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PubMed1995

Accuracy of clinical assessment of deep-vein thrombosis.

The clinical diagnosis of deep-vein thrombosis is generally thought to be unreliable. From experience, we hypothesised that this widely held view might be incorrect. We developed a clinical model and prospectively tested its ability in three tertiary care centres to stratify symptomatic outpatients with suspected deep-vein thrombosis into groups with high, moderate, or low probability groups of deep-vein thrombosis. We evaluated our clinical model in combination with venous ultrasonography to determine the potential for an improved and simplified diagnostic approach in patients with suspected deep-vein thrombosis. All patients were clinically assessed to determine the probability for deep-vein thrombosis before they had ultrasonography and venography. All tests were performed and interpreted by independent observers. In 529 patients, the clinical model predicted prevalence of deep-vein thrombosis in the three categories: 85% in the high pretest probability category, 33% in the moderate, and 5% in the low category. There was no statistical difference in the performance of the model in the three centres. The model demonstrated excellent interobserver reliability (Kappa = 0.85). There were important differences with ultrasonography between the high and low pretest probability groups for both positive predictive values (100% (95% CI, 94-100%) vs (63% [35-85%], respectively). Thus, use of the clinical model combined with ultrasonography would decrease the number of false positive and negative diagnosis if venography were done when the ultrasound result and pretest probability were discordant. The diagnostic process could be simplified by excluding those patients with low pretest probability and normal ultrasound results from serial testing.

Decision Trees↗

PubMed1984

Use of electrocardiographic-thallium exercise testing in clinical practice.

Although there is a great deal of data on the accuracy of combined electrocardiographic-thallium exercise testing, little is known about the use of these tests in clinical practice. A quantitative likelihood system was employed to characterize referral patterns for such testing, and the impact of test results on the likelihood of coronary artery disease was examined. Two hundred thirteen subjects consecutively referred for the purpose of establishing or excluding the presence of coronary artery disease were studied. No subject had a history of a prior myocardial infarction. By historical evaluation, 96 had a low likelihood of coronary disease (less than or equal to 0.20), 88 an intermediate likelihood (0.21 to 0.80) and 29 a high likelihood (greater than 0.80). As anticipated from theoretical analyses, testing produced the greatest shifts in disease likelihood in subjects with an intermediate pretest disease likelihood, and confirmed the historical evaluation in patients at the extremes of pretest disease likelihood. Therefore, although electrocardiographic-thallium stress testing is best suited for subjects with intermediate pretest disease likelihood, the majority of referrals had either a high or low likelihood. Clinicians appear to value confirmatory results in patients at the extremes of pretest disease likelihood. Electrocardiographic exercise testing would serve a similar purpose.

Coronary Disease↗

PubMed1997

Assertion training therapy in psychiatric milieus.

The current investigation involved an attempt to develop a clinical procedure to decrease anxiety and increase responsiveness (assertion) of psychiatric inpatients of both sexes in mixed diagnostic categories and to evaluate the effectiveness of the procedure. Using a Solomon Four-Group Design, patients, matched on age, sex, and diagnosis, were assigned to one of the following conditions: (1) pretest, treatment, posttest; (2) pretest, no treatment, posttest; (3) treatment, posttest; or (4) no treatment, posttest. The Gambrill-Richey Assertive Inventory was used to assess patient Degree of Discomfort and Response Probability with and without assertion training therapy. Results indicated that (1) patients receiving assertion training therapy were less anxious and more responsive after treatment than before, (2) patients receiving assertion training therapy were less anxious and more responsive than were matched control subjects, (3) control subjects who received no assertion training therapy and who were pretested showed moderate significant gains on the posttest measure, (4) patients reported a greater reduction of anxiety than they did an increase in responsiveness, and (5) pretesting did not significantly influence posttest scores.

Adult↗

PubMed2000

Interinstitutional study to compare the effectiveness of a radiology-anatomy module of instruction.

