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At least 469 records · Page 26Linked to original sources
PubMed2000

Maximal exercise testing in late gestation: fetal responses.

OBJECTIVE: To determine the fetal response to and safety of maximal maternal exercise in the third trimester. METHODS: Twenty-three active women with uncomplicated pregnancies (singleton gestations) underwent maximal exercise testing in late gestation using a progressive maximal cycle ergometer protocol. Fetal heart rate (FHR) responses were monitored and classified using National Institute of Child Health and Human Development guidelines. Statistical analyses involved use of the Student t test, repeated measures analysis of variance with Tukey-Kramer multiple comparisons posttest, and the chi(2) test. RESULTS: There was an increase in baseline FHR in the 20-minute posttest period compared with the 20-minute pretest period. There were significantly fewer accelerations in the second posttest 10-minute segment compared with the second pretest 10-minute segment. Variability was reduced in both posttest periods compared with the first 10-minute pretest period. Time to reactivity increased after testing. Mild tachycardia was noted in two tracings and bradycardia occurred in a fetus with previously undiagnosed growth restriction. There were no abnormal neonatal outcomes. CONCLUSION: Maximal exercise testing in late gestation led to minimal changes in FHR. Fetal bradycardiac responses were not seen in appropriate for gestational age fetuses, suggesting that brief maximal maternal exertion for research or diagnostic purposes is safe in this group.

Adult↗
PubMed1999

Videotaped training in alcohol counseling for obstetric care practitioners: a randomized controlled trial.

OBJECTIVE: To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking. METHODS: Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing. Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman. Those randomly assigned to the experimental condition watched the motivational interviewing videotape. Control condition participants watched a 20-minute docudrama of a pregnant problem drinker. Both groups then engaged in a post-test roleplay similar to the pretest. Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures. RESULTS: Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing. Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups. Obstetric care practitioners who viewed the training video were rated as showing greater empathy, minimizing patient defensiveness, and supporting women's beliefs in their ability to change. CONCLUSION: Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing. Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients. Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems.

Alcohol Drinking↗
PubMed2001

Diagnosis of pulmonary embolism.

Pulmonary embolism (PE) is a common, lethal yet treatable disease. The clinical diagnosis of PE remains to be a problem due to the nonspecific presenting signs, symptoms, electrocardiographic findings, arterial blood gas abnormalities and chest X-ray changes. Despite these nonspecific clinical findings, clinicians are adept at assigning pretest probability using overall clinical assessment. Clinical models have been developed to improve the accuracy of pretest probability assessment. D-dimers are becoming a widely available clinical tool useful in the diagnostic management of suspected PE. The limitations of the imaging modalities for PE [ventilation-perfusion (V/Q) scanning, spiral computerised tomography, pulmonary angiography and venous leg imaging] necessitate the use of these tests in series and in combination with clinical pretest probability assessment and D-dimer in diagnostic management algorithms. These algorithms permit safe diagnostic management of patients with suspected PE while limiting invasiveness, inaccessibility and expense.

Algorithms↗
PubMed1997

Impact of an education program about domestic violence on nurses and doctors in an Australian emergency department.

OBJECTIVE: To increase the knowledge of nurses and doctors in an emergency department about the topic of domestic violence; to change any negative practices and attitudes toward victims; to increase knowledge of the referral processes for psychosocial aspects of domestic violence; and to increase knowledge of community resources for domestic violence victims. METHODS: Identical knowledge, attitude, and practice surveys were conducted with nurses and doctors in an emergency department before and after an educational intervention program about domestic violence. A matched-pair analysis of those respondents who answered both pretest and posttest surveys was conducted to measure the impact of the program on nurses and doctors. RESULTS: Nurses and doctors had a reasonable knowledge of the topic of domestic violence before the education program (correct answers: nurses, 61.6%; doctors, 63.4%). However, the program had a positive impact on their knowledge (correct answers posttest: nurses, 71.5%; doctors, 72.4%), with more significant changes for nurses than for doctors. The program affected both nurses' and doctors' attitudes (of 10 positive attitudinal statements: pretest, 7.9; posttest, 8.6). On both the pretest and posttest, nurses and doctors did not subscribe to a number of the myths about domestic violence that have been described in the domestic violence literature. These findings should be treated with caution because of the low response rates to the surveys from doctors (28.0%, n = 20) and nurses (53.0%, n = 48). DISCUSSION: Further research is needed into the beliefs and practices of nurses and doctors about domestic violence. The impact of this education program highlights the necessity for introducing training programs for health professionals on domestic violence problems.

