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PubMed1998

Medical student knowledge of morphine for the management of cancer pain.

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.

Analgesics, Opioid↗
PubMed1998

Effects of an educational program on parents with febrile convulsive children.

The purpose of this study was to characterize the effects of an educational program on knowledge, attitude, concern, and first-aid measures among parents with febrile convulsive children. All parents completed a pretest questionnaire 3 weeks before the meeting. The parents were assigned randomly into experimental (n = 65) and control (n = 64) groups on the day they attended the program. The control group completed the identical questionnaire (posttest) before the program, whereas the experimental group completed the same posttest after the program. In pretest, most parents considered electroencephalogram or computed tomography necessary in evaluating their children, suggested that immunization be postponed, and rated the risk of subsequent epilepsy as high for their children. Most of them favored frequent body temperature measurement, were very anxious about further febrile convulsion episodes during the night, and were fever phobic. After education, although only a slight change in fever anxiety was found, the experimental group showed significant improvement in knowledge, attitude, concerns, and anticipatory practice of febrile convulsion compared with the control group. In conclusion the parents' poor knowledge, negative attitudes, anxiety, and inadequate first-aid measures toward febrile convulsion can be effectively improved by an educational intervention program.

Analysis of Variance↗
PubMed1996

Documenting laryngeal change following prolonged loud reading. A videostroboscopic study.

This study investigated the effects of prolonged loud reading on trained and untrained subjects. Subjects were eight young women singers, and eight young women with limited musical experience. Each subject underwent videostroboscopic examination prior to and following 1 h of prolonged loud reading. The pretest and posttest videotaped samples were randomized and presented to three experienced judges, who evaluated various aspects of laryngeal appearance and vibratory characteristics. Analyses of group data revealed that untrained subjects showed a small but significant increase in amplitude of vocal fold excursion following the experimental task. No significant differences were noted in the trained singer group. When individual variation was analyzed, it was found that most subjects did not show many changes from pretest to posttest. It was concluded that a l-h loud-reading task was not sufficient to induce notable laryngeal alterations.

Adult↗
PubMed1998

Effect of mental stress on plasma homovanillic acid in healthy human subjects.

Plasma levels of homovanillic acid (pHVA) have been suggested to provide a measure of dopaminergic activity in the central nervous system. The present study investigated the effect of mental stress by the Kraepelin test, a test of continuous arithmetic addition of single-digit figures for 30 min, on pHVA levels in 13 male psychiatrically normal healthy volunteers. Following an overnight fast and restricted physical activity, plasma samples were collected immediately before and after the administration of the Kraepelin test. Plasma HVA levels following the administration of the Kraepelin test were significantly lower than the pretest pHVA levels. The percent change in pHVA levels by the Kraepelin test positively correlated with pretest pHVA levels. The observed reduction in pHVA levels by mental stress in normal subjects may reflect some aspects of a dopamine-dependent restitutive system in the brain.

Adult↗
PubMed1999

Cross-cultural adaptation of a psychometric instrument: two methods compared.

Cross-cultural adaptations of questionnaires are needed in multilingual research, but little is known about the effectiveness of specific translation methods. We compared properties of two French-language adaptations of the SF36 health survey: (a) a rapid translation developed over 3 months in Geneva in 1992 (Geneva version), based on three initial translations, one synthesis, and two pretests, and (b) a comprehensive adaptation developed by the International Quality of Life Assessment Project between 1991 and 1994 (IQOLA version), which involved back-translations, focus groups, development of equidistant response options, item difficulty and quality ratings, and multiple pretests. Wordings of 34 of 36 items differed. These two instruments were administered 1 year apart to the same sample of 946 young adults. Ceiling effects were somewhat lower for the IQOLA than for the Geneva version (means 30.4% and 35.5%), and missing scores slightly less frequent (IQOLA: mean 0.5%; Geneva: 1.2%). Floor effects (means 2.7% and 2.4%), proportions of consistent respondents (93.4% and 94.0%), and internal consistency coefficients (IQOLA: 0.78-0.89, Geneva: 0.80-0.92) were similar. Factor analysis supported the existence of two main aspects of health (physical and mental) for both versions. A majority of known-group comparisons were compatible with theory, for both versions. In conclusion, the two French-language versions of the SF36 had similar psychometric properties, despite extensive differences in the development process. This suggests that a moderately resource-intensive translation may produce adequate results. More empirical research is needed to understand what translation methods yield the best results.

