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PubMed2003

The ability to self-monitor performance during a week of simulated night shifts.

STUDY OBJECTIVES: Research has indicated that individuals are able to accurately monitor the performance decrements they experience during unitary periods of acute sleep deprivation. The aim of the current study was to investigate the ability to self-monitor performance during a week of simulated night shifts. DESIGN: Subjects completed 7 consecutive 8-hour night shifts (11 pm-7 am). SETTING: University sleep laboratory. SUBJECTS: Fifteen young (7 men, 8 women, 19-25 years) healthy volunteers. INTERVENTIONS: During the night shifts, performance was measured hourly on 4 performance parameters: psychomotor vigilance test (PVT), tracking, and grammatical reasoning (GRG) accuracy and response latency. Before and after each test, subjects completed visual analogue scales, which required them to rate their alertness and their performance speed and/or accuracy. RESULTS: Analysis indicated that GRG response latency and tracking were significantly impaired (P<0.05) during the first 2 shifts only. The PVT performance displayed consistent impairment, with significant (P<0.05) declines during all but the final shift. The pattern of deterioration in subjective ratings of alertness was similar to that of the PVT data. Correlations between subjective alertness and self-ratings of performance were significant (P<0.01) for all parameters (r=0.39-0.69). Significant (P<0.05) correlations were found across the week between pretest performance ratings and actual performance for all parameters except GRG accuracy (r=0.29-0.58) and between posttest ratings and actual performance for all parameters (r=0.52-0.75). Correlations between pretest ratings and actual performance were also conducted separately for each shift. Highest correlations were found during the first shift, with r-values that were low for GRG accuracy (r=0.32) and GRG response latency (r=0.20), moderate for tracking (r=0.41), and high for PVT (r=0.82). In general, lower correlations were found later in the week. CONCLUSIONS: Overall, results indicate that individuals have only a moderate ability to predict performance impairment during a week of night shifts. It is likely that performance ratings are based, at least to a certain extent, on subjective alertness levels. Furthermore, it seems that rating accuracy is improved on tasks providing performance feedback, such as the PVT. Finally, it appears that after testing, individuals have a more accurate perception of their performance.

Acute Disease↗

PubMed1995

High-dose dexamethasone suppression testing versus inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome: a decision analysis.

Differentiation of adrenocorticotropin (ACTH)-dependent Cushing's syndrome between Cushing's disease and the occult ectopic ACTH syndrome is difficult. Simultaneous bilateral inferior petrosal sinus sampling (IPSS) for ACTH levels in response to corticotropin-releasing hormone has high diagnostic accuracy, but its cost-effectiveness has not been analyzed. In this study, decision analysis was used to compare two diagnostic strategies: IPSS versus high-dose dexamethasone suppression (HDD) followed by IPSS in those with a negative HDD test. Sensitivity analyses were performed for all variables. The authors found that at 100% accuracy, IPSS has an incremental cost-effectiveness ratio of $1,000,000 per life saved. Incremental cost, incremental effectiveness, and incremental cost-effectiveness are sensitive to the pretest probability of Cushing's disease, test characteristics, and test costs. As the pretest probability of Cushing's disease decreases, cost per life saved also decreases to less than 85%, the HDD strategy saves more lives and costs less. When the HDD test has a 83% sensitivity rate and a 100% specificity rate, the two strategy remains less expensive. The IPSS strategy saves lives whenever HDD specificity is less than 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

ACTH Syndrome, Ectopic↗

PubMed1997

A comparison of traditional textbook and interactive computer learning of neuromuscular block.

We designed an educational software package, RELAX, for teaching first-year anesthesiology residents about the pharmacology and clinical management of neuromuscular blockade. The software uses an interactive, problem-based approach and moves the user through cases in an operating room environment. It can be run on personal computers with Microsoft Windows (Microsoft Corp., Redmond, WA) and combines video, graphics, and text with mouse-driven user input. We utilized test scores 1) to determine whether our software was beneficial to be the educational progress of anesthesiology residents and 2) to compare computer-based learning with textbook learning. Twenty-three residents were divided into two groups matched for age and sex, and a pretest was administered to all 23 residents. There was no significant difference (P > 0.05) in the pretest scores of the two groups. Three weeks later, both groups were subjected to an educational intervention; one with our computer software and the other with selected textbooks. Both groups took a posttest immediately after the intervention. The test scores of the computer group improved significantly more (P < 0.05) than those of the textbook group. Although prior to the study the two groups showed no statistical difference in their familiarity with computers, the computer group reported much higher satisfaction with their learning experience than did the textbook group (P < 0.0001).

