Search PubMed⌕ Search

Biomedical subjects

Molly Carnes

Publications and source records attributed to Molly Carnes.

18 recordsLinked to original sources
PubMed2006

A model of teaching-learning transactions in generalist-specialist consultations.

INTRODUCTION: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. METHODS: We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. RESULTS: Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. DISCUSSION: As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.

Education, Medical, Continuing↗
PubMed2006

Adherence to federal guidelines for reporting of sex and race/ethnicity in clinical trials.

BACKGROUND: The National Institutes of Health Revitalization Act of 1993 requires that NIH-funded clinical trials include women and minorities as subjects; other federal agencies have adopted similar guidelines. The objective of this study was to determine the current level of compliance with these guidelines in federally funded randomized controlled trials. METHODS: Randomized controlled trials published in nine influential medical journals in 2004 were identified by PubMed search. Studies where individuals were not the unit of analysis, those begun before 1994, and those not receiving federal funding were excluded. Included studies were examined to determine sample characteristics and presence of subgroup reporting. RESULTS: PubMed located 589 published papers. After exclusion of ineligible papers, 69 remained for analysis. Among 46 clinical studies enrolling both men and women, women were generally underrepresented, comprising on average 37% of the sample and only 24% of the sample when analysis was restricted to drug trials. Eighty-seven percent of the studies did not report any outcomes by sex or include sex as a covariate in modeling. Among all 69 studies, 18% did not break down sample sizes by racial and ethnic groups, and 87% did not provide any analysis by racial or ethnic groups. Only 5 studies indicated that the generalizability of their results may be limited by lack of diversity among those studied. CONCLUSIONS: These findings illustrate inadequate compliance with the NIH guidelines. Researchers, editors, and journal audiences share the responsibility of ensuring compliance with our country's policies regarding federally funded research to effect healthcare improvements for all.

Evidence-Based Medicine↗
PubMed2005

NIH Director's Pioneer Awards: could the selection process be biased against women?

One of the first National Institutes of Health (NIH) Roadmap initiatives to be launched was the Director's Pioneer Award. This award was established to "identify and fund investigators of exceptionally creative abilities and diligence, for a sufficient term (five years) to allow them to develop and test far-ranging ideas." Nine excellent scientists were chosen as NIH Pioneers, but the selection of all men is at odds with the percentage of women receiving doctoral degrees for the past three decades, serving as principal investigators on NIH research grants, and achieving recognition as scientific innovators in non-NIH award competitions. The absence of women Pioneers provokes the following question: In the context of extant research on the impact of gender-based assumptions on evaluation of men and women in traditionally male fields, such as science, were there aspects about the process of nomination, evaluation, and selection that inadvertently favored men? We present evidence to suggest that women scientists would be disadvantaged by the following components of the NIH Director's Pioneer Award initiative: (1) time pressure placed on evaluators, (2) absence of face-to-face discussion about applicants, (3) ambiguity of performance criteria, given the novelty of the award, combined with an emphasis on subjective assessment of leadership, potential achievements rather than actual accomplishments, and risk taking, (4) emphasis on self-promotion, (5) weight given to letters of recommendation, and (6) the need for finalists to make a formal, in-person presentation in which the individual and not his or her science was the focus of evaluation. We offer an analysis of this process to encourage the NIH to embark on self-study and to educate all reviewers regarding an evidence-based approach to gender and evaluation.

Attitude of Health Personnel↗
PubMed2003

Pharmacogenetics.

Explore the source record for details and available documents.

Drug Therapy↗
PubMed2003

The long-term health outcomes of childhood abuse. An overview and a call to action.

While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse.

Adult↗
PubMed2003

Physicians vary in approaches to the clinical management of delirium.

OBJECTIVES: To ascertain the variation in strategies for managing delirium of physicians with expertise in geriatrics. DESIGN: Cross-sectional mail survey. SETTING: United States. PARTICIPANTS: A probability sample of physician members of the American Geriatrics Society. MEASUREMENTS: Management choices presented in a two-part case vignette of an older woman hospitalized with a hip fracture who develops mild and then severe delirium. RESULTS: One hundred twenty-two respondents (43%) selected the three answers constituting current "best practice," 50 (18%) selected an unnecessary diagnostic test (brain imaging, lumbar puncture, or electroencephalogram), and 47 (17%) selected unnecessary pharmacologic therapy for mild delirium. For severe delirium, 270 (96%) selected pharmacological therapy, of whom 180 chose haloperidol alone, 55 chose lorazepam alone, 23 chose lorazepam in combination with haloperidol, and 12 wrote in another drug. Thirty percent of the respondents made any selection of lorazepam, alone or in combination with haloperidol, for mild or severe delirium. Sixty-one percent of those selecting haloperidol for severe delirium chose a dose greater than that recommended for geriatric patients. Sex, date of graduation from medical school, clinical specialty, completion of a geriatric fellowship, or certification in geriatrics had no significant effect on responses. CONCLUSIONS: The common selection of lorazepam to treat delirium is troubling because benzodiazepines themselves are implicated in delirium. Selection of an initial dose of haloperidol higher than that recommended for geriatric patients by more than half of the respondents is also of concern. There is a paucity of sound clinical evidence to guide the choice of pharmacological agents for treating delirium in older hospitalized patients.

Aged↗
PubMed2003

Gender differences among physician-scientists in self-assessed abilities to perform clinical research.

