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Selected AbstractsLaparoscopic paraesophageal hernia repair: quality of life outcomes in the elderlyDISEASES OF THE ESOPHAGUS, Issue 8 2008E. J. Hazebroek SUMMARY Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70,85); mean American Society of Anesthesiologists class was 2.7 (range 1,3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2,14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. [source] A survey of tobacco dependence treatment guidelines in 31 countriesADDICTION, Issue 7 2009Martin Raw ABSTRACT Aims The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence-based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes the national tobacco dependence treatment guidelines of 31 countries. Design, setting, participants A questionnaire on tobacco dependence treatment guidelines was sent by e-mail to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines. Measurements The survey instrument was a 17-item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole health-care system and all professionals; do they refer explicitly to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they endorsed formally by government; did they undergo peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment? Findings According to respondents, all their countries' guidelines recommended brief advice, intensive behavioural support and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost-effectiveness evidence. Seventy-one per cent were supported formally by their government and 65% were supported financially by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% underwent a peer review process and 55% were based on the guidelines of other countries, most often the United States and England. Conclusion Overall, the guidelines reviewed followed the evidence base closely, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be updated periodically. None recommended interventions not proven to be effective, and some recommended explicitly against specific interventions (for lack of evidence). Most were peer-reviewed, many through lengthy and rigorous procedures, and most were endorsed or supported formally by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasizing the need for countries to share experience, something the FCTC process is well placed to support. [source] A survey of tobacco dependence treatment services in 36 countriesADDICTION, Issue 2 2009Martin Raw ABSTRACT Aims This paper reports the results of a survey of national tobacco dependence treatment services in 36 countries. The objective was to describe the services and discuss the results in the context of Article 14 of the Framework Convention on Tobacco Control, which asks countries to promote adequate treatment for tobacco dependence. Design, setting and participants A questionnaire on tobacco dependence treatment services was e-mailed to a convenience sample of contacts in 2007. Completed questionnaires were received from contacts in 36 countries. Measurements The survey instrument was a 10-item questionnaire asking about treatment policy and practice, including medications. Findings According to our informants, fewer than half the countries in our survey had an official written policy on (44%), or a government official responsible for (49%), treatment. Only 19% had a specialized national treatment system and only 24% said help was easily available in general practice. Most countries (94%) allowed the sale of nicotine replacement therapy (NRT), bupropion (75%) and varenicline (69%) but only 40% permitted NRT on ,general sale'. Very few countries responding to the question fully reimbursed any of the medications. Fewer than half (45%) fully reimbursed brief advice and only 29% fully reimbursed intensive specialist support. Only 31% of countries said that their official treatment policy included the mandatory recording of patients' smoking status in medical notes. Conclusion Taken together, our findings show that few countries have well-developed tobacco dependence treatment services and that, at a national level, treatment is not yet a priority in most countries. [source] Treatment satisfaction with insulin glargine in patients with diabetes mellitus in a university hospital clinic in SwedenEUROPEAN DIABETES NURSING, Issue 1 2009M Annersten Gershater RN, MNSc Research Nurse Abstract Background: Few studies evaluate patients' perspectives when a new drug is intro-duced to treat chronic diseases such as diabetes mellitus. The clinical role of a new insulin treatment, in terms of the relationship between higher cost and better treat-ment outcomes (as defined from the patient perspective) has been discussed. We sought to explore patient satisfaction with a new insulin treatment (insulin glargine). At its launch in 2002/3 it was purported to provide constant, peakless insulin release following once- or twice-daily administration, thus leading to fewer hypoglycaemic episodes while providing metabolic control equivalent to that achieved with NPH human basal insulin. Aims: To investigate the indications used for prescription of a new drug and its clinical effects on glycosylated haemoglobin (HbA1c) levels, perceived hypoglycaemic events and patient satisfaction. Methods: The Diabetes Treatment Satisfaction Questionnaire (Status Version, DTSQ-s), which measures satisfaction with treatment regimen, and perceived frequency of hyperglycaemia and hypoglycemia, was circulated to all living patients who had ever started treatment with insulin glargine at the Department of Endocrinology at Malmö University Hospital. Medical records of 913 patients were assessed for HbA1c levels at 0 and 12 months after starting insulin glargine therapy. Results: Completed questionnaires were returned by 615 of 960 patients (64%) who had ever started insulin glargine. The main indications for starting treatment were