Australia↗
PubMedDate not supplied

The effect of standardized patient feedback in teaching surgical residents informed consent: results of a pilot study.

PURPOSE: The purpose of this pilot study was to determine the effectiveness of using feedback from a standardized patient (SP) to teach a surgical resident (SR) informed consent (IC) protocol. METHODS: Four general case types of increasing difficulty were tested in a longitudinal experimental design format. The four types of cases were appendectomy, cholecystectomy, colorectal cancer, and breast cancer. Eight SRs of varying years of completion in medical school served as subjects-four in the experimental group (received performance feedback from an SP) and four in the control group (received no SP feedback). Both the control and experimental groups participated in two patient encounters per case type. The first patient encounter served as the pretest, and the second patient encounter was the posttest. In each encounter, an SP rated the resident on 14 measures using an open-ended seven-point rating scale adopted and modified from the Brown University Interpersonal Skill Evaluation (BUISE). Each resident also reviewed a videotape of an expert giving IC between pretest and the posttest for basic instructional protocol. Random stratified sampling was used to equally distribute the residents by postgraduate years. A total of 16 SPs were used in this study. All patient/SR encounters were videotaped. RESULTS: There was a statistically significant overall change--pretest to posttest and across cases (p = 0.001). The group effect was statistically significant (p = 0.000), with the experimental group averaging about 10 points greater than the control group. CONCLUSIONS: Standardized patient feedback is an effective modality in teaching surgical residents informed consent protocol. This conclusion is tentative, due to the limitations of sample size. The results of this study support continued research on the effects of standardized patient feedback to teach informed consent to surgical residents.

General Surgery↗
PubMed1994

Effect of the infusion of the GABA-A receptor agonist, muscimol, on the role of the entorhinal cortex, amygdala, and hippocampus in memory processes.

Rats were bilaterally implanted with cannulae in the entorhinal cortex, amygdala, and hippocampus; after recovery, they were trained in a step-down inhibitory avoidance task and tested for retention 24 h later. Muscimol (0.03 microgram) or D-amino-5-phosphonovalerate (5.0 micrograms) infused in the entorhinal cortex 20 min prior to training inhibited the amnestic effect of the same dose of muscimol infused into this area 100 min after training. Thus, memory-relevant information must be processed by the entorhinal cortex at the time of training in order that this cortex may play a late post-training role in memory processing. Pretraining intraentorhinal muscimol administration did not affect the amnestic effect of the post-training infusion of muscimol into the amygdala and hippocampus, or the inhibition of memory expression induced by a pretest infusion of CNQX into the amygdala and hippocampus or into the entorhinal cortex. Pretest intraentorhinal muscimol also did not influence the effect of pretest intra-amygdala and intrahippocampal CNQX administration. These data indicate that the cells of the entorhinal cortex that are sensitive to pretraining muscimol are not part of the inputs that lead to post-training processing by the amygdala and hippocampus, or to the intervention of the amygdala, hippocampus, and entorhinal cortex in memory expression. The present findings are compatible with the possibility that, instead, the entorhinal cortex may be an output of the amygdala and hippocampus at the time of memory expression.

2-Amino-5-phosphonovalerate↗
PubMed1985

Factors that influence test session performance measured 0, 3, or 6 h after inhibitory avoidance training.