Adaptation, Psychological↗
PubMed2006

Learning gains derived from a high-fidelity mannequin-based simulation in the pediatric emergency department.

There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 +/- 15% to 93 +/- 4%) and behaviors (from 65 +/- 18% to 85 +/- 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department.

Dyspnea↗
PubMed2000

Minority recruitment in clinical trials: a conference at Tuskegee, researchers and the community.

PURPOSE: This article describes the planning, implementation, and evaluation of a 2-day conference designed to examine the factors related to the participation of African Americans in cancer clinical trials. METHODS: Pre-conference formative evaluations (e.g., focus group discussions and key informant interviews with community leaders and health providers) were conducted in several rural and urban counties in the state of Alabama to determine African Americans' perceptions of participation in clinical research. The findings from these evaluations were used to develop a conference format and agenda. The 2-day conference included: (i) a pretest of African Americans' perceptions of cancer research, participation factors, and communication and recruitment issues; (ii) individual presentations high-lighting community leaders, church leaders, and researchers' perspectives regarding minority participation in research; (iii) working group discussions regarding the barriers and solutions to minority participation in research; and (iv) a posttest evaluation to measure changes in African Americans' perceptions of research. RESULTS: Several recruitment barriers and solutions were identified and reported by the working groups. Comparisons of the pretest and posttest measures showed significant (p > .05) and favorable shifts in the areas of perceptions of cancer research, participation factors, communication issues, and recruitment issues. Participation in the conference reflected a positive change in attitudes on these measures. However, the theme, "barriers that contributed to nonparticipation," did not show any significant changes during the two testing periods. The most critical lesson that resulted from this conference was the need for researchers and community members to have open dialogue about participation in research. CONCLUSIONS: This conference demonstrated that progress can be made when all parties are at the "table" and can be heard. In this model, community members proved to be valuable resources in providing researchers with information that was vital to the success of recruitment and retention studies and trials.

Black or African American↗
PubMed2003

Evidence-based medicine: neuroimaging of seizures.

Evidence-based medicine is useful in epilepsy and neuroimaging (Figs. 1 and 2). An understanding of the pretest probability suggests that focal neurologic deficits are important in predicting the outcome of neuroimaging examinations. In cases of nonacute symptomatic seizures, confusion and postictal deficits should prompt MR evaluation. In remote symptomatic seizures, MR imaging should be performed in a child with unexplained cognitive or motor delays or a child less than 1 year of age. Patients with partial seizures, abnormal EEG, or generalized epilepsy also should be imaged. Acute seizures should be imaged with CT to exclude hemorrhage and because of the availability and speed of the modality. Ictal SPECT is the best neuroimaging examination to localize seizure activity. MR imaging can offer prediction of surgical outcome and may hold promise in the future for dimensional localization of seizure focus. Evidence-based medicine can only work if there is physician communication. The pretest probability is helpful only when an accurate history is provided to the consulting physician. This field will flourish if physicians can develop accurate methods of collating information and reporting it in a timely fashion in the literature.

Evidence-Based Medicine↗
PubMed2000

Sex education in secondary schools: an Italian experience.

PURPOSE: To evaluate the impact on Italian teenagers' knowledge and attitudes of an experimental program in sex education. METHODS: The program consisted of five workshops in five public secondary schools in Rome. The impact of the program was evaluated with three questionnaires designed for this study. A pretest evaluated baseline knowledge, a posttest measured the gain in knowledge, and a third questionnaire estimated retention of information 4-6 months later. Three hundred seventy-six students attending secondary school participated in the program. Thirteen questions were selected for the analysis, and improvement was measured by the difference between pretest and posttest scores. RESULTS: Ninety-six percent of the sample was in favor of sex education programs in schools. The students had an average 50% gain in the percentage of correct answers following the course. The mean score based on the number of correct answers to questions showed a baseline value of 5.00, a posttest value of 11.80, and a test value 4-6 months later of 10.7. Results showed students' positive attitude toward school sex education courses, low baseline knowledge, and a good ability to learn. CONCLUSIONS: In Italy there is a need for collaboration between schools and local health services to promote knowledge and prevention in reproductive health among teenagers.

Adolescent↗
PubMedDate not supplied

Prognostic value of stress myocardial perfusion single photon emission computed tomography imaging in patients with left ventricular bundle branch block.

