Does length of questionnaire matter? A randomised trial of response rates to a mailed questionnaire

OBJECTIVE: To assess whether length of questionnaire affects response rates. METHODS: A quasi-randomised trial of women aged 70 years and over in a general practice in England. Three questionnaires of different lengths: a clinical questionnaire (four pages); the same questionnaire plus the EuroQol (five pages); the same questionnaire plus the SF-12 (seven pages). The impact of length on the proportion of returned questionnaires and item completion rates was assessed. RESULTS: In total, 847 questionnaires were mailed; response rates were 49%, 49% and 40% to the short, medium and long questionnaires, respectively. This difference was statistically significant when the short questionnaire was compared against the longest instrument (9% difference; 95% confidence interval (CI) of difference = 0.3% to 16.6%). Item completion rates for the clinical questionnaire did not differ. Respondents did not differ in age or self-reported health status between the three groups. CONCLUSIONS: Increasing the length of a questionnaire from five to seven pages reduces response rates from women aged 70 years and over. However, lengthening a questionnaire does not seem to affect the quality of responses to questions near the front of the questionnaire.     

Interviewer versus self-administered health-related quality of life questionnaires - Does it matter?

Background  

Patient-reported outcomes are measured in many epidemiologic studies using self- or interviewer-administered questionnaires. While in some studies differences between these administration formats were observed, other studies did not show statistically significant differences important to patients. Since the evidence about the effect of administration format is inconsistent and mainly available from cross-sectional studies our aim was to assess the effects of different administration formats on repeated measurements of patient-reported outcomes in participants with AIDS enrolled in the Longitudinal Study of Ocular Complications of AIDS.     

Does growth hormone allow more efficient nitrogen sparing in postoperative patients requiring parenteral nutrition? A double-blind, placebo-controlled randomised trial

BACKGROUND & AIMS: Growth hormone (GH) has a strong anabolic effect and is thought to be useful in improving the efficacy of parenteral nutrition (PN) to preserve muscle mass (MM) in the postoperative setting. Unfortunately, the negative clinical outcome of GH treatment in intensive care patients limits its use in this setting, but demands answers to the mechanism behind the action of this therapy. METHOD: In a double-blind randomised controlled study consecutive patients after major abdominal surgery were divided into four groups of either 1/2-PN (0.13 g N/kg/day and 52% of calories as lipid) or full-strength PN (Full-PN) (0.3 g N/kg/day and 65% of calories as lipid) receiving daily injections of either GH (8-16 IU) or placebo for a period of 14 days postoperative. Outcome measures included MM derived from measures of total body potassium (40K counting) and total body nitrogen (TBN) (in vivo neutron capture technique); Fat mass from skin folds; serum insulin like growth factor-I (IGF-I) and its binding proteins (IGFBP). RESULTS: From 43 major upper GI surgical patients randomised 35 completed the study (one patient died from sepsis in the half-strength PN (1/2-PN)+GH group). 1/2-PN (n=11) lost TBN (P=0.001), MM (P=0.005) but not fat. Full-PN (n=9) maintained TBN, MM (P=0.056) and fat. 1/2-PN+GH (n=8) maintained TBN and fat but lost MM (P=0.038). Full-PN+GH (n=7) maintained TBN and MM but lost fat (P=0.018). Two-way ANOVA indicated that PN input (P=0.031) and not GH had a significant effect on MM. GH caused a significant rise in IGF-I levels (290+/-67 and 454+/-71 microg/l for 1/2-PN+GH and Full-PN+GH, respectively) and restored serum IGFBP3 and the acid labile subunit to normal, by the postoperative day 9. CONCLUSION: After major gastrointestinal surgery, GH causes a marked hepatic IGF-I response and nitrogen retention but its effect on body composition was more significant with a high PN input. Further, Full-PN alone was sufficient to prevent nitrogen loss and preserved MM and addition of GH does not provide further metabolic advantage.     

