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PubMed1992

Pulmonary function changes following exercise.

Many studies have documented differing changes in forced vital capacity (FVC) following various intensities and durations of exercise. This investigation used three different intensities and durations of treadmill running, with subjects who were active runners, with the intent of finding an intensity or duration that might elicit changes in FVC and if these changes are related to respiratory muscle fatigue. Intensities and durations included a graded maximal test to exhaustion (7-14 min); a 7-min test at 90% of maximal VO2, and a 30-min test at 60% of maximal VO2 (intensity). Maximal inspiratory pressures (MIP), maximal expiratory pressures (MEP), forced expiratory volume in 1 s (FEV1.0) and FVC were measured pretest, and 5, 10, and 30 min post-test (time). MIP was not different across time or intensities. The decrease in MEP approached significance at 10-min post-exercise compared to pretest values (P = 0.0569), with no differences found between intensities. FVC was different between times (P = 0.0117) but not between intensities. FVC was decreased at 5 and 10 min post-test compared with pre and 30 min. FEV1.0 was significantly reduced at 5 and 10 min post-test compared with pretest. These data suggest that a combination of duration and intensity may be necessary to elicit pulmonary function changes after exercise and that expiratory muscle fatigue may be a factor that results in a reduced FVC.

Adult↗
PubMed2004

Efficacy of an educational Web site for educating physicians about bioterrorism.

OBJECTIVES: To determine whether a Web-based educational intervention improves emergency physicians' knowledge about bioterrorism and to survey physicians' knowledge and sources of information on bioterrorism. METHODS: Prospective randomized controlled trial using pre- and postintervention testing in hospitals. Participants were general and pediatric emergency medicine attending physicians, fellows, and fourth-year emergency medicine residents. All participants completed a pretest and attended a lecture on bioterrorism. Participants were then randomized to the Web intervention group that received continuous access to a bioterrorism educational Web site with weekly exposure to case scenarios of diseases due to biological agents, or the control group. Participants were retested after one and six months and surveyed to identify their sources of information and assess their knowledge. RESULTS: Sixty-three physicians completed the pretest. There was no difference in mean +/- standard deviation (SD) pretest scores between Web intervention (45% +/- 10%) and control (44% +/- 10%) groups (mean difference: 1.9%; 95% confidence interval [CI] = -6.7% to 2.9%). There was no significant difference between pre- and posttest scores among groups at one month (Web intervention 48% +/- 10% vs. control 45% +/- 10%; mean difference: 3.3%; 95% CI = -8.5% to 2.0%) and six months (Web intervention 51% +/- 8% vs. control 47% +/- 9%; mean difference: 3.8%; 95% CI = -8.8% to 1.2%). More than 60% of physicians cited media reports as their primary source of information on bioterrorism and believed that their knowledge of bioterrorism was limited after one month. CONCLUSIONS: Providing physicians information on bioterrorism through simulated cases and continuous access to an educational Web site does not increase knowledge of bioterrorism. Physicians are more likely to use media reports for their primary source of information.

Attitude of Health Personnel↗
PubMed2004

[Effect of a life review process to improve quality of life for the homebound elderly in Japan].

OBJECTIVE: This study examined the therapeutic effects of Life Review processes on physical and psychological functions of homebound elderly in Japan. METHODS: From 1998, a cohort of people aged 65 and over living in two cities in Yamagata Prefecture has been followed. Sixty-three subjects (24 men, 39 women) were classified as rank A (homebound). Fifty-two persons completed the baseline survey in 1999 and 46 eligible persons (18 men and 28 women) were allocated to intervention and control groups whose age and sex distribution were matched. Intervention entailed giving some health information and Life Review processing for four months, twice a month on average. Each session started with provision of health information followed by the Life Review process which took an hour to finish. All subjects of both groups were assessed for dependent variables at the beginning and the end of the intervention period (pretest and post-test). Dependent variables were physical (Activities of Daily Living, Visual deficit, and others), psychological (subjective health, life satisfaction, self-efficacy scale, and others), and social (functional ability and frequency of getting out of the house). The control group received only the pretest and the post-test. RESULTS: Pretest scores for all physical, psychological, and social variables did not significantly differ between the two groups. The rate for improvement/no change were higher with regard to hearing deficit, ADL (eating, dressing), cognition, subjective health, ikigai and frequency of getting out of house in the intervention group than in the control group, but there were no significant differences. CONCLUSION: The developed intervention program featuring delivery of health information and structured Life Review Process had no negative influence on physical and psycho-social functions. Practicability of the intervention was suggested. But the study highlights problems such as selection of subjects, duration and method of intervention.

