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PubMedDate not supplied

The effect of promoting intrauterine attachment in primiparas on postdelivery attachment.

Twenty-two women participated in a modified replicate study which examined the effects of prenatal maternal attachment behaviors during first pregnancies. A pretest reflected the degree of maternal-fetal attachment behaviors and attitudes already formed. The women in the experimental group received three interventions aimed at directing the mothers' attentions toward their fetuses. The remaining women received routine prenatal care only. All mothers were observed once in the first few days postpartum to assess maternal attachment behaviors. Data analysis did not substantiate the findings of the earlier study. Factors identified in the added pretest may have accounted for this difference.

Adolescent↗
PubMedDate not supplied

A perinatal continuing education program: its effects on the knowledge and practices of health professionals.

OBJECTIVES: To determine whether there was an increase in knowledge when an interdisciplinary group of health care providers participated in the same comprehensive perinatal continuing education program and to determine whether care practices followed before the program differed from those followed 1 year after its completion. DESIGN: Administration of a 100-item comprehensive pretest and a similar posttest measuring knowledge before the continuing education program and 1 year after taking it, as well as an ex post facto audit of medical records of newborns who were sick and at risk. SETTING: Hospitals throughout the state of Oklahoma that provide perinatal care. Test data were derived from health care providers in 24 hospitals; data on care practices were obtained from 12 hospitals. INTERVENTION: A comprehensive program of perinatal continuing education. PARTICIPANTS: Physicians, nurses, and other providers of perinatal health care. MAIN OUTCOME MEASURES: Scores on a 100-item test measuring knowledge of perinatal care and newborn care practices taught in the educational program. RESULTS: Pretest and posttest scores demonstrated an increase in scores at the p < 0.001 level for each group of providers studied. There was a statistically significant increase in use of two care practices and a definite trend toward an increase in the use of three others. CONCLUSION: A continuing education program delivered to a multidisciplinary group of health care providers can increase knowledge and improve perinatal care to newborns who are sick and at risk.

Chi-Square Distribution↗
PubMedDate not supplied

Evaluation of an emergency-procedure teaching laboratory for the development of proficiency in tube thoracostomy.

OBJECTIVE: Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy. METHODS: A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20-25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest. RESULTS: The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002). CONCLUSION: This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.

Animals↗
PubMed1996

Prospective evaluation of emergency medicine instruction for rotating first-postgraduate-year residents.

OBJECTIVE: To determine whether either bedside teaching alone (group A) or bedside teaching with written course materials (group B) improved written examination scores, satisfaction with the rotation, or clinical grades of rotating PGY1 residents. METHODS: A prospective, controlled educational trial was conducted. Sixty-five PGY1 residents from diverse specialties rotated in the ED for one month over a ten-month study period, and were included in the study. The PGY1 residents were assigned to group by month of rotation. All the PGY1 residents received unstructured bedside teaching by emergency medicine (EM) residents and faculty. In addition, group B received written course materials on day 1. RESULTS: Mean posttest scores were higher than mean pretest scores for the interns considered as a whole (p < 0.0001), but mean pretest, posttest, and clinical grades were comparable across instructional groups. Mean satisfaction ratings were higher for group A than for group B (p < 0.015). The interns specializing in EM achieved higher mean test scores (p < 0.013) and clinical grades (p < 0.003) than did the interns specializing in another medical specialty. CONCLUSION: Both instructional methods were associated with improved written test performance. Written course materials did not augment bedside teaching in terms of test scores, clinical grades, or satisfaction with the rotation. At a university-based, high-volume ED, bedside teaching offers educational benefit to rotating PGY1 residents that may not be augmented by written course materials.

Curriculum↗
PubMed1998

Derivation of a clinical prediction model for the emergency department diagnosis of ectopic pregnancy.

OBJECTIVE: To derive a clinical prediction model for estimating the pretest probability of ectopic pregnancy in ED patients with first-trimester abdominal pain or vaginal bleeding. METHODS: All hemodynamically stable first-trimester patients presenting to the ED of a tertiary care military teaching hospital over a 14-month period with a chief complaint of abdominal pain and/or vaginal bleeding had clinical data coded prior to determining outcome. They were then followed longitudinally until a criterion standard pregnancy outcome was established. RESULTS: Of the 486 patients enrolled, 280 (58%) had viable intrauterine pregnancies, 167 (34%) had nonviable intrauterine pregnancies, and 39 (8%) had ectopic pregnancies. Using a recursive partitioning model, a high-risk group was derived (that was separated from intermediate and low-risk groups), consisting of patients with abdominal peritoneal signs or definite cervical motion tenderness, with a sensitivity of 31% (95% CI: 17-48%), a specificity of 93% (95% CI: 90-95%), a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.74. A low-risk group, consisting of patients with either fetal heart tones or tissue at the cervical os, or the absence of pain other than midline menstrual-like cramping and lacking any pelvic tenderness, was differentiated from an intermediate-risk group, with a sensitivity of 96% (95% CI: 81-100%), a specificity of 22% (95% CI: 18-26%), a positive likelihood ratio of 1.2, and a negative likelihood ratio of 0.17. CONCLUSION: A clinical prediction model for estimating the probability of ectopic pregnancy in ED patients has been derived. It may prove to have practical clinical application for estimating pretest probability of ectopic pregnancy as well as assisting in medical decision making when laboratory and ultrasonographic findings are nondiagnostic. Clinical application should await prospective validation in an independent sample.

