Knowledge about cervical cancer screening among family physicians: cross-sectional survey

Background  Cervical cancer (CC) is an important public health problem worldwide. In Mexico, there has been a National Cervical Cancer Screening Program (NCCSP) since 1974. Mexican Social Security Institute attended Mexican workers and family physicians are responsible of the primary care of patients.
Objective  To evaluate knowledge about the aetiology and prevention of CC among family physicians working in Yucatan, Mexico, at Mexican Social Security Institute.
Methods  A questionnaire was applied to 187 family doctors. Self-administer questionnaire with 10 item previously used by ours and other researchers, was used for the evaluation. Each correctly answered item was given a point. The maximum grade was 10 and the minimum 0.
Results  The knowledge mean was 6.93 points. Fewer than 50% knew what to do with women who are human papillomavirus (HPV) positive without a precancerous cervical lesion and the appropriate age range for Pap smears. A total of 61.1% identified CC as an important health problem in Mexico; however, 95.1% identified CC as a preventive cause of deaths among Mexican women and recognized that HPV is the main CC aetiological agent, and 90.3% mentioned the Pap smear as the main method of diagnosis of CC.
Conclusion  The family doctors need to have an adequate knowledge of the practical elements of the NCCSP to give an efficient attention to their patients.     

Colorectal cancer screening practices in Saskatchewan: Survey of family physicians

Objective

To evaluate current colorectal cancer (CRC) screening practices in Saskatchewan and identify barriers to screening with the goal of improving current practice.

Design

Survey of family physicians.

Setting

Saskatchewan.

Participants

A total of 773 family physicians were surveyed.

Main outcome measures

Demographic characteristics, individual screening practices, and perceived barriers to screening.

Results

The response rate to the survey was 44.5%. When asked what method they used for fecal occult blood testing, almost 40% of respondents were either unsure or did not answer the question. Of those who did respond, 35.8% employed hemoccult testing following digital rectal examination, a practice not recommended for CRC screening. Screening guidelines for average-risk patients were generally well adhered to, with 79.9% of respondents recommending screening beginning at age 50. For screening patients at increased risk of CRC owing to family history, only 64.2% of respondents began screening 10 years before the age of the index patient at diagnosis. Physicians who were more likely to follow guidelines were female, in practice fewer than 10 years, trained in Canada, and practising in urban areas. More than 90% of family physicians agreed that a standard provincewide screening program would be beneficial.

Conclusion

We have identified considerable knowledge gaps with regard to CRC screening. There is confusion about which fecal occult blood tests are recommended for screening. Also, screening guidelines for patients with a family history of CRC are poorly understood. These findings suggest that better physician education about CRC screening is required. Introduction of a provincewide screening program should improve overall screening success.     

Clinical trials attitudes and practices of Latino physicians

BackgroundEthnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking.MethodsCross-sectional data from randomly selected physicians (N = 695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials.ResultsChi-square analyses showed significant (p < 0.05) associations of physician race/ethnicity and clinical trials involvement, type of trial for which the physician is likely to recommend a patient, belief in scientific value, and factors that would influence recommendation for a patient to participate. Multivariate analyses resulted in several significant (p < 0.05) predictors of clinical trials outcomes, including physician race/ethnicity.ConclusionsLatino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.     

Smoking habits among Finnish middle-aged men: experiences and attitudes

The purpose of this study was to explain smoking habits amongst middle-aged men in Finland by describing their experiences of smoking and their attitudes towards smoking. As a pilot survey for a major health campaign targeted at 40-year-old men, the data for this study were collected using two questionnaires in connection with voluntary medical examinations. The first questionnaire was based on Prochaska's theory of stages of change in health behaviour. The second instrument was an attitude scale developed specifically for this study on the basis of Green and Kreuter's theory of factors influencing health behaviour. According to the results 31% of males aged 40 were regular smokers. Men with a lower level of education and out of work smoked more often than others. Non-smokers reported a better self-perceived health than smokers. Smoking cessation is a process in which men gradually proceed from one step to the next. In this study 12% of the men were in the contemplation stage and 11% in the preparation stage. One-quarter of the men had recently given up the habit and were in the action stage, while 2% had quit smoking over 6 months ago and were in the maintenance stage. One-quarter of the men regarded smoking as an integral part of their way of life and felt that public opinion towards smoking is hostile.     

