Inese Grava-Gubins, MA

Inese Grava-Gubins, MA
"Dear Doctor . . .
Inese Grava-Gubins is Director
of Research, The College of Family
Physicians of Canada. Requests for
reprints to: Ms. Inese Grava-
Gubins, The College of Family
Physicians of Canada, 4000 Leslie
Street, Willowdale, Ont. M2K 2R9
T HE DAILY MAIL arrives on your
desk. Amid the plethora of junk
mail, magazines, bills, medical journals,
Speedy-Pizza coupons, more
junk mail, and more bills, there's an
envelope! It looks important-or at
least, it's not addressed to "Occupant"!
You open it, and what falls
out? A questionnaire! Before you
groan, "'Oh no, not another survey!",
you decide to look it over quickly and
see if it is worth your time to answer
these questions. Actually, as you read
the covering letter, you realize that the
topic of this one is important to you.
Let us assume that this one is from the
CFPC, and the questions pertain to the
role of family physicians in their community
hospitals. You decide to fill it
out and mail it back.
At this point, your involvement
stops, right? Wrong! While it may be
the last time you actually put pen to
paper concerning this survey, your involvement
has just begun! Your opinions/experiences,
reflected in your responses,
have but started their journey
towards affecting College policy.
How does this happen? Well, let's
follow what happens to your questionnaire.
First, as the envelopes containing
completed questionnaires reach
our office, they are opened and
counted. All of the (closed-ended) responses
must be coded, according to
pre-defined criteria, while open-ended
questions are dealt with individually.
This means that several trained people
must read through every questionnaire
and assign the appropriate code
numbers to each of your responses.
These numbers are then entered into
the computer, and other people set up
CAN. FAM. PHYSICIAN Vol. 33: SEPTEMBER 1987
.i
MEIN
the statistical analyses required for this
survey. First, however the data must
be cleaned and prepped (so to speak!).
After the data analyses are completed,
the fun part starts: What have all of the
respondents said?
Our questionnaires are usually returned
anonymously, and if they are
not to be anonymous, that fact is
clear/y indicated. We honestly do not
need to know how any specific individual
has responded, as only the entire
group's responses are to be reported.
All of the responses are
considered for each question (for example,
the per cent agreeing/disagreeing
with a statement). I know it sounds
contradictory, as the more questionnaire
that is returned makes my job
easier. How can that be? Simply because
as more readers respond, the answers
to our questions become clearer.
A11 of the results are then compiled
into a report, which is sent on to the
College committee that originated the
survey.
Here your responses start to work in
earnest! The committee members carefully
consider the responses, and what
these responses imply for College activities.
Should we, for example, encourage
the planners of family-medicine
programs to increase hospital
exposure for their residents? Should
we complain to the appropriate bodies
about restricted hospital privileges?
(Do family physicians even want these
privileges?) Our questionnaires are
sent to small, but representative, random
samples of College members and
that is why every returned questionnaire
counts! As an analogy, let us pretend
that you have a very heavy bag
full of 8,000 marbles in various colours.
For some obscure reason, it is
important to know how many of these
marbles are blue. Any statistician will
tell you that there is no point in wasting
your time counting 8,000 marbles!
If you were randomly to pull out approximately
370 marbles ("the ran-
i.
iissimism
MINE
dom sample"), and determine the proportion
of blue marbles in your
sample, you would have a fairly reliable
estimate of the total number of
blue marbles in your bag.
Now, there is a bit more involved in
planning a survey sample, but the
theory on which it operates is basically
the same! On the basis of the responses
of a random sample of College
members, committees have fairly reliable
information about what our membership
thinks about various issues.
Once the committee completes its discussions,
other projects are sometimes
implemented, or motions are sent to
the Board of Directors for action.
Those responses you provided on that
questionnaire five or six months ago
have now found their way into the
hands of the members who determine
College policy! It probably took you
no more than five to 10 minutes to
complete that questionnaire, but your
response will continue to work for the
next year.