physicians' or nurses' initiatives, desire for fewer fluctuations and improved metabolic control. HbA1c levels fell by 0.41% for patients with type 1 diabetes and by 0.68% for those with type 2 diabetes. The mean DTSQ-s score was 28.45 for satisfaction, whereas the mean perceived hypoglycaemic/hyperglycaemic events score was 3. Conclusion: Treatment satisfaction was very high and perceived frequency of hypoglycaemia/hyperglycaemia was very low. The indications for treatment of insulin glargine are being followed in accordance with national recommendations. Copyright © 2009 FEND [source] Root canal treatment in general practice in SudanINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2000M. F. Ahmed Abstract Aim The aim of this study was to evaluate the practice and depth of knowledge of root canal treatment by dental practitioners in Khartoum, the capital city of Sudan, in order to improve the current status of endodontic therapy. Methodology A questionnaire was posted to 55 registered dental practitioners. Completed questionnaires were analysed in term of simple summary statistics. Results A total of fifty-two (95%) practitioners responded. Eighty-five per cent of the respondents indicated that they performed root canal treatment for their patients. Of these, 84% included molars in their activity. Amongst those who carried out root canal treatment, only one practitioner used rubber dam for isolation, whilst the remainder used cotton wool rolls. The majority of respondents (80%) used hydrogen peroxide to irrigate canals during treatment. Three-quarters of practitioners used formocresol as an interappointment medicament. The stepback preparation technique was the method of choice for 98% of respondents. All practitioners used hand instruments to prepare root canals and all used gutta-percha for obturation; three-quarters of them used cold lateral condensation for all or some cases. The average number of radiographs routinely taken for root canal treatment was three. Only 73% used radiographs for measuring the working length. Ninety-five per cent of respondents indicated that they usually completed a root filling in three or more visits. Three-quarters of practitioners restored the teeth permanently immediately after the obturation and one-quarter preferred waiting for 1 or 2 weeks. Conclusions In Sudan, there are no dental practices limited to endodontics and no postgraduate training programmes. This survey shows the importance of establishing higher specialist training or continuing dental education for practitioners to update their knowledge. [source] Home tube feeding: an integrated multidisciplinary approachJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2001E. P. McNamara Background Long-term enteral tube feeding is increasingly required by patients in the community setting. A previous study of 50 adults on home enteral tube feeding in the Dublin area found that some experienced logistical problems and many individuals did not choose to seek advice from their GP regarding their tube feeding. Aims To assess the contribution of health professionals to the care of patients on enteral tube feeding in the community. Methods GPs and hospital dietitians were surveyed using postal questionnaires and nutritional company representatives using structured interviews, to assess their involvement with patients on home tube feeding. Completed questionnaires were received from 77 dietitians and 80 GPs. Ten company representatives were interviewed. Results Hospital dietitians carry out most of the initial education and training of patients, in addition to the nutritional aftercare. General practitioners tend not to be involved, although nutrition specialists working in the nutritional products area report encountering patients with tube-feeding complications in the community. Conclusions Improved co-ordination between hospital and community services and more consistent monitoring of those on home enteral tube feeding would be an advantage to such patients. [source] Comparison of dentine hypersensitivity in selected occidental and oriental populationsJOURNAL OF ORAL REHABILITATION, Issue 1 2001D. G. Gillam Epidemiological data on dentine hypersensitivity (DH) prevalence are limited. Few studies have compared prevalence between populations. The aim of this investigation, therefore, was to compare the perception and prevalence of DH in two distinct non-periodontal practice populations, one U.K. and one Korean. Completed questionnaires from 557 patients (230 males and 327 females, comprising 115 males and 162 females, mean age 41·7 years (s.d.=14·36), U.K. and 115 males and 165 females, mean age 29·7 years (s.d.=11·86), Korean) were collected. Analysis was by frequency distribution and cross-tabulation (Statistical Package for the Social Sciences (SPSS)). DH prevalence was similar and at levels comparable with those reported previously. Prevalence was higher in the third and fourth decades in both populations. Although there were no differences between U.K. or Korean males and U.K. or Korean females, there was a significant difference between gender reporting of DH, with more females complaining of DH than males (standard normal deviation (SND)=4·3, 95% confidence interval (CI)=0·1134,0·2736). DH appeared to be regarded by patients as not severe in most cases, so treatment was not generally sought. Of those who claimed to have sought treatment, a significant number had received restorative treatment. Of those patients, only 23·3% of U.K. and ,2% of Korean patients claimed to have used a desensitizing dentifrice. Pain from DH was reported as low grade (slight, occasional) occurring over 5 years in both populations. Cold appeared to be the most reported stimulus in the two populations. Less periodontal surgery had been undertaken in these two populations (12·6% U.K. and 7·1% Korean) compared with those referred to a teaching hospital periodontal department (34·5%). This compared favourably with previous findings in the general dental population (15·5%). Discomfort following hygiene therapy did not appear to last ,7 days in either population. The results indicated that there were no significant differences between U.K.