RATIONALE AND OBJECTIVES: The purpose of this study was to validate the effectiveness of a proven radiology-anatomy instructional module during I st-year gross anatomy courses at Emory University College of Medicine and the University of Iowa College of Medicine. MATERIALS AND METHODS: This prospective study involved 108 Emory students and 177 Iowa students. The instructional content was the same at both institutions. Each student was randomly assigned into one of three groups at each institution, and each group received a unique, randomized, five-item pretest. All students were posttested as part of their gross anatomy laboratory examination, and the posttests consisted of all 15 items used in the three five-item pretests. RESULTS: No statistically significant pretest effects were demonstrated by t tests. Posttest performances across items ranged from 73% to 96% correct for Emory students and 67% to 98% for Iowa students. Performance levels on the posttests were significantly higher than on pretests, and few significant differences were found in the performance of the two populations. CONCLUSION: The radiology-anatomy instructional module integrated into the gross anatomy courses for 1st-year Emory University and University of Iowa students was not instructor or institution dependent.

Anatomy↗

PubMed1997

Resident learning and knowledge retention from resident-prepared chest radiology conferences.

RATIONALE AND OBJECTIVES: The authors assessed resident learning and retention of knowledge from resident-prepared chest radiology conferences. MATERIALS AND METHODS: Radiology residents presented five chest conferences to their peers during a 5-month interval; the conferences were modeled on a case presentation format. Tests were given 5 minutes before each conference (pretest) and immediately after each conference (posttest). The tests were readministered as a final examination 6 months later, at which time the residents were asked to evaluate the conference format. RESULTS: Conference attendance ranged from six to 11 residents. Mean posttest scores were statistically significantly higher than mean pretest scores (P < .0001). Six-month retention scores were higher than pretest scores (P < .05) but lower than posttest scores (P < .05). On a scale of 1-6, with 1 representing strongly disagree and 6 strongly agree, residents strongly agreed that the conferences provided an excellent learning experience (mean score, 5.27). CONCLUSION: Resident-prepared conferences are effective for teaching residents chest radiology. Resident testing at 6 months demonstrated retention of knowledge above pretest levels but lower than posttest levels.

Analysis of Variance↗

PubMed1999

Medical students and radiology residents: can they learn as effectively with the same educational materials?

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of resident-prepared, independent-learning materials for teaching chest radiology to medical students. MATERIALS AND METHODS: Students from three U.S. medical schools enrolled in radiology clerkships between March 1998 and June 1998 were randomly divided into control (n = 27) and experimental (n = 31) groups. The experimental group studied 12 chest radiology independent-learning cases (intervention) used to teach radiology residents in a previous study. Both groups took a 36-item, multiple-choice test (previously used to test radiology residents) on three occasions (before intervention [pretest], 1 day after intervention [posttest], and 2-4 weeks after intervention [final examination]). Student scores were then compared with resident scores. RESULTS: Mean scores were similar across institutions at pretest, but increases at posttest and final examination scores differed across time, school, and group (P < .005). Mean differences in scores between experimental and control groups at pretest, posttest, and 2-4-week final examination were -0.22, 9.79, and 9.14, respectively, demonstrating increased performance at posttesting that remained present (though slightly attenuated) 2-4 weeks later. Comparing performance, residents had mean pretest scores of 19.2 and students of 14.1, a five-point difference attributable to the residents' greater experience. Both residents and students gained approximately nine points at posttest. At final examination, the difference between residents and students was only 1.4 points, suggesting the experimental program (teaching materials) brought students close to the long-term retention shown by residents. CONCLUSION: Independent study of resident-prepared chest radiology teaching cases increased medical student knowledge for at least 2 or 4 weeks after instruction. Although starting at lower knowledge levels, students experienced gains in knowledge comparable to those of residents, suggesting the same materials can be used to teach both students and residents.

Education, Medical, Undergraduate↗

PubMed1988

Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace.

Despite their growing popularity, worksite health-promotion programs have generally been characterized as having low participation rates, high attrition rates, and modest outcomes. This investigation identified the predictors of participation, attrition, and outcome of worksite smoking-cessation program. Subjects were regular cigarette smokers recruited from two worksites. Of 66 eligible smokers in the two worksites, 44 (67%) agreed to participate in the program. Fifty-five percent (24 of 44) of these completed the program. Of those completing the program, 29% had quit smoking by posttest and 17% were abstinent at the 6-month follow-up. Results indicated that a different set of variables predicted participation, attrition, and outcome. The significant predictors of smokers who participated were the length of cessation in previous abstinence attempts, the number of years they smoked, and the belief regarding personal vulnerability in contracting a smoking-related disease. Levels of pretest carbon monoxide along with attitudes regarding the adoption of smoking restrictions in the worksite predicted attrition. Posttest cessation was related to nicotine levels of cigarette brand smoked at pretest and pretest beliefs regarding postcessation weight gain. Abstinence at the 6-month follow-up was predicted by the number of co-workers who smoked and pretest concerns related to postcessation weight gain. The results are discussed in terms of future evaluation and intervention efforts.