Anesthesiology↗

PubMed2002

Simulation technology: a comparison of experiential and visual learning for undergraduate medical students.

BACKGROUND: The availability of simulator technology at the University of Toronto (Toronto, Ontario, Canada) provided the opportunity to compare the efficacy of video-assisted and simulator-assisted learning. METHODS: After ethics approval from the University of Toronto, all final-year medical students were invited to participate in the current randomized trial comparing video-based to simulator-based education using three scenarios. After an introduction to the simulator environment, a 5-min performance-based pretest was administered in the simulator operating room requiring management of a critical event. A posttest was administered after students had participated in either a faculty-facilitated video or simulator teaching session. Standardized 12-point checklist performance protocols were used for assessment purposes. As well, students answered focused questions related to the educational sessions on a final examination. Student opinions regarding the value of the teaching sessions were obtained. RESULTS: One hundred forty-four medical students participated in the study (scenario 1, n = 43; scenario 2, n = 48; scenario 3, n = 53). There was a significant improvement in posttest scores over pretest scores in all scenarios. There was no statistically significant difference in scores between simulator or video teaching methods. There were no differences in final examination marks when the two educational methods were compared. Student opinions indicated that the experiential simulator sessions were more enjoyable and valuable than the video teaching sessions. CONCLUSIONS: Both simulator and video types of faculty-facilitated education offer a valuable learning experience. Future work is needed that addresses the long-term effects of experiential learning in the retention of knowledge and acquired skills.

Adult↗

PubMedDate not supplied

Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy.

Screening flexible sigmoidoscopy (FS) is an effective tool for the detection of colon cancer. Nonetheless, persons are reluctant to undergo FS for a variety of reasons such as anxiety, discomfort, and the possibility of abnormal findings. Nurses caring for FS patients can implement interventions to allay anxiety and promote comfort in an effort to enhance satisfaction and future compliance. Music therapy is one nonpharmacologic intervention that has been shown to be effective in allaying anxiety, reducing discomfort, and promoting satisfaction in other patient populations. A two-group pretest, posttest experimental design with repeated measures study recruited 64 subjects undergoing FS from one Midwestern tertiary care center. Subjects were randomly assigned to a control condition of usual procedural care or to an experimental condition of music therapy during the examination. State and trait anxieties were measured at pretest. State anxiety, discomfort, satisfaction, and perceived compliance with future screening were measured after the procedure. Subjects in the music group reported less anxiety and discomfort than subjects in the control group. There were no differences on satisfaction ratings or perceived compliance with screening guidelines. Nurses caring for patients undergoing screening FS can offer music therapy as one nonpharmacologic intervention to ameliorate anxiety and reduce discomfort.

Analysis of Variance↗

PubMed2000

Guanosine impairs inhibitory avoidance performance in rats.

The nucleoside guanosine, previously found to exert trophic and neuroprotective effects, was found to impair retention of inhibitory avoidance responses, with a complete effect at 7.5 mg/kg i.p. pretraining. Treated animals, when retrained 1 week later, showed normal learning ability. Guanosine injected immediately after training or pretest did not alter retention latency. Combined pretraining and pretest treatments with guanosine failed to reverse its amnestic effect, excluding the contribution of state dependency. Open field parameters and shock sensitivity were mostly unaltered by guanosine. These results suggest an amnestic effect of guanosine on inhibitory avoidance in rats, in a pattern compatible with inhibition of glutamatergic activity. However, the mechanism for the amnestic effect of guanosine is yet to be elucidated.

Animals↗

PubMed1977

A systematic and comprehensive approach to teaching and evaluating interpersonal skills.

This study addressed one problem with current methods for teaching and evaluating interpersonal skills: the failure to include a wide range of behaviors reported in the literature as contributing to patient dissatisfaction and noncompliance. To address this concern, the authors developed a comprehensive interpersonal skills training program and a pretest-posttest evaluation. The tests were administered to two student groups one of which received the interpersonal skills instruction. The student group exposed to the training exhibited a significant positive change from pretest to posttest. Additionally the change for this group was significantly greater than the change for the group not exposed to interpersonal skills instruction.

Allied Health Personnel↗

PubMed1999

Distilling the literature: a randomized, controlled trial testing an intervention to improve selection of medical articles for reading.