In short, the next time a questionnaire
(at least one from the CFPC!)
lands on your desk-and, I hope, before
you deposit it in your overflowing
"circular file"-take a moment, at
least, to think about it. We do not send
out questionnaires to pry into your life.
Each one of our questionnaires has a
defined purpose, often they are intended
to help shape the future of family
medicine.
Yes, I agree with your protest every
questionnaire represents yet another
piece of tedious paperwork, deviously
prepared to consume more of your precious
free moments, but why not consider
it an investment, both for yourself
and for family medicine. It
provides an easy way to make your
voice heard, and it should provide a
large return on a small investment.
Think about it!
And, to everyone who has ever returned
a CFPC survey, my sincere
thanks! CO)
1935

Inese Grava-Gubins, MA
Cher docteur
Inese Grava-Gubins est
Directrice de la recherche au
College des medecins de famille du
Canada. Les demandes de tires-apart
peuvent etre adressees a': Mme
Inese Grava-Gubins, Le College des
medecins de famille du Canada,
4000 rue Leslie, Willowdale, Ont.
M2K 2R9
E COURRIER de chaque jour atterrit
sur votre bureau. Parmi la
plethore d'envois de toutes sortes, de
periodiques, de comptes, de revues
medicales, de coupons de rabais de la
pizzeria du coin, de correspondance
heteroclite et d'autres comptes se
trouve une enveloppe ! Elle a I'air
d'etre importante, ou du moins elle
n'est pas adressee 'a < l'occupant )) !
Vous l'ouvrez et qu'est-ce que vous y
trouvez ? Un questionnaire ! Avant de
grommeler, "( Ah, non, pas une autre
enquete !, vous decidez d'y jeter un
coup d'oeil pour voir s'il vaut la peine
de repondre 'a ces questions. Effectivement,
'a la lecture de la lettre d'introduction,
vous constatez qu'il s'agit
d'un sujet d'importance pour vous.
Presumons qu'il provient du CMFC et
que les questions ont trait au role des
medecins de famille dans les hopitaux
de leur localite. Vous decidez de le
completer et de le poster.
Votre implication s'arrete la, n'estce
pas ? Faux ! Meme si c'est la
derniere fois que vous avez a compl6ter
quoi que ce soit concernant cette
enquete, votre implication vient tout
juste de commencer ! Vos opinions/
exp6riences, que refletent vos reponses,
viennent 'a peine de se frayer un
chemin pour influencer dans l'avenir
les politiques du College.
CAN. FAM. PHYSICIAN Vol. 33: SEPTEMBER 1987
1.
M. -i Rm
M IRMM E"mwinwm I I ilini
I .0 go
*0 0
Comment cela se produit-il ? Suivons
ensemble le cheminement du
questionnaire. D'abord, des l'arrivee
des enveloppes contenant les questionnaires
completes, elles sont ouvertes
et comptees. Toutes les reponses
(fermees) doivent etre codifiees selon
des criteres predetermines, alors que
les reponses ouvertes seront traitees
individuellement. Cela implique que
plusieurs personnes formees pour
cette tache doivent lire entierement
chaque questionnaire et determiner les
numeros de code appropries pour chacune
des reponses. Ces chiffres sont
alors transf6res dans l'ordinateur et
d'autres personnes entreprennent
l'analyse statistique requise pour cette
etude. Mais les renseignements doivent
d'abord etre passes au peigne
fin. Une fois l'analyse des donnees
completee, la partie interessante commence:
qu'est-ce que les repondants
ont dit ?
Nos questionnaires sont habituellement
retoume's dans le plus strict anonymat
et, si tel n'est pas le cas, on
l'indique clairement. Nous n'avons
honnetement pas besoin de savoir
comment tel individu a repondu puisque
ce sont les reponses du groupe
qui font l'objet d'un rapport. Toutes
les reponses sont consider6es pour
chacune des questions (par exemple,
le pourcentage en accord/desaccord
avec l'enonce). Je sais que ceci peut
paraltre contradictoire, mais plus nous
recevons de questionnaires, plus j'ai
du travail qui m'attend mais plus chaque
questionnaire retourn6 me facilite
la tache. Comment est-ce possible ?
