What's said and what's done: the reality of sexually transmitted disease consultations

OBJECTIVE: Indirect data collection methods, or approaches which disturb usual practice, are generally used in health care evaluation. We have compared what doctors report at interview what is observed by an identified researcher with an unobtrusive measure of their usual practice. DESIGN: Private practitioners who provide a service to sexually transmitted disease (STD) patients were interviewed regarding their usual case management. An identified researcher carried out structured observations of consultations between physicians and patients. Simulated clients then sought consultations, presenting a standardised history and symptom profile. Structured reporting of the history taking, examination, treatment and counselling aspects of these consultations was undertaken. SUBJECTS: Eighteen private practitioners in Madras (now Chennai), India. MAIN OUTCOME MEASURES: Comparisons between interviews, observations by identified researchers and the experiences of simulated clients were carried out. RESULTS: Interviews with physicians and observations by identified researchers indicated more favourable practice than was seen during simulated client visits. These differences were substantial and would lead to a severe misrepresentation of the actual situation-and thus of intervention needs, if data from interviews or observations were relied upon. CONCLUSIONS: The usual methods used in the evaluation of medical services and in carrying out medical audit may produce highly unreliable findings. STD services in the study area are failing to realise their potential of improving the sexual health of populations. The methodological and substantive findings of this study could be combined through the introduction of simulated client visits in the monitoring, improvement and licensing of STD (and perhaps other medical) services.     

Studying Interactions, Reactions, and Perceptions: Can Genetic Disorders Serve as Behavioral Proxies?

Different genetic disorders predispose individuals to display specific, etiology-related profiles, personalities, and maladaptive behaviors. Using groups with genetic etiologies as stand-ins or proxies for a specific behavior or set of behaviors, one can then examine how others in the child's environment react and whether such reactions are limited to a particular disorder or occur generally to all individuals showing that behavior. Just as twins, adopted, and institutionalized children have all been used as natural experiments to tell us about typical development, so too can groups with specific genetic syndromes help us to understand the nature and mechanisms of the reactions and behaviors of others.     

Air and shock two-way shuttlebox avoidance in C57BL/6J and 129X1/SvJ mice

Despite multiple advantages of the use of electric shock as an aversive stimulus, reasons exist for considering alternative aversive stimuli. In the present study, we examined and compared the acquisition of two-way shuttlebox avoidance with 275.8-kPa (40-psi) pulsed air and continuous 0.4-mA shock in two strains of mice commonly employed in targeted gene mutation research, C57BL/6J and 129X1/SvJ. Each trial consisted of a 5-s warning stimulus (WS, light) during which shuttling to the other side cancelled delivery of the aversive stimulus. Once initiated, the aversive stimulus remained active for 20 s or until an escape response occurred. For C57BL/6J mice, air and shock were equally and highly effective aversive stimuli. In contrast, air was less effective than shock for 129X1/SvJ mice. C57BL/6J mice outperformed 129X1/SvJ mice for both stimulus types. For 129X1/SvJ mice, longer escape latencies were observed initially for air, suggesting that shock is more effective. However, these differences in latency dissipated within the first seven sessions. Nevertheless, by the end of the 17-day study, asymptotic levels of avoidance proficiency were substantially lower for air than for shock in 129X1/SvJ mice. These results indicate that air is a suitable substitute for shock as an aversive stimulus in shuttlebox active avoidance; however, the relative efficacies of these aversive stimuli appear to depend upon the strain chosen for study.     

Considerations for use of the Hoffmann reflex in exercise studies

There continues to be great interest in evaluating the adaptive plasticity of the human nervous system in response to exercise training or other interventions. For various reasons, researchers have been interested in estimates of spinal reflex processing in intact human subjects before and after training. A reflex pathway that has been employed in this regard is the Hoffmann (H) reflex. This brief review describes the basic procedure for evoking the H reflex in different muscles. Other sections address methodological issues that affect interpretation of the H reflex. In particular, the role that presynaptic inhibition serves in the modification of the H reflex and how this precludes its use as an unambiguous measure of alpha-motoneuron excitability will be discussed. Applications of the H reflex to study adaptive plasticity in humans is also reviewed, and methodological requirements that should be maintained for accurate interpretation of H reflexes in exercise studies are presented. Electronic Publication     

