Differences in response rates between mail,e-mail,and telephone follow-up in hand surgery research

Background

There is a need to determine the difference in response to mail, e-mail, and phone in clinical research surveys.

Methods

We enrolled 150 new and follow-up patients presenting to our hand and upper extremity department. Patients were assigned to complete a survey by mail, e-mail, or phone 3 months after enrollment, altering the follow-up method every 5 patients, until we had 3 groups of 50 patients. At initial enrollment and at 3 month follow-up (range 2–5 months), patients completed the short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), the short version of the Patient Health Questionnaire (PHQ-2), the Pain Self-Efficacy Questionnaire (PSEQ), and rated their pain intensity.

Results

The percent of patients that completed the survey was 34 % for mail, 24 % for e-mail, and 80 % for phone. Factors associated with responding to the survey were older age, nonsmoking, and lower pain intensity. Working full-time was associated with not responding.

Conclusions

The response rate to survey by phone is significantly higher than by mail or e-mail. Younger age, smoking, higher pain intensity, and working full-time are associated with not responding.Type of study/level of evidence: Prognostic I     

A Theory-Based Newsletter Nutrition Education Program Reduces Nutritional Risk and Improves Dietary Intake for Congregate Meal Participants

At-risk older adults need community-based nutrition programs that improve nutritional status and practices. This 6-month study assessed the impact of the traditional Chef Charles (CC) program (Control) compared to a theory-based CC program (Treatment) on nutritional risk (NR), dietary intakes, self-efficacy (SE), food security (FS), and program satisfaction for congregate meal participants. Participants were mostly educated, single, “food secure” White females. NR change for the treatment group was significantly higher (P = 0.042) than the control group. No differences were noted for SE or FS change and program satisfaction between groups. The overall distribution classification levels of FS changed significantly (P < .001) from pre to post. Over half (n = 46, 76.7%) reported making dietary changes and the majority (n = 52, 86.7%) rated CC as good to excellent. Results suggest the theory-based CC program (treatment) is more effective in reducing NR and dietary practices than the traditional CC program (control).     

Ending neglect: providing effective childhood tuberculosis training for health care workers in Tanzania

Setting: Health care facilities in Dar es Salaam, Pwani, and Arusha, Tanzania.Objective: To assess health care worker (HCW) knowledge and practices 1 year after specialized training in childhood tuberculosis (TB).Design: Using a standardized survey, we interviewed a convenience sample of HCWs providing both general and specialized care to children.Results: We interviewed 117 HCWs in TB clinics, maternal and child health clinics, human immunodeficiency virus (HIV) clinics, out-patient departments, and pediatric in-patient wards at 12 facilities. A total of 81 HCWs (62% of nurses, 74% of clinicians) reported having attended the national childhood TB training course. Most HCWs responded correctly to questions on childhood TB diagnosis, treatment, and TB-HIV co-management, regardless of training history. Most HCWs reported that they routinely obtain chest radiographs, HIV testing, and a TB contact history when evaluating children for TB. Less than half of HCWs reported routinely obtaining sputum for mycobacterial culture or performing a tuberculin skin test. Three times as many trained as untrained HCWs reported having ever prescribed isoniazid preventive therapy (IPT) to a child (P < 0.05).Conclusion: In general, levels of childhood TB knowledge were high and practices were in accordance with national guidance. Specific gaps in diagnosis, treatment and use of IPT were identified for future focused training.     

安徽省阜阳市农村乡镇卫生机构卫生服务质量现状分析

目的：通过对安徽省阜阳市农村乡镇卫生机构卫生服务质量现状调查,了解主要质量问题,为制定持续改进的绩效管理方案提供依据。方法：调查安徽省阜阳市A、B两县内所有乡镇卫生机构卫生服务质量的基础数据,包括常规统计资料收集、抽查各机构的处方、病历,卫技人员知识技能考核,调查居民满意度。结果：乡镇卫生机构门诊抗生素、静脉给药处方比例分别达56．05％和50．38％,病历书写合格率仅为23．02％,医生、护士、防保人员的三基正确率分别为60．38％、55．01％和52．33％。0～6岁儿童系统管理率、孕产妇系统管理率分别为46．06％和22．72％。结论：农村卫技人员素质不高,影响基本卫生服务提供;用药不合理和临床诊疗不规范,导致严重的医疗安全隐患;筹资与分配制度是影响基本公共卫生服务提供的重要因素。建议：优化人才引进机制,健全继续医学教育制度;加强技能培训,完善临床诊疗规范;加强绩效考核,改进经费分配制度。     

心理干预及评估在高校教职工高血压病管理中的应用研究

目的了解心理干预及评估在高校教职工高血压病管理中的作用。方法通过在高校社区高血压病管理过程中,开展心理干预及评估,针对教职工特点和患者存在的抑郁、焦虑fol题进行健康教育与心理辅导,比较干预前后心理健康状况及血压控制情况。结果经过心理干预及健康教育后,高血压病患者抑郁及焦虑的情况明显减少;对疾病了解程度、治疗依从性、血压控制情况较干预前比较明显改善,差异有统计学意义（P〈0．05）。结论开展积极的心理干预和有效的健康教育,能较好控制高血压及其次生危害。     

Factors Associated With Students’ Perception of Preceptor Excellence

Objectives. To identify factors associated with preceptor excellence as rated by student pharmacists and to assess the correlation of excellent ratings with years as pharmacist, specialty certification, and faculty appointment status.Methods. A retrospective analysis of student pharmacist evaluations of preceptors from May 2009 to May 2012 was completed to determine factors associated with preceptor excellence.Results. Preceptors who showed an interest in teaching, related to the student as an individual, encouraged discussion, were accessible, provided feedback, served as a role model, were organized, and/or spent increased time with students were more likely to be rated excellent.Conclusion. Serving as role models and showing an interest in teaching demonstrated the strongest association with being an excellent preceptor. Identifying factors students associate with preceptor excellence may result in enhanced preceptor recruitment, development, and training.     

