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PubMed2000

Effect of national seminar on AIDS and anesthesia upon knowledge, attitude and practice concerning HIV among Thai anesthesia personnel.

In the national seminar of AIDS and Anesthesia which was a short course educational program in all aspects of HIV medicine, 195 questionnaires about knowledge, attitude and practice concerning HIV were distributed among the participants (anesthesiologists and nurse anesthetists) in 3 periods, pretest, post test (at the end of 2 days seminar) and post test 2 (at 4 months after the seminar). There were 177 (90.76%) respondents who completed both pretest and post test 1 questionnaires. About 12 questions of knowledge; mean scores were statistically significantly increased; 7.95 (0.98) vs 9.5 (0.78), P < 0.001. Two thirds (8 out of 12 questions) were answered correctly in post test 1 more than in the pretest by Mc Nemar Chi-square test; P < 0.05. About attitude; 2 out of 5 answers changed significantly by Mc Nemar Chi-square test; P < 0.05. The post test 2 questionnaires were mailed to all 177 participants twice asking to reply only once. All questionnaires were to be completed anonymously. The post test 2 with a response rate of 65.5 per cent revealed that universal precautions were frequently used among Thai anesthesia personnel but not universally followed. At least one-third of the respondents admitted recapping before disposal of used needles. Fifty six per cent of respondents (vs 22.8% in pretest) admitted re-using one syringe for more than one patient. In conclusion, this study showed that a short course educational program may improve knowledge about HIV and partly change attitude, but can not change behaviour. Changing the practice of anesthesia health care workers needs continual education and appropriate training.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Effects of psychosocial education on adaptation in elderly hemodialysis patients.

The purpose of this experimental field pilot study was to determine whether the application of psychosocial education sessions had an effect on the adaptation level of elderly hemodialysis patients. A pretest, posttest control group design with two randomly selected groups was used. Ten patients, 4 males and 6 females, age 65 years and older, were randomly selected and stratified according to gender, with 2 males and 3 females assigned to either an experimental or a control group. The Psychosocial Adjustment to Illness Scale, Self-Report (PAIS-SR) was administered as a pretest 1 week prior to implementation of the intervention with the experimental group. It was again given as a posttest 30 days after completion of the intervention. The intervention, 7 psychosocial educational sessions with 7 audiotapes and a companion text module, provided information. These sessions were conducted with the experimental group, 2 days a week, during the subjects' hemodialysis treatments, taking approximately 20 minutes each, over a period of 4 1/2 weeks. Data were analyzed utilizing t-tests and descriptive statistics. No significant differences were found between the scores of the pretest and posttest when comparing the two groups. However, a significant value of 0.035 (p < 0.05) was evident in one domain of the PAIS-SR, the domestic environment, when comparing the scores of the pretest and posttest of the experimental group. The application of psychosocial education sessions did not have a significant effect on the adaptation level of elderly hemodialysis patients.

Adaptation, Psychological↗
PubMed2000

Review of the Bethesda System atlas does not improve reproducibility or accuracy in the classification of atypical squamous cells of undetermined significance smears.

