Information Sources and Decision-Making in Neurosurgery: Results of a Survey of Members of the Brazilian Neurosurgery Society

Introduction In all surgical disciplines, including neurosurgery, there are questions about the level of evidence supporting surgical practices and the mechanisms and adequacy of knowledge translation. Objectives To assess the perception of Brazilian neurosurgeons of information sources and decision-making mechanisms related to their medical practices. Methods An online questionnaire was sent to the 2,400 members of the Brazilian Neurosurgical Society. Results A total of 32% of the neurosurgeons completed the questionnaire, 53% had more than 10 years experience, 67% had worked in public hospitals, 34% had performed spine surgeries, and 30% had performed brain tumor surgeries. The therapeutic decisions were based mostly on internship learning (54%) and personal professional experience (52%). The most common information sources were scientific abstracts (53%) and the Internet (47%). A total of 89% believed that evidence-based medicine was relevant, 93% believed protocols or guidelines were necessary, and 74% subscribed to a medical journal. Nonetheless, only 43% had protocols implemented in their services, 93% highly valued a surgeon's personal experience, and 63% showed little familiarity with the interpretation of scientific concepts in the literature. Among the respondents, 83% were willing to try an innovative treatment alternative if it was shown to improve clinical outcomes and reduce severe complications. Conclusions The disparity in the responses highlights the need to implement recommendations that improve decision-making mechanisms.

Introdução Em todas as disciplinas cirúrgicas, incluindo a neurocirurgia, existem questões sobre o nível de evidência que apoia as práticas cirúrgicas e os mecanismos e adequação da translação do conhecimento. Objetivos Avaliar a percepção de fontes de informação e mecanismos de tomada de decisão dos neurocirurgiões brasileiros em relação às práticas médicas. Métodos Um questionário on-line foi enviado aos 2.400 membros da Sociedade Brasileira de Neurocirurgia. Resultados Um total de 32% dos neurocirurgiões preencheram o questionário, 53% tinham mais de 10 anos de experiência, 67% trabalharam em hospitais públicos, 34% realizaram cirurgia de coluna, e 30%, de cérebro. As decisões terapêuticas basearam-se principalmente no aprendizado de estágio (54%) e na experiência profissional pessoal (52%). As fontes de informação mais comuns foram resumos científicos (53%) e a Internet (47%). Um total de 89% acreditava que a medicina baseada em evidências era relevante, 93% acreditavam que protocolos ou diretrizes eram necessários, e 74% tinham assinaturas de uma revista médica. No entanto, apenas 43% apresentaram protocolos implementados em seus serviços, 93% valorizaram a experiência pessoal de um cirurgião, e 63% mostraram pouca familiaridade com a interpretação de conceitos científicos na literatura. Entre os respondentes, 83% estavam dispostos a tentar uma alternativa de tratamento inovador se este demonstrasse melhorar os resultados clínicos e reduzir as complicações graves. Conclusões A disparidade nas respostas destaca a necessidade de implementar recomendações que melhorem os mecanismos de tomada de decisão.

Investigation of Universal Drug Information in a Hospital in Japan / 医薬品情報学

<b>Objective: </b>We aimed to integrate drug information (DI) documents universally necessary in most hospitals in Japan and share the DI documents nationwide.  For this purpose, we planned to collect details (e.g., types of document, contents, sources of information used for preparing documents) regarding the DI documents prepared by the DI service section of each hospital.<br><b>Methods: </b>(1) Preliminary research: We searched Ichushi-Web (from January 1977 to December 2015) for cases in which DI documents were prepared by the DI service section of each hospital.  (2) Questionnaire survey: We conducted the survey in DI section of 300 hospitals in Japan that were selected randomly.  We asked the types of DI documents they have, sources of information used for preparing documents, and time needed for preparing documents.<br><b>Results: </b>(1) Forty titles, including those related to preoperative medication management, simple suspension methods of tablets, and list of dosing with renal impairment, were found.  (2) In total, 148 hospitals (49.3%) responded to the survey.  The main contents were as follows: preoperative medication management (130), the influence of a tube and a filter give to stability of injection medicine (67), list of high-risk medicines (54), suspension or porphyrization information on tablets (37), and others.  The source of information used for preparing these documents was common in several hospitals.<br><b>Conclusion: </b>It was confirmed that similar DI documents are prepared by several DI sections of hospitals and some sources of drug information are common.

Perception of Women about Implanon as a Contraceptive Method in Akure Western Nigeria.

Background: Implanon is a single rod implant contraceptive with increasing popularity; however, different views have been expressed by women concerning its use. Aim and Objective: The aim of the study was to evaluate family planning client’s perception and acceptance of implanon as a contraceptive method and the factors affecting its uptake. Study Design/ Methodology: The study used a cross-sectional design consisting of 200 women who visited the family planning clinic of State Specialist Hospital, Akure in Ondo State, Western Nigeria between October and December 2014. Data were collected using self administered questionnaires after obtaining ethical clearance and the clients informed consents. The main outcome measured were awareness of implanon as a method of contraception, source of information about implanon, previous use of implanon and their willingness to accept implanon. Results: The study showed that 54.5% were in the age bracket of 30-39 years and 96% were married. The majority of the women were educated with only 3.5% having no formal education. About 55% had less than 4 children while 45% had 4 or more children. In addition 60% of the women were Christians, 39% practiced Islam while 1% was of other religion. About 69% of the women were already aware of implanon as a contraceptive method with their health care providers being their major source of information. There was a significant association between awareness of implanon with its usage and the health care providers being the source of their information (X2=6.763, P=0.009 and X2 =17.672, P=0.000 respectively). Only 7% of the women had used implanon previously while 24.5% would consider implanon if offered but 75.5% would not. The reasons for this were that insertion and removal could be painful, that it involves a surgical operation and that their husbands may not approve of it. Conclusion: The study showed increased awareness of implanon among our women but this may not translate into its use due to some misconceptions. The findings therefore suggest that additional strategies may be adopted such as the male partner involvement during counselling in order to enhance its use.