Aged↗
PubMed2004

Using CD-ROM technology to increase folic acid knowledge among physician assistant students.

The purpose of this study was to examine the effectiveness of incorporating CD-ROM technology to increase the knowledge of folic acid among physician assistant students. Participants included 76 first-year physician assistant students enrolled in a Women's Health course. A pretest and posttest was used to evaluate the knowledge gain after viewing the CD-ROM over a 2-week period. Of the 76 students in the course, 73 completed the pretest and the post-test. Posttest scores were significantly better than pretest scores (t = -11.83; p < or = 0.001), with means 68.63% and 46.18%. Knowledge scores increased by 22.45% from pre-test to posttest. Student evaluation results suggested that the CD-ROM (1) provided folic acid information in a clear and effective manner, (2) adequately covered the folic acid information, (3) increased student awareness and knowledge about folic acid, and (4) may promote early commitment by students to recommend daily folic acid intake to their patients.

Allied Health Occupations↗
PubMed2004

Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities.

AIM: The reliability evaluation of the Italian version of the Scoliosis Research Society-22 Patient Questionnaire (SRS-22-I), administered to adolescents with mild vertebral deformities, is evaluated. METHODS STUDY DESIGN: forward-backward translation, pretest, final version according to a focus-group evaluation, and 1 week test/retest. POPULATION: pretest: 35 subjects (22 females), age range 8.5-19 years, 28 idiopathic scoliosis (17 degrees +/-7 degrees ), 7 hyperkyphosis (54 degrees +/-4 degrees ); test/retest: 20 subjects (11 females), age range 12-17.5 years, 15 idiopathic scoliosis (16 degrees +/-8 degrees ), 5 hyperkyphosis (55 degrees +/-5 degrees ). STATISTICAL ANALYSIS: Spearman rank test, percent of agreement. Statistical significance: 0.05. Software: Statgraphics 3.0. We calculated the results of the questionnaire and performed the statistical analysis using non parametric test because of the charcteristics of the data: this differ from previously published RESULTS RESULTS: Response rate was 100%. Total score: median 4 (range 3-5); results for different domains (median, range): function/activity 4 (3-5), pain 5 (3-5), self image/ appearance 3 (2-5), mental health 4 (3-5), satisfaction with management 4 (2-5). Time required to answer the questionnaire ranged from 5 to 20'; for 12 to 17.5 years old subjects from 5 to 10'. pretest showed difficulties with questions on pain; the questionnaire was changed accordingly. Spearman's rho ranged from 0.42 to 1, not significantly different from null value for questions 12 and 21. Percent of agreement (evaluated only for question 11a) was 100%. The ceiling and floor effects have been found high. CONCLUSIONS: The SRS-22-I was found to be reliable for young patients with mild vertebral deformities of different type. Lack of reliability for questions 12 and 21 should be better understood. Until now the psychometric properties of SRS-22 questionnaire have been evaluated only in USA populations, and in idiopathic scoliosis. Moreover, only one study has been proposed including patients with mild idiopathic scoliosis. This, together with the non-parametric statistical analysis used, could explain the high ceiling and floor effects we found in our data.

Journal Article↗
PubMed2005

Effects of ultrasonic scaling and hand-activated scaling on tactile sensitivity in dental hygiene students.

