Differential effectiveness of telephone prompts by medical and nonmedical staff in increasing survey response rates: a randomised trial

Abstract: We conducted a randomised trial to determine the differential effectiveness of a telephone prompt by a medical researcher compared with a nonmedical research assistant in improving response rates of general practitioners to a survey and to compare personnel costs. A national random sample of Australian general practitioners was allocated randomly to two intervention groups. In advance of a self–administered questionnaire, Group A (n = 184) received a telephone prompt by a medical researcher and Group B (n = 189) a prompt by an experienced nonmedical research assistant. Other aspects of survey administration were identical for both groups. The five–month cumulative response rate obtained by the medical researcher (81 per cent) was not significantly different from that of 72 per cent obtained by the research assistant ( X ²= 3.3, 1 df, P = 0.07). For Group A, 279 telephone calls, consuming 23 hours 15 minutes, were made. Group B required more calls (384) and more time (32 hours). Using the relevant award pay scales, the estimated personnel costs for each group were $631 and $601 respectively. We conclude that an experienced nonmedical research assistant is as effective as a medical practitioner in administering telephone prompts to enhance survey response rates, although savings are not necessarily made.     

Research engagement and outcomes in public health and health services research in Australia

Objectives: To retrospectively explore research outcomes in Australian public health research and their relationship to full engagement with potential research users during the research process.
Methods: A self-administered survey of all principal investigators (PIs) receiving research funds from one of three well-known research funding agencies. 'Research value' and 'research utility' were self-reported using fixed response sets. Associations between outcomes and 'full engagement' were examined.
Results: Our response rate (75.1%) yielded data for 187 research projects. For just over one-quarter (26.7%), 'research value' was rated 'very important' in terms of knowledge generation. The most common 'research utility' was 'continuing education' (27.3%) followed by 'policy formulation' (25.7%). While 66 (35.3%) projects engaged at least one potential research user group throughout 'full engagement', such an intertwined relationship between researchers and research users was not associated with research value (χ²=0.46, 1df, p=0.5) or research utility (χ²=2.19, 1df, p=0.14). There were no predictors of 'full engagement'. In just over a third of projects (34.8%), both part of the awarded grant and additional funding had been spent to promote research use.
Conclusions and Implications: This snapshot demonstrates patchy research engagement between researchers and research users. Other academic groups were the most common partner for full engagement. In an evidence-based era, innovation in health research funding policy should be evaluated. As NHMRC embarks upon its 'Partnerships initiative' in 2009, we recommend a prospective approach to evaluation.     

The feminisation of Canadian medicine and its impact upon doctor productivity

Objective  We examined the differences in work patterns between female and male doctors in Canada to gain insight into the effect of an increased number of female doctors on overall doctor productivity.
Methods  Data on the practice profiles of female and male doctors across Canada were extracted from the 2007 National Physician Survey. A doctor productivity measure, 'work hours per week per population' (WHPWPP), was created, based on the number of weekly doctor hours spent providing direct patient care per 100 000 citizens. The predicted WHPWPP was calculated for a hypothetical time-point when the female and male doctor populations reach equilibrium. The differences in current and predicted WHPWPP were then analysed.
Results  Female medical students currently (2007) outnumber male medical students (at 57.8% of the medical student population). The percentage of practising doctors who are women is highest in the fields of paediatrics, obstetrics and gynaecology, psychiatry and family practice. Female doctors work an average of 47.5 hours per week (giving 30.0 hours of direct patient care), compared with 53.8 hours worked by male doctors (35.0 hours of direct patient care) ( P  < 0.01, χ² test). Female doctors tend to work less on call hours per week and see fewer patients while on-call. Female doctors are also more likely to take parental leave or a leave of absence ( P  < 0.01, χ² test). The difference in current and predicted WHPWPP was found to be 2.6%, equivalent to 1853 fewer full-time female doctors or 1588 fewer full-time male doctors.
Conclusions  Gender appears to have a significant influence on the practice patterns of doctors in Canada. If the gender-specific work patterns described in the present study persist, an overall decrease in doctor productivity is to be anticipated.     