Abdominal Pain↗
PubMed2000

Ultrasound training for emergency physicians--a prospective study.

OBJECTIVES: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. METHODS: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. RESULTS: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean +/- SD pretest score was 15.6 +/- 4.2, 95% CI = 14. 7 to 16.5 (65% of a maximum score of 24), and the mean +/- SD posttest score was 20.2 +/- 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0. 05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 +/- 1.2, 95% CI = 20.0 to 21.4). CONCLUSIONS: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.

Clinical Competence↗
PubMed1999

Topical pharyngeal anesthesia does not improve upper gastrointestinal endoscopy in conscious sedated patients.

OBJECTIVE: We undertook this study to determine whether topical pharyngeal anesthesia with conscious sedation is superior to conscious sedation alone, with respect to procedure performance or tolerance in patients undergoing diagnostic upper gastrointestinal endoscopy. METHODS: Ninety-five patients undergoing diagnostic upper endoscopy with conscious sedation were randomized to receive either topical pharyngeal anesthesia with 2% tetracaine/14% benzocaine spray or no pharyngeal anesthesia. Conscious sedation was achieved in all patients using intravenous midazolam and meperidine. Patients were asked to rate their pretest anxiety, comfort during endoscopy, recollection of the procedure, and willingness to undergo subsequent examinations using a 100-mm visual analog scale. Additionally, they were asked to estimate procedure duration and rate their tolerance for topical pharyngeal anesthesia. All examinations were performed by two endoscopists who were blinded to whether or not patients had received pharyngeal anesthesia. Endoscopists were asked to determine whether they believed that patients had received topical pharyngeal anesthesia and to estimate ease of esophageal intubation and procedure performance using a 100-mm visual analog scale. Procedure duration and doses of midazolam and meperidine were measured. RESULTS: The two groups did not differ with respect to age, gender, and previous endoscopic history. There were no significant differences between the two groups with respect to pretest anxiety, procedural comfort, and willingness to undergo subsequent examinations. Patients receiving topical pharyngeal anesthesia rated it as moderately unpleasant. Endoscopists were able to discriminate patients who received pharyngeal anesthesia from those who did not with a sensitivity of 0.73 and a specificity of 0.59. There were no significant differences between the two groups with respect to ease of intubation, procedure performance, procedure duration, and dosing of midazolam or meperidine. CONCLUSIONS: In patients undergoing diagnostic upper endoscopy using intravenous midazolam and meperidine, the use of topical pharyngeal anesthesia does not improve patient tolerance or procedure performance. Elimination of this agent in the performance of diagnostic upper endoscopy will save time and money without adversely affecting patient care or outcomes.

Anesthesia, Local↗
PubMed1990

Effect of a nutrition education program, "learning by teaching", on adolescents' knowledge and beliefs.

The purpose of this study was to evaluate the impact of a health education program on a group of adolescents' cognition (knowledge of sugar and caries (SUCA), knowledge of sugar and nutrition (SUNU), and beliefs about susceptibility (SUSC) and self-efficacy (SELF]. The strategy used was to make 14-yr-old students learn about nutrition and dental health through teaching 10-yr-old students this topic. A pretest-posttest non-equivalent control group design was used. The experimental group consisted of four 8th grade classes from two schools and the reference group of four 8th grade classes from two comparable schools. The data was collected prior to, immediately after, and, for the experimental group, 2 months after the program implementation. Analysis of covariance with pretest measures as covariates showed no effect of the program on SUCA, SUSC, and SELF, while a significant interaction effect of study group and gender was found on SUNU. Neither social class of mother nor caries activity had a significant interaction effect on knowledge and beliefs during the course. Future health education research should focus upon the effect of different educational approaches addressing beliefs more salient to adolescents.

Adolescent↗
PubMedDate not supplied

An eating disorders prevention program.