- and Korean-based populations in their perception of DH, with the exception that more females complained of sensitivity than males in both groups. Overall, DH was not considered a major dental problem by most patients in either of the populations. [source] Questionnaire study of canine neutering techniques taught in UK veterinary schools and those used in practiceJOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2005M. S. Tivers Objectives: To gather information about the different techniques employed in general practice and to compare this with current undergraduate teaching. This would provide an insight into any areas of discrepancy and influences on technique in practice. Methods: A questionnaire was composed and distributed to 407 practices throughout the UK, using a commercial mailing list. Fifty further questionnaires were distributed by final-year students to their foster practices and five were sent to practices on request. A second questionnaire was composed and sent to the members of staff responsible for teaching surgical neutering techniques at each of the UK veterinary schools. Results: Completed questionnaires were received from 183 respondents. These were compared with seven questionnaires from university teachers. Only areas in which the teachers reached a consensus of opinion were directly compared. Clinical Significance: Several areas of discrepancy between current teaching and techniques in practice were identified. A study of complications compared with technique would provide further information. There is a lack of published material or an evidence base in many aspects of surgical neutering to support one technique over another. [source] Contraception and pregnancy then and now: Examining the experiences of a cohort of mid-age Australian womenAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Christine READ Background: More than 50% of women who have an unplanned pregnancy report using a contraceptive method. Since the launch of the pill 50 years ago, a number of cross-sectional surveys have examined contraceptive use in the Australian context. There is, however, little data on contraceptive use and efficacy over a woman's reproductive years. Aim: To determine the pattern of contraceptive use of Australian women over their reproductive lifespan, with particular emphasis on the relationship between contraceptive use and pregnancy. Method: One thousand women from the mid-age cohort of the Australian Women's Longitudinal Study were invited to participate in the Family Planning survey by completing a questionnaire about their reproductive histories. Results: Completed questionnaires were received for 812 women. The contraceptive pill was the most commonly ever used contraceptive method at 94% and also the most commonly used method prior to all pregnancies. Contraceptive failure increased with increasing gravidity; 11.4% with the first pregnancy to 23.0% with the fourth pregnancy, while 28.8% of the respondents reported an ,accidental' pregnancy due to stopping contraception for reasons such as concern about long-term effects and media stories. Conclusions: While surveys indicate that 66,70% of Australian women use a contraceptive method, more than half of unplanned pregnancies apparently occur in women using contraception. The modern Australian woman, in common with her predecessors, still faces significant challenges in her fertility management. This survey provides a longitudinal perspective on contraceptive use in relation to pregnancy and highlights the issue of efficacy of contraceptives in real-life situations. [source] Knowledge of and attitude towards circumcision of adult Korean males by ageACTA PAEDIATRICA, Issue 11 2004S-J Oh Aim: Circumcision is widely practised in Korea, but little is known regarding the public's attitude towards circumcision. This study was designed to evaluate the knowledge and the general opinion of Korean adult males towards circumcision. Methods: Fifteen hundred self-completion questionnaires were distributed to adult males in five decadal age groups ranging from 10 to 59 y old. Questions concerning opinions regarding the necessity, reasons, potential benefits and disadvantages of circumcision, as well as the role of peer pressure upon the decision to circumcise were included. Completed questionnaires were collected and analysed statistically. Results: The achieved response rate was 62.7%. 73.1% believed that circumcision is necessary, while 7.1% believed it is not necessary. The principal reason for circumcision was to improve penile hygiene (77.9%). 68.7% did not prefer neonatal circumcision regardless of the respondent's age. The major reason was fear of pain (36.9%). Peer pressure was one of the most influential factors when deciding upon circumcision: 60.8% believed that they might be ridiculed by their peer group unless circumcised, and the younger the age of the respondent, the more frequently this opinion was held (p > 0.05). 