Patient satisfaction with chiropractic physicians in an independent physicians'' association

BACKGROUND: Satisfaction with care is one of the variables that can be used in determining the results of medical care. Patient satisfaction surveys allow managed care plans to determine how well their providers meet certain standards. OBJECTIVE: To determine the level of satisfaction with chiropractic care in a random sample of patients seen by physician members of a chiropractic independent physicians' association. DESIGN: A visit-specific questionnaire was mailed to a random sample of 150 patients from health insurance claims filed in the first two months of 2000. RESULTS: The rate of return was 44%. Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others. CONCLUSION: The study demonstrated a high satisfaction rate among managed-care patients.     

Can cost utility evaluations inform decision making about interventions for low back pain?

Background contextLow back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers.PurposeTo conduct a systematic review of CUAs of interventions for LBP.Study designSystematic review.MethodsA search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results.ResultsThe search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n=8), published in the past 3 years (n=12), studied chronic LBP or radiculopathy (n=13), and had a follow-up >12 months (n=13). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n=17), exercise therapy (n=13), spinal manipulation therapy (n=7), surgery (n=7), and usual care from a general practitioner (n=7). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04. Based on available data and converted to US dollars, the cost per quality-adjusted life year ranged from $304 to $579,527, with a median of $13,015.ConclusionsFew CUAs were identified for LBP, and there was heterogeneity in the interventions compared, direct cost components measured, indirect costs, other methods, and results. Reporting quality was mixed. Currently published CUAs do not provide sufficient information to assist decision makers. Future CUAs should attempt to measure all known direct cost components relevant to LBP, estimate indirect costs such as lost productivity, have a follow-up period sufficient to capture meaningful changes, and clearly report methods and results to facilitate interpretation and comparison.     

Quantitative PET comparing gated with nongated acquisitions using a NEMA phantom with respiratory-simulated motion

This study evaluated the use of gated versus nongated PET acquisitions for absolute quantification of radioisotope concentration (RC) in a respiratory motion-simulated moving phantom filled with radioactive spheres and background for both 2-dimensional (2D) and 3-dimensional (3D) acquisitions. METHODS: An image-quality phantom with all 6 spheres filled with the same (18)F RC (range, 19-62 kBq/mL) was scanned with PET/CT at rest and in motion with and without gating. The background was filled with (18)F solution to yield sphere-to-background ratios of approximately 5, 10, 15, and 20 to 1. Both 2D and 3D acquisitions were used for all combinations. Respiratory motion was simulated by using a motor-driven plastic platform to move the phantom periodically with a displacement of 2 cm and a cycle time of 5.8 s. For gated acquisitions, the phantom was tracked using a real-time position management system. Images were reconstructed, and regions of interest with the same sizes as the actual spheres were manually placed on axial slices to determine maximum and mean pixel RC. A threshold method (70% and 94% for 2D and 3D modes) was also used to determine a mean voxel RC. All values were compared with the expected RC; percentage differences were calculated for each sphere. To reduce partial-volume effects, only data for the 4 largest spheres were analyzed. RESULTS: The mean pixel method was the only method with linear responses for all 3 scan types, enabling direct comparisons. The ranges of RC percentage differences were underestimated for all scan types (using the mean pixel method). The overall mean percentage differences were 37, 49, and 41 in 2D mode and 40, 51, and 41 in 3D mode for static, nongated, and gated acquisitions, respectively. Gated acquisitions improved quantification (by reducing underestimation) over nongated acquisitions by 8% and 10% for 2D and 3D modes. CONCLUSION: In the presence of motion, the use of gated PET acquisitions appears to improve quantification accuracy over nongated acquisitions, almost restoring the results to those observed when the phantom is static.     

Self‐reported daily stress,squelching of anger and the management of daily stress and the prevalence of uterine leiomyomata: the ultrasound screening study

Self‐reported daily stress, ways of managing stress and squelching anger were examined in association with uterine leiomyomata (aka fibroids). These stress factors were obtained from 560 Black and 375 White women enrolled in the National Institute of Environmental Health Sciences Uterine Fibroid Study. Race‐specific prevalence differences (PD) and 95% confidence intervals (95% CI) were calculated. Black women with severe stress had a prevalence of fibroids that was 11% higher (95% CI: 0%, 21%) than those in the no or mild stress group (referent). White women with severe stress, compared to the referent, had a non‐significantly (NS) higher prevalence of fibroids [PD = 7%; 95% CI: (?10%, 21%)]. For both groups, moderate daily stress was associated with a weak elevation (NS) in fibroid prevalence. Black women who reported squelching their anger had an elevated prevalence of fibroids (8%) compared to non‐squelchers [95% CI: (?0%, 15%)] while there was no association for White women. Women with symptomatic fibroids had higher stress than those without, but exclusion of symptomatic women only slightly attenuated the associations. Consistent with a previous report, symptomatic fibroids may cause stress. However, further research is warranted to prospectively investigate a possible aetiologic role for stress in the development of fibroids. Copyright © 2010 John Wiley & Sons, Ltd.     

Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital

A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central Hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics.