was established. All patients who have been in an EP lab receive an electronic FU questionnaire (ePROM) 1 year after the date of ablation. In Norway, it has been developed a technical solution which allows data submitted from the patient to be registered in the Health Network,"ePROM engine". Little is known about the functionality and response rate of electronic solutions. Purpose The aim of our study was to investigate an electronic FU approach in general and in different patient subgroups from AblaNor. Method We used data from the National register of ablation and electrophysiologi in Norway, Ablanor. The data are FU questionnaire who all patients received 1 year after ablation. All questionares are the same, independent diagnosis group. The patients received the FU questionnaires electronically via Helse Norge.no. The data is based on registrations from 2020-21. Results The data shows that amongst the 7169 selected procedures in 2020 and 2021, 5235 completed the ePROM form . There is a difference in response rates for both age and sex alone. Younger women have a higher response rate than men of same age, whereas in older age groups,men have higher response rates than women . Patients who have been ablated for AF have a higher respons rate than other procedures. Patients who have only undergone an electrophysiological examination (EP) have the lowest response rate. Conclusion Mandatory follow-up 1 year after completion of the procedure takes place in electronic form and contains simple registration of PROMS. The response rate among patients is 78% over the two years. This indicates an extremely high level of digital competence and motivation among patients to provide feedback for completed treatment. This shows that there is a discrepancy for FU regarding patient who has been ablated for atrial fibrillation (AF) . Abbreviations RFA: Radiofrequency Ablation; FU: Follow-up; AF: Atrial fibrillation; PROM: Patient reported outcome Measurement

The American Short Story and Me

The American Short Story and Me

Reflextherapy in Healthcare – Reflection on Audit Result and Employment of Therapy

An article was published in 20141 reporting on an audit of the Membership of the Association of Chartered Physiotherapists in Reflextherapy (ACPIRT). This article reflects on the outcome of the audit in the context of a treatment tool in physiotherapy and allied health professions in the United Kingdom and abroad. Background: ACPIRT was established in 1992 by Christine Jones, physiotherapist, and associated colleagues to provide a clinical interest group for physiotherapists and allied health professionals practising reflextherapy (RT), a manual therapy applied to the feet (or hands) similar and akin to reflexology. The audit was carried out in 2009 to establish a professional profile of members and to document their clinical experiences in using RT in healthcare. Methodology: 161 ACPIRT members were sent a postal questionnaire (including a stamped return envelope) regarding their experience using RT treating patients in the NHS and/or in private practice. One hundred (62%) members responded. A pilot study was carried out prior to the main enquiry including 14 ACPIRT committee members. Their results were included in the final audit result. Aims: i) To describe members’ demographics, work environments and opinions of the value of RT in healthcare. ii) To describe the historical background and development of RT to become an accepted therapeutic intervention by the Chartered Society of Physiotherapy. Results: Sixty-eight respondents (68%) considered RT ‘very good’, ‘good’ and ‘as good as’ orthodox physiotherapy. Fifty-eight respondents (58%) thought RT had a 25% placebo effect. No one considered RT to have a 100% placebo effect. Overwhelmingly, 95 respondents (95%) reported ‘relaxation’, ‘reduced stress’ and ‘reduced pain’ as main benefits of the treatment. A few respondents reported ‘increased fertility’, ‘improved bowel function’ and ‘reduced appetite’. Comments were made on the future of RT and recommendation for a Foundation Course. The results showed a mature, highly experienced professional membership with a female gender bias.