62.7% thought that circumcision would prevent genital tract infection of the sexual partner. Respondents with older age tended to emphasize improved sexual potency (p > 0.05). Conclusions: This study indicates that common beliefs of adult males about circumcision in Korea are relatively homogeneous. Tailored education about circumcision is needed. [source] Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort StudyHIV MEDICINE, Issue 6 2006TR Glass Objective Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. Methods All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Results Overall, 8033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10,20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. Conclusion During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol. [source] Barriers to, and facilitators of, research utilisation: a survey of Hong Kong registered nursesINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2006David R Thompson RN BSc MA PhD MBA FRCN FESC Abstract Aim, Despite increasing efforts to promote the utilisation of research in daily nursing practice it is apparent that there are a number of obstacles to address. This paper reports a study to examine the barriers to, and facilitators of, research utilisation among registered nurses in Hong Kong. Methods, A survey design and a random sampling method was used. The final sample consisted of 1487 registered nurses working in private and public health-care sectors in Hong Kong. A bilingual version of the Research Utilisation Questionnaire, comprising a 31-item barriers scale, and an 8-item facilitators scale was used. The instrument was mailed to participants who were asked to return the completed questionnaire by mail. Results, The highest ranking barriers to research utilisation reported by respondents were related mainly to organisational factors with regards to inadequate facilities, no authority to change procedures, and time constraints. Hong Kong nurses, however, did not appear to see any problem with regards to items related to characteristics of research, such as conclusions drawn from research being justified, research articles not being published fast enough, and literature reporting conflicting results. This indicates that nurses are aware of research developments in nursing and can critically analyse research reports. With regards to facilitators of research utilisation, respondents agreed that managerial and peer support are the greatest facilitators. Conclusions, The results indicate that factors influencing research utilisation are multidimensional and should be taken into account by all involved in the research enterprise: researchers, practitioners, educators, managers and policy-makers. The results of this study provide directions on how to assist nurses in Hong Kong in their efforts to utilise research. [source] Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorderJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2002KA Shaw Objective: To assess understanding of, and actual and potential roles in management of attention-deficit/hyperactivity disorder (ADHD) among GPs. Methods: A cross-sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self-perceived information and training needs. Results: Three hundred and ninety-nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD. Conclusions: General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services. [source] Universal problems during residency: abuse and harassmentMEDICAL EDUCATION, Issue 7 2009Shizuko Nagata-Kobayashi Objectives, Perceived abuse or harassment during residency has a negative impact on residents' health and well-being. This issue pertains not only to Western countries, but also to those in Asia. In order to launch strong international preventive measures against this problem, it is necessary to establish the generality and cultural specificity of this problem in different countries. Therefore, we investigated mistreatment among resident doctors in Japan. Methods, In 2007, a multi-institutional, cross-sectional survey was conducted at 37 hospitals. A total of 619 residents (409 men, 210 women) were recruited. Prevalence of mistreatment in six categories was evaluated: verbal abuse; physical abuse; academic abuse; sexual harassment; gender discrimination, and alcohol-associated harassment. In addition, alleged abusers, the emotional effects of abusive experiences, and reluctance to report the abuse to superiors were investigated. Male and female responses were statistically compared using chi-square analysis. Results, A total of 355 respondents (228 men, 127 women) returned a completed questionnaire (response rate 57.4%). Mistreatment was reported by 84.8% of respondents (n = 301). Verbal abuse was the most frequently experienced form of mistreatment (n = 256, 72.1%), followed by alcohol-associated harassment (n = 184, 51.8%). Among women, sexual harassment was also often reported (n = 74, 58.3%). Doctors were most often reported as abusers (n = 124, 34.9%), followed by patients (n = 77, 21.7%) and nurses (n = 61, 17.2%). Abuse was reported to have occurred most frequently during surgical rotations (n = 98, 27.6%), followed by rotations in departments of internal medicine (n = 76, 21.4%), emergency medicine (n = 41, 11.5%) and anaesthesia (n = 40, 11.3%). Very few respondents reported their experiences of abuse to superiors (n = 36, 12.0%). The most frequent emotional response to experiences of abuse was anger (n = 84, 41.4%). Conclusions, Mistreatment during residency is a universal phenomenon. Deliberation on the occurrence of this universally wrong tradition in medical culture will lead to the establishment of strong preventive methods against it. Current results indicate that alcohol-associated harassment during residency is a Japanese culture-specific problem and effective preventive measures against this are also urgently required. [source] Apgar score and dental caries risk in the primary dentition of five year oldsAUSTRALIAN DENTAL JOURNAL, Issue 3 2010AE Sanders Abstract Background:, Conditions in utero and early life underlie risk for several childhood disorders. This study tested the hypothesis that the Apgar score predicted dental caries in the primary dentition. Methods:, A retrospective cohort study conducted in 2003 examined associations between conditions at birth and early life with dental caries experience at five years. Dental examination data for a random sample of five-year-old South Australian children were obtained from School Dental