Characteristics of a Mild Head Injury Subgroup With Extreme, Persisting Distress on the Rivermead Postconcussion Symptoms Questionnaire

Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms Questionnaire.

Objective

To examine baseline variables and identify characteristics of participants with extremely high reports of symptoms (ie, outliers) 12 months after mild head injury (MHI).

Design

A prospective cohort study of MHI with and without loss of consciousness (LOC) and/or posttraumatic amnesia (PTA) recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.

Setting

Level II community hospital ED.

Participants

Participants (n=58) with MHI and LOC less than or equal to 30 minutes and/or PTA less than 24 hours and participants (n=173) with MHI but no PTA/LOC. Inclusion criteria: age greater than or equal to 18 years, less than or equal to 24 hours after injury, Glasgow Coma Scale score greater than or equal to 13, and discharge from the ED. Fourteen (6%) participants had extremely high scores on the Rivermead Postconcussion Symptoms Questionnaire (RPQ).

Main Outcome Measures

RPQ and questions on health services use and litigation.

Results

Characterizing the outlier cases are prior head injury, preinjury disability, history of substance use, unemployment, and elevated somatic symptoms at the ED. At 12 months, outliers had higher use of health services and litigation.

Conclusions

The existence of a subgroup with a distinctive pattern of baseline characteristics in combination with elevated somatic symptoms at the time of presentation to the ED suggests that further taxonomic distinctions may be warranted for the MHI population, each requiring appropriately targeted interventions for addressing symptomatic complaints.     

Health care utilization before and after an outpatient ED visit in older people

Background

Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population.

Objectives

The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults.

Methods

This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits.

Results

Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status.

Conclusion

Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.     

Predictors of respiratory failure among previously healthy children with respiratory syncytial virus infection

Background

Respiratory syncytial virus (RSV)-related disease is the leading cause of hospitalization among infants, with approximately 7% to 21% of these patients developing acute respiratory failure.

Objective

The aim of this study was to identify clinical variables at initial presentation in the emergency department (ED) that may predict the subsequent need for mechanical ventilation among previously healthy, RSV-infected children who require pediatric intensive care unit (PICU) hospitalization.

Study design

This is a retrospective study of 67 previously healthy, RSV-infected patients admitted from January 1997 to March 2000 to the PICU. The primary outcome for this study was the need for mechanical ventilation. The relationship between clinical variables at initial ED presentation and the need for mechanical ventilation were explored using univariate and multiple logistic regression analysis.

Results

On multivariate analysis, the presence of lethargy (odds ratio [OR], 12.2; P = .005), grunting (OR, 9.3; P = .01), and a Paco₂ 65 mm Hg or greater (OR, 11.8; P = .013) were clinical factors at initial presentation in the ED associated with the subsequent need for mechanical ventilation among the study cohort. A developmental model that included lethargy, grunting, and a Paco₂ of 65 mm Hg or greater performed well as a prediction model. The developmental model had a sensitivity of 71%, specificity of 96%, a positive predictive value of 86%, and a negative predictive value of 91%.

Conclusions

The presence of lethargy, grunting, and a Paco₂ of 65 mm Hg or greater at initial presentation in the ED were predictive for the subsequent need for mechanical ventilation in previously healthy, RSV-infected children admitted to the PICU.     

Comparison of Broselow tape measurements versus physician estimations of pediatric weights

Objective

We sought to determine the agreement of physician estimates compared with Broselow tape measurements in accurately determining children's weights. Our secondary objective was to evaluate whether physician adjustment of the Broselow tape weight measurement is a better estimate of pediatric weight compared with either method alone.

Methods

This cross-sectional study was conducted in the emergency department (ED) of a tertiary children's hospital. Children between the ages of 0 and 14 years consecutively registered in the pediatric ED were eligible for enrollment. Height, weight, body mass index, and Broselow tape measurement were obtained for all subjects. Blinded ED physicians provided estimates for weight and body habitus for enrolled subjects. Physicians next were given the Broselow weight measurement and then submitted a second, amended estimate (hybrid). Percentage differences were used to analyze the discrepancy between estimates and actual weight. Specifically examined were the proportion of estimates that fell within 10% of the patients' actual body weights.