They still like to get a letter – Patient preference for follow-up after radiofrequency ablation for atrial fibrillation

ABSTRACT Background: Several studies have shown that phone calls are an effective but resource-intensive follow-up (FU) method to collect patient reported data (PROM) after discharge from hospital. No studies regarding FU methods are available for patients treated by radiofrequency ablation (RFA) for atrial fibrillation (AF). We wanted to examine the recent practice and resource needs for telephone contact. Method: In a 4-month period, we called 167 patients scheduled for RFA of AF on their mobile telephones. We registered the number of attempts needed to reach patients (maximum 3 times). In addition to medical issues, 70 of the patients were asked how they would like to answer FU questions after RFA. Results: Of the 167 patients, we received 96 responses (57%) on the first dialling attempt, 35 responses (21.%) on the second dialling attempt and no responses (n=36) on the third dialling attempt (22%). Of the 167 patients, 131 (78.4%) responded. Of these 167 patients, 135 were men. Regarding patient preference for FU, 50 (71.4%) favoured a questionnaire with a stamped return envelope. Conclusion: As in other patient groups, we demonstrate that telephone FU in AF patients is a resource-intensive task. For sufficient data quality, a higher response rate is required. Conclusion: As in other patient groups, we demonstrate that telephone FU in AF patients is a resource-intensive task. For sufficient data quality, a higher response rate is required.

Examining project learning, project management competencies, and project efficiency in project-based firms (PBFs)

PurposeThe purpose of this paper is to use survey data to rank the relative importance of perceived factors that inhibit the transfer of knowledge across projects and examine the statistical relationship between various “higher order” dimensions of project management competencies and project efficiency among a sample of project-based firms (PBFs).Design/methodology/approachThe research philosophical approach adopted was post-positivism, a half-way house between positivism and phenomenological approaches. The author used a largely structured survey questionnaire with an inclusion of few open-ended items. The survey data collected were largely based on the “perceptions” of mostly experienced project management practitioners, whose perspectives on project processes and performance are likely to be more dependable. Because of budget limitations, a total of 260 questionnaires were mailed to randomly selected PBFs (with an enclosed self-addressed and stamped return envelope). Of the 260 questionnaires sent to PBFs, 58 questionnaires were returned, representing a return rate of just over 22 percent.FindingsResults indicate that “high time pressures towards the end of the project,” “too much focus on short-term project deliverables,” and “fear of negative sanctions when disclosing project mistakes” were three top-ranked factors that inhibited knowledge transfer across projects. Some “higher order” project management competencies like “dynamic competencies” have relatively a greater impact on predicting project efficiency. Dynamic competencies will only continue to increase in importance as today’s project environments are characterized as continuously evolving, turbulent, and complex and require the need to be effective in dealing with various uncertainties. Once included in the regression equation, the “ownership variable” dominates all other explanatory variables in predicting project efficiency among a sample of PBFs in the United Arab Emirates (UAE), most likely driven by the project management competencies of multinational corporations (MNCs). However, the project efficiency of state-owned PBFs did not differ significantly from that of “international firms that were not MNCs.” Specific conditions may have led to such an outcome. The author shows that enhancing project efficiency requires the reinforcement of multiple but specific factors.Research limitations/implicationsAs the study was largely conducted on a limited budget and time frame, the author was not able to employ a multi-method approach. The inclusion of a few case studies would have facilitated triangulation of the current findings. In addition, the study captures “perceptions” and practical experiences of project management practitioners. Future studies could possibly develop what may be seen as “objective” measures of project learning and project management competencies. A larger survey supported by a larger budget would be one option in which some of the findings could be tested across PBFs located in different sectors and countries.Practical implicationsThe author argues that the creation of a client-led “no-blame culture” within PBFs can ensure the development of a “safe” environment in which project team members can acknowledge project mistakes without the fear or danger(s) that may come with such admission. This may require changes in project organizational culture that reduces power distance, lowers sensitivity to hierarchal power relations, enhances team building efforts, and fosters a “learning climate” that tolerates “trial and error” experimentation. It may also require strengthening clients’ specific capabilities. Such change may require time and patience but could take advantage of “positive” aspects of participatory practices, personal relationships, and consensus decision-making approach that is prevalent in the UAE culture. One managerial implication points to the need to tailor scarce resources in building up multi-dimensional “higher order” competencies like “dynamic competencies” that have a relatively higher significant impact on enhancing project efficiency. Linking MNCs with local PBFs as collaborative mega project delivery partners may lead to enhancing project management competencies of the latter, conditional on their absorptive capacity.Originality/valueThe contribution of the paper is in providing survey-based empirical evidence that goes beyond case studies to highlight the importance of enhancing “higher order” project management competencies, such as “dynamic competencies,” that have a stronger predictive power of project efficiency in PBFs. The study also ranks the relative importance of various factors that inhibit the transfer of new knowledge across projects. To the author’s knowledge, this is the first study that has demonstrated the statistical relationship between “higher order” project management competencies and project efficiency. Project efficiency is a multi-faceted construct. Its strengthening is determined by a configuration of multiple but specific factors. A more “nuanced” understanding of the relationship between project management competencies and project efficiency in a particular context may be required.