Addressing Ceiling Effects in Health Status Measures: A Comparison of Techniques Applied to Measures for People with HIV Disease

Objectives. To compare different approaches to address ceiling effects when predicting EQ-5D index scores from the 10 subscales of the MOS-HIV Health Survey.
Study Design. Data were collected from an HIV treatment trial. Statistical methods included ordinary least squares (OLS) regression, the censored least absolute deviations (CLAD) approach, a standard two-part model (TPM), a TPM with a log-transformed EQ-5D index, and a latent class model (LCM). Predictive accuracy was evaluated using percentage of absolute error ( R ¹) and squared error ( R ²) predicted by statistical methods.
Findings. A TPM with a log-transformed EQ-5D index performed best on R ¹; a LCM performed best on R ². In contrast, the CLAD was worst. Performance of the OLS and a standard TPM were intermediate. Values for R ¹ ranged from 0.33 (CLAD) to 0.42 (TPM-L); R ² ranged from 0.37 (CLAD) to 0.53 (LCM).
Conclusions. The LCM and TPM with a log-transformed dependent variable are superior to other approaches in handling data with ceiling effects.     

Bacterial colonization of enteral feeding tubes

An in-vitro model system was used to determine the number of bacteria infused into a 'patient' when three types of polyurethane enteral feeding-tubes that had been experimentally contaminated with feed containing K . aerogenes on day I, were then perfused with sterile feed for periods of 8 h on three consecutive days (days 2–4). The tubes were syringed with 20 ml sterile water at regular intervals. Viable counts were made on syringe washings, feed collected from the ends of the tubes and feed from the nutrient containers.
On day 1, the total number of K . aerogenes in feed samples collected from the nutrient containers and the ends of the tubes rose from 10² to 103–10⁴ cfu ml^-1 over 8 h. On days 2–4 no organisms were detected in the feed samples from the nutrient containers whereas viable counts on feed samples collected from the tubes and syringe washings rose from 10⁴ to 10⁷ and from 10¹ to 10⁷ cfu ml^-1 respectively.
It can be concluded that a single incidence of feed contamination could lead to a patient receiving contaminated feed from an enteral feeding-tube colonized with bacteria which will not be detected by normal monitoring of the remainder of the system.     

Competency domains in an undergraduate Objective Structured Clinical Examination: their impact on compensatory standard setting

Context  Following a 15-week attachment in paediatrics and child health, general practice and dermatology medical students in their second clinical year at this medical school undertake a high-stakes assessment including an objective structured clinical examination (OSCE). There were 2 hypotheses. Firstly, groups of similar stations map to competency domains identifiable by factor analysis. Secondly, poor performance in individual domains is compensated for by achieving the required standard of performance across the whole assessment.
Methods  A total of 647 medical students were assessed by an OSCE during 5 individual examination sittings (diets) over 2 years. Ten scoring stations in the OSCE were analysed and confirmatory factor analysis performed comparing a 1-factor model (where all the stations are discrete entities related to one underlying domain) with a 3-factor model (where the stations load onto 3 domains from a previously reported exploratory factor analysis).
Results  The 3-factor model yielded a significantly better fit to the data (χ² = 15.3, P  <   0.01). Assessing the compensation data of 1 diet, 29 of 127 students failed in 1 or more domains described, whereas only 5 failed if compensation was allowed across all domains.
Discussion  Confirmatory factor analysis showed a significant fit of the data to previously described competency domains for a high-stakes undergraduate OSCE. Compensation within but not between competency domains would provide a more robust standard, improve validity, and substantially reduce the pass rate.     

DIETARY CHOLESTEROL AND LIVER MICROSOMAL FATTY ACID DESATURASES

Dietary cholesterol increased the activity of rat liver microsomal fatty acid Δ⁹ desaturase, decreased that of Δ⁵ and Δ⁶ desaturases, and increased the fluorescence anisotrophy of 1,6-diphenyl-1,3,5-hexatriene.     