Results

A total of 372 subjects met the inclusion criteria. Mean age was 45.7 months, mean body mass index was 17.4, mean weight was 16.8 kg, and 39 participants (18.1%) met the definition for obese. Broselow estimates were within 10% of actual weight 63% of the time, physician estimates were within 10% of the actual weight 43% of the time and hybrid estimates 55% of the time. Based on average mean percent error, compared with actual weight, Broselow differed by 10.8% (95% confidence interval [CI], 9.7-12), hybrid estimate by 11.3% (95% CI, 10.3-12.2), and physician estimate by 16.2% (95% CI, 14.7-17.7). The Broselow tape was significantly worse than physician estimate for obese patients: 26.4% (95% CI, 19.7-33.1) versus 16.0% (95% CI, 12.3-19.8).

Conclusion

The Broselow tape generally has greater agreement with actual weight than physician visual estimation, except for obese children. Physician adjustment of the Broselow measurement also proved to be comparable to the Broselow tape.     

Effect of training on upper-extremity prosthetic performance and motor learning: a single-case study

Dromerick AW, Schabowsky CN, Holley RJ, Monroe B, Markotic A, Lum P. Effect of training on upper-extremity prosthetic performance and motor learning: a single-case study.

Objectives

To examine the impact of a new prosthesis on an experienced and highly motivated prosthetic limb user, to evaluate the effects of training and the ability of clinical measures to detect change, and to gain insight into the mechanisms by which improvement occurs.

Design

A single-case study.

Setting

An outpatient clinic.

Participant

A bilateral high-arm amputee (right shoulder disarticulation, left above elbow).

Interventions

Provision of new prosthesis and occupational therapy.

Main Outcome Measures

Action Research Arm Test, box and block test of manual dexterity, Jebsen-Taylor Hand Function Test, and speed and accuracy of reaching movements with and without visual guidance.

Results

In this experienced prosthesis user, provision of a new prosthesis led to an immediate worsening in functional limitation. With training, the subject recovered his baseline status and then exceeded it in both proximal and distal function. All study clinical measures detected change, but the change detected varied as much as 300-fold depending on the measure chosen. The clinical improvements were associated with modest improvements in the speed of reaching but not the accuracy of reaching under visual guidance. Improvements in reaching accuracy without visual guidance were seen after 10 trials, suggesting that some motor learning had occurred.

Conclusions

Provision of a new prosthesis can cause functional decline even in an experienced user; this decline can be reversed with training. There is wide variability in sensitivity to change among functional limitation measures. Although some training-related improvements may have been due to increased speed and accuracy of reaching without visual guidance, skill in prosthesis use also plays a role.     

The need for dental care among adults presenting to an urban ED

Objective

The study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics.

Methods

This was a cross-sectional study conducted in the emergency department (ED) of a level I trauma center between June 1 and August 31, 2009. All ED patients were prospectively screened during randomly selected 8-hour blocks of time; consenting patients completed a survey on sociodemographics and health. The treating clinician completed an oral health examination to determine the patient's need for dental care as none (continue usual care), early (need to be seen soon), or urgent (need to be seen immediately). Data were analyzed using logistic regression.

Results

There were 4670 patients who presented to the ED, 2787 (59.7%) were eligible, 1190 (63.2%) consented and enrolled, and 653 (54.9%) had a dental examination. Of these, 388 (59.4%; 95% confidence interval [CI], 56%-63%) had no need for dental care, 199 (30.5%; 95% CI, 27%-34%) had an “early need,” and 66 (10.1%; 95% CI, 8%-12%) had an “urgent need.” Logistic regression showed the need for dental care was associated with age, ethnicity, and having not had a routine checkup/cleaning in the last 3 years.

Conclusions

Of the patients presenting to the ED, 40.6% were in some need of dental care. This need was not associated with insurance or socioeconomic status as shown in previous studies. Age, ethnicity, and no routine oral care in the last 3 years were all associated with early/urgent need for oral health care.     

Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty

Nantel J, Termoz N, Vendittoli P-A, Lavigne M, Prince F. Gait patterns after total hip arthroplasty and surface replacement arthroplasty.

Objective

To compare gait patterns in patients with total hip arthroplasty (THA) and surface hip arthroplasty.

Design

Observational study.

Setting

Outpatient biomechanical laboratory.

Participants

Two groups of 10 surface hip arthroplasty and THA patients and 10 control subjects participated in the study (N=30). The patients were volunteers recruited from a larger randomized study.

Interventions

Not applicable.

Main Outcomes Measures

Gait patterns, hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups.

Results

In the sagittal plane, the THA group showed a larger flexor moment and larger mechanical work in H2S and K3S power bursts compared with surface hip arthroplasty and control subjects. In the frontal plane, both THA and surface hip arthroplasty patients had smaller hip abductor muscles energy generation (H3F) than the control group. No difference was found for the hip abductor muscles strength.

Conclusions

In the THA group, the larger energy absorption in H2S and K3S would be a cost-effective mechanical adaptation to increase stability. The surface hip arthroplasty characteristics could allow the return to a more normative gait pattern compared with THA. The modification in the frontal plane in surface hip arthroplasty and THA would be related to the hip abductor muscles strength.     

Short-term functional decline of older adults admitted for suspected sepsis

Introduction

We investigated the degree of functional decline and loss of independence among older adults presenting to the emergency department (ED) with serious infection and to estimate 90-day case fatality.

Methods

Consecutive patients 70 years or older (n = 50) presenting to the ED with potentially serious infection were identified using an automated case-identification algorithm. Fifty age- and sex-matched controls were recruited from a registry of community volunteers. Functional and residential statuses were ascertained at hospital admission, discharge, and 90 days. Details regarding patients' comorbidities, acute illness, and diagnostic evaluation were collected along with 90-day survival.

Results

Older adults with suspected sepsis had substantial 90-day mortality (32.0%). Baseline functional impairment was more severe among cases than among control subjects, although activities of daily living and instrumental activities of daily living deficits did not predict outcome. Hospital admission was also not uniformly associated with deterioration in either activities of daily living or instrumental activities of daily living performance. Patients admitted from home were at no greater risk of functional decline than were those admitted from care facilities. No enrolled case enjoyed an increase in residential independence after discharge; of the 28 who were independent upon admission, 19 survived to 90 days, and 8 of the 19 required visiting assistance or were in a care facility.

Conclusions

Older adults presenting to the ED with potentially serious infection have significant 90-day mortality. Although functional status does not consistently deteriorate in survivors, there seems to be considerable risk in the short-term for loss of residential independence.     

Impact of computerized physician order entry on ED patient length of stay

Objectives

We evaluated whether implementation of computerized physician order entry (CPOE) reduces length of stay (LOS) for discharged emergency department (ED) patients.

Methods

Emergency department LOS for discharged and admitted patients were analyzed in a university-affiliated ED before and after introduction of CPOE. Patient demographics and covariates that may affect LOS (mode of arrival, provider staffing, daily census, and admission rate) were measured.

Results

The study included 71?188 patients; 49?175 (69%) were discharged from the ED (28?687 before and 20?488 after CPOE). Length of stay for discharged patients decreased from 198 to 168 minutes (difference of −30; 95% confidence interval [CI], −28 to −33), whereas LOS for admitted patients increased from 405 to 441 minutes (difference of +36; 95% CI, 26-46). After controlling for covariates, CPOE implementation was associated with a 23-minute decrease in LOS for discharged patients (β = −23 [95% CI, −26 to −19]).

Conclusion

Implementation of CPOE was associated with a clinically significant (23-minute) decrease in LOS among patients who were discharged from the ED.     

Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service

Background

Hypoxemia may occur during rapid sequence intubation (RSI). This study establishes the incidence of this adverse event in patients intubated by physicians in a helicopter emergency service in Norway.