Web-Based Quality of Life Questionnaire Followed by Paper-Based Questionnaire for the Non-Responders: Daily Practice in Patients with Prostate Cancer

Purpose: Patient-related outcome measures (PROMS) play an increasingly important role in the planning and evaluation of medical care. A high response rate is crucial to get a good view of the patient population. Quality of life questionnaires in oncology are important in order to evaluate the impact of the disease or the treatment of cancer patients and guide treatment decisions. The traditional way to collect data is a paper-based questionnaire sent by post. However, online questionnaires seem an attractive and cheap way to send a survey. In this study we describe our experience with the introduction of digital questionnaires in daily practice and study factors that affect the response rate. Methods: The study design was an observational cohort study of patients who had a localized prostate cancer and underwent a Robot Assisted Radical Prostatectomy (RARP) at our institute. Validated questionnaires were mailed to the patients before the RARP and subsequently, 6 months, 1 and 2 years after surgery. After sending twice a digital questionnaire and without any response, we sent the patients a paper-based questionnaire with a stamped return envelope. Results: The response rate was higher when a reminder paperbased questionnaire was sent to the patients who did not respond to the web-based questionnaire. Furthermore, the elderly patients respond significantly more often than younger patients to both questionnaires (web-based or paper-based). Age was the strongest predictive factor for response on quality of life questionnaires. The fact that the patient no longer came to our institute for follow-up had no negative influence on the response rate.

Posttraumatic Growth Among Operation Enduring Freedom and Operation Iraqi Freedom Amputees

Posttraumatic growth (PTG) is a positive psychological change experienced as a result of struggle with highly challenging life circumstances. This study tested the PTG Model in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans following a major combat-related amputation. Specifically, the relationships among social support, rumination, length of time since amputation, and PTG among these veterans were examined. This was a descriptive correlational design using a mailed survey. Data were collected from OEF and OIF veterans with a major traumatic amputation (excluding digit-only loss). A nationwide postal survey was conducted in 2007 of veterans with a major combat-related traumatic amputation. 210 veterans registered at the Department of Veterans Affairs were sent a survey packet containing a letter of introduction, informed consent form, stamped return envelope, and four surveys: a study-specific demographic questionnaire, the Posttraumatic Growth Inventory (PTGI), Postdeployment Social Support scale, and a Rumination scale. The mean PTGI score among OEF and OIF amputees (N= 56) was 59.1 (SD= 23). Rumination showed the strongest correlation with PTG: r= .43, p= .001. There was a small positive relationship between postdeployment social support and PTG: r= .24, p= .039. No statistically significant correlation between PTG and time since amputation was found in this sample. As proposed in the PTG model, the findings of this study support the benefit of rumination or cognitive processing of the traumatic event and postdeployment social support in the process of developing PTG following a major combat-related amputation. Following a life-threatening war injury, the patient's worldview is dramatically altered or shattered. Old assumptions and belief systems are rebuilt in the acute phase, rehabilitation, and reintegration into the community. The struggle in the aftermath of the traumatic event that results in personal transformation is known as PTG. Nurses contribute to a patient's physical and psychosocial adjustment by cultivating an environment in which the patient can explore and cognitively process the traumatic event and the resulting injury. Postdeployment social support in the form of emotional support (comforting gestures) or instrumental support (providing tangible goods or services) can be a means to foster PTG.