End-of-life attitudes of intensive care physicians in Poland: results of a national survey

Purpose  

This study was designed to assess the ethical attitudes and practices of intensive care physicians regarding life-sustaining treatment in intensive care units (ICUs) in Poland.     

Palliative sedation in Latin America: survey on practices and attitudes

Introduction Palliative sedation (PS) is the subject of ethical and legal debates worldwide. Statistics of its utilization are available in developed countries; however, in Latin America, these data are scarcely known. The purpose of this research was to determine the practices and attitudes of palliativists in Latin America towards PS. Materials and methods Data was collected during the Latin American Congress on Palliative Care in Isla Margarita, Venezuela. A total of 89 professionals participated in this survey. Results It was found that the use of PS was positively associated with being a physician and being members of a palliative care (PC) group. On the other hand, it was found that being a psychologist and identifying barriers toward PS limited its utilization. Discussion The findings of this study support the need to establish clinical guidelines for its utilization and to educate other specialists on end-of-life care approaches, and the need to develop PC programs in acute care hospitals in Latin America.     

High-flow nasal cannula therapy: A multicentred survey of the practices among physicians and respiratory therapists in Singapore

BackgroundUse of high-flow nasal cannula (HFNC) has become a regular intervention in the intensive care units especially in patients coming in with hypoxaemic respiratory failure. Clinical practices may differ from published literature.ObjectivesThe objective of this study was to determine the clinical practices of physicians and respiratory therapists (RTs) on the use of HFNC.MethodsA retrospective observational study looking at medical records on HFNC usage from January 2015 to September 2017 was performed and was followed by a series of questions related to HFNC practices. The survey involved physicians and RTs in intensive care units from multiple centres in Singapore from January to April 2018. Indications and thresholds for HFNC usage with titration and weaning practices were compared with the retrospective observational study data.ResultsOne hundred twenty-three recipients (69.9%) responded to the survey and reported postextubation (87.8%), pneumonia in nonimmunocompromised (65.9%), and pneumonia in immunocompromised (61.8%) patients as the top three indications for HFNC. Of all, 39.8% of respondents wanted to use HFNC for palliative intent. Similar practices were observed in the retrospective study with the large cohort of 63% patients (483 of the total 768 patients) where HFNC was used for acute hypoxaemic respiratory failure and 274 (35.7%) patients to facilitate extubation. The survey suggested that respondents would initiate HFNC at a lower fraction of inspired oxygen (FiO₂), higher partial pressure of oxygen to FiO₂ ratio, and higher oxygen saturation to FiO₂ ratio for nonpneumonia patients than patients with pneumonia. RTs were less likely to start HFNC for patients suffering from pneumonia and interstitial lung disease than physicians. RTs also preferred adjustment of FiO₂ to improve oxygen saturations and noninvasive ventilation for rescue.ConclusionsAmong the different intensive care units surveyed, the indications and thresholds for the initiation of HFNC differed in the clinical practices of physicians and RTs.     

Family physicians who have focused practices in oncology: Results of a national survey

Objective

To characterize the demographic characteristics, practice profile, and current work life of general practitioners in oncology (GPOs) for the first time.

Design

National Web survey performed in March 2011.

Setting

Canada.

Participants

Members of the national GPO organization. Respondents were asked to forward the survey to non-member colleagues.

Main outcome measures

Profile of work as GPOs and in other medical roles, training received, demographic characteristics, and professional satisfaction.

Results

The response rate was 73.3% for members of the Canadian Association of General Practitioners in Oncology; overall, 120 surveys were completed. Respondents worked in similar proportions in small and larger communities. About 60% of them had participated in formal training programs. Most respondents worked part-time as GPOs and also worked in other medical roles, particularly palliative care, primary care practice, teaching, and hospital work. More GPOs from cities with populations of greater than 100 000 worked solely as GPOs than those from smaller communities (P = .0057). General practitioners in oncology played a variety of roles in the cancer care system, particularly in systemic therapy, palliative care, inpatient care, and teaching. As a group, more than half of respondents were involved in the care of each of the 11 common cancer types. Overall, 87.8% of respondents worked in outpatient care, 59.1% provided inpatient care, and 33.0% provided on-call services; 92.8% were satisfied with their work as GPOs.

Conclusion

General practitioners in oncology are involved in all cancer care settings and usually combine this work with other roles, particularly with palliative care in rural Canada. Training is inconsistent but initiatives are under way to address this. Job satisfaction is better than that of Canadian FPs in general. As generalists, FPs bring a valuable skill set to their work as GPOs in the cancer care system.     