Service electronic records. A questionnaire mailed to the parents obtained information about neonatal status at delivery (five-minute Apgar score, birthweight, plurality, gestational age) and details about birth order, weaning, and behavioural, familial and sociodemographic characteristics. Results:, Of the 1398 sampled children with a completed questionnaire (response rate = 64.6%), 1058 were singleton term deliveries among whom prevalence of dental caries was 40.1%. In weighted log-binomial regression analysis, children with an Apgar score of <=8 relative to a score of 9,10 had greater probability of dental caries in the primary dentition after adjusting for sociodemographic and behavioural covariates and water fluoridation concentration (adjusted PR = 1.47, 95% CI = 1.11, 1.95). Conclusions:, Readily accessible markers of early life, such as the Apgar score, may guide clinicians in identifying children at potentially heightened risk for dental caries and aid decision-making in allocating preventive services. [source] Continuing education self-assessment quiz: Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case reportAUSTRALIAN DENTAL JOURNAL, Issue 1 2006Article first published online: 12 MAR 200 In the case report by Lew and Townsend on page 86 of this issue several important issues are raised about the administration of mandibular anaesthesia in dental practice. Test your knowledge here by first reading the article entitled: Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case report, answer the following questions and then forward the completed questionnaire to the Australian Dental Journal Office and we will let you know how you scored. Please place a tick in the box alongside the option that you think provides the best answer to each question, i.e., one tick per question. The Editor's decision is final and no correspondence will be entered into. [source] Continuing education self-assessment quiz: New standards for permanent tooth emergence in Australian childrenAUSTRALIAN DENTAL JOURNAL, Issue 1 2003Article first published online: 12 MAR 200 In the scientific article by Diamanti and Townsend on page 39 in this issue a number of interesting issues are raised regarding tooth emergence in Australian children. Test you knowledge here by first reading the article entitled: New standards for permanent tooth emergence in Australian children, answer the following questions by indicating what you believe is the one best answer for each of the six questions and then forward the completed questionnaire to the Australian Dental Journal Office and we will let you know how you scored. Please note that the answers have been provided in good faith and to the best of our knowledge are correct. The Editor's decision is final and no correspondence will be entered into. [source] General practitioners' ranking of evidence-based prescribing quality indicators: a comparative study with a prescription databaseBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2006Ifeanyi Okechukwu Background To ensure that indicators for assessing prescribing quality are appropriate and relevant, physicians should be involved in their development. How general practitioners (GPs) rank these indicators is not fully understood. Aims (i) To determine how GPs in Ireland rank a set of evidence-based prescribing quality indicators in order of importance and relevance to their practice, and (ii) to compare the GPs' ranking of the defined set of indicators with actual prescribing practice using a prescription database. Methods A postal questionnaire was sent to 105 GPs, who were asked to rank a set of 11 prescribing quality indicators, identified from the literature from most to least important. The results were aggregated and a weighted score for each indicator determined. These same prescribing indicators were then applied to a prescription database to compare the ranking provided with actual prescribing practice. Results Eighty-six GPs (82%) returned the completed questionnaire. The higher ranks were for quality issues,use of inhaled corticosteroids, statins and benzodiazepines. Actual prescribing data showed prolonged use of benzodiazepines in over half of the prescriptions dispensed (n = 18 171), 52.48% (95% confidence interval 51.95, 53.01) and low usage of generic drugs, 17.78% (17.70, 17.90) despite their high ranking by the GPs. Conclusion While GPs have diverse views about the value of different prescribing quality indicators, the results suggest that they do rank evidence-based guidelines on patient management highly, but those based on costs and less evidence the lowest. There was considerable divergence between theory and practice in the application of quality indices. [source] Evaluation of the processes of family-centred care for young children with intellectual disability in Western AustraliaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2010A. Wilkins Abstract Introduction Government early intervention services for children with intellectual disability (ID) in Western Australia have adopted the model of family-centred care. The aim of this study was to evaluate how well it was being practised, to describe the pattern of service utilization and to identify factors influencing parental perceptions of family-centred care. Methods The study included children aged 0,6 years with ID, who were registered clients of Disability Services Commission, Western Australia. Parents completed a postal survey questionnaire about the frequency and type of services received and their perceptions of services using the Measure of Processes of Care (MPOC-56) questionnaire. Mean scores for the five MPOC domains were compared using anova against the independent variables of child age group, child diagnostic group, service type and frequency, place of residence, family and demographic variables. Significant variables in each domain were then