The Effectiveness of Risk Management Plans in Recreational Sport Programs of Division I-A Universities

The purpose of this study was to investigate the relationships between the existence of a risk management plan and reported participant injury rates and annual operating budgets in recreational sport programs at Division I-A colleges and universities. Surveys with self-addressed, stamped return envelope and a cover letter were sent to each identified recreational sport program director or coordinator at 114 NCAA members of Division I-A colleges and universities. A total of 72 respondents or 63.1% returned the questionnaire for the study. Descriptive statistics and χ2 tests were performed to describe and analyze the data and relationships among the variables. Based on the results of this study, a risk management plan in intramural sports programs is a kind of minimum investment to protect both recreational sport program suppliers and participants because it can reduce lawsuits and provide high levels of safety.

Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors

Study Objective To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology. Design Survey instrument. Setting Anesthesia residency training programs in the United States. Measurements After obtaining institutional review board approval, a list of current academic anesthesia residency programs in the United States was compiled. A survey was mailed to 131 program directors along with a self-addressed stamped return envelope to ensure anonymity. Returned surveys were reviewed and data compiled by hand, with categorical variables described as frequency and percentages. Main Results A total of 91 (69%) surveys were returned, representing experience with 11,293 residents over the ten-year period from July of 1997 through June of 2007. Fifty-six (62%) program directors reported experience with at least one resident requiring treatment for substance abuse. For residents allowed to continue with anesthesia residency training after treatment, the relapse rate was 29%. For those residents, death was the initial presentation of relapse in 10% of the reported cases. 43% of the program directors surveyed believe residents in recovery from addiction should be allowed to attempt re-entry while 30% believe that residents in recovery from addiction should not. Conclusions The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.

Polycystic ovarian syndrome (PCOS) patient education – effectiveness of lecture series compared to providing patient with written materials for self-learning

The purpose of this study was to determine the best method of providing education to patients seen in our RE practice and to evaluate the cost-effectiveness of providing a lecture series vs. giving patients self-learning packets. The topic selected for patient education was PCOS. Prospective study. Approximately 30% of the patients seen at our RE practice have PCOS. An education series consisting of 4 independent evening lectures presented over a period of 3 months on PCOS and its impact on health, nutrition, exercise and mental health were offered. Attendees completed a questionnaire to determine if the information was beneficial. Costs included advertising, speaker fees, handouts, refreshments, conference room fees, planning and administrative time. 40 patients with PCOS that didn't attend any of the series received a self-learning packet. This included an introductory letter, written PCOS information, a questionnaire and a stamped return envelope. Patients were asked to read the information and return the questionnaire by a set date. Costs associated with this included postage, handouts, planning and administration time. Approximately 120 patients are seen in our office weekly. The series was advertised through posters, handouts, our newsletter and the newspaper. Information about the series was also mailed to 4 local, private practices. Lecture #1 had 8 attendees, Lecture #2 had 7, Lecture #3 had 4, and Lecture #4 had 5. Of those, 11 patients attended only 1 lecture, 3 patients attended 2, 1 patient attended 3 and 1 attended all 4 lectures. Patients reported the presentation met their expectations. Of the 40 patients who received the self-learning packet, only 7 returned the questionnaires. They reported the information was helpful. 4 stated they would prefer their educational information from a website. Our results suggest that offering either lectures or self-learning packets are not cost effective ways of educating our patients. Patients faced with infertility and treatment can be overwhelmed with the commitments their treatment requires. Although patients may find the information beneficial, taking time to attend an optional offering may be the barrier to attendance. Although the self-learning packets would seem to eliminate that, based on the return rate this is also not an efficient use of our education money. Further analysis will be done to determine the best options.

