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Biomedical subjects

J K Stross

Publications and source records attributed to J K Stross.

At least 37 records · Page 2Linked to original sources
PubMed1986

Evaluation of an education program on the management of rheumatic diseases for physical therapists.

An educational program on the management of rheumatic diseases was developed for physical therapists. It was community based and designed to measure changes in patient care and physician behavior in the utilization of physical therapy services. Substantial changes in the utilization of physical therapy services were documented in 3 intervention communities, but not in control communities. In patients undergoing total hip arthroplasty, there was a 1.8 day reduction in the hospitalization, significant increases in the use of preoperative physical therapy and a shift in the use of walking aids. These data suggest that physical therapists can play an important role in physician and patient education, and this may result in lower costs and improved outcomes.

Arthritis, Rheumatoid↗
PubMed1985

An educational view of a national initiative to lower plasma lipid levels.

Two intervention trials have found significant reduction in coronary heart disease mortality and morbidity following reduction of plasma cholesterol levels by diet or drugs. The implications of these studies have been broadened to support a national effort directed to plasma lipid reduction. The evidence suggests that both a public health and medical approach can be effective and that each would be complementary in a national initiative. An important and critical dimension would be education, both of the public and of health professionals. The pertinent educational issues are identified in the categories of knowledge, attitudes, and skills. Economic considerations are an important factor in implementing a national initiative and require attention in development of a program.

Attitude of Health Personnel↗
PubMed1985

Continuing medical education. Changing behavior and improving outcomes.

A study was undertaken to determine if an intensive continuing medical education program in rheumatology could improve patient care. Fifteen primary care practitioners, who fit the description of educationally influential physicians, completed a 2-week academic medical center-based preceptorship. Improvement in physician knowledge, from a mean score of 65.3% to a mean of 82.9%, was documented using pre- and post-tests. Significant changes in physician behavior were documented using chart audits and patient interviews. The use of diagnostic tests and corticosteroids, and physician-patient interactions were the areas of greatest improvement. Functional outcomes for patients, measured by the Sickness Impact Profile, also improved. These findings suggest that a well-designed continuing medical education program can effect some changes in physician knowledge and behavior that will result in at least short-term improvement in patient outcomes.

Clinical Competence↗
PubMed1985

Self-evaluation by house officers in a primary care training program.

Expertise in ambulatory care requires a broad range of knowledge and skills. A modified Delphi survey technique was used to delineate diagnoses, management techniques, and procedural skills in seven subspecialty areas necessary for house officers in a primary care internal medicine training program. Self-evaluation instruments were developed, and residents were asked to rate their abilities in the seven areas. At entry, the house officers generally had more confidence in their diagnostic abilities than in their management techniques and procedural skills. Progression through the training program was accompanied by increases in confidence in all areas except the behavioral sciences. The self-evaluation approach provided a longitudinal assessment of changes in the confidence of house officers throughout their training and an indication of the effectiveness of the educational program.

Ambulatory Care↗
PubMed1984

Cardiopulmonary resuscitation: an update.

We are currently witnessing the emergence of a physiologic approach to cardiopulmonary resuscitation. The algorithms and recommendations provided by the AHA provide an excellent framework for managing cardiac emergencies. As new knowledge becomes available, these recommendations should be modified and expanded. Continued assessment of the patient is a critical factor in managing cardiac arrest. As more complex technology and newer medications crowd the resuscitation scene, it is extremely important not to lose sight of the patient and the basics of good resuscitation: airway, breathing, and circulation. Technology provides helpful adjuncts to our assessment but cannot replace direct contact with the patient and the information gathered by direct observation. Students often fix their attention on the cardiac monitor, treating the electrical activity but ignoring the patient. Only by bringing together our observations from the patient, the laboratory, and our diagnostic tools will our knowledge of resuscitation develop to the point where we can improve survival from cardiac arrest.

Airway Obstruction↗
PubMed1984

Clinical competence certification: a critical appraisal.