Simplement du fait que plus il y a de
gens qui repondent a nos questions,
plus ces reponses deviennent claires.
Tous les resultats sont alors compiles
sous forme de rapport, lequel est
envoye au Comite du College qui a
prealablement elabore cette enquete.
C'est ici que vos reponses commencent
'a etre prises ou serieux ! Les
membres du comite considerent soigneusement
chacune des reponses et
leur implication au niveau des activites
du College. Devrions-nous, par
exemple, encourager les planificateurs
de programmes de medecine familiale
a augmenter l'exposition hospitaliere
des residents ? Devrions-nous denoncer
la limitation des privileges hospitaliers
aupres des organismes concernes
? (Les medecins de famille
sont-ils seulement interesses 'a conserver
de tels privileges ?) Nos questionnaires
sont achemines 'a de petits
echantillonnages aleatoires de membres
du College consideres comme
tres representatifs, et c'est pour cette
raison que chaque questionnaire retoume6
a de l'importance ! Par analogie,
supposons que vous avez un tres
gros sac contenant 8,000 billes de
diff6rentes couleurs. Pour quelque
obscure raison, il est important de savoir
combien de ces billes sont
bleues. Tout statisticien vous dira
qu'il est inutile de perdre votre temps
a compter les 8,000 billes. Si vous retirez
environ 370 billes au hasard
(< l'echantillonnage au hasard >>) et
determinez la proportion de billes de
couleur bleue parmi cet echantillonnage,
vous obtiendrez un estime passablement
fiable du nombre total de
billes bleues dons votre sac.
La planification de l'echantillonnage
d'une etude implique davantage
de preparation, mais la theorie de son
fonctionnement est fondamentalement
la meme ! Sur la base des reponses
obtenues par un echantillonnage de
Suite page 2158
1949

Prolopa® (levodopa/benserazide)
Rx Sunmtu
Anlparkinsonism Agent
Indicaens Treatment of Parkinson's syndrome when not druginduced.
Conrandlcatons Known hypersensitivity to levodopa or benserazide;
in pabents in whom sympathomimetic amines are contraindicated;
concomitantly with, or within 2 weeks of, MAOI administration;
uncompensated cardiovascular, endocrine, renal, hepatc,
hematologic or pulmonary disease; narrow-angle glaucoma.
Warnings Discontinue levodopa at least 12 hours before initiating
'Prolopa'. See Dosage section for substituton recommendations.
Not indicated in intention tremor, Huntington's chorea or druginduced
Parkinsonism.
Increase dosage gradually to avoid CNS side effects (involuntary
movements). Observe patients for signs of depression with suicidal
tendencies or other serious behavioural changes. Caution in patients
with history of psychotic disorders or receiving psychotherapeubc
agents.
In patients with atrial, nodal or ventricular arrhythmias or history of
myocardial infarction initiate treatment cautiously in hospital.
Caution in patients with history of melanoma or suspicious undiagnosed
skin lesions.
Safety in patients under 18years has not been established. In women
who are or may become pregnant, weigh benefits against possible
hazards to mother and fetus. Not recommended for nursing mothers.
Preations Monitor cardiovascular, hepatic, hematopoietic and
renal function during extended therapy. Caution in patients with
history of convulsive disorders. Upper gastrointestinal hemorrhage
possible in patients with a history of peptic ulcer.
Normal activity should be resumed gradually to avoid risk of injury.
Monitor intraocular pressure in patients with chronic wide-angle
glaucoma. Pupillary dilation and activation of Horner's syndrome
have been reported rarely. Exercise caution and monitor blood
pressure in patients on antihypertensive medication. 'Prolopa' can be
discontinued 12 hours prior to anesthesia. Observe patients on concomitant
psychoactive drugs for unusual reactions.