BACKGROUND: The Bethesda System (TBS) and its accompanying atlas were developed to promote uniform diagnosis and reporting of cervical and vaginal cytology, especially with respect to borderline abnormal smears. The authors assessed whether group study of TBS atlas improves the reproducibility and accuracy of the cytopathologic diagnosis of equivocal Papanicolaou smears. METHODS: One hundred "atypical" smears were divided into pretest and posttest sets containing equal numbers of negative, atypical squamous cells of undetermined significance (ASCUS), and squamous intraepithelial lesion (SIL) diagnoses based on a five-member panel review. Two comparable teams of four pathologists from George Washington University Medical Center (Washington, DC) and Kaiser Permanente (Portland, OR), each comprised of two more experienced cytopathologists and two less experienced pathologists, independently reviewed the 50 pretest slides and classified the slides according to TBS as negative, ASCUS, or SIL. The teams then conducted group study sessions using TBS atlas. After the review, the pathologists independently classified the 50 posttest slides in a similar manner. RESULTS: Pretest, pair-wise interobserver agreement ranged from 30% to 66% compared with 34-62% for posttest agreement. Absolute percent agreement of reviewers' diagnoses with a previously developed consensus diagnosis based on opinions of a five-expert panel (cytopathologic certainty scale) ranged from 44% to 62% for the pretest set and from 40% to 60% for the posttest set. Comparison of the detection of oncogenic human papilloma virus (HPV) DNA by hybrid capture tube test with smears classified as negative, ASCUS, or SIL revealed that seven of eight reviewers did not demonstrate a stronger association between HPV detection and cytologic diagnosis in the posttest set. CONCLUSIONS: Review of TBS atlas by itself does not appear to improve the reproducibility or accuracy of cytologic diagnoses. The lack of improvement was similar among the pathologists involved regardless of experience level or whether they had a close working relation. Cancer (Cancer Cytopathol)

Cervix Uteri↗
PubMed2002

The use of information graphs to evaluate and compare diagnostic tests.

OBJECTIVES: The purpose of this communication is to demonstrate the use of "information graphs" as a means of characterizing diagnostic test performance. METHODS: Basic concepts in information theory allow us to quantify diagnostic uncertainty and diagnostic information. Given the probabilities of the diagnoses that can explain a patient's condition, the entropy of that distribution is a measure of our uncertainty about the diagnosis. The relative entropy of the posttest probabilities with respect to the pretest probabilities quantifies the amount of information gained by diagnostic testing. Mutual information is the expected value of relative entropy and, hence, provides a measure of expected diagnostic information. These concepts are used to derive formulas for calculating diagnostic information as a function of pretest probability for a given pair of test operating characteristics. RESULTS: Plots of diagnostic information as a function of pretest probability are constructed to evaluate and compare the performance of three tests commonly used in the diagnosis of coronary artery disease. The graphs illustrate the critical role that the pretest probability plays in determining diagnostic test information. CONCLUSIONS: Information graphs summarize diagnostic test performance and offer a way to evaluate and compare diagnostic tests.

Computer Simulation↗
PubMed1976

The lecture: increasing student learning.

This study involved a single lecture given to second-year medical students. Its purpose was to detemine whether significant learning of the lecture content could occur during the lecture. The author's criteria for "significant" learning was mastery of 75 percent of what he predetermined to be the important of "required" content plus T-test analysis of pretest-posttest learning. The class divided into Groups A and B. At the commencement of the lecture Group A took Test 1 as its pretest and Group B took Test 2. Immediately following the lecture Group A took Test 2 as its posttest and Group B took Test 1. Comparing Test 1 with Test 2 as pretests and again as posttest, they were not significantly different at the .05 level. However, Group A's posttest scores were significantly higher than its pretest scores (p less than .005). The same was found for Group B, with both groups' averaging over 90 percent mastery of the required content and demonstrating that significant learning occurred during the lecture.

Education, Medical, Undergraduate↗
PubMed2004

Extensive evaluation of the instrumentation laboratory IL test D-Dimer immunoturbidimetric assay on the ACL 9000 determines the D-Dimer cutoff value for reliable exclusion of venous thromboembolism.