Methods

This was a prospective, observational study of all RSIs performed by helicopter emergency service physicians during a 12-month period. Hypoxemia was defined as a decrease in Spo₂ values to below 90% or a decrease of more than 10% if the initial Spo₂ was less than 90%.

Results

A total of 122 prehospital intubations were performed during the study period. Spo₂ data were available for 101 (82.8%) patients. Hypoxemia was present in 11 (10.9%) patients.

Conclusions

Prehospital, RSI-related hypoxemia rates in this study are lower than reported rates in similar studies and are comparable with in-hospital rates. Prehospital RSI may accordingly be considered a safe procedure when performed by experienced physicians with appropriate field training.     

Patient-Reported Cognitive and Communicative Functioning: 1 Construct or 2?

Hula WD, Doyle PJ, Austermann Hula SN. Patient-reported cognitive and communicative functioning: 1 construct or 2?

Objectives

To examine the dimensionality of scales for measuring patient-reported cognitive and communicative functioning in a sample of stroke survivors and to evaluate the consequences for measurement of treating them as a single, undifferentiated construct.

Design

Secondary analysis of existing cross-sectional data.

Setting

Data were collected in outpatient rehabilitation clinics and in the community.

Participants

Unilateral stroke survivors (N=316) 3 months or more postonset referred for participation in research.

Interventions

Not applicable.

Main Outcome Measures

The Burden of Stroke Scale cognition and communication domain scales were evaluated by using confirmatory factor analysis, Rasch analysis, and tests of differential item functioning (DIF). To evaluate the impact of multidimensionality on the measurement of individual patients, separately estimated cognition and communication scores were compared. Combined and separately estimated scores were also examined for responsiveness to group differences in the presence of cognitive and communicative impairment.

Results

Factor analysis and Rasch model fit analyses equivocally supported the unidimensionality of the item pool. DIF analyses between participants with right versus left hemisphere stroke suggested multidimensionality. Scaling cognition and communication items separately resulted in different person scores for a significant number of patients and greater responsiveness to group differences.

Conclusions

Patient-reported scales assessing communication along with more general cognitive activities may possess an internal structure that is inconsistent with a unidimensional measurement model with potential negative consequences for measurement.     

Factors Associated with Adverse Events Resulting From Medical Errors in the Emergency Department: Two Work Better Than One

Background

The Emergency Department (ED) is an environment at risk for medical errors.

Objective

Our aim was to determine the factors associated with the adverse events resulting from medical errors in the ED among patients who were admitted.

Methods

This was a prospective observational study. For a 1-month period, we included all ED patients who were subsequently admitted to the medical ward. Detection of medical errors was made by the admitting physician and then validated by two experts who reviewed all available data and medical charts pertaining to the patient’s hospital stay, including the first review from the ward physician. Related adverse events resulting from medical errors were then classified by type and severity. Adverse events were defined as medical errors that needed an intervention or caused harm to the patient. Univariate analysis examined relationships between characteristics of both patients and physicians and the risk of adverse events.

Results

From 197 analyzed patients, 130 errors were detected, of these, 34 were categorized as adverse events among 19 patients (10%). Seventy-six percent of these were categorized as proficiency errors. The only factors associated with a lower risk of adverse events were the transition of care involving a handoff within the ED (0% vs. 19%; p = 0.03) and the involvement of a resident (junior doctor) in addition to the senior physician (37% vs. 67%; p < 0.01).

Conclusions

In our study, the involvement of more than one physician was associated with a lower risk of adverse events.     

Relationship Between Age and Spasticity in Children With Diplegic Cerebral Palsy

Pierce SR, Prosser LA, Lauer RT. Relationship between age and spasticity in children with diplegic cerebral palsy.

Objective

To examine the relationship between passive torque, reflex activity, co-contraction, and age during the assessment of spasticity of knee flexors and extensors in children with spastic diplegic cerebral palsy (CP).

Design

Retrospective.

Setting

Pediatric orthopedic hospital.

Participants

Children (N=36) with spastic diplegic CP.

Interventions

Not applicable.

