Effectiveness of telephone prompts when surveying general practitioners: a randomised trial

BACKGROUND

Response rates to recent surveys of general practitioners have ranged from 44-95%. The effectiveness of a telephone prompt by a non-medical research assistant in advance of survey mail-out was unknown at the time of this study.

OBJECTIVE

To determine the effectiveness of a telephone prompt by a non-medical research assistant to enhance response rates to a lengthy survey.

SUBJECTS

364 randomly selected general practitioners randomised into intervention and control groups.

OUTCOME VARIABLE

Cumulative response rate at Day 18 and Day 60.

DESIGN

Intervention group received a telephone call in advance of the survey. The control group received conventional mail-outs. Non-responders in both groups were telephoned at Day 28 and sent a reminder letter and questionnaire.

RESULTS

77% of the intervention group responded to the survey compared to 64% of the control group. Intention-to-treat analysis demonstrated a significantly earlier response by Day 18 (continuity corrected chi 2 = 18.15; df = 1; p < 0.001) and a significantly higher overall response by Day 60 (continuity corrected chi 2 = 5.41, df = 1, p < 0.009) from the intervention group.

CONCLUSION

A telephone prompt by a non-medical research assistant will accelerate and enhance response rates to a survey of general practitioners although the differential effectiveness of a non-medical researcher compared to a medical practitioner conducting such prompts remains unstudied.

A randomised controlled trial of strategies to prompt attendance for a Pap smear

OBJECTIVE

To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians.

METHODS

Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base.

RESULTS

A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention.

CONCLUSIONS

The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

Gravid students. Characteristics of nongravid classmates who react with positive and negative feelings about conception

OBJECTIVE

To determine whether gravid classmates affect nongravid students' feelings about conception.

METHOD

Cross-sectional survey of a school-based clinic population. We asked 130 nulliparous high school students who were seeking routine health care at an urban school-based clinic to complete an anonymous questionnaire concerning risk factors for and attitudes about teen pregnancy.

RESULTS

The respondents were grouped according to the effect that contact with gravid classmates had on their desire for conception: increased desire (n = 13), no change in desire (n = 59), and decreased desire (n = 49). The analysis disclosed no significant group differences for age (mean +/- SD, 16.3 +/- 1.2 years), sex (65% female), welfare use (20%), or living situation (85% lived with a parent). The increased-desire group had significantly more sociodemographic risk factors for teen pregnancy than did the groups with no change and decreased desire. The group with increased desire was significantly more likely than the other two groups to be failing in school (54% vs 44% and 12.2%; P < .001), to have low education goals (15.4% vs 3.4% and 0%; P = .02), to be unhappy with their family support (69.2% vs 27.1% and 29.8%; P = .01), to be concerned about sterility (30.8% vs 8.6% and 6.1%; P = .03), not to be using contraceptives (77% vs 35.6% and 30.6%; P < .01), to want a pregnancy within 2 years (61.5% vs 25.4% and 12.2%; P < .001), and to have a sexual partner who wanted a pregnancy within 2 years (61.5% vs 13.6% and 8.2%; P < .0001).

CONCLUSIONS

Our findings support the study hypothesis that that never-pregnant students in the increased-desire group had more sociodemographic risk factors for teen pregnancy than did students in the groups with no change or decreased desire. The results of this study may help to ally concerns about the adverse effect that the increased prevalence of gravid students in American schools might have on the childbearing attitudes of never-pregnant students.

Malignant cystosarcoma phyllodes

This study reviewed 26 women who had resection of a malignant cystosarcoma phyllodes. Clinical presentations were palpable mass, 25; pain, 11; and ulceration, 2. Definitive surgical therapy was radical mastectomy (RM), 2; modified radical mastectomy (MRM), 14; total mastectomy (TM), 4; and partial mastectomy (PM), 6. Tumors ranged in size from 1-20 cm (median, 7 cm). Eight patients developed recurrent disease after 10-45 months. Local recurrence was more likely after TM and PM than after MRM and RM (P < 0.05). Patients who developed local recurrence only were treated by wide re-excision, and all such patients are alive with no evidence of disease at 5-25 years. Only one of 16 patients undergoing axillary dissection had involved lymph nodes. Four patients whose tumors ranged from 5-8 cm and who underwent one RM and three MRM developed systemic recurrence; all died of their disease after 15-48 months.