Adult↗

PubMed2005

Postsynaptic 5-HT1B receptors modulate electroshock-induced generalised seizures in rats.

1. Although an important regulatory role for serotonin (5-HT) in seizure activation and propagation is well established, relatively little is known of the function of specific 5-HT receptor subtypes on seizure modulation. 2. The aim of the present study was to investigate the role of 5-HT(1A, 1B and 1D) receptors in modulating generalised seizures in the rat maximal electroshock seizure threshold (MEST) test. 3. The mixed 5-HT receptor agonists SKF 99101 (5-20 mg kg(-1) i.p.) and RU 24969 (1-5 mg kg(-1) i.p.), 0.5 h pretest, both produced marked dose-related increases in seizure threshold. These agents share high affinity for 5-HT(1A, 1B and 1D) receptors. 4. Antiseizure effects induced by submaximal doses of these agonists were maintained following p-chlorophenylalanine (150 mg kg(-1) i.p. x 3 days)-induced 5-HT depletion. 5. The anticonvulsant action of both SKF 99101 (15 mg kg(-1) i.p.) and RU 24969 (2.5 mg kg(-1) i.p.) was dose-dependently abolished by the selective 5-HT1B receptor antagonist SB-224289 (0.1-3 mg kg(-1) p.o., 3 h pretest) but was unaffected by the selective 5-HT1A receptor antagonist WAY 100635 (0.01-0.3 mg kg(-1) s.c., 1 h pretest). This indicates that 5-HT1B receptors are primarily involved in mediating the anticonvulsant properties of these agents. 6. In addition, the ability of the 5-HT(1B/1D) receptor antagonist GR 127935 (0.3-3 mg kg(-1) s.c., 60 min pretest) to dose-dependently inhibit SKF 99101-induced elevation of seizure threshold also suggests possible downstream involvement of 5-HT1D receptors in the action of this agonist, although confirmation awaits the identification of a selective 5-HT1D receptor antagonist. 7. Overall, these data demonstrate that stimulation of postsynaptic 5-HT1B receptors inhibits electroshock-induced seizure spread in rats.

Animals↗

PubMed2003

Training with an upper-limb prosthetic simulator to enhance transfer of skill across limbs.

OBJECTIVE: To examine what effect bilateral transfer of movement across limbs may have in a person's ability to learn use of an upper-limb prosthetic simulator. DESIGN: Randomized trial. SETTING: University laboratory. PARTICIPANTS: Able-bodied subjects randomly assigned to 1 of 3 groups. INTERVENTIONS: Subjects performed 3 different tasks that required manipulation of objects with the simulator. Group 1 practiced with the simulator on the preferred limb and then transferred it to the nonpreferred limb; group 2 practiced with the simulator on the nonpreferred limb and then transferred it to the preferred limb; group 3 was a control group. Groups 1 and 2 underwent pretest trials, acquisition practice, posttest trials, and a 24-hour retention test; the control group followed the same design with the exception of acquisition practice. MAIN OUTCOME MEASURES: Elapsed time (1) from a signal to move until movement began (initiation time) and (2) from the beginning of movement to task completion (movement time). RESULTS: Compared with the controls, groups 1 and 2 significantly reduced initiation time across all tasks from pretest to posttest (P=.003) and from pretest to retention test (P=.029). Groups 1 and 2 did not differ from each other. Movement time did not differ among the groups in the posttest. However, groups 1 and 2 significantly (P=.026) reduced movement time across all tasks from pretest to retention test compared with the control group. Groups 1 and 2 did not differ from each other. CONCLUSION: The effects of bilateral transfer were evident for initiation time immediately on transfer, and this learning effect persisted to the retention test. The ability to execute movement, represented by movement time, occurred after consolidation of learning was complete. Cross-limb training with a prosthetic simulator may be useful for persons with recent unilateral upper-extremity amputation who are learning to use a prosthesis.

Adult↗

PubMed2000

Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women.