BACKGROUND: Left bundle branch block (LBBB) may occur with or without structural heart disease. In patients with coronary artery disease the presence of LBBB is associated with an increased risk of cardiovascular events. METHODS AND RESULTS: This study examined the outcome of 293 medically treated patients with LBBB and symptoms who were undergoing stress thallium-201 single photon emission computed tomography imaging. One hundred seventy-three men and 120 women with an age range of 67 +/- 9 years and a pretest probability of coronary artery disease of 77% +/- 28% were studied. During a mean follow-up of 33 months 58 hard cardiac events (death or nonfatal myocardial infarction) and 112 total events (hard events, coronary angioplasty, coronary bypass surgery, or cardiac transplantation) occurred. Univariate and multivariate Cox survival analysis with clinical, stress, hemodynamic, and single photon emission computed tomography variables identified the perfusion defect size (chi square = 27, p = 0.0001) and increased lung thallium uptake as the most important independent predictors of hard or total cardiac events. The hard event-free survival rate was 91% in patients with no or small defects (<15% of left ventricular myocardium) and 72% in patients with large defects (p = 0.0001, RR = 3.2, 95% CI 1.7 to 5.9). The total event-free survival rate was 81% in patients with small defects and 48% in patients with large defects (p = 0.0001, RR = 2.7, 95% CI 1.9 to 4.0). The total event rate was 54% in patients with large perfusion defects and increased lung uptake and 17% in patients with no or small abnormality and normal lung thallium uptake (p = 0.0001). CONCLUSION: Single photon emission computed tomography perfusion imaging is useful in predicting outcome in patients with LBBB and intermediate pretest probability of coronary artery disease. The size of perfusion abnormality and lung thallium uptake stratified patients into high and low risk groups with a threefold difference in hard and total cardiac events.

Aged↗
PubMedDate not supplied

Cost analysis of diagnostic testing for coronary artery disease in women with stable chest pain. Economics of Noninvasive Diagnosis (END) Study Group.

BACKGROUND: Seven clinical sites compiled data from 4638 women who were referred directly to coronary angiography (catheterization-first strategy; n = 3375) or who underwent stress myocardial perfusion imaging (MPI) first (n = 1263) followed by coronary angiography if at least one reversible myocardial perfusion abnormality was detected. The study examines the cost minimization potential of these available invasive and noninvasive diagnostic strategies in women with chest pain. METHODS AND RESULTS: Women in both groups were subclassified by the core laboratory as being at low (<0.15), intermediate (0.15 to 0.60), or high (>0.60) pretest likelihood for coronary artery disease (CAD). Among the catheterization-first patients, at least one coronary stenosis >70% was present in 13% of low likelihood patients, 29% of intermediate likelihood patients, and 52% of patients with high CAD likelihood. Perfusion abnormality rates in the MPI-first group were 23% in low likelihood patients, 27% in intermediate likelihood patients, and 34% in high CAD likelihood patients. Of the MPI-first subset, 50%, 55%, and 76%, respectively, underwent catheterization in at least one coronary stenosis >70%. Cardiac death rates ranged from 0.5% to 2.2% in patients with CAD and did not differ from the 2 testing strategies (P = not significant). The composite cost per patient of diagnostic testing plus follow-up medical care over a period of 2.5 +/- 1.5 years (calculated for both strategies from inflation-corrected Medicare charges, adjusted for institutional cost-charge ratios) ranged from $2490 for patients with low likelihood to $3687 for patients with high likelihood with the catheterization-first strategy and from $1587 to $2585 for patients undergoing MPI first (P < .01 between risk subsets and strategies). CONCLUSIONS: In women referred for diagnostic evaluation of stable chest pain, MPI followed by selective coronary angiography in patients with at least 1 perfusion abnormality minimizes the near-term composite cost per patient compared with a direct catheterization-first strategy, regardless of pretest CAD likelihood.

Aged↗
PubMed2002

Distributed Web-supported radiology clerkship for the required clinical clerkship year of medical school: development, implementation, and evaluation.

RATIONALE AND OBJECTIVES: The authors performed this study to develop, implement, and evaluate a new radiology clerkship for the required clinical clerkship year of medical school. MATERIALS AND METHODS: A mandatory radiology clerkship experience was added to the required clinical clerkships as a series of 10 independent half-day teaching sessions. These sessions were distributed as one session per existing clerkship throughout the year. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the radiology clerkship. The new clerkship was evaluated with observations, pretest and posttest measures with a control group, structured and unstructured student and faculty surveys, and individual and small group interviews. RESULTS: The clerkship was successfully developed and implemented. Ninety-five students have completed the clerkship. Their mean posttest score (84.8) was significantly higher than their mean pretest score (58.8, P < .001) and the mean control group score (59.7, P < .001). Students rarely used the Web site. Disadvantages of the distributed clerkship were identified. CONCLUSION: A radiology clerkship distributed among existing clerkships is feasible but has many disadvantages. Students greatly prefer live instruction, and Web-based educational materials are more valuable to faculty and administrators than to students.