UNLABELLED: Rats were trained in a step-down inhibitory avoidance task using a 0.3-mA, 60-Hz footshock, and were tested at 0, 3, and 6 h from training. Retrieval scores (test session minus training session step-down latencies) were higher in control groups at 0 than at 3 or 6 h. Test session performance at 0 h was unaffected by the pretraining ip injection of ACTH1-24 (0.2 microgram/kg), epinephrine-HCl (5.0 micrograms/kg), human beta-endorphin (1.0 microgram/kg), or naloxone-HCl (0.4 mg/kg); or by a pretreatment with dexamethasone phosphate (2.0 mg/kg in divided doses 24 and 12 h before training); or by anterior or posterior hypothalamic deafferentation. Test session performance at 0 h was depressed by prior bilateral transection of the fornix, which suggests it depends on hippocampal function. The effect of the fornix lesion on test session performance at 0 h was not counteracted by ACTH, epinephrine, or beta-endorphin administration. When animals were tested 3 h after training, the post-training administration of ACTH and epinephrine caused an enhancement of test session performance; neither post-training beta-endorphin or naloxone, nor pretest ACTH, epinephrine, or beta-endorphin administration, had any effect in these animals. At 6 h from training, the post-training facilitatory action of ACTH and epinephrine was still present and the post-training depressant effect of beta-endorphin and the post-training facilitatory effect of naloxone became manifest, and so did the naloxone-reversible pretest facilitation induced by ACTH, epinephrine, or beta-endorphin. The influence of post-training naloxone or pretest beta-endorphin on retrieval scores at 6 h was not observed in the fornix-lesioned animals. IN CONCLUSION: Test session performance of this task at 0 h from training is regulated by different mechanisms than those which regulate test session performance at 3 or 6 h; in particular, it is less susceptible to modulation by the drugs used in the present study and it depends on the fornix; At least two major classes of modulatory factors influence retrieval scores at later times: consolidation-enhancing effects of ACTH and epinephrine, which become manifest at 3 h, and mechanisms related to beta-endorphin, which involve a form of state dependency and only become manifest at 6 h from training.

Adrenocorticotropic Hormone↗
PubMed2003

Novel management strategy for patients with suspected pulmonary embolism.

AIMS: A simple management strategy is required for patients with acute pulmonary embolism which allows a rapid and reliable diagnosis in order to start timely and appropriate treatment. METHODS AND RESULTS: Two hundred and four consecutive patients with suspected pulmonary embolism were managed according to a standardized protocol based on the clinical pretest probability and the initial haemodynamic presentation (shock index=heart rate divided by systolic blood pressure). Patients with a high pretest probability and a positive shock index (> or =1) (n=21) underwent urgent transthoracic echocardiography. Based on the presence or absence of right ventricular dysfunction, reperfusion treatment was initiated immediately. Patients with a negative shock index (<1) (n=183) underwent diagnostic evaluation including pretest probability, D-dimer, and spiral computed tomography (CT) as first-line tests. Echocardiography was performed only when a central pulmonary embolism was found in the spiral CT(n=33). According to our strategy, 98 patients met the diagnostic criteria of pulmonary embolism: 75 patients (all shock index <1) were treated with heparin alone, 16 (seven had a shock index > or =1) with thrombolysis, four (all shock index > or =1) with catheter fragmentation, and three (all shock index > or =1) with surgical embolectomy. The all-cause mortality rate at 30 days was 5%, and at 6 months 11%. Right ventricular dysfunction on baseline echocardiography was not associated with a higher mortality rate at 6 months (logrank 2.4, P=0.12). CONCLUSIONS: The novel management strategy for patients with suspected pulmonary embolism resulted in a rapid diagnosis and treatment with a low 30-day mortality. In patients with pulmonary embolism and a positive shock index, time-consuming imaging tests can be avoided to reduce the risk of sudden death and not to delay reperfusion therapy.

Acute Disease↗
PubMedDate not supplied

Smokers in four stages of readiness to change.