Does environment matter? A review of nonshared environment and eating disorders

OBJECTIVE: Nonshared environmental influences are experiences that are unique to siblings reared in the same family. We review studies highlighting the importance of nonshared factors for the development of eating disorders and suggest areas for future research. METHODS: Findings from behavioral genetic studies of eating disorders as well as methodological issues are reviewed. RESULTS: Twin studies suggest that approximately 17%-46% of the variance in both anorexia nervosa (AN) and bulimia nervosa (BN) can be accounted for by nonshared environmental factors. Studies directly examining these influences are scarce, although initial data indicate that differential paternal relationships, body weight teasing, peer group experiences, and life events may account for the development of eating pathology in one sibling versus another. DISCUSSION: Additional research is needed to identify specific nonshared environmental influences on eating disorders such as differential parental and sibling treatment, disparate peer group characteristics, and differential experience of life events such as physical and sexual abuse.     

Does doctors' experience matter in LASIK surgeries?

In this article, we use a longitudinal census of laser in situ keratomileusis (LASIK) eye surgeries collected directly from patient charts to examine the learning‐by‐doing hypothesis in medicine. LASIK surgery has precise measures of presurgical condition and postsurgical outcomes. Unlike other types of surgery, the impact of unobservable underlying patient conditions on outcomes is minimal. Individual learning by doing is identified through observations of surgical outcomes over time, based on the cumulative number of surgeries performed. Collective learning is identified separately, through changes in a group adjustment rule determined jointly by all the surgeons in a structured internal review process. Our unique data set overcomes some of the measurement problems in patient outcomes encountered in other studies and improves the possibility of identifying and separating the impact of learning by doing from other effects. We cannot conclude that the outcome of LASIK surgery improves as an individual surgeon's experience increases, but we find strong evidence that experience accumulated by surgeons as a group in a clinic significantly improves outcomes. Copyright © 2010 John Wiley & Sons, Ltd.     

Does teacher thinking match teaching practice? A study of basic science teachers

OBJECTIVE: To obtain an understanding of basic science medical teachers' conceptions of learning and their ideas for facilitation of learning. METHODS: Teaching staff at a biomedical centre (n = 62) were asked to describe their definitions of learning, their suggestions for how to solve an applied educational problem and their intended activities when teaching students. The research was carried out using a questionnaire consisting of open-ended and fixed-choice questions. RESULTS: Although 1 in 4 teachers endorsed constructivist conceptions of learning, only 1 in 8 actually reported using activating teaching strategies. Conceptions of learning did not co-vary with teaching practice. CONCLUSIONS: The assumption that conceptions of learning and teaching practice are aligned was challenged. The current questionnaire could be used as an intervention tool for educational development to map whether or not there is a match between teachers' conceptions and their practice.     

Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial

STUDY OBJECTIVE: To compare health walks, a community based lay-led walking scheme versus advice only on physical activity and cardiovascular health status in middle aged adults. DESIGN: Randomised controlled trial with one year follow up. Physical activity was measured by questionnaire. Other measures included attitudes to exercise, body mass index, cholesterol, aerobic capacity, and blood pressure. SETTING: Primary care and community. PARTICIPANTS: 260 men and women aged 40-70 years, taking less than 120 minutes of moderate intensity activity per week. MAIN RESULTS: Seventy three per cent of people completed the trial. Of these, the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6% in the advice only and 35.7% in the health walks group at 12 months (between group difference =13% (95% CI 0.003% to 25.9%) p=0.05). Intention to treat analysis, using the last known value for missing cases, demonstrated smaller differences between the groups (between group difference =6% (95% CI -5% to 16.4%)) with the trend in favour of health walks. There were improvements in the total time spent and number of occasions of moderate intensity activity, and aerobic capacity, but no statistically significant differences between the groups. Other cardiovascular risk factors remained unchanged. CONCLUSIONS: There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat. In people who completed the trial, health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week.     