Main Outcome Measures

Spasticity of the knee flexors and knee extensors (as measured by peak passive torque, mean passive torque, reflex activity of the medial hamstrings, reflex activity of vastus lateralis, and co-contraction) was assessed during passive movements completed using an isokinetic dynamometer with concurrent electromyography.

Results

A significant positive relationship was found between age and mean knee flexor passive torque (P<.05), while a significant negative relationship was found between age and mean percentage of the range of motion with co-contraction (P<.05).

Conclusions

Our results suggest that passive stiffness may play a larger role in spasticity than reflex activity as children with spastic diplegic CP age. Additional research is needed to determine whether subject age could influence the effectiveness of interventions, such as serial casting or botulinum toxin, for spasticity in children with spastic diplegic CP.     

A 2-year survey of treatment of acute atrial fibrillation in an ED

Objective

Pharmacologic cardioversion of atrial fibrillation (AF) is a reasonable mode of treatment if the arrhythmia is of recent onset. Results concerning the response rates of different drugs, respectively, in daily clinical practice and data with regard to the parameters associated with successful cardioversion are not very prevalent.

Methods

Three-hundred seventy-six patients who were admitted to the emergency department with acute AF and a duration of shorter than 48 hours were enrolled into the AF registry.

Results

The most effective drugs were flecainide and ibutilide (95% and 76%). Low response rates were observed with amiodarone (36%) and the individual use of digoxin or diltiazem (19% and 18%). Factors associated with a successful cardioversion were a lower blood pressure on admission (P = .002), a shorter time interval between the onset of AF and admission to the ED (P = .003), and adherence to treatment guidelines (P < .0001).

Conclusion

The use of flecainide and ibutilide is associated with a much higher rate of cardioversion than other drugs we studied.     

Impact of essential surgical skills with an emphasis on emergency maternal, neonatal and child health training on the practice of doctors: a cluster randomised controlled trial in Pakistan

Introduction

Majority of studies on evaluation of emergency management courses have focused on outcomes such as knowledge and skills demonstrated in non-clinical or traditional testing manner. Such surrogate outcomes may not necessarily reflect vital changes in practice. The aim of this study was to determine if and to what extent, specific training in the management of life threatening emergencies resulted in an increased in compliance with established care guidelines of doctors working in the emergency departments of public sector hospitals in Pakistan.

Methods

A cluster randomised controlled trial was conducted in three districts hospitals in three cities (Khairpur, Vehari and Peshawar) of Pakistan. Thirty-six doctors, 18 in intervention (trained in ESS-EMNCH training) and 18 in control (untrained), were enrolled and 248 life threatening emergency events, 124 in each group, were observed for the correct use of the Airway, Breathing, Circulation (ABC) structured approach. The outcome measure was structured approach defined a priori. Data was analysed by using STATA software.

Results

At individual level, 79 (63.7%) life threatening episodes were managed according to the structured approach in the intervention group and 46 (37.1%) were managed according to the structured approach in controls (OR 2.98, 95%CI 1.78-4.99, p-value = 0.0001). At cluster level, the mean percentage (95% CI) of the structured approach used by doctors in the intervention group [62.9% (50.4-75.3%)], was significantly higher than those in the control group, [36.3% (26.3-46.4)] (p-value = 0.001).

Conclusions

5-day training of ESS-EMNCH significantly increased the compliance with established care guidelines of doctors during their management of life threatening emergency episodes in the public sector hospitals in Pakistan.     

Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation

Study Objective

Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all emergency department (ED) visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF.

Methods

We systematically reviewed the electronic medical records of ED patients with newly diagnosed AF between August 2005 and July 2008. We measured the frequency of the Framingham Heart Study predictors and calculated each patient's risk score.