Having a baby in Victoria 1989-2000: women's views of public and private models of care

Objective : To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000.
Methods : Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5–8 months after the birth.
Results : 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (χ² for trend=15.01, p <0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989–67%, 1994–71 %, 2000–72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (χ² for trend=33.1, p <0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'.
Conclusions : The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.     

Problems with the re-use of enteral feeding systems—a study of the effectiveness of a range of cleaning and disinfection procedures

Although many manufacturer's state that their systems are 'single-use only', some authors are now recommending that enteral feed delivery systems can be re-used, particularly in the home, in order to reduce the expense of enteral feeding.
The purpose of this study was to evaluate the effectiveness of a range of currently recommended cleaning and disinfection procedures in removing bacteria from five commonly used enteral feeding systems. The systems used were, a collapsible, top-fill reservoir with integral giving set, a plastic enteral nutrition bag with side port and integral giving set, and three different types of rigid plastic reservoirs with separate giving sets.
The systems were filled with 1000-ml portions of feed experimentally contaminated with either Klebsiella aerogenes or Escherichia coli and the feed perfused through the systems for 15 h; viable counts increased from 10²-^-10³ to 10⁷-^-10⁹ cfu ml^-1. The systems were then cleaned by a range of methods including rinsing and/or immersing them in sterile water, sterile water and detergent, and/or disinfection with hypochlorite solutions. When the systems were refilled with sterile feed it was found that residual bacteria in the systems multiplied to yield levels ≤10⁹ cfu ml^-1 after 15 h.
The results of the present study demonstrate that none of the methods tested can be recommended as being totally effective in removing bacteria from contaminated systems.     

The effect of the pregnancy-induced hypertension on fetal growth: a review of the literature

Summary. Understanding how pregnancy-induced hypertension affects fetal growth could suggest a particular biological mechanism leading to intrauterine growth retardation (IUGR) and improve our understanding about how other exposures affect the risk of IUGR. It is hypothesised that hypertension reduces uteroplacental perfusion and through this route inhibits fetal growth.¹-² Definitions and associated incidence rates are given. The findings from the epidemiological literature on hypertension in pregnancy and fetal growth are then critically discussed and summarised. Finally, the steps to be taken next in this area of research are outlined.     

Dietary advice, nutritional knowledge and attitudes towards nutrition in primary health care

The high priority of health promotion within primary health care in the UK is evidenced through the acceptance, by the primary health care team (PHCT), of a contractual responsibility for health promotion, including the provision of dietary advice. This study sought to investigate the level of advice given on dietary matters, the methods used to give this advice and the nutritional knowledge and attitudes towards nutrition of Sheffield PHCTs; general practitioners (GPs) and practice nurses (PNs) were compared. All active practices ( n = 100) on Sheffield Health Authority's GP practice lists were invited to participate. A total of 58 interviews in 46 practices were completed, representing a response rate of 46%. Information was collected using an interviewer-administered questionnaire. Data analysis was carried out using MINITAB (Minitab Inc., Pennsylvania, USA); differences between groups were tested using the x² test.
It was found that PNs gave dietary advice more frequently than GPs ( P <0.05). GPs were more likely ( P <0.05) to give verbal advice only, whereas PNs tended to take a dietary history and to give both written and verbal advice. GPs were less likely than PNs to give comprehensive advice for type II (maturity onset) diabetes, hypercholesterolaemia and obesity. There were appreciable gaps in the nutritional knowledge of both groups. The majority of GPs and PNs believed nutrition to be important in disease prevention and expressed a desire for nutritional teaching as part of their medical training. The primary health care team is in a prime position to give dietary advice, however, it is evident that there is a need for improved nutrition education and training in dietary counselling.     

Postcard reminders from GPs for influenza vaccine: Are they more effective than an ad hoc approach?