Technical Considerations in the Operative Management of Femoral Neck Fractures in Elderly Patients: A Multinational Survey

To identify current opinions among orthopedic traumatologists relating to technical aspects of internal fixation and arthroplasty for patients with femoral neck fractures. We developed and administered a survey to orthopedic surgeons who were members of the Orthopedic Trauma Association and European clinics affiliated with AO International (Davos, Switzerland). Surgeons reported preferences in specific aspects of the surgical technique for internal fixation as well as arthroplasty. Each surgeon received either a mailed package (7-page survey, a personalized cover letter, and a stamped return envelope) or an email with a link to the same survey on the Internet with an identification code. At 6 weeks, 12 weeks, and 18 weeks after the initial mailing, we remailed the questionnaire to all nonresponders. Of the 442 surgeons who were sent the questionnaire, 298 (68%) responded. The typical respondent was a North American aged more than 40 years, in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center. Among surgeons who treated displaced femoral neck fractures with arthroplasty, significant disparities existed in terms of the type of anesthesia (51% preferring general anesthesia), surgical approach (47% used posterior approach), and placement of unipolar implants (50%). Surgeons tended to agree on the use of cement fixation (69%), repairing the capsule (80%), and not using a drain postoperatively (68%). Surgeons who preferentially treated hip fractures with internal fixation tended to have a lack of consensus in terms of what constituted acceptable surgical delays (43% allowing greater than 48 hours) and which screw configuration to use, with more than half using a triangle with base inferior construct. Surgeons tended to agree on the use of closed fracture reduction techniques (69%), three cannulated screws (73%), and did not routinely perform a capsulotomy (80%) or aspirate the fracture hematoma (90%). Within both treatment groups (internal fixation and arthroplasty), surgeons tended to agree on the use of perioperative antibiotics (>92%), thromboprophylaxis (98%), and postoperative weight bearing status (>87%). A general lack of consensus exists among orthopedic trauma surgeons in the management of displaced femoral neck fractures. With an ever-growing emphasis upon the practice of evidence-based medicine, we have demonstrated several disparities in the technical aspects of fixation and perioperative care likely caused by a general lack of available evidence. We recommend the need for future research and large collaborative efforts.

Cardiologists' Perception of Secondary Prevention and Cardiac Rehabilitation Referral Patterns

Formal cardiac rehabilitation (CR) programs result in decreased cardiovascular and all-cause mortality. Despite overwhelming evidence for the benefits of contemporary CR, fewer than 20% of patients with coronary artery disease participate in such programs, highlighting the vast underutilization of these services, especially in older adults and women. PURPOSE: To quantify/clarify physician perceptions of formalized secondary prevention initiatives and to evaluate CR referral patterns, with specific reference to physician lifestyle practices. METHODS: A 23-item questionnaire was developed and sent to all Michigan cardiologists (N = 840) registered with the American College of Cardiology. The survey, which included a stamped return envelope, was designed to assess referral patterns, perceived benefits of CR, insurance coverage and personal therapeutic lifestyle practices. RESULTS: Of the surveys mailed (N = 840), 105 (13%) were returned by the requested deadline. Most respondents had practices in urban areas (73%), knew of a hospital-based CR program in close proximity (99%), and referred their patients to CR “routinely” (97%). Whereas 92% of respondents felt that CR decreased morbidity, 63% believed that CR decreased mortality. The majority of cardiologist respondents (64%) referred ? 70% of their eligible patients, independent of gender; however, 35% stated a patient's age influences the rate of referral. An increase in exercise tolerance, serial monitoring, education, and improved patient outcomes were the most commonly cited rationale for referral. Respondents who took a cholesterol-lowering statin each day tended to have higher referral rates of all eligible patients (P ≤ 0.05). Although 65% of respondents participated in personal exercise programs at least 3 days/week for at least 30 min/day, there was no relationship between exercise frequency and the reported referral rate to CR. CONCLUSION: These findings indicate that selected personal lifestyle practices among cardiologists may be associated with their referral rates to CR. Primary rationale for referral to CR include increased exercise tolerance, serial monitoring, education, and improved patient outcomes. These data have relevance to CR program staff in clarifying the utilization of services among referring physicians.