Smoking cessation is increasingly considered to be a process rather then a discrete event. Several stage models that stress the process nature of behavior change have been developed in the last decade. In the present study, a stage model is investigated that categorizes smokers into four groups with increasing readiness to change: immotives, precontemplators, contemplators, and preparers. Smokers from the general population were recruited to participate in an investigation on smoking cessation interventions. At pretest, the anticipated positive and negative outcomes of quitting, perceived self-efficacy, and smoking behavior were assessed. Three and 14 months after the pretest, the follow-up measurements were conducted. The cross-sectional results showed that smokers in the four stages differed from each other on the factors pertaining to the positive outcomes and perceived self-efficacy. No differences between the four stages were detected concerning the number of cigarettes smoked a day, the nicotine dependence score, and the number of years smoked. The longitudinal results showed that the stage of readiness to change at pretest was highly predictive of quitting at both follow-ups. It is concluded that this stage model is worthy of support.

Adolescent↗
PubMedDate not supplied

Outpatient educational program for rheumatoid arthritis patients.

A patient-education program was designed to meet the expressed needs of clinic rheumatoid arthritis patients. This program consisted of six educational seminars involving various health professionals. A quasi-experimental control group design was employed to evaluate the patients' cognitive and behavioral responses to this program. Responses were assessed through the administration of pretests, posttests, and three-month follow-up tests to treatment and control groups. The treatment group increased its cognitive score 22.5% from initial pretest to long-term follow-up, whereas the control group improved only 5.1% on these questions. The treatment group improved its behavioral score between the administration of the pretest and the posttest and maintained this improvement on the long-term follow-up. Although the control group initially scored somewhat higher on the behavioral measures, it reported a decrease in the performance of self-care activities on the posttest and follow-up.

Arthritis, Rheumatoid↗
PubMedDate not supplied

A cystic fibrosis handbook for teachers.

The purposes of this project were to (1) develop a handbook on cystic fibrosis for elementary school teachers and to (2) pilot this handbook with a group of teachers and school nurses. The project used a descriptive survey design in which parents, teachers, and school nurses of 14 elementary-age children with cystic fibrosis were recruited from one cystic fibrosis clinic. Interest in using the handbook with their child's teachers was elicited from parents; also, interest in using the handbook was obtained by open-ended questions in a mailed survey sent to teachers and school nurses. Levels of teacher and school nurse knowledge were measured with a true/false pretest and posttest instrument. All parents expressed a desire to use the handbook with their child's teachers. Sixty-seven percent of the teachers and 89% of the school nurses returned the survey, and all endorsed the use of the handbook in their classrooms or schools. Comparison of the pretest and posttest scores from the teachers revealed an increase in teachers' knowledge. Scores on pretest and posttest measures from school nurses were high at each testing time. Results support the use of a printed handbook to promote knowledge of cystic fibrosis in teachers and to support communication among nurses, parents, and teachers.

Child↗
PubMed1998

Prognostic implications of a normal dobutamine-atropine stress echocardiogram in patients with chest pain.

To assess the prognostic significance of a normal dobutamine-atropine stress echocardiogram in relation to the pretest probability of coronary artery disease (CAD), 200 consecutive patients (86 men and 114 women, mean [SD] age 59 [13] years) with a stable chest pain syndrome and a normal dobutamine-atropine stress echocardiogram were followed-up for 21 +/- 16 months. Outcome events were cardiac death, non-fatal myocardial infarction, and coronary revascularization procedures. Low (<10%), intermediate (10% to 80%), and high (>80%) pretest probabilities of CAD were present in 27 (14%), 108 (54%), and 65 (33%) patients, respectively. During follow-up, 2 patients (annual event rate 0.6%) had cardiac death, none had nonfatal myocardial infarction, and 4 patients (annual event rate 1.1%) underwent a coronary revascularization procedure. All patients with cardiac events had high pretest probabilities of CAD. Patients with cardiac death (but unproven significant CAD) had maximal tests without angina or ischemic electrocardiographic changes. In contrast, all patients with subsequent coronary revascularization had dobutamine-induced angina or ischemic electrocardiographic changes, and all except one study were submaximal. We conclude that patients with a stable chest pain syndrome and normal findings on dobutamine-atropine stress echocardiograms have an excellent cardiac prognosis. However, patients with typical angina, high pre-test probabilities of CAD, and stress-induced angina or ischemic electrocardiographic changes, and in particular those with submaximal stress, still appear to be at risk for functionally important CAD despite a normal dobutamine-atropine stress echocardiogram.