Epidemiologic studies indicate that alcohol consumption is associated with improved insulin sensitivity; however, scant experimental evidence confirms this observation. To determine the effects of regular moderate wine consumption on insulin sensitivity, 20 overweight women (body mass index [BMI], 29.8 +/- 2.2 kg/m2) participated in a 20-week free-living randomized crossover trial. The subjects, serving as their own controls, consumed wine (190 mL red wine, 13% vol/vol ethanol, 5 days per week) for 10 weeks and abstained for 10 weeks or vice versa. The dependent variables (body weight, BMI, percent body fat, blood pressure, fasting blood glucose and insulin, blood lipids, dietary intake, and insulin sensitivity by intravenous glucose tolerance test [IVGTT]) were measured at the pretest, at the 10-week crossover, and at the 20-week completion of the study. Data were analyzed at the pretest and at completion of the wine drinking and abstention periods of the study using ANOVA by order of treatment. Fasting glucose remained unchanged (mean +/- SD; P > .05) throughout the experiment (pretest, drinking, and abstention, 91.1 +/- 9.2, 91.6 +/- 9.1, and 88.5 +/- 11.2 mg/dL), as did the measures of insulin sensitivity, fasting insulin (pretest, drinking, and abstention, 8.6 +/- 3.3, 8.6 +/- 4.1, and 9.1 +/- 4.7 microU/mg) and the insulin sensitivity index (3.60 +/- 2.96, 3.25 +/- 2.17, and 3.30 +/- 1.84). Body composition and blood lipids also remained unchanged (P > .05) during treatment. Moderate wine consumption at this dose in overweight women did not improve or impair insulin sensitivity, nor did it change any of the known correlates of insulin sensitivity, including body weight and composition, blood lipids, and blood pressure.

Adult↗

PubMed2003

Increasing physician awareness of the common uses and contraindications of herbal medicines: utility of a case-based tutorial for residents.

OBJECTIVES: To determine the need for incorporating herbal medicine into residency curricula and to assess efficacy of a case-based tutorial. DESIGN: Pilot survey of residents' knowledge, practice, and desire to learn about herbal remedies indicated need for instruction. A case-based tutorial was given as a required conference for residents. Participants were pretested, post-tested within 2 weeks, and their satisfaction evaluated. The pretest, tutorial text, and post-test were distributed at clinic to residents who had missed conference. The tutorial was also placed online. SETTINGS/LOCATION: Stony Brook University Hospital and Northport VA Medical Center, affiliates of the State University of New York at Stony Brook, School of Medicine, Stony Brook, NY. They serve a suburban/rural population. SUBJECTS: Eight-two (82) residents were pretested (49 medicine, 7 preventive medicine, 12 family medicine, 10 obstetrics-gynecology, and 4 anesthesia). Sixty-six (66) participated in the tutorial. Residents in the pilot group (n = 12) graduated before the tutorial was given. It was not offered to anesthesia residents (n = 4). Because of scheduling, only 37 tutorial participants were available for post-testing. INTERVENTION: Tutorial on uses, contraindications, and drug interactions of popular herbal medicines was presented as a live session, text-only exercise, and online. RESULTS: Pretest scores revealed a knowledge deficit, room for improvement in doctor-patient dialogue, and demand for instruction on herbal medicine. The mean knowledge score of all post-tested participants (n = 37) rose from 34% to 61% (p < 0.0001). The live lecture group (n = 29) increased from 32% to 63% (p < 0.0001). The text-only group (n = 8) increased from 40% to 55% (p = 0.004). Satisfaction was high. Residents did not access the online tutorial, so it was not evaluated. CONCLUSIONS: Residents request instruction on uses, contraindications, and drug interactions of herbal medicines and should ask patients about use more routinely. A live, case-based tutorial appears effective for introducing herbal medicine into residency curricula.

Adult↗

PubMed2003

Controlled trial of effect of computer-based nutrition course on knowledge and practice of general practitioner trainees.