entered into multivariate analyses. Results Of 292 eligible families, 165 (59%) returned a completed questionnaire. While over 50% of children had contact with occupational, speech and physical therapists at least once per month, less than 20% of children had at least annual contact with either psychology or dental services. Families rated their satisfaction highest for ,respectful and supportive care' and lowest for ,providing general information'. Individual item analyses indicated less satisfaction with ,co-ordinated and comprehensive care'. Higher means were associated with more frequent contact with occupational therapy. Conclusion Overall respondents reported early intervention services for young children with ID in Western Australia provided satisfactory family-centred care by means of the 56-item MPOC. The frequency of contact with allied health professionals was positively associated with parental ratings of family-centred care. The study indicates under-servicing in dental care and psychology services. [source] Impulsive aggression in adults with attention-deficit/hyperactivity disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010J. H. Dowson Dowson JH, Blackwell AD. Impulsive aggression in adults with attention-deficit/hyperactivity disorder. Objective:, DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) include examples of ,impulsivity'. This term can refer to various dysfunctional behaviours, including some examples of aggressive behaviour. However, impulsive aggression is not included in the DSM-IV criteria for ADHD. The associations of impulsive aggression with ADHD were investigated. Method:, Seventy-three male adults with DSM-IV ADHD, and their informants, completed questionnaires. Impulsive aggression was assessed by ratings of two criteria for borderline personality disorder (BPD), involving hot temper and/or self-harm. Results:, Logistic regression indicated that features of DSM-IV ADHD were predictors of comorbid impulsive aggression. However, compared with ADHD features, verbal IQ and comorbid psychopathology were more strongly associated with impulsive aggression. Conclusion:, The findings support the inclusion of features of impulsive aggression, such as hot temper/short fuse, in the ADHD syndrome in adults. These overlap with features of BPD. The findings inform the selection of research samples. [source] Unplanned attempts to quit smoking: missed opportunities for health promotion?ADDICTION, Issue 11 2009Rachael L. Murray ABSTRACT Objectives To investigate the occurrence, determinants and reported success of unplanned and planned attempts to quit smoking, and sources of support used in these attempts. Design Cross-sectional questionnaire survey of 3512 current and ex-smokers. Setting Twenty-four general practices in Nottinghamshire, UK. Participants Individuals who reported making a quit attempt within the last 6 months. Measurements Occurrence, triggers for, support used and success of planned and unplanned quit attempts. Results A total of 1805 (51.4%) participants returned completed questionnaires, reporting 394 quit attempts made within the previous 6 months of which 37% were unplanned. Males were significantly more likely to make an unplanned quit attempt [adjusted odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04,2.46], but the occurrence of unplanned quit attempts did not differ significantly by socio-economic group or amount smoked. The most common triggers for unplanned quit attempts were advice from a general practitioner or health professional (27.9%) and health problems (24.5%). 5.4% and 4.1% of unplanned quit attempts used National Health Service cessation services on a one to one and group basis, respectively, and more than half (51.7%) were made without any support. Nevertheless, unplanned attempts were more likely to be reported to be successful (adjusted OR 2.01, 95% CI 1.23,3.27, P < 0.01). Conclusions Unplanned quit attempts are common among smokers in all socio-demographic groups, are triggered commonly by advice from a health professional and are more likely to succeed; however, the majority of these unplanned attempts are unsupported. It is important to develop methods of providing behavioural and/or pharmacological support for these attempts, and determine whether these increase cessation rates still further. [source] Progression of oral snuff use among Finnish 13,16-year-old students and its relation to smoking behaviourADDICTION, Issue 4 2006Ari Haukkala ABSTRACT Aims To examine the progression of oral moist snuff use among adolescents and its relation to smoking behaviour and nicotine addiction. Design and setting A 3-year smoking prevention study in 27 schools of Helsinki, Finland, starting with the seventh grade to the ninth grade., Participants and measurements Pupils (n = 2816) completed questionnaires four times, which included information on smoking behaviour, snuff experiments, nicotine addiction (Fagerström Tolerance Questionnaire) and other activities. Findings The prevalence of snuff experimentation rose among boys from 7% in the seventh grade to 43% 3 years later in the ninth grade, and among girls from 2% to 13% for the corresponding period. Among boys, smoking predicted later snuff use in all assessments and snuff experimentation predicted later weekly smoking. The impact of snuff experimentation upon later smoking experimentation was smaller than vice versa. Among boys active in sports, smoking was less common but snuff use was more common. Combined use was common; by the end of the follow-up only 10% of weekly smokers had not tried oral snuff. Nicotine dependence scores increased linearly with snuff use among weekly smokers., Conclusions Despite the European Union sales ban on oral snuff products since 1995, in Finland snuff use is common among boys. Although combined use of snuff and cigarettes is associated with higher levels