PURPOSE: This study was conducted to determine if tactile sensitivity varies in dental hygiene students who use the ultrasonic scaler, as compared to those who scale with hand-activated instruments. METHODS: A two-group, randomized subjects, pretest-posttest design was carried out mid-semester for five weeks on 40 first-year dental hygiene students who met the inclusion criteria of this study and who agreed to participate. A convenience sample of 40 consenting, first-year dental hygiene students were randomly assigned to one of two groups (experimental or control). After establishing a baseline tactile sensitivity score with the Vibratory Sensory Analyzer (VSA), experimental group subjects used the ultrasonic scaler to remove 4 cc's of artificial calculus from a typodont in a controlled, simulated clinical setting for 45 minutes, while each control subject manually scaled 4 cc's of artificial calculus on a typodont in a controlled, simulated situation for 45 minutes. Immediately following exposure to either the ultrasonic scaler or hand-activated scaling instruments, tactile sensitivity scores were obtained using the VSA. Analysis of variance with one repeated measures factor was used to determine between group and within group differences on the pretest and posttest tactile sensitivity scores. RESULTS: Results revealed that tactile sensitivity increased after a 45-minute scaling session with the ultrasonic scaler. Pretest to posttest changes in tactile sensitivity for the ultrasonic scaling group exhibited a much larger threshold as compared to those in the hand-activated scaling group, supporting a gain in students' level of sensitivity with stimulus (vibration). Tactile sensitivity decreased in those who used hand-activated scaling instruments. The thumb, index, and middle fingers of students in both groups showed similarities in tactile sensitivity, with the index finger being the most sensitive. CONCLUSION: Tactile sensitivity decreases with hand-activated scaling and increases with ultrasonic scaling over a 45-minute period. Short-term vibration exposure from the ultrasonic scaler is insufficient to negatively affect tactile sensitivity.

Analysis of Variance↗
PubMedDate not supplied

Resistance training and head-neck segment dynamic stabilization in male and female collegiate soccer players.

CONTEXT: Cervical resistance training has been purported to aid in reducing the severity of brain injuries in athletes. OBJECTIVE: To determine the effect of an 8-week resistance-training program on head-neck segment dynamic stabilization in male and female collegiate soccer players. DESIGN: Pretest and posttest control group design. SETTING: University research laboratory and fitness center. PATIENTS OR OTHER PARTICIPANTS: Thirty-six National Collegiate Athletic Association Division I collegiate soccer players (17 men, 19 women). INTERVENTION(S): The resistance training group underwent an 8-week cervical resistance training program that consisted of 3 sets of 10 repetitions of neck flexion and extension at 55% to 70% of their 10-repetition maximum 2 times a week. Participants in the control group performed no cervical resistance exercises. MAIN OUTCOME MEASURE(S): Head-neck segment kinematics and stiffness, electromyographic activity of the upper trapezius and sternocleidomastoid muscles during force application to the head, and neck flexor and extensor isometric strength. RESULTS: No kinematic, electromyographic, or stiffness training effects were seen. The posttest resistance training group isometric neck flexor strength was 15% greater than the pretest measurement. Isometric neck extensor strength in the female resistance training group was 22.5% greater at the posttest than at the pretest. Women's neck girth increased 3.4% over time regardless of training group level. Women exhibited 7% less head-neck segment length and 26% less head-neck segment mass than men. CONCLUSIONS: Despite increases in isometric strength and girth, the 8-week isotonic cervical resistance training did not enhance head-neck segment dynamic stabilization during force application in collegiate soccer players. Future researchers should examine the effect of head-neck segment training protocols that include traditional and neuromuscular activities (eg, plyometrics) with the focus of reducing head acceleration on force application.

Journal Article↗
PubMed1999

Proprioception and neuromuscular control of the shoulder after muscle fatigue.

OBJECTIVE: To examine the effects of fatigue on proprioception and neuromuscular control of the shoulder. DESIGN AND SETTING: Subjects were randomly assigned to either an experimental group or control group. Subjects were tested using either the active angle-reproduction or the single- arm dynamic stability test. The subjects were then fatigued using a dynamometer performing continuous, concentric rotation exercises of the shoulder. Once fatigued, the subjects were posttested using the same test. One week later, the subjects returned and were pretested, fatigued, and posttested using the other test. SUBJECTS: Thirty-two college-age (18 to 25 years) subjects (16 males, 16 females) with no history of glenohumeral instability or upper extremity injury volunteered for this study. MEASUREMENTS: Absolute angular error was measured using an electrogoniometer present within the isokinetic dynamometer, while sway velocity was measured using a force-plate system. RESULTS: Repeated-measures analysis of variance revealed a significant difference between the pretest and posttest values for absolute angular error in the experimental group, whereas no significant difference was revealed between pretest and posttest sway velocity for either the control or experimental group. CONCLUSIONS: Fatigue of the internal and external rotators of the shoulder decreased proprioception of the shoulder, while having no significant effect on neuromuscular control.