BACKGROUND: Nutrition education is not an integral part of either undergraduate or postgraduate medical education. Computer-based instruction on nutrition might be an attractive and appropriate tool to fill this gap. OBJECTIVE: The study objective was to assess the degree to which computer-based instruction on nutrition improves factual knowledge and practice behavior of general practitioner (GP) trainees. DESIGN: We carried out a controlled experimental study, using a 79-item knowledge test and 3 incognito standardized patients' visits in a pre- and posttest design with 49 first-year GP trainees. The experimental group (n = 25) received an average of 6 h of a newly developed computer-based instruction on nutrition. The control subjects (n = 24) took the standard vocational training program. RESULTS: The percentage of correct answers on the knowledge test increased from 30% at pretest to 42% at posttest in the experimental group, and from 36% to 37% in the control group. Analysis of covariance, with the pretest scores as covariate, showed a significant experimental versus control group difference at posttest: 9.2% (P = 0.002). The mean percentage of correctly performed items during the 3 standardized patients' visits (assessed by checklists) showed an increase in the experimental group from 20% at pretest to 36% at posttest, whereas the control group changed from 20% to 22%. Analysis of covariance, with the pretest scores as covariate, revealed a significant group difference at posttest: 13.7% (P < 0.001). CONCLUSION: The computer-based instruction proved its effectiveness, both by increasing factual knowledge and by substantially enhancing GP trainees' practice behavior on the subject of nutrition.

Adult↗

PubMed2001

Effects of a music therapy voice protocol on speech intelligibility, vocal acoustic measures, and mood of individuals with Parkinson's disease.

This study examined the effects of a Music Therapy Voice Protocol (MTVP) on speech intelligibility, vocal intensity, maximum vocal range, maximum duration of sustained vowel phonation, vocal fundamental frequency, vocal fundamental frequency variability, and mood of individuals with Parkinson's disease. Four female patients, who demonstrated voice and speech problems, served as their own controls and participated in baseline assessment (study pretest), a series of MTVP sessions involving vocal and singing exercises, and final evaluation (study posttest). In study pre and posttests, data for speech intelligibility and all acoustic variables were collected. Statistically significant increases were found in speech intelligibility, as rated by caregivers, and in vocal intensity from study pretest to posttest as the results of paired samples t-tests. In addition, before and after each MTVP session (session pre and posttests), self-rated mood scores and selected acoustic variables were collected. No significant differences were found in any of the variables from the session pretests to posttests, across the entire treatment period, or their interactions as the results of two-way ANOVAs with repeated measures. Although not significant, the mean of mood scores in session posttests (M = 8.69) was higher than that in session pretests (M = 7.93).

Affect↗

PubMed1996

Effectiveness of health education to increase screening for cervical cancer among eastern-band Cherokee Indian women in North Carolina.

BACKGROUND: The North Carolina Native American Cervical Cancer Prevention Project was a 5-year, National Cancer Institute-funded trial of health education designed to increase screening for cervical cancer among Native-American women in North Carolina. PURPOSE: This study was conducted to evaluate the effectiveness of this education program in the Eastern-Band Cherokee target population. METHODS: Cherokee tribal lands were mapped and all households (N = 2223) were listed to ensure maximum coverage of the eligible population (women, aged 18 years and older, who were enrolled tribal members). Eligible women were identified by the use of a brief questionnaire administered to an adult member of the household. Of the 1279 households with eligible women, 1020 (79.8%) agreed to participate. The intervention was an individualized health education program delivered by female Cherokee lay health educators. The participants were randomly assigned to receive or not to receive the intervention (i.e., to program and control groups, respectively) by use of the Solomon Four-Group design. Data were collected in face-to-face interviews conducted in the participant's home. Of the 996 women who were ultimately enrolled, 540 were randomly assigned to receive a pretest (preintervention) interview that involved administration of a 96-item questionnaire designed to collect data on knowledge, intentions, and behaviors related to cervical cancer; of these 540 women, 263 were randomly assigned to receive the education program. The remaining 456 women did not receive the pretest, but 218 were randomly assigned to receive the education program. Six months after receiving the education program, the women in all four groups were administered a post-test that was identical to the pretest. Logistic regression was used to assess the effects of the pretest and the educational program. All P values resulted from two-sided statistical tests. RESULTS: Eight hundred and fifteen (81.8%) of the 996 participants completed the post-test interview. The remaining 181 women who were lost to follow-up were evenly distributed among the four study groups. At the post-test, 282 (73.2%) of the 385 women who received the education program reported having had a Pap smear following the intervention, compared with 275 (64%) of the 430 control subjects. Women who received the education program were more likely to answer all knowledge items correctly on the post-test (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.08-4.39) and to report having obtained a Pap smear in the past year (OR = 2.06, 95% CI = 1.14-3.72) than women in the control groups. CONCLUSION: Women who received the education program exhibited a greater knowledge about cervical cancer prevention and were more likely to have reported having had a Pap smear within the past year than women who did not receive the program.