Competencies, Essential Training, and Resources Viewed by Designated Institutional Officials as Important to the Position in Graduate Medical Education

In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). The authors conducted this study via a cross-sectional survey designed to provide descriptive data on the beliefs held by DIOs regarding required competencies, training and experience, and desired resources for the position. The authors collected data between January 2004 and May 2004 using a multistep process that included a prenotice letter; a survey, cover letter, and stamped return envelope; a thank you/reminder postcard; and a replacement survey with new cover letter and stamped return envelope. Data were summarized using descriptive statistics. Completed surveys were received from 243 of 363 DIOs (66.9%). Eighty-two percent indicated that DIOs should have specified minimum experience or training requirements. Ten competency items were viewed as essential by greater than 50% of respondents, with five items endorsed by over 95% of respondents: professionalism, verbal communication skills, interpersonal skills, leadership skills, and written communications skills. The percentage of responding DIOs who indicated they would be very likely to use resources were as follows: templates for GME policies, contracts, and affiliation agreements (83.1%); DIO-specific training (58.0%); data on DIO demographics (53.9%); DIO job description templates (46.9%); a clear description of DIO versus program director responsibilities (46.1%); and a DIO certification program (32.1%). Designated Institutional Officials supported the idea that there should be minimum experience and requirements and demonstrated remarkable consistency in endorsing essential competencies for the position. DIOs, their respective institutions, the ACGME, and other GME organizations and associations may use the data from this study to develop the role further.

Characteristics, Roles, and Responsibilities of the Designated Institutional Official (DIO) Position in Graduate Medical Education

In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). Little is known about the effect of new accreditation requirements on GME practice and outcomes. The authors conducted a cross-sectional survey designed to provide descriptive data about DIOs and to validate a DIO Responsibility Scale (DIORS). DIOs were identified by the ACGME. The following delivery strategy was used to administer the survey from January 2004 to May 2004: prenotice letter; survey with self-addressed, stamped return envelope and cover letter; thank-you/reminder postcard; and replacement survey with new cover letter and self-addressed, stamped return envelope. Completed surveys were received from 243 of 363 DIOs (66.9%). Responses indicated wide ranges in DIO titles, report titles, time spent accomplishing responsibilities, DIO-specific salaries, credentials, and Graduate Medical Education Committee reporting arrangements. DIOs reported confusion or overlap between DIO and program director roles (72.0%), decreasing funding for GME (50.6%), and inadequate support staff (25.1%). The 11-item DIO Responsibility Scale demonstrated a Cronbach alpha of .86 and a statistically significant relationship to five variables selected to establish construct validity. The wide variability in DIO characteristics found in this study supports the premise that the DIO role is underdeveloped. The authors established the reliability and validity of the DIORS, which now may be used in future research of the DIO role. The data from this study may be used by DIOs and institutions to develop the role further, improve DIO performance, and create more useful job descriptions.

DXA and Pregnancy Issues in Research Involving Minors

0478 Dual-energy x-ray absorptiometry (DXA) exposes subjects to a small radiation dose and raises procedural issues regarding pregnancy testing and confidentiality, especially with minors. Although DXA has become a widely used technique in exercise science for body composition analysis with youths, researchers rarely report in detail on procedures related to pregnancy issues. PURPOSE: To determine current practice among U.S. researchers regarding DXA use and pregnancy-related issues with minors. METHODS: A search of the PubMed database was made to identify studies meeting the following criteria: original research published in English with a PubMed entry date between June 30, 2002 and June 30, 2003; DXA measurement of female subjects 18 years-of-age or younger; and U.S. mailing address for the author of correspondence. Twenty-three authors were identified with this process. A 16-item questionnaire dealing with DXA and pregnancy issues was sent to each of the 23 authors along with a cover letter and self-addressed, stamped return envelope. RESULTS: Fourteen of the 23 questionnaires (61%) were returned. All reported having conducted research using DXA with females 18 years-of-age or younger. Eleven of 14 (79%) respondents said an attempt was made to determine pregnancy prior to DXA scanning, with 8 of the 11 (73%) using a urine pregnancy test. Reasons for not determining pregnancy included pre-pubertal status of the subjects, minimal radiation dose associated with DXA, and lack of exposure of the abdominal region during DXA scanning. Of those who determined pregnancy status, 8 of 11 (73%) indicated that the parental consent form contained information about determining the pregnancy status of the daughter, while only 5/11 (45%) said the child assent form contained such information. Ten of 11 (91%) responded that in the event that evidence of pregnancy had been identified the child would have been informed, whereas only 4/11 (36%) said the parent would have been informed. None of the respondents reported ever seeking an attorney's opinion regarding DXA and pregnancy issues with minors. CONCLUSIONS: Current practice among U.S. researchers utilizing DXA with minors usually includes an attempt to determine pregnancy status prior to scanning. Most respondents indicated that minors would have been informed of positive pregnancy results, but fewer than half indicated that parents would have been informed.