Attitude↗
PubMed1999

Chest radiology case exchange program: a paradigm for resident teaching and independent resident learning.

RATIONALE AND OBJECTIVES: The purpose of this study was to test the effectiveness of resident-prepared, independent learning cases in teaching residents chest radiology. MATERIALS AND METHODS: Three 2nd-year residents (one each from the University of Wisconsin, the Oregon Health Sciences University, and the University of Michigan) prepared four chest radiology teaching cases each (total, 12 cases). Radiology residents from each institution were randomly divided into control (n = 30) and experimental (n = 35) groups. Residents from both groups took a pretest of 36 multiple-choice questions covering the material from the 12 teaching cases. Residents in the experimental group reviewed these cases independently, and both groups took the same test (posttest) immediately after the teaching cases had been reviewed and again 3 months later (final test). RESULTS: Test scores were similar across institutions (P > .05) but differed across time and treatment groups (experimental vs control) (P < .0001). Mean differences in test scores between the experimental and control groups at pretest, posttest, and final test were -0.4, +9.0, +4.0, respectively, demonstrating increased performance at posttesting that was still present (though somewhat attenuated) 3 months later at final testing. CONCLUSION: Independent study of resident-prepared chest radiology teaching cases increases the resident's knowledge for as long as 3 months after instruction.

Analysis of Variance↗
PubMed2004

Patient knowledge of immunotherapy before and after an educational intervention: a comparison of 2 methods.

BACKGROUND: Immunotherapy is an invaluable therapy for allergic asthma, allergic rhinitis, and hymenoptera hypersensitivity. It is, however, not without risks. OBJECTIVES: To examine patient knowledge regarding immunotherapy and to determine the most effective educational method to improve their knowledge by answering the following questions: Before educational intervention, what is the current knowledge level regarding allergy vaccinations of patients receiving immunotherapy? What effect does an educational encounter have on that level of knowledge? Which educational intervention--a one-on-one session vs a handout--if either, increases patient knowledge more? METHODS: An original, self-administered patient questionnaire was distributed to all patients receiving immunotherapy. Patients were randomly assigned to a control group, an intervention group that received an educational handout monthly for 2 months, or an intervention group that had a one-on-one educational session with a physician or nurse practitioner. After 3 months, all patients completed an identical follow-up questionnaire. Pretest and posttest scores were compared for each group and among the different groups to determine which method was more effective. Repeated-measures analysis of variance was used to determine the effect of instruction type on differences in pretest and posttest scores. RESULTS: All 3 groups significantly improved their mean overall questionnaire scores (P < .001). The amount of change was greater in the intervention groups than in the control group, but it did not reach statistical significance (P = .59). CONCLUSIONS: Baseline immunotherapy knowledge of allergy vaccination patients was better than expected, and further educational interventions did not significantly improve this knowledge.

Adrenergic beta-Agonists↗
PubMed2003

The effects of fexofenadine on reaction time, decision-making, and driver behavior.

OBJECTIVE: To evaluate the effect of fexofenadine on driver behavior, decision-making, and reaction time in a blinded, randomized, parallel, placebo-controlled study. METHODS: A total of 259 male and female adult volunteers participated in a standardized BMW advanced driving test (the skid-pan test; Pretoria, South Africa) and a decision and reaction test of the Vienna Psychomotor Test System. The psychomotor test focused on mean decision times, mean reaction time, decision errors and reaction errors. After a baseline pretest run, the test was repeated 2.6 hours after ingesting either fexofenadine hydrochloride (180 mg) or placebo (the posttest; 1:1). RESULTS: Two hundred fifty-five volunteers were included in the final efficacy analysis (195 males and 60 females). There was a reduction in the road test time going from the pretest to the posttest, signifying a learning effect, and an increase in the decision time. Although there was a consistent increase in the number of errors committed in the road test, decision time, and reaction time, there were no significant differences between the placebo and the fexofenadine groups. Although significant differences were observed between men and women for the road test time (P < 0.001), decision time (P < 0.001), and reaction time (P = 0.003), there were no differences between the fexofenadine and placebo groups in these subgroups. CONCLUSIONS: No differences were found between the fexofenadine and placebo groups on reaction times, decision-making, driver behavior, or adverse effects.