Adult↗

PubMed1975

The development of cognitive knowledge in clinical clerkships.

As part of an attempt to match the seminar program in pediatrics to the increased level of sophistication that students during the latter half of their core clerkship year would possess compared with students who enter pediatrics early in the year, the faculty of the Department of Pediatrics at The University of Texas Medical Branch in Galveston developed a typical final examination (a 100-item, multiple-choice test) and administered it as a pretest to each section of the junior class as it entered pediatrics. Analysis of the data indicated the following. A substantial portion of the cognitive information required for success in the clinical years was acquired prior to entry to the clerkship; scores of students entering their last clerkship were almost the same in the pretest in pediatrics as were those of students who took the pretest 10 monts earlier; posttest scores were substantially higher than pretest scores for all groups of students. The paper includes some discussion of the reasons for the findings and a description of the steps being taken to remedy deficiencies in the educational and evaluation program revealed by the study.

Curriculum↗

PubMed1995

Shifting students and faculty to a PBL curriculum: attitudes changed and lessons learned.

BACKGROUND: The University of Toronto Faculty of Medicine is implementing a new undergraduate curriculum that emphasizes active, self-directed learning. The aims of this study were to (1) evaluate shifts in students' attitudes after initial direct experience with problem-based learning (PBL), (2) describe faculty experiences, and (3) develop guidelines for further implementation of PBL. METHOD: Questionnaires were administered at the beginning of the first PBL session and at the close of the last session (five weeks later) to the 250 second-year students in 1992-93 and to their 15 faculty tutors. Quantitative data were analyzed using multivariate analysis of variance and univariate tests. Open-ended questions were categorized based on common patterns that emerged. RESULTS: Of the 250 students, 196 (78%) responded to the pretest, and 207 (83%) responded to the posttest. There was a statistically significant shift in the students' perceptions from pretest to posttest in agreeing that PBL is more effective than traditional teaching methods (increasing from 38% to 52%). The students rated traditional methods as better for knowledge acquisition, whereas PBL methods were rated better for improving teamwork and doctor-patient relationships. At pretest, the most common themes concerned a perceived danger that PBL would result in knowledge gaps, reinforce the wrong information, and make inefficient use of valuable time. Perceived advantages of PBL included that it is more stimulating and enjoyable, and it teaches students how to learn rather than to memorize. At posttest, there was an increase in favorable comments by the students. Virtually all of the attitudes expressed by the students were shared by the faculty. In addition, at pretest the faculty were anxious about the perceived lack of structure in PBL. CONCLUSION: Direct experience with PBL led to more favorable attitudes among the students and faculty. Recommendations are suggested for other schools and programs seeking to implement PBL curricula.

Adult↗

PubMed2002

Testing an instrument measuring Greek nurses' knowledge and attitudes regarding pain.

This pretest-post-test study was conducted to test the construct validity, test-retest reliability, and internal consistency of the Nurses' Knowledge and Attitudes Survey Regarding Pain with Greek nurses. Forty-six registered nurses were randomly assigned to an expert or nonexpert group. The expert group viewed 4 translated educational videotapes about pain management. The nonexpert group received no pain education. All of the nurses completed a pretest and a post-test using a Greek translation of the Nurses' Knowledge and Attitudes Survey Regarding Pain, with a time delay of 8 to 12 days between testing. The expert nurses learned significantly more than the nonexpert nurses from pretest to post-test, M = 9.0 and M = 1.5 items, respectively. Expert and nonexpert nurses correctly answered 51.5% and 43.3% of the pretest and 74.6% and 47.2% of the post-test questions, respectively. Test-retest reliability for the 28 nonexpert nurses was r = 0.68, P < .001. Cronbach's alpha for the entire sample was 0.88 (n = 30) at the post-test. These results contribute to the validity and reliability of the Greek version of the Nurses' Knowledge and Attitudes Survey Regarding Pain and provide the basis for phase II of the study, which will use the Nurses' Knowledge and Attitudes Survey Regarding Pain to examine the state of pain management in an anticancer facility in Greece.

Adult↗

PubMed2003

Efficacy of therapeutic group by telephone for women with breast cancer.

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. ttests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

Affect↗