of nicotine dependence among adolescent boys, the direction of causality is not known. Unlike cigarette smoking, oral snuff use was tried among boys who spent their free time with sports-related activities. [source] The creation of an international audit and database of equine colic surgery: Survey of attitudes of surgeonsEQUINE VETERINARY JOURNAL, Issue 4 2008T. S. MAIR Summary Reasons for performing study: Currently, there is a lack of available evidence-based data concerning the optimum treatments for horses affected by different types of colic and this precludes the application of clinical audit in this area. In order to accumulate such data, a large-scale, multicentre database of the outcomes of colic surgery is proposed. The attitudes of surgeons is an important consideration in determining the feasibility of developing this database. Objectives: To assess attitudes and opinions of equine surgeons concerning clinical audit and to assess the perceived advantages and problems of setting up a large-scale international audit/database of colic surgery. Methods: Interviews were conducted with 30 equine surgeons (large animal/equine surgeons who are diplomates of either the American College of Veterinary Surgeons or the European College of Veterinary Surgeons). Questionnaires were sent by e-mail to 98 equine surgeons. Results: Face to face interviews were conducted (n = 30) and 43/98 completed questionnaires received (44%). The results of the 2 techniques were very similar. There was generally a high level of interest in the development of a large scale database of colic surgery, but perceived problems included time to collect and submit data, and confidentiality issues. A minority of surgeons reported that they were undertaking any form of specific monitoring of the results of colic surgery within their hospitals. Conclusions: There is a good level of interest among equine surgeons to develop a large scale database of colic surgery and most would be willing to contribute data from their own hospitals provided that data collection is quick and easy, and that confidentiality is maintained. Potential relevance: A large scale audit and database would provide relevant information to equine surgeons concerning the current success and complication rates of colic surgery. Such evidence-based data could be used in clinical audits within individual equine hospitals. The data would also be useful to identify trends within the discipline and could highlight areas that would benefit from active research. [source] Quality of care experienced by Finnish cancer patients during radiotherapyEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2008M. SIEKKINEN The purpose of this study is to describe patients' experiences of the quality of care received at a radiotherapy centre. The data were collected using the Good Nursing Care Scale For Patients (GNCS/P), which was modified for this study. Structured questionnaires were handed out in March-May 2004 to 150 adult curative cancer patients attending outpatient radiotherapy at a university hospital in Finland. A total of 135 completed questionnaires were returned. The patients were generally satisfied with the quality of care they received. Among the four quality categories, the highest ratings were given to staff characteristics, and the lowest to the environment. Younger patients, employed patients and those with a higher level of education gave the lowest quality ratings. Improvements are needed primarily in the counselling and education of patients and their relatives. The results of this study provide valuable clues for improving the quality of care in radiotherapy based on patients' expectations. [source] External Examiners and Immediate Post Qualification Clinical Dental Training in EuropeEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004G. H. Moody Background: A conversation at the ADEE Conference in Bern, 2001, revealed an apparent diversity in the use and role of External Examiners in dental undergraduate examinations in ADEE-associated schools. There also appeared to be considerable variation in the amount of post-graduate supervised clinical training. Aims: (i) To elicit information on the use of External Examiners in dental undergraduate examinations. (ii) To acquire information about immediate post-qualifying supervised clinical experience and training. Method: Questionnaire to the 205 Dental Schools listed in the ADEE Directory in 35 European countries. Results: Eighty-two (40%) completed questionnaires were returned. Of these 82 schools, 43 (52.4%) did not use External Examiners. The remaining 39 (47.6%) used an External Examiner at least once during the under-graduate course. All 39 used an External Examiner in ,Finals', 34 in all clinical examinations and 30 in pre-clinical examinations. Thirty out of 39 allowed external examiners to scrutinize papers before the examination. Although 31/39 were asked to advise on problems during examinations, only 26/39 were consulted about the fate of ,failed' candidates and 23/39 asked to adjudicate in such instances. Following qualification, graduates from 38/82 schools experienced some form of supervised further clinical training ranging from 3 months to 2 years. The majority (21/38) were trained for 1 year and 13 for 2 years. However, 30/82 (36.5%) schools produced graduates who qualified without any external assessment and without the benefit of any post-qualifying supervised training. Conclusions: Although the questionnaire response rate is low, it is clear that there are disparities in practice with regard to the use of external examiners and post-graduate training, which need to be evaluated if dental undergraduate standards in Europe are to converge. [source] Opiate Use to Control Bowel Motility May Induce Chronic Daily Headache in Patients With MigraineHEADACHE, Issue 3 2001S.M. Wilkinson MD Objectives.,To investigate