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Biomedical subjects

S A Mazzuca

Publications and source records attributed to S A Mazzuca.

45 records · Page 3Linked to original sources
PubMed1982

Scoring patient management problems: external validation of expert consensus.

This study determined the extent to which medical faculty agreed when rating options in two written patient management problems in diabetes mellitus. Another purpose was to determine whether option weights (used for scoring) based on the consensus ratings of faculty actually predict the choices of well-qualified physicians. Experts showed better-than-chance agreement but with considerable variation from one part of a problem to another (31% to 73%). Nevertheless, consensus ratings were very accurate predictors of the decisions of endocrinology fellows (correlations from .60 to .97). When scoring weights are assigned to options in patient management problems, consensus (average) ratings of experts are likely to demonstrate high concurrent validity for well-qualified clinicans.

Adult↗
PubMed1981

Evaluating clinical knowledge across years of medical training.

The evolution of clinical knowledge about the management of a common chronic disease was determined by applying analysis of variance and multiple discriminant analysis to responses on two patient management problems by groups of junior medical students and internal medicine residents. Differences between junior and resident groups were found on both problems for management decisions and therapeutic actions and on one problem for information-gathering. Discriminant analyses of original responses clearly identified patterns of choices contributing to group differences. The utility of patient management problems when analyzed under these two empirical models is discussed.

Clinical Competence↗
PubMedDate not supplied

How much of the placebo 'effect' is really statistical regression?

Statistical regression to the mean predicts that patients selected for abnormalcy will, on the average, tend to improve. We argue that most improvements attributed to the placebo effect are actually instances of statistical regression. First, whereas older clinical trials susceptible to regression resulted in a marked improvement in placebo-treated patients, in a modern series of clinical trials whose design tended to protect against regression, we found no significant improvement (median change 0.3 per cent, p greater than 0.05) in placebo-treated patients. Secondly, regression can yield sizeable improvements, even among biochemical tests. Among a series of 15 biochemical tests, theoretical estimates of the improvement due to regression by selection of patients as high abnormals (i.e. 3 standard deviations above the mean) ranged from 2.5 per cent for serum sodium to 26 per cent for serum lactate dehydrogenase (median 10 per cent); empirical estimates ranged from 3.8 per cent for serum chloride to 37.3 per cent for serum phosphorus (median 9.5 per cent). Thus, we urge caution in interpreting patient improvements as causal effects of our actions and should avoid the conceit of assuming that our personal presence has strong healing powers.

Clinical Trials as Topic↗
PubMedDate not supplied

The Diabetes Education Study: a controlled trial of the effects of intensive instruction of internal medicine residents on the management of diabetes mellitus.

The Diabetes Education Study was a controlled trial of the effects of physician and patient education. This article describes an educational program for internal medicine residents and its effects on ambulatory diabetes management practices. Forty-five of 86 residents practicing in the general medicine clinic of a university-affiliated city/county hospital were assigned randomly to receive a multifaceted program intended to 1) provide specific care recommendations, 2) teach necessary skills, and 3) make the professional and institutional environment more supportive. During the subsequent 11 months, 323 diabetic patients were interviewed and their records audited for evidence of changes in care. Experimental residents utilized fasting blood glucose determinations more often than controls (i.e., during 40% of visits vs. 31%, p = 0.004). Experimental residents also engaged more frequently in a variety of recommended dietary management recommendations. Isolated differences in monitoring/management of chronic complications also were found (e.g., lipid screening: 70% of experimental residents' patients vs. 58%, p = 0.016). Intensive, multifaceted programs of this nature are concluded to result in improvements in diabetes care, over and above that which is attainable through routine methods of clinical training for residents.

Diabetes Mellitus↗
PubMedDate not supplied

Discussion: the recent past, present, and foreseeable future of research on patient teaching.

Research on diabetes patient education over the last decade has flourished in a general climate of interest in the therapeutic value of tight metabolic control. That climate is changing. Whether patient education contributes to metabolic control may not be as much a research question in the future as what specific teaching protocols and/or communication strategies produce the highest levels of cognitive and behavioral outcomes. Quality control is a growing area of interest. This paper discusses how each of the symposium presenter's remarks might contribute to research on new teaching methods to increase the overall quality of diabetes patient education.