Adrenergic beta-Agonists↗
PubMed1995

Learning radiology from interactive videodiscs: bar-code book versus computer-assisted instruction.

RATIONALE AND OBJECTIVES: We compared an interactive videodisc with bar-code book with an interactive videodisc with computer-assisted instruction for learning radiology to determine whether there would be differences in instructional effectiveness, instruction time, or subjective preference. METHODS: Two different videodisc modules were created. Each was presented in two formats with identical content: bar-code book and computer-assisted instruction. In a controlled crossover experimental design, 48 fourth-year medical students were assigned one bar-code book module and one computer module. Pre- and posttests were administered. RESULTS: Mean scores improved from pretest to posttest after students used the modules in either format (p < .01). There were no significant differences between students who used the bar-code book and those who used the computer in pretest scores, posttest scores, gains in score from pretest to posttest, or instruction time for either module. Subjectively, 74% of the students preferred computer-assisted instruction, 20% preferred bar-code book, and 7% preferred neither. CONCLUSION: Although bar-code book and computer versions of an interactive videodisc can be educationally equivalent, most students preferred the computer. When videodisc is being integrated into the curriculum, the choice between bar-code book and computer-assisted instruction can be made on the basis of noneducational factors such as cost and availability.

CD-I↗
PubMedDate not supplied

Web-based intervention for changing attitudes of obesity among current and future teachers.

OBJECTIVE: To evaluate attitude change among student teachers and schoolteachers when exposed to a Web-based educational module promoting size acceptance. DESIGN: Subjects were randomly assigned to a control group or 1 of 4 treatment groups to evaluate the effect of module, presenter credibility, and/or image on attitudes of obesity and processes of change using the Elaboration Likelihood Model (ELM) testing cognitive and psychological cues. On-line assessment occurred at the pretest, posttest, and 6-week follow-up. SETTING: Web-based. PARTICIPANTS: 258 adults, mean age 26.8 +/- 10.2 years. INTERVENTION: Module content included factors related to obesity, implications of weight loss efforts, classroom activities, and bias-free intervention techniques. MAIN OUTCOME MEASURE(S): Attitudes of obesity by the Anti-Fat Attitudes Test and the effect of the presenter using a bipolar rating scale. ANALYSIS: One-way repeated measures analysis of variance, analysis of covariance, and general post hoc analysis. RESULTS: Negative attitudes decreased in treatment groups between pretest to posttest (P < .001) and pretest to follow-up (P < or = .006). Unlike the credible "nonfat" presenter, exposure to the credible "fat" presenter positively influenced attitude change (P = .031). CONCLUSIONS AND IMPLICATIONS: On-line communication of size acceptance improved attitudes of obesity long term. The findings support the ELM. The module demonstrates promise for teacher training in size sensitivity.

Adult↗
PubMedDate not supplied

Effects of the video case study in preparing paramedic preceptors for the role of evaluator.