CONCLUSION

1) Although there is a higher local recurrence after PM and TM as compared with MRM and RM for malignant cystosarcoma phyllodes, the local recurrence can be treated with wide excision without affecting long-term survival; 2) systemic recurrence was not related to size or extent of resection; 3) axillary dissection does not predict for or prevent recurrence.

Stroke in the elderly

The incidence of stroke increases dramatically with advancing age. Progressive carotid atherosclerosis, cardiac arrhythmia and emboli, and vascular changes all contribute to this increasing incidence of stroke in the elderly. Treatment of hypertension and other risk factors have resulted in a decline in stroke over the last 50 years. The decline has been most prominent in the elderly. In recent years, this decline has slowed down or may even be reversing. Early and effective control of risk factors together with comprehensive management of acute stroke in a specialized unit is needed to further improve prognosis. Such an approach is especially important in the elderly, who may suffer from multiple problems. Treatment of hypertension and other risk factors have resulted in a decrease in an overall decline in the incidence of stroke over the last 50 years. This decline has been most apparent in the elderly. In recent years, however, there has been a slowing or possibly a reversal of this trend. Early and effective management of risk factors, aggressive therapy of patients with transient ischemic attacks and comprehensive management of acute stroke patients in specialized units may be required to further improve prognosis.

Computerised infrared thermography and isotopic bone scanning in tennis elbow

Thirty five cases of tennis elbow (17 unilateral, nine bilateral) were studied with infrared thermography and isotopic bone scanning. A hot focus was visualised in 16 of 17 cases of unilateral tennis elbow (94%) and in all nine cases of bilateral tennis elbow (100%) on infrared thermography, and abnormal increased epicondylar activity seen in 12 of 17 (71%) and eight of 18 (44%) cases respectively with isotopic bone scanning. Unilateral visual cooling (somatosympathetic responses) occurred in seven of 13 cases of unilateral tennis elbow (54%) with infrared thermography, and reduced perfusion in seven of 12 (58%) of similar cases with blood pool isotopic bone scanning. Computerised temperature assessments showed statistically significant side to side temperature differences when 17 active tennis elbows were compared with the opposite normal elbows for spot temperatures, proximal and distal forearm gradients. Similar temperature assessments in 18 bilateral tennis elbows compared with 17 normal elbows showed significant temperature differences for elbow spot temperatures and distal forearm gradients, but not for proximal gradients.

Abdominal wall actinomycosis associated with use of an intrauterine device: a case report

The association between pelvic actinomycosis and the use of intrauterine devices is well established. However, abdominal wall actinomycosis without clinical involvement of the pelvic organs has been reported only once in the literature. The authors present a second case, which occurred in a 24-year-old woman who was using a copper 7 intrauterine device.

The relationship of locus of control, age, and sex to life satisfaction and death anxiety in older persons

The present study examined Rotter's Internal-External (I-E) locus of control (LOC) concept in relation to life satisfaction and death anxiety in an aged population. Age and sex of the individual were also considered. In the case of life satisfaction, a strong sex and a strong locus of control effect were found. For death anxiety, again a strong sex effect was found, but there was also a significant interaction between locus of control and age. The article suggests the need for a life span developmental perspective in LOC research. Studies which explore the influence of life experiences, situational and environmental variables, and their effect on control orientation are also needed.