Profiles of asthma control in 12,488 patients in 30 practices in East Anglia

Introduction:Since the introduction of the British Thoracic Society Guidelines for Asthma Management in 1993, updated in 1997 and 2003, there have been substantial shifts in asthma management in general practice with improved patient care, but many reports indicate that for some patients, it is still difficult to maintain good control and improve quality of life. The ELEVATE study investigates asthma control and quality of life for adults in practices in East Anglia.Methods:Searches of computerised records of all active registered adult (age 16-80 years) patients at 30 practices participating in the ELEVATE study were performed using the search and report system in each practice's software. Patients who had prescriptions for inhaled salbutamol or terbutaline and who did not have prescriptions for Ipratropium containing products in the past 2 years received a screening questionnaire by post.The Asthma Control Questionnaire (ACQ) and Mini-Asthma Quality of Life Questionnaire (MiniAQLQ) were sent by the practices to each patient with a stamped return envelope. Cut-off points of scores =1 for the ACQ (0=well controlled, 6=extremely poor control) and =6 for the MiniAQLQ (7=no impairment, 1= severe impairment) were set as markers of inadequate asthma control and asthma related quality of life respectively.In 12 of the practices a further search was made of the registry to identify patients with a prescription or refill issue for inhaled cortico-steroids (ICS) in the past 4 months. This was used to categorise the patients from the first search into those most likely to be at step 1, and those likely to be at step 2 or higher (“2+”).Results:12488 patients were identified and sent questionnaires. Return rates were 60.3% overall with a range among practices from 52 to 69%. The ACQ score was >1 for 49.4% of the 7094 valid responses. The MiniAQLQ score was <6 for 56.6% of the 6751 valid responses. Cases with a combination of both an ACQ score=1 and MiniAQLQ score =6 were 43.7% of the 6574 valid casesFor the 6488 patients categorised as likely being either step 1 (3873) or step 2+ (2615), the ACQ score was =1 for 59.2 and 61.7% respectively of the 2132 step 1 and 1683 step 2+ valid responses. The MiniAQLQ score was =6 for 49.9 and 66.8% respectively of the 2040 step 1 and 1628 step 2+ valid responses.Conclusion:Examination of indicators of asthma control and quality of life among adult patients in general practice settings show a substantial level of inadequate asthma control and impaired quality of life. Further work to characterise the factors which influence these problems is needed.

Incontinence after prostatectomy: coping with incontinence after prostate cancer surgery.

To describe the nature of postprostatectomy urinary incontinence, determine how men manage postsurgery urinary incontinence, identify men's perceptions of adequacy of preoperative counseling, and identify men's expectations regarding the probability of postsurgery incontinence. Survey. United States. Members of US TOO International, who experienced urinary incontinence after surgery. Copies of the survey (N = 370) were mailed to all chapters of US TOO International, a prostate cancer support group, for distribution to members. A letter of invitation also was posted on the US TOO International Web site and in the monthly newsletter. Men who desired to complete the survey (N = 130) called the researcher's office, and a copy of the survey and a stamped return envelope was mailed to them. Surveys returned to the researchers from June 1998 to January 1999 were included in the analyses. Urinary incontinence, management of urinary incontinence, and coping. 166 men returned surveys. The majority was Caucasian (95%) and married (83%). The median age was 67 years, 87% of the men rated their health as good or excellent, and 114 men (69%) reported becoming incontinent after surgery. Most men experienced stress incontinence symptoms. The majority (89 of 111 men) reported that they were told preoperatively that urinary incontinence was a possible complication. Overall, regardless of length of time since surgery, men (74%) thought that incontinence was an important problem to resolve. Men used containment devices such as pads, special undergarments, and even sanitary napkins as management strategies. The majority of men (54%) used pelvic muscle exercises, especially those who were fewer than two years postsurgery (72%). Urinary incontinence is a prevalent postoperative complication for men, even up to five years after surgery, and a source of great distress for some. Men reported stress and urge incontinence symptoms and used an array of strategies to contain their urine. Finding effective treatments for postprostatectomy urinary incontinence and receiving adequate information before surgery is important to these men. As the number of men who undergo surgical treatment for prostate cancer increases, nurses need to be equipped with the necessary knowledge and information to answer preoperative concerns and provide effective strategies for managing postoperative urinary incontinence.