Cervical cancer screening knowledge and practices among Korean-American women.

Cervical cancer is one of the most common cancers of American women. The Papanicolaou (Pap) smear test for cervical screening is a widely used and effective means to reduce the morbidity and mortality rate from cervical cancer through early detection. Despite these benefits, many women have never been screened or are not screened at regular intervals. The purpose of this study was to examine cervical cancer screening knowledge and practices of Korean-American women. The sample consisted of 159 Korean-American women, 40 to 69 years of age. The 1987 Cancer Control Supplement questionnaire was translated into Korean and used to collect data. Twenty-six percent of the respondents never heard of the Pap smear test. Only 34% of respondents reported having had a Pap smear test for screening. The most frequently cited reason for not having had a Pap smear test was absence of disease symptoms. Results indicate that education and usual sources of health care were significant factors related to having heard of or having had a Pap smear test. The findings from this study have important implications for health practitioners and policy makers who serve this ethnic population.     

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Background

Several efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if residency and current training, awareness of guidelines is sufficient for registered EPs to adequately perform PSA and if the availability of both adult and paediatric PSA in the ED is adequate.

Methods

A cross-sectional nationwide survey was performed amongst Dutch EPs (n?=?463) in June 2016. We collected data on background, training, practice, and competencies of both adult and paediatric PSA. We investigated guideline adherence, reasons for not performing PSA, and desired improvements.

Results

The respondents (n?=?191) represented 84.6% hospitals with EPs and 41.3% of all EPs in The Netherlands. Nearly all EPs (97.8%) performed PSA in adult patients compared to only 59.1% who performed PSA in paediatric patients (p?<?0.001). The major reason for not performing paediatric PSA was caused by a lack of exposure during the training-program (74.1%). PSA-guideline knowledge (98.3%) and PSA related adverse event registration (98.3%) were excellent. Lack of 24/7-availability of both adult and paediatric emergency department PSA was mainly caused by a shortage of EPs. Self-reflection indicated that EPs feel less competent in performing paediatric PSA when compared to adult PSA.

Conclusion

This nationwide survey demonstrates that there is still a significant gap between the performance of adult and paediatric PSA even though guideline adherence and registration of PSA-related adverse events appear to be adequate. Enhancement of paediatric PSA training in combination with an increase of EP-staffing can help improve the availability of adult and paediatric PSA in the emergency department.

     

Factors related to health practices: cervical cancer screening among Filipino women

This correlational study developed and tested theory to better understand health practices, including cervical cancer screening, among young Filipino women. It tested theoretical relationships postulated among (a) positive health practices, (b) cervical cancer screening, (c) social support, (d) acculturation, and (e) optimism. A convenience sample of 89 young Filipino women in an urban setting was obtained. Participants completed a demographic sheet and five instruments. Significant positive correlations were found between PHP and social support (r = .169, p <.05) and previous cervical cancer screening behavior (r = .285, p <.01) and cervical cancer screening frequency (r = .33, p <.01). Social support was not significantly related to cervical cancer screening. Previous cervical cancer screening behavior was significantly related to optimism (r = .285, p <.01) and screening frequency (r = .924, p <.01). Optimism was significantly related to positive health practices (r = .209, p <.05) and cervical cancer screening knowledge (r = .224, p <.05) but not significantly related to previous cervical cancer screening behavior or screening frequency. Findings contribute to a more comprehensive knowledge base regarding positive health practices, including cervical cancer screenings, among young Filipino women.     

Clinical trials in Dakar: survey on knowledge, attitudes and practices of key actors on the period from 2003 to 2007

AIM: The general objective of this study was to agree an inventory of fixtures of clinical trials done in Dakar, in order to make recommendations to improve the quality of clinical trials in Senegal. METHOD: We have done a survey from mars to may 2007, with investigators of the two biggest Senegalese university teaching hospitals and to the pharmacy management and the ethical committee. RESULTS: Our key results showed: 1) a small participation rate of teachers to clinical trials (11 on 37 interviewed); 2) that the principal sponsor is pharmaceutical industry; 3) that most of investigators have not degree in clinical trials; 4) that most pathologies concerned were malaria and AIDS; 5) that there are regulations related to clinical trials in Senegal. CONCLUSION: This study shows the necessity to integrate, in Senegal, clinical trials in the curricula of students training.