PURPOSE: To examine gender differences in physicians' self-assessed abilities to apply knowledge and skills in six core competencies for success as a clinical investigator. METHOD: A written questionnaire containing 35 learning objectives was administered to physicians involved in a clinical-research training program at the University of Wisconsin-Madison. Between 2000 and 2002, 57 postgraduate trainees (49% women) completed the questionnaire; 40 of the 57 completed the questionnaire a second time after a four-day intensive workshop in clinical research. The main outcome measure was gender differences in ratings for each question answered. RESULTS: Before the workshop, women physicians rated their abilities lower than men rated their own abilities on 22 of 35 learning objectives and women were significantly lower in rating their ability to spend sufficient time developing and advancing their own area of scientific knowledge and research. After the workshop, women rated themselves lower than men rated themselves on 33 of 35 objectives, with significant differences in seven. Women did not rate themselves significantly higher than men rated themselves on any of the 35 objectives assessed. CONCLUSION: Women physicians consistently rated their abilities to perform or apply knowledge and skills related to clinical research lower than men rated themselves, and a traditional training venue exacerbated these gender differences. This previously unexplored gender difference in self-perceived competency may indicate an additional barrier women face in academic career development and suggests that educational programs incorporate learning activities that address gender differences when training physicians for careers in clinical research.

Biomedical Research↗
PubMed2003

Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D.

STUDY OBJECTIVES: To determine the prevalence of osteoporosis as assessed by peripheral bone mineral density (BMD) in women living in a nursing home, to determine how many women with low BMD had received a diagnosis of osteoporosis, to assess the prevalence of vitamin D deficiency, and to seek reasons for vitamin D deficiency. DESIGN: Measurement of calcaneal BMD and serum 25-hydroxyvitamin D. SETTING: Skilled nursing facility. PATIENTS: Forty-nine women aged 68-100 years. MEASUREMENTS AND MAIN RESULTS: Bilateral calcaneal BMD was measured by dual-energy x-ray absorptiometry and serum 25-hydroxyvitamin D by radioimmunoassay. Medical records were reviewed to assess osteoporosis risk factors, previous documentation of osteoporosis or malabsorption, and supplemental vitamin D intake. Fifty-nine percent of the 39 women with calcaneal BMD measurements (95% confidence interval [CI] 44-74%) exhibited calcaneal osteoporosis (T score < -2.5). Sixty percent (95% CI 46-74%) had 25-hydroxyvitamin D levels of 20 ng/ml or less, which is associated with secondary hyperparathyroidism; only 4% of women had levels above 30 ng/ml, recently recommended as optimal. Vitamin D status was suboptimal even in most women taking multivitamins. Osteoporosis was documented in the records of 17% of 23 women with calcaneal osteoporosis. CONCLUSION: Osteoporosis was prevalent but poorly documented in women living in the nursing home. Peripheral BMD measurements have the potential to improve the recognition and management of osteoporosis in women in long-term care facilities. The high prevalence of vitamin D deficiency, even in those taking multivitamins, indicates that practical new approaches for vitamin D repletion in this population are urgently needed.

Aged↗
PubMed2002

A controlled trial of inpatient and outpatient geriatric evaluation and management.

BACKGROUND: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain. METHODS: We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs. RESULTS: A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups. CONCLUSIONS: In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.

Activities of Daily Living↗
PubMed2002

Health-related quality of life and long-term therapy with pravastatin and tocopherol (vitamin E) in older adults.

INTRODUCTION: Concerns about the effects of HMG-CoA reductase inhibitors ('statins') on health-related quality of life may contribute to their underuse in older adults with and at risk for cardiovascular disease. These concerns also may prevent clinicians from enrolling older patients in clinical trials assessing the efficacy of statins as a preventive therapy for Alzheimer's disease. OBJECTIVE: To determine the effects of pravastatin and tocopherol (vitamin E), alone and in combination, on health-related quality of life in older adults. STUDY DESIGN: Double-blind, randomised, placebo-controlled, crossover study. PARTICIPANTS: Forty-one community-dwelling men and women aged > or = 70 years with low-density lipoprotein-cholesterol (LDL-C) > or = 3.62 mmol/L (140 mg/dl) participated. METHODS: Subjects received pravastatin for 6 months then pravastatin plus tocopherol for an additional 6 months (group 1), or tocopherol for 6 months then pravastatin plus tocopherol for an additional 6 months (group 2). Dosages were pravastatin 20 mg daily and tocopherol 400 IU daily. MAIN OUTCOME MEASURES: The following health-related quality-of-life measures were assessed at baseline, after 6 months and after 1 year: health perception, depression, physical function, cognitive function and sleep behaviour. In addition, data on adverse effects and laboratory abnormalities were obtained. RESULTS: Pravastatin reduced levels of total cholesterol (-21%, p < 0.001) and LDL-C (-29%, p < 0.001). Health-related quality-of-life scores, physical adverse effects, muscle enzyme levels and liver function tests did not change after 12 months of therapy with pravastatin, tocopherol or their combination. CONCLUSION: Both pravastatin and tocopherol have a good safety profile, are well tolerated and do not adversely affect health-related quality of life in older patients with hypercholesterolaemia. Given the significant beneficial cardiovascular effects of statin therapy in older adults and the potential role of statins in prevention of Alzheimer's disease, concerns about adverse effects on quality of life should not deter use of these medications in this population.

Aged↗