The clinical diagnosis of venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is often difficult and requires a number of imaging tests plus clinical assessment. It is now accepted that pretest clinical probability of disease plus a sensitive, quantitative D-Dimer assay can be used to reliably exclude VTE. In design of diagnostic strategies for VTE it is recommended that the D-Dimer assay be evaluated for sensitivity and specificity in well-designed, blinded studies using a cohort of patients for whom the assay will ultimately be used. Therefore we evaluated the IL Test D-Dimer on the ACL 9000 automated coagulation analyzer for its sensitivity and specificity in the diagnosis of VTE. A total of 512 patients admitted to the emergency department of Providence Hospital with suspected VTE were included in the dataset. Our aim was to find the clinically meaningful IL Test D-Dimer cutoff value, which would give us 100% sensitivity and the highest possible specificity for exclusion of VTE. Patients were categorized clinically into low, medium, or high pretest probability and had computed tomographic and/or ventilation-perfusion scans for investigation of PE and ultrasound studies for suspected DVT, with the laboratory blinded to the clinical findings. Of the 511 patients, 28 (5.4%) had confirmed VTE (PE and/or DVT) based on imaging and clinical studies. Applying receiver operating characteristic curve (ROC) analysis, we determined from our study that a cutoff value of 237 ng/mL IL Test D-Dimer gave a 100% sensitivity with a specificity of 38% for detection of VTE. The findings demonstrate that a diagnostic strategy using the IL Test D-Dimer assay as a first-line test in combination with pretest probability is safe and can be used in patients with suspected VTE. In conclusion, patient analysis results indicating low or moderate pretest probability for VTE and a negative IL Test D-Dimer (cutoff value of 237 ng/mL) assay result on the ACL 9000 reliably exclude VTE (both PE and DVT). We expect that inclusion of the rapid IL Test D-Dimer assay for assessment of suspected VTE in the emergency department at Providence will result in improved patient diagnosis and therapy, reduction in unnecessary radiological investigations, and lowering of overall costs associated with investigation of patients suspected of having VTE disease.

Clinical Laboratory Techniques↗
PubMed2005

Comparison of knowledge acquired by students in small-group seminars with and without a formal didactic component.

BACKGROUND AND OBJECTIVES: This study compared student knowledge gain from using a CD-ROM-based lecture only, from attending small-group seminars only, and from using a combination of both methodologies. METHODS: During a required second-year case-based seminar about falls in the elderly, one third of the 96 second-year medical students were randomized into each of three study groups. One group viewed a 12-minute CD-ROM didactic presentation on falls in the elderly, another group participated in the small-group seminars, and the third group did both. All three groups took a pretest and posttest to assess any change in knowledge. The timing of the viewing of the CD-ROM and of the pretests and posttests were varied to test the effects of each modality separately and of the modalities combined. RESULTS: The difference between the pretest and the posttest scores was significantly different among groups. Post hoc analysis showed that the change from pretest to posttest was greater for students who participated in the combined modalities than in those who viewed the CD-ROM only or participated in case-based seminars only. DISCUSSION: The addition of a 12-minute CD-ROM on the topic to a small-group seminar appears to increase student knowledge of the material being taught.

Accidental Falls↗
PubMed1992

Changing medical students' attitudes about AIDS.

Medical students may have negative attitudes about persons with the acquired immunodeficiency syndrome (AIDS) as well as concerns about occupational infection with human immunodeficiency virus. We conducted a brief intervention to assess and modify attitudes of first-year students. The intervention was presented to small groups of students by peers, faculty, and a person with AIDS. Assessments of attitudes and knowledge were conducted one week prior to the intervention (pretest), and one (posttest 1) and 47 weeks (posttest 2) afterwards. Females had more positive attitudes about AIDS on pretest and posttest 1. Attitude scores improved significantly from pretest to posttest 1 but returned close to baseline by posttest 2. Knowledge scores were high on pretest and did not change significantly. Attitude scores were significantly correlated with knowledge, and with students' opinions regarding obligation to care for AIDS patients. Acquaintance with a homosexual was highly correlated with both scores. This intervention may serve as a model in improving students' attitudes about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Increasing orgasm and decreasing dyspareunia by a manual physical therapy technique.