PURPOSE: To test whether an academic detailing intervention would improve journal reading among residents. METHOD: In 1995-96, the authors conducted a randomized controlled trial at two family medicine residencies in Missouri. Fifty-nine family practice residents were randomized into two groups identical in baseline characteristics; 29 received individual 15-minute educational presentations, based on academic detailing, that emphasized careful selection of medical journal articles for reading. The authors measured the percentage of important journal articles of which the residents were aware, the percentage of those they had read (either abstract only or the whole article), and the percentage of correctly answered knowledge questions. RESULTS: Despite randomization, the residents in the control group indicated on the pretest that they were more likely than were the residents in the intervention group to be aware of and to have read abstracts from selected articles. However, when comparing pretest with posttest results, the intervention group recalled 18.2% (95% CI, 2.0, 34.0) more articles and correctly answered 16.6% (95% CI 3.0, 29.9) more knowledge questions than did the control group. CONCLUSION: A brief intervention increased residents' recall of important articles and knowledge of those articles' conclusions.

Decision Making↗

PubMed2002

A prospective, randomized controlled study of computer-assisted learning in parasitology.

PURPOSE: To compare, using a prospective, randomized controlled study, three methods of teaching a medical school parasitology course: computer-based instruction, traditional lecture-based instruction, and a combination of computer-based and lecture-based instruction. METHOD: A single class of the University of Utah School of Medicine was randomized into three study groups for the second-year parasitology course. The computer group (n = 29) used a locally developed interactive parasitology computer program; the lecture group (n = 32) had traditional lectures, and the combined group (n = 33) used both the computer program and lectures. Students' knowledge was assessed using a pretest, a final examination, and a posttest administered four months after the course. Students also used logs to track the amounts of time they spent studying. Their impressions and course evaluations were collected using a standardized course-evaluation form. RESULTS: The groups' scores on the pretest, final examination, and posttest were not statistically significantly different. Students in the computer group averaged 26.8 hours of studying over the two-week course compared with 32.1 hours in the lecture group and 32.7 hours in the combined group. The difference in study times between the computer and combined groups yielded a significant p value of 0.036. Students were generally positive about the course and the computer program. CONCLUSION: Students can learn parasitology from computer-based instruction as effectively as from traditional lecture-based instruction, and they can do so in less time.

Adult↗

PubMed2004

Musculoskeletal injection skills competency in physical medicine and rehabilitation residents: a method for development and assessment.

An educational module was developed in attempt to satisfy two main objectives: to develop and implement a methodology for instruction of generally encountered injection techniques in the practice of physical medicine and rehabilitation and to implement an objective assessment format to measure attainment of these skills. Guidelines for this module were developed in consideration of Accreditation Council for Graduate Medical Education (ACGME) physical medicine and rehabilitation residency program requirements and ACGME Outcome Project. Eleven physical medicine and rehabilitation residents participated in a 1-day didactic/laboratory workshop covering injection education and techniques, followed by a supervised 2-wk practice session. Knowledge acquisition and skill attainment were measured via before and after multiple-choice written examination and simulated patient encounters utilizing anatomic models. An increase in knowledge was observed on the multiple-choice examination from pretest to posttest (pretest, 59.3%; posttest, 90.6%). Before instruction, 0 of 11 residents were able to perform any of the injection techniques (14 injection techniques and one sterile technique). At completion of the module, 7 of 11 residents (64%) competently performed 15 of 15 techniques (100%), 3 of 11 (26%) competently performed 14 of 15 techniques (93%), and 1 of 11 (9%) competently performed 11 of 15 techniques (73%). Participation in this module resulted in substantial acquisition of knowledge and skills regarding musculoskeletal injections for physical medicine and rehabilitation residents. This workshop provided a framework for the definition of baseline competency in this clinical skill area.

Attitude of Health Personnel↗

PubMedDate not supplied

Development of a population-based questionnaire to explore psychosocial determinants of screening for memory loss and Alzheimer Disease.

Alzheimer disease research has focused on detecting the earliest signs of cognitive decline and efforts are ongoing to develop biomarkers and cognitive measures that reliably distinguish between nondemented and demented individuals. However, little is known about factors that may directly or indirectly influence screening behavior of older community-dwelling adults. We describe an iterative process for the development and formative evaluation of a questionnaire about dementia knowledge and screening behaviors in older adults to understand the psychosocial factors underlying intention to obtain dementia screening to profile individuals manifesting intention to undergo dementia screening compared to those who will not. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire with constructs from the Health Belief Model, Theory of Reasoned Action and Self-Efficacy. After pretesting, we used a random dialing strategy to test our questionnaire on a final sample of 1024 older Missourians. Internal consistency and construct validity were examined. Pretesting identified several potential problems that were improved with rewording. Cronbach alpha was greater than 0.6 (range 0.62 to 0.92) in all but one construct testing dementia knowledge, suggesting good to excellent internal consistency. Convergent (construct) validity was assessed using confirmatory factor analysis. All constructs but 3 demonstrated good validity. Addressing these issues will allow researchers to identify unique characteristics based on age, race, sex, socioeconomic differences and geographic location, and characterize barriers to screening programs to more effectively develop targeted community-based interventions.