PROBLEM: To develop, implement, and evaluate a school personnel training program on eating disorders. METHODS: The pretest-posttest control group design was used to examine effects of this training with 117 high school personnel. Both experimental (n = 85) and control (n = 32) groups were given a pretest and a posttest on knowledge and attitudes. The experimental group participated in a training program. Both groups were asked to keep a 3-month count of students at risk for eating disorders. FINDINGS: Results included a significant difference in knowledge between the experimental and control groups. School personnel in the experimental group were more likely to identify students at risk for developing eating disorders. CONCLUSIONS: Training school personnel to identify students at risk for eating disorders holds promise as a strategy for dealing with this disease. All at-risk students for eating disorders should be further evaluated and additional treatment initiated as needed.

Adolescent↗
PubMed1977

The effect of nutrition education on dietary habits on fifth-graders.

Two fifth-grade classes of 45 students, a majority in the Mexican-American culture, participated in the five month study. One group was taught a series of eight nutrition education units emphasizing weight control while the other group received no nutrition instruction. Pretests and posttests were given to each group and a 24-hour dietary recall was obtained. Findings from the written pretest and posttest showed that the group receiving nutrition instruction learned a significantly (p less than .01) greater number of nutrition concepts than the control group. Dietary intakes revealed that the diets of the experimental group did not improve after nutrition instruction. A majority of postdietary intakes met less than 50% of the RDA.

Child↗
PubMed1983

Comparing the self-image of prepubescent girls before and after four sessions on body awareness.

The purpose of this research was to determine whether increasing the knowledge of prepubescent girls concerning emotional and physiological changes would result in a more positive self-image. Eleven Junior Girl Scouts comprised the sample. The procedure consisted of pretesting with the "How I See Myself Scale" and the "Sex Knowledge Test," teaching a four-session Body Awareness Course and posttesting with pretest instruments. Body awareness of the participants was significantly increased following the course. Self-image was improved, although not significantly. Each participant indicated a strong interest in body awareness and her developing sexuality. This study demonstrates that prepubescent females need and desire factual information about their physical and emotional concerns.

Body Image↗
PubMed1984

Developing, implementing, and evaluating a wellness education program.

A Wellness Behavior Inventory and a wellness education program were developed and implemented to determine the effectiveness of the program in changing 10th grade students' attitudes and behaviors concerning wellness. Experimental (N = 24) and control (N = 24) groups completed the Attitudinal Inventory of Wellness and the Wellness Behavior Inventory developed by the researchers as a pretest, four week later as a posttest, and an additional four weeks later as a post-posttest. The experimental group participated in the four-week, 800-minute educational program between the pretest and posttest, while the control group received no intervening treatment. Groups were matched by age, IQ, and sex. The research concluded that the education program was effective in enhancing positive attitudes and behaviors toward wellness among selected 10th grade students. A follow-up study was conducted and an additional questionnaire was used to identify encouragers and/or discouragers for participants who continued to practice or not practice wellness behavior.

Adolescent↗
PubMed1988

AIDS: what you and your friends need to know--a lesson plan for adolescents.

The AIDS knowledge and attitudes of students attending an urban high school in Seattle were pretested. Subsequently, a 50-minute AIDS lesson plan was designed using the findings. Instruction occurred one month following the pretest, with a posttest administered one week after instruction. Significant increases in knowledge about AIDS, and parallel changes in tolerant and compassionate beliefs about people with AIDS were observed. Learning outcomes were retained at retesting eight weeks after instruction. Prior to receiving the AIDS lesion, 34% of students listed schools as their source of learning about AIDS. Schools became the major source of learning (82%) after one hour of instruction.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Educating school nurses to care for HIV-infected children in school.

Effects of an educational program on school nurses' knowledge and attitudes about human immunodeficiency virus (HIV) infection in children and changes in practice was investigated. Participants (N = 205) attended a one-day workshop held at 11 sites in New Jersey. Content was clinically focused and derived from a needs assessment of a sample of school nurses throughout New Jersey. An adult education format was used, with interactive and affective teaching strategies modeled on the AIDS Training Program of the California Nurses' Association. Subjects were pretested and posttested for knowledge and attitudes about HIV in children. An identical posttest mailed three months later included a self-report of change in practice since attending the workshop. Knowledge and attitude scores were significantly higher at program completion (p < .0001). Three months after the program, knowledge scores had fallen but not to pretest levels. No significant difference existed between attitude scores after the program and three months later. On self-report of change in practice, respondents indicated they institute or improved universal precautions, and were more comfortable in teaching children, staff, and their communities about HIV.

Adolescent↗
PubMed1994

Longitudinal evaluation of an enhanced alcohol misuse prevention study (AMPS) curriculum for grades six-eight.