CONTEXT: Female sexual pain and dysfunction. OBJECTIVE: To evaluate the effectiveness of a new site-specific, manual soft-tissue therapy in increasing orgasm and reducing dyspareunia (painful intercourse) in women with histories indicating abdominopelvic adhesion formation. DESIGN AND INTERVENTION: A total of 29 new patients presenting with infertility or abdominopelvic pain-related problems, and also indicating sexual pain or dysfunction, received a series of treatments (mean, 19.5 hours) designed to address biomechanical dysfunction and restricted mobility due to adhesions affecting the reproductive organs and adjacent structures. OUTCOME MEASURES: Primary outcome measures were post-test vs pretest scores on: (1) the Female Sexual Function Index (FSFI) full scale, orgasm domain, and pain domain; and (2) 3 supplemental 10-point rating scales of sexual pain levels. Secondary outcome measures were post-test vs pretest scores in the other 4 FSFI domains (desire, arousal, lubrication, and satisfaction). The Wilcoxon signed-rank test was used for all statistical analyses. RESULTS: For the 23 patients available for follow-up, the paired FSFI post-test vs pretest scores were significant (P < or = .003) on all measures. Of the 17 patients who completed the 3 sexual pain scales, the paired post-test vs pretest scores were significant (P < or = .002). CONCLUSIONS: Many cases of inhibited orgasm, dyspareunia, and other aspects of sexual dysfunction seem to be treatable by a distinctive, noninvasive manual therapy with no risks and few, if any, adverse effects. The therapy should be considered a new adjunct to existing gynecologic and medical treatments.

Adult↗
PubMedDate not supplied

Meals-on-wheels improves energy and nutrient intake in a frail free-living elderly population.

BACKGROUND: With the increasing life expectancy and associated health care cost in the elderly population, it is fundamental to study and improve interventions that help older persons to have a better and healthier life in their home for a longer period. OBJECTIVES: Evaluate the effect of Meals-on-Wheels (MOW) on dietary intakes of frail elderly. DESIGN: An untreated control group quasi-experimental design with pretest and post-test was used to compare users (n = 20) and non-users (n = 31) of MOW. Descriptive and dietary data were compared at pretest and 8 weeks later. Analysis of Covariance (ANCOVA) was used to control for initial differences between groups. RESULTS: Both groups were similar at pretest except for weight (p = 0.028) and weekly number of meals eaten outside the home (p = 0.008). In both groups, dietary intakes at pretest were below Estimated Average Requirements (EAR) for the same nutrients. At post-test, intake of most nutrients increased in the Experimental group in comparison with the Control group. After controlling with the ANCOVA model, increases were significant for energy (p = 0.050), protein (p = 0.030), lipid (p = 0.034) and thiamin (p = 0.035). Provision of MOW did not permit to achieve a low risk of nutrient inadequacy in the Experimental group. CONCLUSIONS: MOW programs improve dietary intakes of recipients. However, a more intensive intervention is needed to prevent nutrient deficiencies in this group.

Aged↗
PubMed1991

Economic decision analysis model of a paratuberculosis test and cull program.

A spreadsheet program was written to perform decision tree analysis for control of paratuberculosis (Johne's disease), when testing all adults in a herd and culling all animals with positive test results. The program incorporated diagnostic test sensitivity, specificity, and test cost with the cost or value of each of the 4 possible outcomes; true-positive, true-negative, false-positive, and false-negative test results. The program was designed to repeat the analysis for the independent variable pretest paratuberculosis prevalence (0 to 100%). Model output was graphed as profit or loss in dollars vs pretest prevalence. The threshold was defined as the pretest prevalence at which benefit-cost equaled zero. Reed-Frost disease modeling techniques were used to predict the number of Mycobacterium paratuberculosis-infected replacement heifers resulting from infected cows during a control program. Sensitivity analysis was performed on variables of the decision tree model; test sensitivity, specificity, test cost, and factors affecting the cost of paratuberculosis to a commercial dairy. A test and cull program was profitable when paratuberculosis caused greater than or equal to 6% decrease in milk production if the pretest prevalence was greater than 6%, test sensitivity was 50%, test specificity was 98%, and the testing cost was $4/cow. Test specificities greater than 98% did not markedly affect the threshold for tests with a 50% sensitivity and costing $4/cow. Test sensitivity had minimal effect on the threshold. Using a diagnostic test with a 50% sensitivity and a 98% specificity as an example, test cost was shown to affect the threshold prevalence at which the test and cull program became profitable.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Changes in knowledge, attitudes, and behavior as a result of a community-based AIDS prevention program.