Peripheral Nerve Blockade with Long-Acting Local Anesthetics: A Survey of The Society for Ambulatory Anesthesia

Despite the growth of ambulatory anesthesia and the renewed popularity of regional techniques, there is little current information concerning outpatient regional anesthesia practices or attitudes about discharge with an insensate extremity. We present results from a survey sent to all members of the Society for Ambulatory Anesthesia (SAMBA). The survey was mailed in January 2001 to 2373 SAMBA members, along with a self-addressed stamped return envelope. After 3 mo, 1078 surveys were returned (response rate 45%). Respondents indicated that they were most likely to perform axillary (77%), interscalene (67%), and ankle blocks (68%) on ambulatory patients. They were less likely to perform lower extremity conduction blocks in ambulatory patients (femoral blocks, 40%; all other types of blocks, <23%]. Eighty-five percent of respondents discharged patients with long-acting blocks, but this was mainly limited to three types. Of the 16% who never or rarely discharged patients with long-acting blocks, the primary reasons were concern about patient injury (49%) and the inability for patients to care for themselves (28%). Only 22% of office-based anesthesiologists would perform upper extremity blocks and only 28% would perform lower extremity blocks (P < 0.001). This survey demonstrates that use of regional anesthesia in outpatients is common but restricted to a few techniques. Discharge with an insensate upper extremity is prevalent but discharge with an insensate lower extremity is not common and remains controversial. Despite the reasoning for the reported practices, randomized data are necessary to confirm the validity of these concerns. This survey demonstrates that use of regional anesthesia in outpatients is common but restricted to a few techniques. Discharge with an insensate upper extremity is common but discharge with an insensate lower extremity is not prevalent and remains controversial.

Maternal-Fetal Attachment in Twin Pregnancies

To describe maternal attachment to twin fetuses and determine whether such attachment differs between the twins. A descriptive, correlational, nonexperimental design was used to collect data on a convenience sample of high-risk and low-risk women pregnant with twins. Questionnaires were distributed or mailed by presidents of parents of multiples clubs to interested participants. Participants mailed the questionnaires back to the researcher via stamped return envelope. During a 14-month period, 214 eligible women from 41 states and the District of Columbia completed the survey instruments. The Prenatal Attachment Inventory. Pregnant women reported greater attachment to Twin B than to Twin A. Pregnant women may be more attached to Twin B (typically the nonpresenting fetus) because this twin may be easier to see and touch. While the mean attachment scores between twins differed, the size of the difference was small. Further study is needed to determine the predictive value and clinical significance of this finding for future mother-infant relationships.

Response rates to surveys with self-addressed, stamped envelopes versus a self-addressed label.

Return rates were studied for a survey on the perceived professional preparation of therapeutic recreation specialists by directors of college and university recreational therapy programs. Specifically, returns for surveys with self-addressed, stamped return envelopes enclosed were compared to those with self-adhering return address labels. Of the 75 surveys sent with a self-addressed, stamped return envelope, 42 responses (56%) were returned at a cost of $2.58 per respondent. Of the 72 surveys sent with a self-adhering return address label 43 responses (59.7%) were returned at a cost of $1.56 per response. While there was no significant difference in return rates, the self-adhering return address label was more cost effective than the self-addressed, stamped, return envelopes.