Communication↗
PubMedDate not supplied

Clinician communication associated with diabetic patients' comprehension of their therapeutic regimen.

The purpose of this study was to identify the types of statements used by medical and nursing clinicians in encounters with diabetic outpatients that are associated with accurate comprehension of their therapeutic regimen. Encounters between 19 clinicians and 29 patients followed in an urban diabetes clinic were examined. Statements made by clinicians were classified by trained observers according to an 11-category observation scheme. Immediately after the encounters, each patient was interviewed and asked to recall his or her regimen as just discussed. Recall was verified by review of a videotape of the encounter. By use of multiple discriminant analysis, a combination of three types of statements by clinicians was found to predict high (better than 80%) comprehension by patients: demonstrating respect, sharing current clinical data, and acknowledging patient statements (inversely). Insofar as patient comprehension of the diabetic regimen is a prerequisite for compliance with that regimen, this study suggests that the chances for therapeutic success are increased when the interaction of clinician and patient takes a certain tone. Most importantly, the clinician should be informative. Current laboratory and physical findings should be shared with the patient in order to make more obvious the successes and failures of recent attempts at compliance. As suggested in previous research, this information should have its strongest effect when conveyed in a nonthreatening manner.

Communication↗
PubMedDate not supplied

The diabetes education study: a controlled trial of the effects of diabetes patient education.

The Diabetes Education Study (DIABEDS) was a randomized, controlled trial of the effects of patient and physician education. This article describes a systematic education program for diabetes patients and its effects on patient knowledge, skills, self-care behaviors, and relevant physiologic outcomes. The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center. Patients were predominantly elderly, black women with non-insulin-dependent diabetes mellitus of long duration. Patients randomly assigned to experimental groups (N = 263) were offered up to seven modules of patient education. Each content area module contained didactic instruction (lecture, discussion, audio-visual presentation), skill exercises (demonstration, practice, feedback), and behavioral modification techniques (goal setting, contracting, regular follow-up). Two hundred seventy-five patients remained in the study throughout baseline, intervention, and postintervention periods (August 1978 to July 1982). Despite the requirement that patients demonstrate mastery of educational objectives for each module, postintervention assessment 11-14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge. However, statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous. Experimental group patients experienced significantly greater reductions in fasting blood glucose (-27.5 mg/dl versus -2.8 mg/dl, P less than 0.05) and glycosylated hemoglobin (-0.43% versus + 0.35%, P less than 0.05) as compared with control subjects. Patient education also had similar effects on body weight, blood pressure, and serum creatinine. Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization.

Blood Glucose↗
PubMedDate not supplied

Prescribing behaviors of family physicians in the treatment of osteoarthritis.

BACKGROUND: Patients with osteoarthritis are frequently managed by family physicians. New evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) are no more effective than simple analgesics for treating osteoarthritis. The purpose of this study was to characterize the pharmacologic prescribing practices of family physicians for treatment of osteoarthritis. METHODS: One hundred eleven Indian family physicians were asked to provide their initial treatment recommendations for a hypothetical patient who had uncomplicated osteoarthritis. Responses were analyzed and subsequently validated by an audit of actual cases managed by family physicians. RESULTS: The response rate was 78%. Of those responding, 97% chose NSAIDs as their first line of therapy. Physicians were more than twice as likely to use anti-inflammatory doses of these agents as they were to use analgesic doses. There were no significant differences between the results of the written simulation and the actual case audit (P = .4216). CONCLUSIONS: Family physicians generally treat osteoarthritis with NSAIDs, and they prescribe anti-inflammatory doses more than twice as often as analgesic doses. An audit of the actual practice behaviors of family physicians corroborated this prescribing pattern. This prescribing behavior may be inappropriate given evidence that simple analgesics are as effective as NSAIDs.

Analgesics↗