Adolescent↗
PubMedDate not supplied

Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting.

OBJECTIVES: To identify patients at risk for coronary artery disease (CAD) through a search of a community pharmacy's prescription database, to screen and identify patients with elevated cholesterol and at risk for CAD, to enroll patients in a pharmacist-directed lipid management program, and to evaluate selected clinical and humanistic outcomes. DESIGN: Randomized, pretest-posttest control groups. SETTING: Independent community pharmacy in a suburban metropolitan area. PATIENTS: 51 patients who were not at National Cholesterol Education Program low-density lipoprotein cholesterol (LDL-C) or defined triglyceride goals and who met inclusion criteria. INTERVENTION: Pharmacist-directed lipid management program. MAIN OUTCOME MEASURES: Clinical outcome measures included total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglyceride levels; achievement of LDL-C goal; and risk factor prediction scores. Humanistic outcome measures included patient satisfaction with pharmaceutical care and patient knowledge of hyperlipidemia. RESULTS: LDL-C was decreased in the pharmacist intervention group (n = 25), compared with an increase in the control group at study end. HDL-C levels increased and triglyceride levels decreased in both groups. Of treatment group patients, 32% achieved their cholesterol goals, compared with 15% of control group patients. Risk factor prediction scores improved in the treatment group and worsened in the control group. The treatment group's hyperlipidemia knowledge scores improved significantly from pretest to posttest. Both treatment and control group patient satisfaction scores for the pharmacist investigator were favorable at study end. CONCLUSION: Both treatment and control patients benefited from participating in this study. Patients enrolled in the lipid management program made greater improvements in their knowledge of hyperlipidemia, risk factor scores, and cholesterol levels.

Community Pharmacy Services↗
PubMed2000

Comparing wobble board and jump-landing training effects on knee and ankle movement discrimination.

The effects of two training programs on movement discrimination ability, at the ankle and knee, were assessed from the left and right lower limbs of forty-four football players. All players in three Under 18 Victorian Football League (VFL) squads were allocated to either wobble board training, jump landing training, or no-training conditions. Pre-tests to assess discrimination of extent for active movements made while standing were carried out on both ankles and knees of all subjects, using an automated device to accurately set the different movement stop points. Five distances were used, between 10.5 degrees and 14.5 degrees from horizontal for ankle inversion, and between 30.3 degrees and 31.7 degrees from vertical for knee flexion. From a series of 50 inversion movements and 50 knee flexion movements, matrices of absolute judgement by actual movement extent were produced. Non-parametric signal detection analysis was applied to the discrimination score. All subjects were retested after eight weeks. Improvement in discrimination of ankle movements into inversion from pre-test (0.65) to post test (0.70) for the wobble board trained group was significantly larger than the change in the jump-landing trained and the untrained groups (Jump Landing: Pretest: 0.64 to Post-test: 0.64 and Control; Pretest: 0.63 to Post-test: 0.64). Discrimination of knee flexion movements improved significantly from pre-test to post-test in all three groups. These data demonstrate that wobble board training can improve discrimination of discrete ankle inversion movements, an effect interpreted as enabling greater accuracy in the making of inversion movements in foot preparation prior to ground contact.

Adolescent↗
PubMedDate not supplied

Nutrition education materials from the National Institutes of Health: development, review, and availability.

Many of the institutes, centers, and offices (ICOs) within the National Institutes of Health (NIH) develop and disseminate nutrition education materials for the general public. These materials provide information about the relationship of diet to health and about associations between diet and specific diseases. The materials, which are drafted by the NIH or contract science writers, go through pretesting (for literacy level and appropriateness for target audiences) and ICO clearance (for scientific accuracy). To further ensure scientific and technical accuracy and consistency with the Dietary Guidelines for Americans, the materials then go through a two-tiered governmental review system. The first review is through the Nutrition Education Subcommittee (NES) of the NIH Nutrition Coordinating Committee. The second review, which is required for federal nutrition education materials, is conducted jointly by the Department of Health and Human Services (DHHS) Nutrition Policy Board Committee on Dietary Guidance and by the US Department of Agriculture (USDA) Dietary Guidance Working Group. The review process helps ensure consistency in nutrition messages within the NIH ICOs and among government agencies. The pretesting, ICO clearance, NES review, and joint DHHS/USDA review result in materials for nutrition educators that are high in quality, low in cost or free, easily accessible, appropriate for the intended target audience, and consistent with the Dietary Guidelines for Americans.

Government Publications as Topic↗