Cross-sectional study on knowledge of chronic kidney disease among medical outpatient clinic patients

Background: Chronic kidney disease (CKD) is a major health concern worldwide. There are limited studies which look into the actual knowledge level of CKD among the general population both locally and internationally. This study aims to assess the knowledge level of CKD among patients in a secondary hospital in Malaysia. Methods: Consecutive sampling of patients attending the Medical Outpatient Clinic was performed in this crosssectional study. Respondents were given self-administered questionnaires which contain questions on demographic characteristics and knowledge on CKD. Results: Out of 300 respondents, 78.6% (n=236) of the respondents completed the questionnaire. Majority of respondents (73.7%, n=174) scored less than 4 out of 7 marks on knowledge on CKD. Respondents who were younger, males, having higher education status, professionals/executives and earned higher monthly income were more likely to have a higher mean knowledge score of CKD. Respondents who have heard of CKD were also significantly associated with higher mean knowledge score of CKD. Conclusion: The study findings suggest that our Malaysian population is still inadequately informed on CKD, especially those who are at risk of developing CKD and its complications, and also among those of the lower socioeconomic group. In order for successful primary and secondary prevention of CKD, more importance should be placed on increasing awareness on CKD among these atrisk groups.

Survey of Knowledge and Source of Information Relating to Reproduction and Sexually Transmitted Infections among Senior Secondary Schools Students in a Military Barracks in Nigeria.

Context: Adolescents seek health information from diverse sources. When such information is appropriately sought, correct and complete, it ensures an understanding of their reproductive health needs and encourages healthy sexual decision making and behaviors. Objective: To determine the level of knowledge and source of information about reproduction and sexually transmitted infections among senior secondary schools students in Ojo military barracks, Lagos. Materials and Methods: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using multistage sampling technique was done. Data collection employed pretested, self- administered structured questionnaires. Data was analysed using statistical package for social sciences version 17. Tests of statistical significance were carried out using chi square and t tests. A p value of <.05 was considered significant. Results: Majority of them 391(97.8%), were in the age group (10-19 years) while the mean age was 152.4 for males and 152.2 for females respectively. Information on sexual and reproductive health was sought from the electronic media by 238(59.5%), 115 (52.0%) males and 123 (68.7%) females; peer group 231(57.8%), 120 (54.3%) males and 111 (62.0%) females as well as print media and other sources with a statistically significant difference in this practice between the males and females (P=.01). Only 38 (9.5%) had very good knowledge. The sexually experienced were less knowledgeable than the non-experienced (3.71.3 and 3.91.3 respectively; P<.05). Knowledge was found to increase with age (P<.05). Females had more knowledge than males (P<.05). Conclusions: Overall knowledge was assessed as fairly good, while key sources of information were the electronic media and peer groups. Interventions including peer education are recommended to ensure that these sources provide veritable information on reproductive health.

A Comparative Study between Emergent and Elective Admission: Identifying Medicines Brought to Hospital by Inpatients / 医薬品情報学

<b>Objective: </b>Information on medicines brought to hospital by inpatients is essential to optimize drug use and patient safety.  However, the actual situation and usefulness of identifying such medicines on the emergent admission of patients remain to be clarified.  The objective of this study was to examine the usefulness of identifying the medicines patients bring to the hospital on emergent admission.<br><b>Methods: </b>We compared the source of information on identifying medicines between two groups of patient: emergent admissions (<i>N</i>=276) and elective admissions (<i>N</i>=50), and also investigated intervention by pharmacists regarding the medicines patients had brought with them.<br><b>Results: </b>Regarding the source of information to identify the medicines, the rate of utilizing medicine notebooks on emergent admission was significantly lower than on elective admission, and the rate of inquiring with community pharmacies on emergent admission was significantly higher than on elective admission.  The frequencies of intervention by pharmacists in the two groups were similar, and, therefore, the usefulness of identifying the medicines patients brought was noted regardless of the admission course.<br><b>Conclusion: </b>Identifying the medicines patients bring to the hospital might be useful on emergent admission.  Hospital pharmacists should promote an increase in the medicine notebook utilization rate and reinforce cooperation with community pharmacies.

Source of Information on Sexual and Reproductive Health among Secondary Schools’ Girls in the Klang Valley

Adolescents are known to obtain information regarding sexual and reproductive health from a variety of sources and not just during formal lessons in schools. This cross-sectional descriptive study was carried out to determine the source of information on sexual and reproductive health among Form four secondary schools girls in the Klang Valley as well as parents’ relationship profile. A total of 520 secondary school girls were recruited for the study. In this study, the source of information on puberty and sexual topics were categorized as follows: first level of importance – mothers, second level of importance – siblings, third level of importance – fathers, fourth level of importance – friends, fifth level of importance – teachers and sixth level of importance – books/internet. A majority of respondents agreed that their mothers were the first level of importance they sought for information on puberty (74.8%) and sexual topics (53.8%). Thirty nine point three percent (39.3%) of respondents reported it was very easy to have a dialogue with their mothers while only 10.0% of the respondents said it was very easy to have a dialogue with their fathers. While this was the case, only 6.3% of the respondents reported discussing sex-related matter with their mothers.