我国药品不良反应研究现状及其对策

目的：对我国药品不良反应(ADRs)研究现状进行分析,为深入开展ADRs研究提供基础信息。方法：以“药品不良反应、ADRs”为关键词在中国期刊全文数据库中进行文献检索,根据文献所用的方法学对其进行分类统计,以分析ADRs研究现状。结果：近10年来,有关ADRs研究呈逐年增加趋势,但文献仍以病例报道为主．缺乏高质量、深入的流行病学调研。结论：随着“国家ADR监测信息网”的建立与不断完善,在加速ADRs信息传递与交流的同时,对于临床用药频度高、用药量大的常规用药,在有病例报告支持的基础上,开展深入的流行病学调研。从而为临床医生及人们的用药决策提供最佳证据。     

The methodology of HIV/AIDS impact studies: a review of current practices

This review of studies on the socio-economic impact of HIV/AIDS shows that diversity in methodological design, which often is a result of practical considerations and resource constraints rather than of poor design, is the norm. This limits the comparability of research findings. More detailed reporting on method, which is not the norm, can go some way towards facilitating such comparison. Furthermore, the review underlines the importance of exploring intervention issues in more detail. Researchers need to employ results in answering specific policy questions. Scope remains for more impact studies to be conducted in developing countries in general and in certain high prevalence countries in specific, i.e. Southern Africa. Studies that explore the urban/rural dynamics of and clients' perceptions and behavior in seeking care and support are necessary to better understand the epidemic. The role of community-based organizations, non-governmental organizations and other stakeholders in studies of this nature can be expanded. Larger studies generally have more statistical power, but smaller, in-depth studies can be equally valuable. A careful stratification of sample populations can enhance the quality of cross-sectional studies. Qualitative methods should be used to complement the current reliance on survey-based methods of data collection. More longitudinal studies are required to explore the long-term impacts of HIV/AIDS. HIV/AIDS training for fieldworkers should be standard in studies of this nature, while cognizance should be taken of the dangers of employing local people as fieldworkers in studies of such sensitive nature. Scope remains for the further empirical analysis of data from impact studies, which requires these data sets being made accessible to more researchers. In the longer term, an attempt at standardizing core modules in impact studies can help to improve our understanding of the impact of HIV/AIDS in different settings.     

Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication

BACKGROUND: Outcomes after surgery can be determined by face-to-face interview, interviewing patients by telephone, or by mailing out questionnaires. For reasons of convenience, many clinical research studies use mail survey methods. Mail-out responses, however, are rarely complete, and patients returning mail-out questionnaires might be different from patients who do not return questionnaires. METHODS: We identified a group of 75 patients who were all sent a mail-out questionnaire 5 or more years after a laparoscopic fundoplication. Some of these patients returned questionnaires and some did not. All patients were subsequently interviewed by telephone. The responses to the two different data collection methods were compared as well as the interview responses of patients who returned questionnaires with those of patients who did not to determine the influence of follow-up methodology on apparent clinical outcome. RESULTS: Of the 75 patients interviewed, 49 patients (65%) had previously returned a mail-out questionnaire and 26 patients had not. The mean time difference between mail-out response and telephone interview was 1 month. When mail-out responses were compared with interview responses of the patients who had returned questionnaires, equivalent answers were obtained for all symptoms except for dysphagia, for which a higher incidence and greater scores were reported by patients in their mail-out questionnaire responses. When mail-out nonresponders were compared with responders, the nonresponders had a lower level of overall satisfaction with the outcome of surgery, a higher incidence of dysphagia, and greater levels of heartburn. CONCLUSIONS: The measurement of surgical outcomes using a mail-out questionnaire may not be an accurate method of assessing patient symptoms and satisfaction after surgery, particularly if follow-up is incomplete. In this study, patients not responding to mail-out questionnaires were more likely to have adverse symptoms and a lower level of satisfaction than patients returning questionnaires. This dissatisfaction could make patients less likely to return mail-out questionnaires, and for this reason studies with incomplete follow-up that rely on mail-out questionnaire responses may report erroneously higher surgical success rates.     

Practice development: purpose,methodology, facilitation and evaluation

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if practice development is to be transparent, rigorous and systematic in its intentions and approaches. A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustainable change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development. Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted. Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research.