The study evaluates the outcome of a California-based AIDS prevention program, "Stop AIDS." Community discussion groups focusing on information, attitudes, and behavior associated with HIV infection and transmission were conducted in one-time, 3 1/2-hour sessions. Participants completed different versions of the AIDS Prevention Test before and after the discussion group. Significant positive shifts in information, attitudes, and behavior were observed as a function of the discussion group participation. Whereas pretest knowledge correlated with pretest behavior and posttest knowledge, only pretest behavior correlated with the crucial variable of posttest intended behavior. When changes from pretest to posttest were analyzed, both information and attitude change correlated to changes in behavior. The intervention and evaluation procedures are proposed as a replicable national model for community-based AIDS prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A preliminary investigation using drama in community AIDS education.

This investigation assessed the impact of drama on AIDS-related knowledge and beliefs of selected individuals in a university community. Subjects were 136 members of the audience attending two performances of "As Is," the award-winning drama by William Hoffman depicting the illness and inevitable death of a homosexual man with AIDS. The investigation used a pretest-posttest design in which subjects completed a survey instrument before and immediately after the performance. No changes in AIDS-related beliefs were detected as a result of the play. However, knowledge decreased slightly. A linear multiple regression analysis determined variables that contributed significantly to variation in pretest knowledge about AIDS. Pretest knowledge scores were high, particularly in terms of modes of transmission. However, some confusion was evident concerning the concept of casual contact. Though subject responses on a pretest tolerance index generally indicated tolerant beliefs toward people with AIDS, substantial concerns were evident among a minority of subjects. More definitive research is needed to examine the impact of drama as a medium for affecting knowledge and beliefs about AIDS and other complex, emotion-laden health education issues.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Central circulation in the healthy human being during 7 days of head-down tilt and decompression of different body areas].

The effect of 7-day head-down tilt (-15 degrees) and decompression of various body parts (lower body-LBNP, upper body in the area of the hydrostatically indifferent point-UBNP, and local negative pressure applied to both calves-LNP) on central circulation was investigated on eight healthy test subjects who, for 10 days, had catheters (Swan-Ganz) implanted into the pulmonary and radial arteries. It was shown that, when calculated by square centimeter of the decompression area, the effect of UBNP on central venous pressure (CVP) and pulmonary artery pressure (PAP) was 3-4 times greater than that of LBNP or LNP. This indicates a high sensitivity of this body part to the exposure. During the 7-day study, CVP and PAP showed the most distinct changes. By the 7th hour of the head-down tilt study, CVP remained unchanged and systolic PAP increased by 5.5 mm Hg (27%) (p less than 0.05). This was paralleled by a decrease of plasma aldosterone and renin. By the 2nd day of the study, CVP and PAP were close to the pretest level; on the 3rd day, they began to decline and remained about 3 mm Hg lower than the pretest values to the end of the study (p less than 0.05). During this same period, the contractility of the right heart (the mean rate of right ventricular pressure increment) decreased by 34% (p less than 0.05) and its work by 27% (p less than 0.05). By the 24th hour after the study (the recovery period), CVP and PAP were close to the pretest values, whereas heart rate, cardiac index and oxygen tension in the mixed venous blood were significantly higher than the pretest values (p less than 0.05). The factors responsible for these changes and the potential application of the catheterization technique in biomedical investigations during real space flight are discussed.

Adult↗
PubMed1978

Sex-related differences in response to practice on a visual-spatial test and generalization to a related test.