Aged↗

PubMed2004

Clinical applications of antineutrophil cytoplasmic antibody testing.

PURPOSE OF REVIEW: Antineutrophil cytoplasmic antibodies are closely associated with Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome and have contributed to new pathogenetic concepts and improved nomenclature of systemic vasculitides (antineutrophil cytoplasmic antibody-associated vasculitides). However, the application of antineutrophil cytoplasmic antibody testing as a clinical diagnostic tool is still regarded as controversial. This review summarizes the most recent developments in the field, identifies areas of uncertainty, and gives practical guidelines. RECENT FINDINGS: The problems of antineutrophil cytoplasmic antibody testing include the diversity of antineutrophil cytoplasmic antibody target antigens, assay standardization and performance, the application of antineutrophil cytoplasmic antibody testing in a clinical setting with a low pretest probability, and, finally, the widespread assumption that antineutrophil cytoplasmic antibody titers alone may closely reflect disease activity and therefore may be used to guide therapy. SUMMARY: Recent findings demonstrate that the combined use of indirect immunofluorescence tests and solid phase assays to detect antineutrophil cytoplasmic antibody directed against myeloperoxidase and proteinase 3 can minimize the occurrence of false-positive antineutrophil cytoplasmic antibody results. Furthermore, the yield of antineutrophil cytoplasmic antibody testing can be improved by the use of a well-standardized test, adherence to published guidelines, and restricting the use of the tests to clinical situations with a rather high pretest probability for antineutrophil cytoplasmic antibody-associated vasculitides. However, treatment decisions should be based on the clinical presentation of the patient and histologic findings and not on the results of antineutrophil cytoplasmic antibody testing alone.

Antibodies, Antineutrophil Cytoplasmic↗

PubMedDate not supplied

An evaluation of standardized patients in improving clinical breast examinations for military women.

There is a need to improve the quality of clinical breast examination (CBE) and breast cancer screening for women. The purpose of this study was to determine whether instructions from a standardized patient to military healthcare providers would increase the quality of CBE and breast cancer screening for military women. The study used a 2-group pretest and posttest experimental design with random assignment by study site. Before and after the intervention, the providers completed a 13-item survey to assess their current breast cancer screening practices and the standardized patient used an investigator-developed checklist to assess the providers' breast cancer screening performance. The survey of breast cancer screening practice scores and the interview and CBE performance scores were analyzed using analysis of covariance with the pretest scores as covariates. Results showed the experimental group made significantly more improvement than did the control group in their total scores on the observational checklist of interview and CBE skills (F = 19.18, P < .001, observed power = 0.99). In conclusion, this method of continuing education was effective with military healthcare providers.

Adult↗

PubMed1988

Clinical survey of adverse reactions to contrast media.

From October 1983 to June 1986, 33,400 individuals participated in a clinical survey of adverse reactions to conventional high osmolar contrast media. The frequency of reactions was 7.5% (2,523/33,400). No fatal cases resulted. In patients pretesting positive, the incidence of adverse reactions was 48%. In individuals with a positive history of allergy, the incidence of the reactions was 52%. There was no correlation between the incidence of reactions and the presence or absence of a history of previous contrast media administration. The value of pretesting can not be negated from the present results.

Contrast Media↗

PubMedDate not supplied

In search of effective education in burn and fire prevention.

Children younger than 14 years continue to be a high-risk group for burn-related and fire-related injuries. Burn and fire educators must find a way to reach these children that captures their imaginations. There may be no better way than games. Two burn and fire prevention games were developed. The games were distributed to 38 school districts encompassing a total of 164 elementary schools and reaching more than 1,035 youngsters in grades 1 through 4 in a two-county community. Before playing each game, the participants completed a multichoice pretest. A similar posttest was administered after gaming to determine mastery and retention of knowledge. In addition, classroom instructors were given an evaluation form to assess content, quality, and effectiveness. Pretest and posttest results indicated students gained and retained significant knowledge. Instructor evaluation recognized these games as entertaining and exciting, precipitating additional questions leading to further classroom discussion and learning.

Adolescent↗

PubMedDate not supplied

Promoting spiritual knowledge and attitudes: a student nurse education project.