All persons 65 years and older are recommended to be immunised against influenza each autumn. As immunisation rates remain low, we conducted a randomised control trial in a three-partner urban general practice to evaluate the differential effectiveness of a single postcard reminder in a general practice setting compared to usual care. All non-residential patients aged 65 years and over were identified from the age/sex/disease register. After exclusions, 325 patients were stratified by sex (125 men and 200 women) and randomised to receive either a postcard reminder in large print mailed in April or usual care. General practitioners (GPs) were blind to the randomisation. A blinded record audit performed in July demonstrated that the postcard was effective in increasing immunisation for men (X²_1df=3.85; p=0.05) but not for women (X²_1df=0.45; p=0.50). After adjusting for 1995 immunisation status, the effect of the postcard on immunisation rates was even stronger in men (Wald X²_1df=6.20; p=0.01) but remained non-significant in women (Wald x²_1df=1.38; p=0.24). With this adjustment, the odds of having the 1996 flu vaccine for men sent the postcard reminder were three times that of men in the control group (OR=3.0; 95% Cl 1.3–6.9). In a general practice setting, a single postcard reminder appears to be a promising way to boost influenza immunisation rates among ageing men. Replication of the study is recommended.     

Increasing response rates of gynaecologists to a survey: a randomised trial of telephone prompts

Abstract: This study used a randomised controlled trial to evaluate the effectiveness of telephone prompts to increase the response rate of gynaecologists to a survey. A nine-page questionnaire about management of women with abnormal Pap smears was mailed to Fellows of the Royal Australian College of Obstetricians and Gynaecologists. A random sample was contacted in advance by telephone, and nonrespondents received a telephone reminder 14 days after the initial mail-out. The control group was mailed questionnaires and a reminder letter conventionally. On Day 25, nonresponders in both groups were mailed a second questionnaire. Of the intervention group, 84 per cent responded to the survey compared to 69 per cent of the control group (P = 0.005). A telephone call in anticipation of a mailed questionnaire is highly recommended.     

Students' and general practitioners' perceptions of a recently introduced clerkship in general practice. A survey from Austria

Abstract

Background: In autumn 2007, the Medical University of Graz (MUG) upgraded the status of general practice in medical training by integrating a compulsory five-week clerkship in general practice surgeries in the sixth and last year of the curriculum. In cooperation with the Styrian Academy of General Practice (STAFAM), more than 200 general practitioners (GPs) had been accredited to introduce medical students to the specific tasks, problems and decision-making process in general practice. Between October 2007 and June 2009, more than 300 students completed the clerkship. Objective: To explore the perceptions of students and GPs towards this new approach to undergraduate teaching in Austrian general practice. Methods: Between March and June 2009, we conducted a cross-sectional survey by using a self-administered questionnaire with 14 items for students as well as GPs. To limit recall bias, we gave the questionnaire to all students (n = 146) and GPs (n = 146) immediately after the clerkship. The response rates were 146/146 (100%) and 114/146 (78%) for students and GPs, respectively. Results: The study results show high satisfaction rates among students as well as GPs. Most of the students and GPs perceive the compulsory clerkship in general practice as an essential part of medical education. The organization of the clerkship had the least positive outcome.

Conclusion: Our survey shows that the clerkship is well accepted among Austrian medical students and GPs.     

Work–related injuries in trade apprentices

Abstract: This study attempted to identify and describe all work–related injuries in a cohort of trade apprentices at the Canberra Institute of Technology over an approximate one–year period. In 997 persons followed for a total of 198 456 days of exposure there were 771 injuries of which 191 were classed as serious (defined as at least one day off work and/or received sutures and/or required hospital treatment). The most common circumstance of injur) was a cut to the fingers or hand while using a sharp–edged, non–powered hand tool. At least 52 persons required hospital treatment and another 51 required suturing. Overall rates of injury were 222 (95 per cent confidence interval (CI) = 193 to 256) injuries per 1000 full time equivalents (FTEs) and 169 (95% CI=147 to 193) injured persons per 1000 persons. Injury rates adjusted for stage (year of course) were significantly different between schools and were highest in the construction and engineering trades groups ( X ²₅= 57.30, P < 0.001). There was a statistically significant trend of higher risk of injury with later stage after adjustment for school ( X ²₂= 6.34, P = 0.042). This study has shown that trade apprentices are at high risk of significant work–related injury and provides important insights into the characteristics of work–related injuries in trade apprentices. These have significant implications for the safety expectations apprentices may bring to the workplace and for the appropriate targeting of occupational health and safety training of apprentices in the trade occupations.     