The American Board of Internal Medicine has requested that residency program directors certify the clinical competence of their candidates. The clinical evaluation exercise (CEX) is one component of the overall certification process. During 1980-1982, 120 residents at the University of Michigan Hospitals participated in a CEX. The results show recurrent inadequacies among the residents in eliciting the social and family histories and performing the mental status and neurologic examinations. The ability to elicit a complete medical history correlated (p less than .01) with communication skills. In three of four specific organ examinations, the ability to perform a technically correct and complete physical examination correlated with the accuracy of the residents' findings (p less than .05). Separate evaluations by senior faculty members generally did not correlate with the residents' performance on the CEX. Analysis of the program described here showed that it requires considerable faculty time, requires training of evaluators to develop interrater reliability, and raises questions as to the validity of the CEX. As national certification boards integrate a formal clinical component into the certification process, such problems need to be addressed and rectified.

Certification↗
PubMed1983

Maintaining competency in advanced cardiac life support skills.

One hundred thirty-two physicians who successfully completed advanced cardiac life support (ACLS) training were randomly placed in a control group or one of two groups receiving interventions designed to provide reinforcement of previously mastered knowledge and skills. These interventions included mailed periodic reprints (group 1) or quarterly patient management problems (group 2). All physicians were retested for knowledge and skills related to ACLS one year later. Fifty-two (39.4%) could successfully ventilate the mannequin, and 62 (47.0%) could perform cardiac compression adequately. No differences were noted among groups. Significant differences in knowledge were found. The control group initiated appropriate therapy in a mock-arrest situation 52% of the time, while group 1 averaged 75% and group 2 averaged 82%. These results indicate that reinforcement after continuing medical education may enhance knowledge retention, but does not maintain motor skills. Yearly recertification in ACLS skills should be considered, and frequent practice sessions should be encouraged for those physicians who are not active participants in ACLS activities.

Clinical Competence↗
PubMed1983

Continuing education in pulmonary disease for primary-care physicians.

A continuing medical education program was implemented and evaluated in 16 community hospitals. It was targeted at primary-care physicians and used physicians identified by their peers as being educationally influential for the dissemination of information. Self-study materials were used, followed by an intensive 2-wk preceptorship that resulted in a significant increase in physician knowledge. Inpatient chart audits identified a series of changes in the management of chronic obstructive pulmonary disease in the intervention hospitals that were not noted in the control hospitals. These included the increased use of intravenously administered fluids, loading doses of intravenously administered bronchodilators, aerosolized and single agent bronchodilators, and respiratory therapy services. Continuing medical education, delivered through community-based educationally influential physicians, is an effective way of changing physician behavior in small communities with no prior ongoing educational programs. This approach should improve patient care and may reduce the need for participation of academic faculty in traditional continuing education programs.

Education, Medical, Continuing↗
PubMed1980

Evaluation of a continuing education program in rheumatoid arthritis.

A continuing medical education (CME) program in rheumatoid arthritis was implemented and evaluated in six community hospitals. It was targeted at primary care physicians and utilized physicians identified by their peers as being educationally influential for the dissemination of content knowledge. Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians. CME delivered through community-based educationally influential physicians is an effective way to change physician behavior in small communities with no prior ongoing educational programs. This approach should improve the primary care given to patients with rheumatoid arthritis and reduce the need for participation of academic faculty in traditional CME programs.

Adrenal Cortex Hormones↗
PubMed1979

The dissemination of new medical information.

Dissemination of new medical information to the practicing physician is a complex and often faulty process. To examine the magnitude of this problem, we surveyed primary care physicians to determine their knowledge of the results of the cooperative trial of photocoagulation in diabetic retinopathy. Despite the acknowledge relevance to their practice, only 28% (38/137) of family physicians and 46% (42/91) of internists were aware of the study results (P less than .001). Respondents were asked to manage two patient problems involving diabetic retinopathy. Only 33% (75/229) handled both correctly, although the retinopathy photocoagulation study had been published 18 months earlier. These findings indicate that results from clinical trials may not be disseminated to practicing physicians and, therefore, not incorporated into practice. Greater attention should be directed toward making findings from clinical trials available to practitioners.

Diabetic Retinopathy↗
PubMed1979

Continuing education in rheumatoid arthritis for the primary care physician.

An educational program in rheumatoid arthritis was developed for primary care practitioners. This program is community based and utilizes physicians, identified by their peers as being influential, for the dissemination of information. A marked change in knowledge has been noted in those completing the program, but further followup is needed to determine if a change in the care of patients with rheumatoid arthritis will also result.

Arthritis, Rheumatoid↗