INTRODUCTION: Accurate field evaluations are critical in determining paramedic students' competency to provide patient care. The [U.S.] National Paramedic Curriculum does not address the skills needed by evaluators, and requirements to be a preceptor/evaluator vary from state to state. Therefore, it is imperative that educational programs develop an evaluation process that reflects valid performance criteria and assure a high degree of rating consistency among the evaluators. This study sought to determine the effects of using a video case based teaching approach in preparing paramedic preceptors for the role of evaluator. HYPOTHESIS: Paramedic preceptors receiving the case-based teaching approach to prepare them for the role of evaluator would demonstrate significantly higher scores on a video posttest than paramedic preceptors who were not prepared for the role of evaluator using the case-based approach. METHODS: Thirty-four paramedic preceptors from a Midwestern fire-based EMS system were enrolled in this study. Two scripted video student/patient encounters were used to measure evaluation scores in a pretest-posttest comparison of control versus experimental group. The experimental group was given structured rating guidelines and practice applying those guidelines to a case study. Pretest and posttest scores were weighted and analyzed using ANOVA. RESULTS: Analysis of the pretest-posttest differences revealed significantly higher scores for the experimental group in the categories containing complex behaviors: communication F (1,16) = 13.21,p <.01, assessment F (1,16) = 8.81,p <.01, and knowledge F (1,16) = 29.64, p <.001. There was no significant difference between groups in the categories containing simple, easily observed behaviors: reliability F (1,16) = .55, p >.05 and cooperativeness F (1,16) = 3.02,p >.05. CONCLUSIONS: Using the case study method and written guidelines that provide concrete examples of complex behaviors appears to increase reliability of evaluations among preceptors.

Adult↗
PubMed2003

Evidence-based diagnosis in patch testing.

Evidence-based medicine (EBM) is defined as the integration of the best research evidence with clinical expertise and patient values. Based on the principles of EBM, we can conclude that patch testing is cost-effective only if patients are selected on the basis of a clear-cut clinical suspicion of contact allergy and only if patients are tested with chemicals relevant to the problem (high pretest probability). Random patch testing (low pretest probability) should be discouraged. Proper pretest probability assessment can only be done in expert centres, because problem-based testing requires both a thorough knowledge of the patch-test procedure and knowledge about potential sensitizers in a specific environment.

Allergens↗
PubMed1995

Effects of baseline responses, in-task feelings, and duration of activity on exercise-induced feeling states in women.

This study investigated the hypothesis that the effects of acute aerobic exercise on feeling states may be influenced by the objective dose of activity, subjective responses during exercise, and preexisting levels of feeling states. College-age women (N = 80) completed baseline measures and were then randomly assigned to 1 of 4 conditions: attention control for 10 min, or exercise for 10 min, 25 min, or 40 min. Levels of exertion and affect were assessed during exercise, and posttesting occurred 20 min following activity. Exercise enhanced revitalization in comparison with the control condition; however, this effect occurred only for participants scoring low to moderate on the pretest. In addition, in-task feeling states predicted postexercise revitalization even after we controlled for the treatment, the pretest, and the Pretest x Treatment interaction.

Adolescent↗
PubMed1988

State dependent learning and morphine tolerance.

On the basis of a Pavlovian conditioning analysis of morphine tolerance, cues signaling the systemic effects of morphine come to elicit conditional pharmacological responses that attenuate the effect of the drug. Experiments were conducted to evaluate the relevance of this analysis to recent reports that morphine-experienced rats, anesthetized with pentobarbital prior to a final test injection of morphine, do not display the analgesic tolerance seen in nonanesthetized rats. It was hypothesized that such pentobarbital blockage of morphine tolerance represents an instance of state-dependent learning: the barbiturate alters predrug cues so that the final, barbiturate-signaled morphine administration is presented in the context of different signals than those accompanying pretest administrations of the opiate. Results of the present experiments confirmed the finding that pentobarbital interferes with the expression of morphine tolerance in rats that had not previously received barbiturate-opiate pairings. In addition, the results supported the state-dependency interpretation of this interference: Rats that had pretest administrations of morphine signaled by pentobarbital, as well as the test administration, displayed substantial morphine tolerance. Moreover, if pretest morphine administrations were signaled by pentobarbital, omission of the barbiturate cue on the test session attenuated tolerance.

Animals↗