Physicians’ use of and attitudes toward electronic mail for patient communication

To assess physicians' use of and attitudes toward electronic mail (e-mail) for patient communication, we conducted a mail-in survey of physicians who see patients in outpatient clinics affiliated with a large academic medical center (N = 283). Seventy-two percent of physicians reported using e-mail to communicate with patients, averaging 7.7 e-mails from patients per month. The lowest level of use was by community-based primary care physicians (odds ratio, 0.22; 95% confidence interval, 0.08 to 0.59). Those physicians who reported using e-mail with patients reported high satisfaction with its use. Although physicians were concerned about the confidentiality of e-mail, few discussed this issue with patients.     

Patients’ use of the internet for medical information

OBJECTIVES: To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients' perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors. DESIGN: Self-administered mailed survey. SETTING: Patients from a primary care internal medicine private practice. PARTICIPANTS: Randomly selected patients ( N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%. MEASUREMENTS AND MAIN RESULTS: Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated ( P <.001) and had higher incomes ( P <.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the "same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers. CONCLUSIONS: Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.     

Is sekentei associated with attitudes toward use of care services?: Multilevel analysis in Japan

Aim: To examine the relationship between individual and regional levels of sekentei and attitudes toward care services in the general Japanese population. Methods: A cross‐sectional survey was conducted in January and February 2005 using a mailed‐in self‐administered questionnaire. Participants were 4735 community residents aged 20–75 years living in 23 regions in the city of Koka in Shiga Prefecture. Questions encompassed demographic data, attitudes toward the use of formal care services and the Sekentei Scale. The regional variable of sekentei was constructed by aggregating the individual sekentei scores within elementary school districts. Multilevel logistic regression analysis was conducted to assess the association between individual and regional sekentei and attitudes toward care services. Results: A total of 2264 questionnaires were analyzed. Approximately 16% of respondents were willing to use formal care services. Multilevel analysis showed that lower individual sekentei was associated with the willingness to use formal care services among both men and women (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.93–0.99 in men; OR = 0.96, 95% CI = 0.92–1.00 in women). Among men, the negative association between regional sekentei and the willingness to use formal care services was marginally significant (OR = 0.69, 95% CI = 0.48–1.01) as was the interaction between individual and regional sekentei levels. Conclusion: These results indicate the importance of assessing not only the individual sekentei level but also the sekentei level in different regions to develop strategies for the allocation of care resources. Geriatr Gerontol Int 2011; 11: 166–173.     

Does an IV bolus of methylprednisolone relieve dyspnea in asthma exacerbations?

STUDY OBJECTIVES: To assess whether IV methylprednisolone exerts a specific early effect on dyspnea in patients with an exacerbation of asthma. DESIGN: Randomized, placebo-controlled, double-blind crossover trial. SETTING: Medium-sized university general hospital. PATIENTS: Twenty-five asthma patients attending the chest clinic with spontaneous complaints of increases in dyspnea and with a Borg scale dyspnea rating >/= 1 at rest. INTERVENTIONS: At 0 min, IV methylprednisolone (125 mg) vs saline solution; at 60 min, 5 x 500 microg terbutaline inhaled from an inhaler device. Measurements and results: Change in dyspnea was assessed with bipolar visual analog scale (VAS) (much more short of breath, -100%; much less short of breath, + 100%), FEV(1), and visual memory (using the Benton visual retention test). Eighteen subjects (mean age, 61 years) completed the study. At 5 min and 60 min, shortness of breath improved with no statistically significant difference between saline solution and methylprednisolone. The mean (SD) VAS rating at 60 min was 29% (39%) on the day that saline solution was administered and 36% (25%) on the day the steroid was administered. FEV(1) and Benton score did not significantly change from baseline on either study day. Shortness of breath and FEV(1) improved following terbutaline administration, with no significant difference between the days on which saline solution and the steroid were administered. In the seven subjects who were randomized to receive methylprednisolone on the first day, baseline dyspnea rated on the Borg scale was significantly lower on the second day (first day: median, 3; range, 3 to 4; second day: median, 2; range, 0.5 to 3; p = 0.040). CONCLUSIONS: We conclude that in patients with an exacerbation of asthma, an IV bolus of methylprednisolone does not reduce dyspnea more than saline solution after 5 min and 60 min.     

Primary care physicians’ use of lumbar spine imaging tests

Objective

To reduce variability in primary care physicians’ use of procedures for imaging the lumbar spine.

Design

Controlled intervention using clinical practice guideline and practice pattern feedback.

Study Sample

Sixty-seven internists and 28 family practitioners in a large, group-model HMO.

Measurements and Main Results

Intervention group physicians received the clinical practice guideline for low back pain, followed after 4 months by three bim onthly feedback reports on their current use rates for lumber spine x-rays and computed tomography and magnetic resonance imaging scans of the lumbar spine. Control group physicians received neither the guideline nor the feedback reports. Automated radiology utilization data were used to compare intervention and control group physicians’ changes in use rates and variability in use rates over the course of the study period. Neither the guideline alone nor the guideline plus feedback was associated with a significant decrease in use rates or in the variability in use rates for the lumbar spine imaging procedures under study.

Conclusions

Clinical practice guidelines and practice pattern feedback fall to achieve their goals when features of the practice setting and patient expetations and behavior are not identified and addressed.     

“Spike” in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey

Background

In September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations.

Is the use of unfractionated heparin in acute coronary syndrome outmoded?

Because of the key role of thrombin in the pathogenesis of acute coronary syndrome (ACS), the appropriate selection of antithrombotic therapy is important. Unfractionated heparin (UFH) has been the agent of choice for decades. Unfortunately, UFH has a number of limitations related to its pharmacokinetic and pharmacodynamic properties. Low molecular weight heparins (LMWHs) are attractive alternatives to UFH for several reasons, including predictable anticoagulation and ease of administration. Two LMWHs (dalteparin and enoxaparin) have been approved as alternatives to UFH in patients presenting with unstable angina and non-ST-segment elevation myocardial infarction. Randomized, controlled trials, in addition to open-label series, indicate that LMWH can safely be the agent of choice with or without glycoprotein IIb/IIIa in the medical and upstream management of patients with ACS. Although the data are not definitive, several trials suggest that given intravenously, enoxaparin is safe as the sole antithrombotic agent in the catheterization laboratory.