Results

During the 3-year study period, 914 patients had 1228 ED visits. New AF was diagnosed in 296 (32%) patients. Among these patients, 107 (36%) were female, 127 (43%) had prior ED visits since 2003, 189 (64%) were taking hypertension medications and 170 (57.4%) had previous electrocardiograms with measurable PR intervals. The median PR interval was 166 ms (151 to 180) and 60% of available PR intervals were 160 ms or greater. The median (interquartile range) age, body mass index, and systolic blood pressure were 66 years (53-77), 27 (23-31), and 134 mm Hg (118-151), respectively. Median risk score was 7 (3-9) indicating high predicted risk. Heart failure and cardiac murmurs were previously diagnosed in 45 (15%) and 32 (11%) of these patients, respectively.

Conclusions

The Framingham risk factors for AF are commonly encountered among ED patients with newly diagnosed AF. The ED might provide an opportunity to identify patients at high risk for AF and refer them for primary prevention interventions.     

Non-invasive mechanical ventilation in Australian emergency departments: A prospective observational cohort study

Objectives

Data describing use of non-invasive ventilation (NIV) in the emergency department (ED) setting consist primarily of physician surveys. Our objective was to conduct a prospective study to document the characteristics of patients receiving NIV, interfaces, mode, and parameters used as well as NIV duration and decision-making responsibility.

Methods

We conducted a 2-month prospective observational study of adult patients who received NIV in 24 EDs. Patient characteristics, delivery methods, and decision-making responsibility were documented for each ED presentation.

Results

Data were recorded on 245 patients; 185 patients received non-invasive positive pressure ventilation (NIPPV) and 60 received continuous positive airway pressure (CPAP). Acute cardiogenic pulmonary oedema (ACPO) (80/245, 33%) and exacerbation of chronic obstructive pulmonary disease (COPD) (75/245, 31%) were the two most frequent indications for NIV. Compared to patients with respiratory failure from other aetiologies, those with ACPO were more likely to receive CPAP (28/80 [35%] versus 32/165 [19%] P = 0.008). Initial NIV settings were selected by ED nurses for 118/245 (48%) patients, by ED physicians for 118/245 (48%) patients, and by ICU staff for 3/245 (1.5%) patients (not reported for 6 [2.5%] patients). The role of ED nurses in the selection of initial NIV settings was not influenced by ED location, patient type or triage category.

Conclusions

Acute exacerbations of CPO and COPD were the most common indications for NIV. Clinicians demonstrated a preference for NIPPV for all patient aetiologies except ACPO. Responsibility for NIV management was shared by ED nurses and physicians.     

Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?

Introduction

In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment. The aim of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity.

Methods

Data were prospectively recorded in our MECU database and we reviewed all cases of opioid overdose between 1994 and 2003. The MECU database was cross-referenced with the Central Personal Registry. For patients who died within 48 h of MECU contact we reviewed the forensic autopsy reports to establish whether rebound opioid toxicity was likely.

Results

We found 4762 cases of acute opioid overdose. In 3245 cases positive identification was obtained. Over this ten year period fourteen patients who were released on-scene after having been treated with naloxone died within 48 h, but only in 3 of these we found a rebound opioid toxicity to be the likely cause of death, corresponding to 0.13% of those 2241 released on scene who were identified.

Conclusion

Prehospital discharge-on-scene after naloxone treatment is associated with a low risk of death due to rebound toxicity.     

The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening

Purpose of the research

The aim of this study was to investigate the effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening.

Methods and sample

In this pretest-posttest longitudinal study, Turkish men over 40 years of age were given an interactive educational session on prostate cancer and prostate cancer screening, and were then given related web-assisted education and consultation for a period of 6 months. As well as the Internet, reminders such as desk calendar, booklets, e-mails and cell phone messages were used in the study. Changes in the screening behaviors, the health belief and knowledge level of patients were examined 3 and 6 months after the interventions.

Key results

During the study, participants’ prostate examination rate increased from 9.3% to 19.1% and PSA measurement rate increased from 6.7% to 31.4%. The interventions raised the susceptibility perception on prostate cancer and prostate cancer screening while decreasing the barrier perception (p < 0.05). No change was observed in other health belief components and the level of knowledge.

Conclusion

Web-assisted education and reminders provided positive changes in the barrier and susceptibility perceptions of individuals. Participation in the screening also increased.