Application of Hazard Analysis Critical Control Points system to enteral tube feeding in hospital

An HACCP system was implemented for the quality assurance of preparation, storage and delivery of enteral feeds to patients in hospital. Routine methods of feed preparation, storage and delivery to patients were studied and a flow chart was initially made. After identifying hazards, an HACCP team was assembled, a flow chart was modified and critical control points were defined using a decision tree. Control measures for each step of the process and its monitoring and corrective measures to be applied were also defined. In addition, feed samples were analysed for microbiological quality and feed storage temperatures were also recorded, before and after the implementation of the HACCP system. When the control measures were applied and monitored, the hazard was reduced. Bacterial counts in feed were reduced from 10⁵ cfu mL^–1 to < 10¹ cfu mL^–1. The results show that contamination of enteral feed may be reduced or eliminated if a systematic approach such as HACCP is applied effectively.     

编辑因素对我国中文医学期刊学术质量影响的实证研究

【目的】验证与期刊编辑/编辑部相关的、中文医学期刊论文学术质量的影响因素,有针对性地提出控制我国中文医学期刊学术质量的策略。【方法】以田野调查、文献研究和专家访谈法募集中文医学期刊论文质量影响因子,分别设计针对作者/作者机构和医学期刊编辑/编辑部的问卷;以已有的论文质量评价指标对我国医学期刊近年发表的临床研究论文的学术质量进行抽样评价;通过问卷调查获取抽样论文的作者/作者机构与医学期刊编辑/编辑部的数据;采用假设检验法验证论文质量的影响因素。【结果】最终纳入质量抽样评价的我国中文医学期刊近年发表的临床研究论文有229篇,同时获得229篇论文的作者及所涉138种中文医学期刊编辑的问卷数据。数据统计学分析显示:在与作者/作者机构相关的23项可能因素中,仅伦理审查1项与论文综合质量相关(χ²=11.075,P=0.001);在与编辑/编辑部相关的18项可能因素中,编辑是否具有医学专业背景(χ²=21.533,P<0.001)、统计学掌握水平(t=2.221,P=0.028)、在版面形式上的耗费时间(t=-3.064,P=0.002)以及期刊是否为核心期刊(χ²=4.714,P=0.034)4个变量与论文综合质量显著相关。结果证实,编辑/编辑部相关因素与我国中文医学期刊论文学术质量存在关联。【结论】为控制我国中文医学期刊的学术质量,医学期刊编辑部应将具备医学学科背景作为科学编辑入职的必备条件;持续强化对医学编辑的临床研究方法学和统计学培训;按工作需要配备编辑人力并合理化分工,减少科学编辑在论文版面形式上的耗费时间。此外,编辑部在初审论文时须严格执行形式审查制度,对未经伦理审查的医学研究论文应予以“一票否决”。     

PROPERTIES OF VITAMIN D-DEPENDENT CALCIUM-BINDING PROTEIN FROM CHICK DUODENAL MUCOSA

Chick intestinal calcium-binding protein has a molecular weight of approximately 28,000 and is comprised solely of 242 amino acids, of which over half are polar and a fourth of these contain side-chain carboxyls. Calcium is bound tightly at four sites with an intrinsic association constant of 2 times 10⁶ M^-1. Divalent cations bind in the order Mg < Ni < Co < Zn < Mn < Cd < Ca > Sr> Ba, which appears to be related to the crystal ionic radii.