以生存率和肿瘤控制率评价吉非替尼治疗晚期非小细胞肺癌的疗效

目的:以生存期和肿瘤进展情况评价吉非替尼治疗晚期非小细胞肺癌(NSCLC)的疗效。方法:回顾性分析2005年6月-2008年12月我院NSCLCⅢ^Ⅳ期出院患者中服用吉非替尼(吉非替尼组)以及未服用吉非替尼(非吉非替尼组)患者的临床资料。评价33例吉非替尼组患者和38例非吉非替尼组患者的半年生存率、1年生存率、生存期、中位生存期,入组的病例均做了电话随访。调查有肿瘤进展情况评价的44例吉非替尼组患者以及53例非吉非替尼组患者,分别为有疗效评价的吉非替尼组的男性、女性、吸烟、不吸烟、腺癌、非腺癌患者与非吉非替尼组患者进行配对分析。结果:吉非替尼组的半年生存率为78.8%(26/33),1年生存率为36.4%(12/33),生存期为1Ⅳ期出院患者中服用吉非替尼(吉非替尼组)以及未服用吉非替尼(非吉非替尼组)患者的临床资料。评价33例吉非替尼组患者和38例非吉非替尼组患者的半年生存率、1年生存率、生存期、中位生存期,入组的病例均做了电话随访。调查有肿瘤进展情况评价的44例吉非替尼组患者以及53例非吉非替尼组患者,分别为有疗效评价的吉非替尼组的男性、女性、吸烟、不吸烟、腺癌、非腺癌患者与非吉非替尼组患者进行配对分析。结果:吉非替尼组的半年生存率为78.8%(26/33),1年生存率为36.4%(12/33),生存期为1²2个月;非吉非替尼组的半年生存率为89.5%(34/38),1年生存率为73.7%(28/38),生存期为122个月;非吉非替尼组的半年生存率为89.5%(34/38),1年生存率为73.7%(28/38),生存期为1⁴8个月。非吉非替尼组各亚组的中位生存期均高于吉非替尼组,疾病类型亚组差异有统计学意义,性别及吸烟状态两个亚组差异均无统计学意义。性别、吸烟状态和疾病类型各亚组的半年生存率差异均无统计学意义;女性、非腺癌两个亚组的1年生存率差异无统计学意义,其余各亚组的1年生存率差异均有统计学意义。不吸烟亚组的有效控制率差异有统计学意义,其余各亚组的有效控制率差异均无统计学意义。吉非替尼组与非吉非替尼组各亚组的配对分析差异均无统计学意义。结论:NSCLC患者在服用吉非替尼之后半年生存率、1年生存率、中位生存期、有效控制率低于未服用吉非替尼的患者。     

基于5种罕见病可负担性评价的我国罕见病保障机制研究

目的:为我国建立完善罕见病保障机制提出政策建议,以解决因其所致的"因病致贫、因病返贫"问题。方法:分别通过世界卫生组织/国际健康行动组织(WHO/HAI)标准调查法、灾难性支出评价法和致贫作用评价法3种方法对我国城镇和农村居民多种羧化酶缺乏病、苯丙酮尿症等5种罕见病的可负担性进行分析。结果:按WHO/HAI标准调查法,5种罕见病年治疗费用都很高,费用最低的疾病也相当于城镇居民0.28年的收入,农村居民比城镇居民疾病负担更重;按灾难性支出评价法,5种罕见病在全国范围内造成灾难性支出的人口比例均不超过0.060 6‰,但对部分罕见病,一旦居民患病并采用药物治疗,即陷入灾难性卫生支出;按致贫作用评价法,5种罕见病在城镇、农村的致贫率均很低,但仅这5种罕见病在全国范围内会导致超过20万人陷入贫困。结论:我国罕见病及罕用药的可负担性较差,不同收入水平的居民均有一定的支付困难,因病致贫、因病返贫现象普遍。因此应完善罕见病患者保障机制,建立专门针对罕用药的费用负担方式。     

我院门诊药房绩效考核标准的建立与实施

目的:介绍我院门诊药房绩效考核标准的改革与实施效果。方法:结合我院门诊西药房的工作特点,根据工作量、药品日常养护、账物相符率、特殊任务几方面标准综合评分,制订科学的绩效考核方案并评价实施后效果。结果与结论:实施绩效考核方案后对每位药师的工作量与工作质量等建立了量化考核标准,激励了药师的工作积极性,调配差错从2013年6月的485例降至12月的406例,患者对药师的服务满意度从93.2%上升至96.7%。建立的绩效考核标准可相对较公平、公正、公开地对门诊药房工作的药师进行绩效考评,促进了药房整体工作水平的提高。