Journal Article↗
PubMed2006

Accuracy and consistency of radiographic interpretation among clinical instructors in conjunction with a training program.

There are inaccuracies and inconsistencies of radiographic interpretation among clinical instructors. The purpose of this investigation was to determine if a training program could improve the accuracy and consistency of instructors' ratings of bone loss. A total of thirty-five clinical instructors consisting of periodontal faculty (periodontists and general dentists), dental hygiene faculty, and periodontal graduate students viewed projected digitized radiographic images and quantified bone loss for twenty-five teeth into four descriptive categories. Ratings of bone loss were made immediately before (pretest) and after (post-test 1) initiation of the training program and then again three months later (post-test 2). Ratings were compared to the correct choice categories as determined by direct measurement using the Schei ruler. Overall agreement with the correct choice improved over time (from 64.5 percent to 85.2 percent) with the greatest change from pretest (64.5 percent) to post-test 1 (76.5 percent). Mean and absolute differences improved in three of the four categories, but worsened in one from pretest to post-test 1. This category returned to its original high value at post-test 2. The greatest improvement in consistency among instructors' ratings was seen in one of the four categories, which was "none" (no bone loss). Extension of the training program may further enhance the accuracy and consistency of instructors' radiographic interpretation.

Adult↗
PubMedDate not supplied

Academic outcomes for students with learning disabilities in consultation and resource programs.

In this study, pretest and posttest achievement test data were collected for 67 children with learning disabilities assigned to one of four conditions: one period of resource room instruction per day; two periods of resource room instruction per day; consultative services combined with in-class instruction; and consultative services to classroom teachers. Analysis of pretest achievement measures indicated that students assigned to two periods of resource room per day differed significantly from the other groups and results from this group were analyzed separately. Students in the remaining three conditions made gains in standing relative to same-age peers from pretest to posttest. Students receiving a combination of consultation and direct services showed small, but significantly greater overall gains in achievement than did students placed in the resource room.

Achievement↗
PubMedDate not supplied

Methodologic dilemmas in tapping the concept of patient needs.

Patients' awareness of their own physical and emotional needs during hospitalization and nurses' perception of those needs were tested by a questionnaire constructed for the purpose. The test took place in five units of a large university medical center and included 30 patients and their 20 nurses. A comparison group included ten patients and eight nurses. Despite apparent reliability after pretesting, the questionnaire proved unreliable after use with the study group. This difference may have resulted from differences in responses between the pretest and study groups or from interviewer variability. Or contrary to pretest findings, the real contents of physical and emotional needs may not have been tapped.

Adolescent↗
PubMed1985

Pharmacist competency certification in aminoglycoside dosing.

A pharmacist competency-certification program was developed to train and evaluate newly hired pharmacists, provide continuing education and skills development for staff pharmacists, and standardize clinical pharmacy practice at a 940-bed teaching hospital. A pretest, self-teaching module, and written final examination were developed; the total program can be completed in approximately one month. The self-teaching module contains 37 pages of factual material on the pharmacology, pharmacokinetics, antimicrobial spectra, cost, relative toxicities, and dosing and monitoring techniques for aminoglycoside antibiotics. The pretest and final examination consist of 20 multiple-choice questions based on actual patient cases. Following its initial implementation, 21 of 49 staff pharmacists elected to complete the program. There was an equal representation of pharmacist trainees, novice pharmacists, and experienced clinical pharmacists. All three groups demonstrated improvement over pretest scores. The trainees and novice pharmacists showed the greatest improvement. This program defines a standard of practice and provides a continuing-education tool. Because of its success, the program has been mandated in the orientation of all clinical pharmacists.