whether opiate overuse might cause chronic daily headache in those with migraine, we studied patients who were taking codeine (or other opiates) for control of bowel motility after colectomy for ulcerative colitis. Background.,Analgesic overuse is considered by many to be one factor which can result in the transformation of migraine into a chronic daily headache pattern. Most of the evidence for this comes from patients with migraine who are taking increasing amounts of analgesia for headache. Many of these patients revert to an intermittent migraine pattern once the analgesics are stopped. Methods.,Women who were 1 year postcolectomy for ulcerative colitis were identified in several colorectal surgery practices in Calgary. They were sent a questionnaire designed to determine if they had a history of migraine prior to surgery, if they currently had chronic daily headache, what medications they were taking to control bowel motility, and what medications they were taking for headache. Results.,Twenty-eight patients who met our inclusion criteria returned completed questionnaires. Eight of these exceeded the recommended limits for opiate use in patients with headache. Eight patients met diagnostic criteria for migraine. Two patients had chronic daily headache starting after surgery. Both used daily opiates beginning after their surgery, and both had a history of migraine. The other six patients who used opiates daily did not have a history of migraine and did not have chronic daily headache. All patients with migraine who used daily opiates to control bowel motility following surgery developed chronic daily headache after surgery. Conclusions.,Patients with migraine who use daily opiates for any reason are at high risk of developing transformed migraine with chronic daily headache. This risk appears much lower in patients without a history of migraine who use opiates for nonpain indications. [source] Social support and postpartum depressive symptomatology: The mediating role of maternal self-efficacyINFANT MENTAL HEALTH JOURNAL, Issue 3 2006Divna M. Haslam Research shows that social support and maternal self-efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self-efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192). It was hypothesized that higher levels of parental support, partner support, and maternal self-efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self-efficacy. Results indicated that as expected, higher parental support and maternal self-efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self-efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self-efficacy. [source] Endodontic teaching in Philippine dental schoolsINTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2000E. V. Cruz Abstract Aim The aim of this study was to evaluate the pattern of undergraduate endodontic teaching in Philippine dental schools. Methodology Data were gathered by sending questionnaires to the deans of the 23 dental schools in the country to determine details of the teaching of root canal treatment in permanent teeth. The covering letter requested that endodontic staff complete the questionnaire. Results Twenty of 23 dental schools returned completed questionnaires. Similarities were observed in the timing of undergraduate endodontic teaching, working length determination, and root canal preparation technique. Irrigating fluids recommended included one or a combination of the following: sodium hypochlorite, hydrogen peroxide, distilled water and EDTA. The root canal medicaments popularly employed were CMCP and eugenol. Most schools used slow-setting zinc oxide eugenol cement as sealer. Differences between schools were noted in the laboratory component of the course. The time allotted for the laboratory exercises, as well as the number of teeth used, differed greatly between each school. An inadequate tutor to student ratio was noted in the majority of schools. Teaching aids were limited and, in most instances, produced by faculty members. Most faculty members teaching endodontics had no specialist training. Conclusion The results of this study have demonstrated that there is a need to review endodontic teaching in the majority of the Philippine dental schools to ensure that the course content and curriculum employed by all schools meet specified standards and that appropriate measures should be considered to enhance the learning experience of students. [source] Emotion avoidance in patients with anorexia nervosa: Initial test of a functional modelINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2010Jennifer E. Wildes PhD Abstract Objective: This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group. Method: Seventy-five patients with AN completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN. Results: Patients with AN endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology. Discussion: Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older peopleINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2003Paul Clarkson Abstract Background This paper investigates the potential effects of a policy change in the funding of UK residential care. The White Paper Modernising Social Services (Cm 4169, 1998) outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the perverse incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. Methods Managers from 16 UK social services departments attended a focus group discussion, completed questionnaires and provided information to assist in calculating the potential diversionary effect of the policy. Results Managerial estimates indicated a small diversionary effect of the policy; A potential effect of 0.26 and 0.19 per 1000 older people diverted from residential and nursing care respectively. Conclusions The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people. Copyright © 2003 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||