Adverse Ractions Most common are abnormal involuntary movements,
usually dose dependent, which necessitate dosage reduction.
Other serious reactions are periodic oscillations in performance (end
of dose akinesia, on-off phenomenon and akinesia paradoxica) after
prolonged therapy, psychiatric disturbances (including paranoia,
psychosis, depression, dementia, increased libido, euphoria,
sedation and stimulation), and cardiovascular effects (including
arrhythmias, orthostatic hypotension, hypertension, ECG changes
and angina pectoris).
Neurologic, intellectual, gastrointestinal, dermatologic, hematologic,
musculoskeletal, respiratory, genitourinary and ophthalmologic
reactions have also been reported. Consult Product Monograph for
complete list.
Dotes Individualize therapy nd tIrat In small steps to masimiks
ene wIthout dyW ne . Do ot excee the recommended
dogsa rngs.
Initially, one capsule 'Prolopa' 100-25 once or twice daily, increased
carefully by one capsule every third or fourth day (slower in postencephalitic
Parkinsonism) until optimum therapeutic effect obtained
without dyskinesias. At upper limits of dosage, increment slowJy at
24 week intervals. Administer with food.
Optimal dose Is usually 44 'Prolopa' 100-25 capsules daily, In
46 divded dms.
'Prolopa' 200-50 capsules are intended for maintenance therapy
once optimal dosage has been determined using 'Prolopa' 100-25
capsules. No patient should receive more than 1000 - 1200 mg
levodopa daily during the first year of treatment. 'Prolopa' 50-12.5
capsules should be used when frequent dosing is required to
minimize adverse effects.
For patients previously treated with levodopa, allow a leat 12 hours
to eslps and initiate 'Prolopa' at 15% of previous levodopa dosage.
During maintenance, reduce dosage slowly, if possible, to a
maximum of 600 mg Jevodopa daily.
Supply 'Prolopa' 50-12.5 capsules containing 50 mg levodopa and
12.5 mg benserazide.
'Prolopa' 100-25 capsules containing 100 mg levodopa and 25 mg
benserazide.
'Prolopa' 200-50 capsules containing 200 mg levodopa and 50 mg
benserazide.
Bottles of 100.
Product Monograph available on request.
References: 1. Rondot P. Advantages of a Low Dosage of The
Levodopa-Benserazide Combination in the Treatment of Parkinson's
Disease. Med. et Hyg., 1981:39:3832-3835. 2. Data on file. 3.
Mondal BK, Mondal KN. Parkinson's Disease in the Elerly: A Long-
Term Efficacy Study of Levodopa/Benserazide Combination Therapy.
Pharmather., 1986:4(9):571-576. 4. Ontario Drug Benefits Plan,
December, 1986.
a Registered Trade Mark
© Copyright 1987 Hoffmann-La Roche Limited
Hoffmann-La Roche Limited
Etobicoke, Ontario M9C 5J4
rPAAB
7009
Original Research in Medicine and Chemistry
Suite de la page 1949
membres du College, les comites
regoivent des renseignements fiables
sur les opinions de leurs membres
concemant differents sujets. Lorsque
le comite a termine ses discussions,
d'autres projets sont parfois mis de
I'avant ou encore des propositions
sont faites au Conseil d'administration
pour decision executoire. Les reponses
que vous avez inscrites sur ce
questionnaire il y a cinq ou six mois
ont maintenant fait leur chemin
jusqu'aux responsables des politiques
du College ! Le questionnaire n'aura
necessite que cinq 'a dix minutes de
votre temps mais votre contribution
continuera de generer du travail pendant
un an encore.
Bref, la prochaine fois que vous
serez sollicite pour repondre 'a un
questionnaire (du moins de la part du
CMFC !)-et avant que vous n'ayez
decide de le faire disparaitre dans
votre