Aminoglycosides↗
PubMedDate not supplied

[Functional state and work capacity of man when breathing oxygen and hypoxic mixtures at excess pressure].

Experiments were carried out at sea level to investigate tolerance and work capacity of test subjects breathing 100% oxygen and hypoxic gas mixtures (HGM) containing 12.7-12.8% O2 at a positive pressure of 800 mm H2O. All test subjects tolerated 1 hour exposure to 100% O2 or HGM under positive pressure. However, HGM induced more distinct cardiopulmonary changes than O2. During the first minutes of exposure to positive pressure breathing the tracking performance deteriorated most. The number of errors was 24.5% with O2 and 21.4% with HGM more than in the pretest study. As the adaptation developed, the number of tracking errors decreased to reach the pretest level with O2 and to remain 6-10% higher than the pretest level with HGM.

Adolescent↗
PubMed1983

Evaluation of a cardiopulmonary-resuscitation training manual for pharmacists.

The development and evaluation of a training manual for pharmacists participating in cardiopulmonary resuscitation (CPR) efforts at an institution encompassing ambulatory-care, acute-care, and emergency-trauma facilities are described. The manual was developed to familiarize pharmacists who had little or no experience in CPR procedures with the equipment and medications used and the pharmacist's role on the CPR team. To evaluate the effectiveness of the manual, a 29-question multiple-choice test was administered to 35 staff pharmacists who were randomly assigned to study and control groups. Training manuals were issued to members of the study group, who were asked to document time spent studying them. Three weeks after the pretest, the same test was administered to all subjects. There was no control on the number of CPR events attended during the three-week period. The study group spent less than two hours (mean +/- S.D. = 97.5 +/- 34.22 min) using the manual. For the study group, posttest scores were significantly higher than pretest scores. The difference in pretest scores for the study and control groups was not significant, but for the posttest the study group scores were significantly higher. Because use of the manual appeared to improve knowledge of drug therapy and procedures used in CPR, the pharmacy department incorporated it into its orientation procedure.

Education, Pharmacy, Continuing↗
PubMed1995

Social skills training for young adolescents: symbolic and behavioral components.

The assertiveness program developed by Wise, Bundy, Bundy, and Wise (1991), which focused on the unique problems and peer interactions of young adolescents, was expanded to a 12-week program and presented to a group of 28 sixth graders. Cognitive acquisition and retention of the symbolic information was measured with a pretest, posttest, and follow-up administration of the multiple-choice tests that were designed and used in the prior study. Verbal content of assertive behavior was measured in a pretest and posttest role-play situation. When trained students were compared to a control group on the symbolic measures, a significant effect for treatment (p < or = .000); a significant effect for measures (p < or = .000); and a significant Treatment x Measure interaction (p < or = .000) were found. A comparison of means showed a significant difference between pretest vs. posttest and follow-up (p < or = .000). However, no difference between posttest and follow-up was found (p < .351). Unlike the earlier study, in which girls benefited more from training than did boys, no treatment by gender interaction was found for the cognitive measure (p < .691). Boys and girls benefited similarly in terms of the cognitive acquisition of assertiveness information from this program. However, the results did not show that these students were able to demonstrate assertiveness on the behavioral level. Results are discussed in terms of the difference between simply having stored symbolic information regarding assertive responses and recognizing contexts in which accessing the information would be appropriate. Suggestions for designing programs aimed at bringing about changes in adolescents' assertive behavior that will generalize to their lives beyond the training context are also offered.

Analysis of Variance↗
PubMed1995

Improving pediatric residents' alcohol and other drug use clinical skills: use of an experiential curriculum.

