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Participant reactions to a cognitive-behavioral guided self-help program for binge eating: developing criteria for program evaluation.

This article evaluates the effectiveness of a telephone-based guided self-help program for women who binge eat. We report how key program components (e.g., phone sessions, the self-help book) contribute to the four self-help goals identified in the clinical literature: (1) decrease isolation/increase support; (2) increase knowledge of the problem; (3) broaden coping skills; and (4) improve self-esteem. Using the example of our feasibility study, we illustrate that even minimal interventions create a relational context which can promote entry into and engagement with treatment. We conclude that program evaluation should include not only traditional measures of outcome (e.g., reduction in symptomatology), but utilize outcome measures related to the specific goals of minimal interventions (e.g., changes in help-seeking behavior).

Attitude↗

Developing emergency nursing competence.

Developing and maintaining the competence emergency nurses need is an important function of emergency clinical nurse specialists (CNS), educators, and other members of the emergency department (ED) leadership team. A thorough orientation is the first and most important step in developing the competence of emergency nurses. After orientation, the challenge is to maintain currency of practice in the face of incessant change such as new medications, new equipment, and new therapies in emergency care. This article focuses on the orientation of emergency nurses. A related article in this issue addresses assessment of competency.

Clinical Competence↗

Project Towards No Drug Abuse: two-year outcomes of a trial that compares health educator delivery to self-instruction.

OBJECTIVES: This paper describes the 2-year follow-up of a 12-session version of an indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education. However, a health educator-led program is much more interactive. METHODS: The effects of self-instruction versus health educator-led versions of this curriculum were examined. Eighteen schools were randomly assigned by block to one of three conditions--standard care (control), health educator-led classroom program, and self-instruction classroom program. Subjects were followed up 1 and 2 years later. Two-year results are reported here. RESULTS: The self-instruction program produced no behavioral effects relative to the standard care control condition. The 2-year follow-up results indicated maintenance of program effects on cigarette smoking and hard drug use in the health educator-led version. CONCLUSIONS: Project TND shows maintenance of effects on some drugs 2 years after program implementation, when most youth were young adults. More work is needed to learn how to maintain effects across substances. Continued exploration of modalities of implementation may be helpful.

Adolescent↗

The MacArthur Foundation Depression Education Program for Primary Care Physicians: background and rationale.

In order to improve the assessment and management of depression in general medical care, the John D. and Catherine T. MacArthur Foundation supported the development, evaluation, and dissemination of an eight-hour depression education program (DEP) for primary care physicians. This publication includes a paper describing the background and educational rationale for the program structure, the complete participant's workbook, and a facilitator's guide for teaching the program. Given in two separate four-hour workshops by a psychiatrist and a primary care physician, DEP is delivered to small groups of learners (about 12) using an interactive adult learning model and multiple teaching techniques including targeted yet flexible objectives, two lectures, videotape demonstration and discussion, role-play exercises, a focused monograph on depression, an interview checklist, structured assessment and outcomes tools, clinical case studies, and audiotape review of actual patient interviews. DEP has been shown in a prospective randomized trial to improve physicians' interview-ing skills as well as simulated-patient satisfaction scores. Over 150 PCPs in four states have taken DEP in more than 30 separate programs given by 24 trained facilitators. Participants, despite a wide diversity of background knowledge and skills, have uniformly reported remarkably positive learner satisfaction with all dimensions of the Program.

Depression↗

CPR instruction: modular versus lecture course.

A randomized prospective study was done to examine long-term cardiopulmonary resuscitation (CPR) cognitive and motor skills retention and to compare the "self-taught" modular course with the standard lecture course. Both cognitive and motor skills were tested at one-, two- and four-year intervals after the initial course. Approximately half the students in both the modular and standard lecture courses also took a refresher course after one year. While there was no significant difference (P greater than .05) in retention based on the method of teaching (modular vs lecture course), students who took the refresher course after one year performed significantly better (P less than .01) at the two-year interval. Results four years after the initial CPR course (three years after the refresher course) were uniformly poor in both groups. Only three of 104 students were able to meet American Heart Association standards for the performance of CPR. Refresher courses are vital if CPR is to be performed effectively and competently. They should be available on a continuing basis with self-taught courses providing a good alternative to the formal didactic course as a means of providing instruction.

Educational Measurement↗

Self-paced learning stations for tuberculosis respirator training: report of a pilot program.

BACKGROUND: In response to the Centers for Disease Control and Prevention's recently issued "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, 1994," during May 1994 we implemented and evaluated a pilot tuberculosis respirator training program that used four self-directed learning stations, through which participants proceeded at their own pace. Employee tuberculin skin testing was included in the training program. METHODS: The time required to train each employee was recorded. At the completion of the training program, all participants were asked to assess their ability to attain the learning objectives and whether they believed the program format was an effective and efficient use of their time. Two weeks later, a convenience sample of 100 employees completed an 11-question test designed to measure knowledge retention. RESULTS: One hundred seventy-six employees completed training during the pilot period. The average time necessary to train each employee was 19.5 minutes. Overall 97.1% of participants stated that they were able to fully meet the course objectives. Test scores among the convenience sample averaged 88% 2 weeks after training. CONCLUSIONS: The use of self-paced stations for tuberculosis respirator training and employee tuberculosis skin test screening was both effective and time-efficient for employees. We have expanded this program to include all of our approximately 500 employees who may be exposed to tuberculosis.

Educational Measurement↗