Does a single cup of coffee at dinner alter the sleep? A controlled cross‐over randomised trial in real‐life conditions

Aim: To report changes in the quality of sleep after drinking an evening cup of either caffeinated or decaffeinated coffee, in healthy subjects in everyday life. Methods: Sixty‐three healthy men and women, who considered themselves to be caffeine sensitive were included in a double‐blind, cross‐over trial, randomised to receive either caffeinated coffee containing 90 mg of caffeine, or, as control, a dose of decaffeinated coffee containing 4.5 mg caffeine, taken after dinner. The primary outcome measure was the degree of sleep disturbance, scored on a visual analogue scale, ranging from 0 (excellent sleep) to 100 (very disturbed sleep). Ancillary criteria were patients' reported estimate of sleep latency, and how often the subjects reported waking. Results: Mean age of subjects was 30.5 ± 12 years. The quality of sleep was significantly worse with caffeinated (mean 30.8 ± 22.7) than with decaffeinated coffee (mean 19.5 ± 16.9), P = 0.001. Caffeinated coffee also significantly increased the sleep latency (mean difference 17 ± 31 minutes, P < 0.001) and the frequency of waking (mean 1.3 vs 0.8 episodes in the night, P = 0.006) compared with decaffeinated coffee. Conclusions: Even a single cup of caffeinated coffee consumed before bedtime in real‐life conditions causes a deterioration in the quality of sleep in caffeine‐sensitive subjects.     

Absolute and relative densities of fast-food versus other restaurants in relation to weight status: Does restaurant mix matter?

BackgroundGiven the continuing epidemic of obesity, policymakers are increasingly looking for levers within the local retail food environment as a means of promoting healthy weights.PurposeTo examine the independent and joint associations of absolute and relative densities of restaurants near home with weight status in a large, urban, population-based sample of adults.MethodsWe studied 10,199 adults living in one of four cities in southern Ontario, Canada, who participated in the Canadian Community Health Survey (cycles 2005, 2007/08, 2009/10). Multivariate models assessed the association of weight status (obesity and body mass index) with absolute densities (numbers) of fast-food, full-service and other restaurants, and the relative density (proportion) of fast-food restaurants (FFR) relative to all restaurants within ~ 10-minute walk of residential areas.ResultsHigher numbers of restaurants of any type were inversely related to excess weight, even in models adjusting for a range of individual covariates and area deprivation. However, these associations were no longer significant after accounting for higher walkability of areas with high volumes of restaurants. In contrast, there was a direct relationship between the proportion of FFR relative to all restaurants and excess weight, particularly in areas with high volumes of FFR (e.g., odds ratio for obesity = 2.55 in areas with 5 + FFR, 95% confidence interval: 1.55–4.17, across the interquartile range).ConclusionsPolicies aiming to promote healthy weights that target the volume of certain retail food outlets in residential settings may be more effective if they also consider the relative share of outlets serving more and less healthful foods.     

A systematic review and meta-analysis of racial disparities in prenatal care in California: How much? Does insurance matter?

This meta-analysis compares California to 13 states with regard to adequacy of prenatal care in the context of the major Medicaid expansion. It shows a reduction in prenatal care inadequacy after 1992, especially in California. It also shows persistent racial ethnic disparities. By examining how California differed from other states, this study provides not only benchmarks for attaining the Healthy People 2010 goal of 90% adequacy but also possible strategies for achieving this goal. Attaining the Healthy People 2010 objective for prenatal care for California as a whole will require further efforts to understand and address racial/ethnic and insurance-related inequalities.     

Research governance: impeding both research and teaching? A survey of impact on undergraduate research opportunities

OBJECTIVE: To explore the impact of research governance on medical students' ability to gain an understanding of research methodology, as required by the General Medical Council. METHODS: We carried out a qualitative study based on semi-structured interviews, in 3 medical schools in the UK, with 12 interviewees including academic supervisors and administrative staff. RESULTS: Research governance has the potential to facilitate medical undergraduates to experience better quality research but, unfortunately, the inhibitory effects of the current framework overwhelm this. Participants highlighted the bureaucracy of the process, particularly the complexity of securing ethical approval and the length of application forms. In addition, there is widespread confusion and uncertainty about the process at a variety of levels. For medical teachers, confusion exists around the practicalities of the current process, the boundaries between core clinical experience, audit and research, and how the process may change in the future. Academic supervisors have adopted several strategies, including amending existing research projects, and in some cases have withdrawn from student supervision altogether. CONCLUSIONS: The present research governance requirements, especially for ethical approval, are too unwieldy to facilitate medical students' assimilation of research experience as a required learning outcome. Precise and clear definitions of the types of projects that necessitate ethical approval and the development of a shortened, simplified ethical approval application form are recommended.