93 first graders (mean age 6.5 years) were given a pretest and posttest on half of the items from the Children's Embedded Figures Test. Half of the children were randomly assigned to a training condition and received a brief training procedure on visual-spatial disembedding prior to the administration of the posttest. Children in the control condition received no training. The performance of girls improved significantly more from pretest to posttest than the performance of boys. Boys and girls showed similar beneficial effects of training in addition to the benefit of direct practice. The tendency that was observed for boys to perform higher than girls on the pretest, p less than .10, was not evident on the posttest. Scores on the pretest predicted scores on a different measure of visual-spatial ability only for children in the control group. The results are interpreted in terms of current theories of sex differences in visual-spatial perception.

Child↗
PubMed1981

The importance of central nicotinic receptors in footshock-induced aggression in mice.

The action of nicotine and other agonists of central cholinergic receptors on aggressiveness was tested in the footshock-induced fighting test in mice. Nicotine in doses 0.25-2 mg/kg ip and 5-30 micrograms ivtr potentiated the aggressiveness, but a dose of 4 mg/kg ip suppressed it in naive (not pretested) mice. Of other cholinergic agonists betanechol, a specific muscarinic agonist, facilitated the aggression. Similar effect was produced by arecoline, a muscarinic-nicotinic agonist, while carbachol, a compound of pharmacological profile similar to that of arecoline, was ineffective. Mecamylamine, a central nicotinic antagonist, in doses 2 and 4 mg/kg moderately facilitated the aggressiveness, while in a dose of 8 mg/kg inhibited it. Hexamethonium, a peripheral nicotinic antagonist, strongly potentiated aggressiveness. Mecamylamine and hexamethonium antagonized the facilitatory action of nicotine on aggression in non-pretested mice, and of arecoline both in non-pretested an pretested mice, but did not change the effect of betanechol. The results indicate that in addition to muscarinic receptors, the nicotinic receptors in the central nervous system may participate in evoking affective aggression in mice subjected to electric foot-shock.

Aggression↗
PubMed1982

Cognitive self-modeling, conventional group counselling, and change in interpersonal skills.

This study compared Cognitive Self-Modeling [CSM(N = 39)]--a new treatment using a highly structured, cognitively oriented approach to increasing interpersonal skills among adolescents--with Conventional Group Counselling [CGC(N = 40)]--a widely accepted nondirective approach. A no-treatment group of which about half were pretested, served as a control [NTC(N = 18)]. Students (N = 97, mean age = 16.5) in a school setting were administered self-report trait and behavior indices at pretest, posttest (six weeks), follow-up-1 (10 weeks) and follow-up-2 (52 weeks). In addition, a measure of participation in clubs and organizations was administered at pre and posttest. Scheffé post hoc analyses revealed significant results for both treatment groups: CSM changes occurred early (posttest) and generally remained stable over time (follow-up-1 and 2), whereas CGC changes emerged slowly with significant findings on all measures at follow-up-2. NTC volunteers made no significant changes. Also, no differences were obtained between students who were pretested and those who were not, indicating that pretesting made no contribution to outcome.

Adolescent↗
PubMed1982

Effect of pharmacist counseling on drug information recall.

The effect of counseling by pharmacists on patients' long-term recall of drug information was studied. Clinic and hospital neurological patients were counseled by a physician regarding a drug newly prescribed for them. Each patient in the study was then given a 15-item multiple-choice pretest specific for the new medication. Patients in the control group were given a posttest identical to the pretest eight weeks later. Test group patients were counseled by a pharmacist and were given the posttest eight weeks later. Specific information was categorized as to source. The mean scores of the test group patients increased 26.2 percentage points between pretest and posttest. Scores on information covered by the physician and reinforced by the pharmacist increased 19.6 percentage points, and scores on information presented only by the pharmacist with written reinforcement increased 30.6 percentage points. Scores of the control group patients showed no improvement between pretest and posttest. Pharmacist counseling had a significant effect on patients' recall of drug information after eight weeks.

Age Factors↗