PURPOSE: The spiritual dimension of holistic nursing is an area that has been neglected within nursing education. The purpose of this project was to develop and test a spirituality-focused nursing student education project designed to enhance the knowledge and understanding of spiritual care among nursing students. The researchers anticipated that the pilot program would result in a spiritually focused clinical experience that could be permanently implemented in the course and integrated throughout other clinical courses in the curriculum. METHODS: The Spirituality and Spiritual Care Rating Scale (SSCRS) was used to measure students' knowledge and understanding of spirituality and spiritual care. Following the administration of the pretest, a set of educational strategies was implemented to promote the spiritual knowledge and attitudes of nursing students. Examples of strategies used included a half-day educational presentation as well as the incorporation of presence, prayer, reminiscence, and chapel visits into resident care. RESULTS: Significant differences were seen between student total pretest and posttest scores on the SSCRS (t = -2.893, P = .018) as well as individual instrument items when compared before and after the intervention. CONCLUSIONS AND IMPLICATIONS: This pilot project focused on a spirituality-focused nursing student education project designed to enhance the knowledge and understanding of spiritual care among nursing students. Results indicated that the pilot program was beneficial and should be disseminated more widely.

Adult↗

PubMed1993

Role of warm-water bath in anorectal conditions. The "thermosphincteric reflex".

Why anorectal pain is relieved by sitting in a warm-water bath was investigated in 18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids). Investigations consisted of measuring rectal and interstitial sphincter temperature, rectal and rectal neck pressures, and electromyographic activity of both the external and internal anal sphincters before and after the subjects sat in a warm-water bath at temperatures of 40, 45, and 50 degrees C for 10 min each time. Pain relief was more evident and lasted longer at higher bath temperatures. The rectal and interstitial sphincter temperatures were unchanged before and after bath in both the healthy volunteers and patients. The rectal neck pressure and internal and sphincter electromyographic activity dropped significantly in the bath, but increased gradually to pretest levels 25-70 min after exiting the bath. The higher the bath temperature, the greater the drop in rectal neck pressure and internal sphincter EMG activity, and the longer the time needed to return to pretest levels. Pain relief after Sitz bath seems to be the result of internal anal-sphincter relaxation with a resulting diminution of the rectal neck pressure. The relaxation of the internal sphincter following the warm bath postulates a relationship, but direct action was ruled out. A neural pathway through a "thermosphincteric reflex" seems most likely.

Adult↗

PubMed1999

Myocardial perfusion abnormalities in treated hypertensive patients without known coronary artery disease.

OBJECTIVE: Myocardial perfusion abnormalities may occur in hypertensive patients in absence of significant coronary artery disease. However, it is not well established whether hypertensive patients without known coronary artery disease have a higher prevalence or extent of myocardial perfusion abnormalities compared with normotensive patients with similar clinical features. DESIGN: This study compares the prevalence and extent of rest and stress-induced myocardial perfusion abnormalities in patients with and without hypertension. METHODS: Dobutamine (up to 40 microg/kg per min) stress technetium-99m myocardial perfusion SPECT imaging was performed for evaluation of myocardial ischaemia in 350 patients (mean age = 60+/-13 years, 146 men) without known coronary artery disease. One hundred and forty-eight patients were hypertensive. Rest SPECT images were acquired 24 h after the test Abnormal perfusion was defined as the presence of reversible or fixed perfusion defects. RESULTS: No significant difference was detected between patients with and without hypertension regarding gender, prevalence of symptoms, risk factors, pretest probability of coronary artery disease (52+/-28 versus 53+/-29%), peak rate pressure product (21040+/-4755 versus 20774+/-4865) or number of patients achieving the target heart rate during stress (85 versus 86%). Hypertensive patients were significantly older (62+/-11 versus 58+/-13 years, P = 0.005) and were receiving beta-blockers more frequently (34 versus 18%, P = 0.0001). The prevalence of myocardial perfusion abnormalities was similar in patients with and without hypertension (28 versus 31% in patients with low, 38 versus 33% in patients with intermediate and 60 versus 58% in patients with high pretest probability of coronary artery disease, respectively). No significant difference was detected between the two groups regarding stress perfusion defect score (1.45+/-2.5 versus 1.50+/-2.6) or rest score (0.72+/-1.8 versus 0.68+/-1.6). CONCLUSION: Treated hypertensive patients without known coronary artery disease have a similar prevalence and severity of myocardial perfusion abnormalities at rest and at dobutamine stress compared with normotensive patients with similar clinical characteristics.

Adrenergic beta-Antagonists↗