OBJECTIVE: To evaluate the effectiveness of an experiential alcohol and other drug curriculum on pediatric residents' knowledge, attitudes, and skills in alcohol and other drug (AOD) issues. DESIGN: Nonrandomized control trial. SETTING: Two university pediatric residency programs. PARTICIPANTS: Pediatric residents (n = 44). INTERVENTION: Intervention residents received an experiential AOD curriculum consisting of participation in an adolescent assessment program, interactive didactic sessions, role-playing practice, and interviewing skills sessions. The control group received no formal training. MAIN OUTCOME MEASURES: Pretesting and posttesting each group using written and Objective Structured Clinical Examination evaluations using standardized patients. Evaluations were videotaped and scored by an expert panel using a standardized scoring process. RESULTS: Pretest comparisons of written knowledge and clinical skills as assessed by the Objective Structured Clinical Evaluation showed no significant differences between the intervention and the control groups. Analysis of written test scores revealed that residents' general knowledge as well as knowledge of screening techniques and management resources related to AOD issues increased significantly more for the intervention group than for the control group from pretest to posttest (P < .001). Evaluation of the videotapes showed significant improvement for the intervention group compared with controls in overall score and in the use of specific screening techniques and interviewing skills (P < .05). Self-assessment of residents' interest, confidence, and competence in AOD issues improved significantly for intervention residents vs controls (P < .05). CONCLUSIONS: Pediatric residents receiving an experiential AOD curriculum increased their knowledge and clinical skills in AOD issues significantly more than residents receiving no formal training. Similar curricula and evaluation could be used by other primary care residency programs and could be implemented in other areas of adolescent health risk behaviors.

Adolescent↗
PubMed1994

Appropriate use of predictive values in clinical decision making and evaluating diagnostic tests for TMD.

Temporomandibular disorder literature contains serious misunderstandings and misapplications of statistical concepts, including predictive values, in evaluating diagnostic modalities and in clinical decision making. The use of general population prevalence data for temporomandibular disorders to evaluate positive predictive values of diagnostic modalities is shown to be invalid. The positive predictive value of a diagnostic tool should not be used to evaluate the efficacy of the tool or to confirm the presence of temporomandibular disorders when the pretest likelihood of temporomandibular disorder is low (eg, 10%). In such a situation, the TMJ Scale's negative predictive value of 98% supports the dentist's clinical impression of the absence of temporomandibular disorders. When the pretest likelihood of TMD is high (eg, 90%), the TMJ Scale's positive predictive value of 97% supports the dentist's clinical impression of the presence of temporomandibular disorders. The predictive values of the subscales of the TMJ Scale that measure joint dysfunction and stress may be used to further refine the diagnostic impression. When the dentist is unsure of the presence of TMD and makes a pretest estimate of 50%, the TMJ Scale's positive predictive value of 81% and negative predictive value of 83% substantially improve the accuracy of clinical decisions.

Decision Support Techniques↗
PubMed1994

Instruments for assessing the quality of drug studies published in the medical literature.

OBJECTIVES: To develop valid and reliable instruments to assess the methodologic quality and clinical relevance of drug studies. DESIGN: We developed an instrument to assess the methodologic quality of articles reporting clinical research and an instrument to measure nonmethodologic measures of quality, such as clinical relevance, generalizability, and adherence to ethical standards. Each instrument was pretested by seven independent, masked reviewers and modified based on interrater agreement and content validity of individual items. We determined correlational validity of the final methodologic quality instrument by comparing quality scores assigned to 10 articles by means of our instrument and a previously published one. PARTICIPANTS: Clinical drug studies published in symposium proceedings and peer reviewed biomedical literature. MAIN OUTCOME MEASURES: Interrater reliability of overall quality scores, measured by intraclass correlation (r) and Kendall's coefficient of concordance (W), and interrater reliability of individual items, by percentage agreement. MAIN RESULTS: The interrater reliability of the pretest methodologic quality instrument was high (r = .89 [95% confidence interval, .73 to .96]; W = 0.64). Correlational validity of the final instrument was suggested by the high degree of concordance with another previously published one (W = 0.74). The interrater reliability of the pretest clinical relevance instrument was moderate (r = .41 [95% confidence interval, .18 to .64]; W = 0.47). Reviewers confirmed the content validity of both instruments. CONCLUSIONS: The two instruments we developed, one measuring methodologic quality and one measuring clinical relevance of articles reporting clinical research, are reliable, valid, and applicable to a variety of research designs.

Drug Evaluation↗