For students progressing from sixth to eighth grade, an enhanced Alcohol Misuse Prevention Study (AMPS) curriculum that emphasized social pressure resistance training, peer support, and norm-setting was developed, implemented, and evaluated. Schools were randomly assigned within communities to curriculum or control groups. Students were pretested early in sixth grade before the intervention and posttested at the end of sixth, seventh, and eighth grades. Results indicated the curriculum was effective in increasing students' knowledge of curriculum material, and among the subgroup of students who had used alcohol unsupervised by adults before the pretest, in reducing the rate of increase of alcohol misuse. The findings result from a replication of the analytic approach used with the initial AMPS cohort data.

Adolescent↗
PubMed2002

Increasing self-esteem and school connectedness through a multidimensional mentoring program.

High levels of self-esteem and positive school, peer, and family connections represent protective factors against youth involvement in risky behavior. This paper reports findings from year one of the Healthy Kids Mentoring Program, a multidisciplinary mentoring program for fourth-grade students in a Midwestern public school. In October 2000, 28 fourth-grade students were admitted into the program, based on findings from a 55-item survey distributed to all fourth-grade students (N = 283) regarding overall self-esteem, school, peer, and family connectedness and involvement in risky behavior. The program, which ran from January 2000 to May 2000, consisted of four components: 1) relationship building, 2) self-esteem enhancement, 3) goal setting, 4) academic assistance. Pretest-Posttest data showed significant improvements at posttest in mentored students' self-esteem levels and positive connections to school, peers, and family. Mentored students also were significantly less likely to be depressed or involved in bullying and fighting at posttest than at pretest. Compared to nonmentored students, mentored students reported significantly higher school and family connectedness scores at posttest. Recommendations for effective mentoring program design are offered.

Child↗
PubMed1996

Cancer prevention strategies among California farmworkers: preliminary findings.

This study was conducted to identify barriers to cancer prevention and evaluate the effectiveness of a cancer prevention project to increase screening for cervical and breast cancer among Spanish-speaking farmworkers in California's Central Valley. Bilingual health educators met with farmworker communities near Merced and Modesto, CA, to determine barriers that prevented women from seeking screening for breast and cervical cancer. Using information from focus groups and health fairs, a targeted outreach protocol was developed that will eventually enroll 2,500 farmworkers in a cancer education and screening program. Participants received a presentation in Spanish on breast and cervical cancer that included a pretest and post-test to assess increases in knowledge. Clients were encouraged to attend Golden Valley Health Centers Inc. (GVHC) to receive free breast and cervical cancer screenings. Vouchers, redeemable for modest personal hygiene gifts by clients, were tracked to assess prevention behavior when appointments were kept at GVHC. Sixty farmworkers attended focus groups and 363 attended health fairs to provide input to The cancer prevention program. As of December 1, 1995, 1,732 female farmworkers were enrolled in an outreach program designed to increase knowledge and promote cancer screening. Data from pretests and post-tests indicated a statistically significant increase in knowledge about cancer and its prevention among participants. Furthermore, 317 participants redeemed vouchers for cancer screenings at GVHC. Active community collaboration and culturally appropriate intervention strategies, employed in conjunction with clinical services, can be successful in increasing cancer prevention awareness and screenings among female farmworkers.

Agriculture↗
PubMed1997

Student teacher anxieties related to class management, pedagogy, evaluation, and staff relations.

BACKGROUND: Anxiety is an important consideration in teaching, with implications for classroom success. AIMS: We investigated the nature of anxiety in student teachers. SAMPLES: Approximately 1000 student teachers in Canada were involved in four studies to explore education-related anxieties. METHODS: Incorporating a cross-cultural focus, student teachers were tested on an anxiety measure designed for British student teachers, then examined for (1) the impact of practice teaching, (2) the value of instructional preparation, (3) demographic variables, and (4) models that predict anxiety. RESULTS: Anxiety factors (i.e., evaluation, pedagogical, class management, and staff relations), similar to those for British participants, emerged with evaluation anxiety being highest. A practice teaching experience generated reduced anxiety for both sexes, but more so for females, with the greatest reductions for evaluation and pedagogical anxiety. In one study, participants reported anxieties prior to instruction (PRETEST), following instruction (POST-INSTR) and following practice teaching (POST-TEACH). Females showed higher anxiety ratings than males (PRETEST and POST-INSTR) but were comparable to males after practice teaching. Females in the lower grades division showed higher anxiety scores. Anxiety decreased between PRE-TEST and POST-INSTR for all four scales, and between POST-INSTR and POST-TEACH for evaluation, pedagogy and staff relations; however, class management anxiety did not decrease after practice teaching. Also, anxiety increased as placement grade level decreased. All models (demographic, experiential, and dispositional) were predictive but the best predictor was the psychological disposition to feel overwhelmed. CONCLUSIONS: Student-teacher anxieties are related to demographic variables, experiential variables, and dispositional variables.

Adult↗