Peripartum cardiomyopathy: echocardiographic features in five cases

Five cases of peripartum cardiomyopathy are presented. All patients were aged less than 35 years, and four were multiparous. Two cases followed twin deliveries. Pulmonary embolism was diagnosed in four patients. Electrocardiograms showed left ventricular hypertrophy or left bundle branch block. On echocardiography, left ventricular minor axis dimensions were increased (diastolic, 67 +/- 7 mm; systolic, 59 +/- 7 mm) and mean fractional shortening was reduced (13% +/- 5%). All patients had hypokinesis or akinesis of the left ventricular segments and two had right ventricular dilatation. Gallium scanning performed in three patients was negative. Viral serologic testing was negative in all cases. All patients died within 5 years, three within 5 months. Survival duration was closely correlated with left ventricular fractional shortening. Autopsy in three patients confirmed the diagnosis of a dilated cardiomyopathy.

Hemodynamic properties of bucindolol, a beta-adrenoreceptor blocking drug with vasodilator activity

Bucindolol is a new nonselective beta-adrenergic blocking agent with direct vasodilator, partial agonist and alpha-adrenergic blocking properties. Its hemodynamic effects were evaluated in 13 healthy young men. In an open study, the effects of increasing single oral doses (50 to 200 mg) were examined. Two hours after each dose there was little effect at rest, but the responses of heart rate and systolic blood pressure to cycle exercise (50 to 150 W) were significantly reduced. There was no greater effect with larger doses. The second phase was a 3-way double-blind study comparing the effects of placebo with 50 and 200 mg of bucindolol. Left ventricular (LV) ejection phase indexes derived from digitized M-mode echocardiograms (% fractional shortening, mean and peak velocity of circumferential fiber shortening, stroke volume) increased more than 10% 2 and 4 hours after bucindolol was administered, whereas systemic vascular resistance and the ratio preejection period/LV ejection time decreased to the same extent. Although there was little effect on measurements at rest, the response to cycle exercise of heart rate and systolic blood pressure were significantly attenuated. These results show that the effects of bucindolol on LV systolic function are related at least in part to reduction of afterload, but do not indicate whether the drug has an additional direct inotropic effect.

Comparison of flexible sigmoidoscopy with other diagnostic techniques in the diagnosis of rectocolon neoplasia

Flexible sigmoidoscopy was compared to rigid sigmoidoscopy in the detection of colorectal neoplasia in a select group of patients. A distance of 30 cm or greater was obtained by flexible sigmoidoscopy in 94% of patients and a distance of 50 cm or greater in 46% of patients. A significant number of cancers and adenomas detected by flexible sigmoidoscopy were not detected by rigid sigmoidoscopy. Flexible sigmoidoscopy was tolerated better than rigid sigmoidoscopy but required twice the time. Flexible sigmoidoscopy could be combined with air-contrast barium enema the same day with the one preparation and did not interfere with the x-ray examination. All cancers and a significant number of adenomas detected subsequently on colonoscopy were detected by the combination of flexible sigmoidoscopy and air-contrast barium enema. Although the combination of flexible sigmoidoscopy and air-contrast barium enema is not adequate for thorough diagnostic evaluation of patients with a positive screening test, it may be of value in other select clinical situations. Flexible sigmoidoscopy has the potential for higher yield and better patient tolerance as compared to rigid sigmoidoscopy. This warrants further evaluation.

Carcinoembryonic antigen in colonic lavage

Colonoscopic lavage was performed for assay of carcinoembryonic antigen (CEA) concentration in patients with small and large colonic adenomas, in patients with adenocarcinoma of the colon, and in normal controls. CEA concentration was considerably higher in colonoscopic lavage as compared to plasma. CEA concentration in normal controls and in patients with colonic adenomas less than 1 cm in size were not significantly different. CEA concentrations in patients with colonic adenomas greater than 1 cm in size and in patients with adenocarcinoma of the colon were significantly higher than those observed in patients with small adenomas and in the normal controls. In all except 2 patients, plasma CEA concentrations were normal. Assay of CEA concentrations in colonic lavage may have potential application in the further assessment of the mucosa at risk for colon adenomas and for colon cancer. It does not appear to be accurate enough for diagnosis of colon cancer in individual patients.