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PubMed1999

Method of preparing emergency medicine residents for giving legal depositions.

This study was performed to determine if a simulated legal deposition increases emergency medicine (EM) residents' knowledge, self-confidence, and understanding of a legal deposition. This prospective study included a convenience sample of EM 1-3 residents. A knowledge and a self-assessment pretest were given, followed by a didactic session moderated by local attorneys, followed by knowledge and a self-assessment posttest. The total time involved was 2 hours. The mean score on the knowledge pretest was 4.5 and 5.25 on the posttest. Using a paired t-test, the authors found this difference to be statistically significant. (P < 0.01) Using Hotelling's T2 test, the authors compared presimulation and postsimulation self-assessment questions. The results revealed that there was a difference between these scores (P < 0.001). Participants in the deposition significantly improved their self-assessment ranking and knowledge inventory test scores by participating in a simulated legal deposition.

Adult↗
PubMed1997

Exercise blood pressure changes between seasons.

BACKGROUND: Blood pressure (casual and daytime) is higher in winter than it is in summer, and this factor might be partly responsible for the higher cardiovascular mortality in winter. OBJECTIVE: To determine in a prospective study whether there is also a seasonal variation in exercise blood pressure. METHODS: We evaluated the pretest, exercise (five-step treadmill test) and recovery values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate of 94 healthy men, aged 20-65 years, during the summer and winter. RESULTS: SBP and DBP values were higher in winter than they were in summer during the resting period immediately before exercise (P = 0.003 and P = 0.07, respectively), and during recovery (both P < 0.0001). Exercise SBP and heart rate values were similar in the two seasons, although exercise DBP was higher in winter than it was in summer (P < 0.0001). The increase in DBP from pretest to stage 3 was 6.5 mmHg in summer and 10.4 mmHg in winter (P = 0.002). After we had controlled for possible confounders, the increase in DBP during exercise was found to be independently associated with season of the year and resting DBP. CONCLUSIONS: Exercise DBP varies according to season whereas exercise SBP does not. Our results suggest that, since measures of the response of blood pressure to exercise testing are frequently used in blood pressure and hypertension research as well as in clinical practice, the seasonal influences should be taken into account.

Journal Article↗
PubMed1999

Using physiologic and pharmacologic stress testing in the evaluation of coronary artery disease.

Evaluating and treating coronary artery disease (CAD), the leading cause of death in the United States, are priorities for primary care practitioners. Stress testing is a noninvasive, cost-effective technique to help diagnose CAD and evaluate its extent. The test can also be used to clarify the etiology of chest pain, evaluate a medical regimen, identify arrhythmias, risk-stratify patients preoperatively, and determine exercise tolerance. Myocardial perfusion imaging and echocardiography can increase the test's sensitivity and specificity. Pharmacologic testing is available to evaluate patients who are unable to exercise adequately. Test selection is based on the patient's ability to exercise, concurrent illnesses (for example, reactive airway disease), and desired findings. The evaluation of results should be based on history and the pretest probability of cardiovascular disease. A cardiologist should evaluate any results that fall to correlate with the patient's presentation or pretest likelihood of disease for possible coronary angiography.

Adenosine↗
PubMed1985

A comparison of a multi-media instructional module with a traditional lecture format for geriatric pharmacy training.

The purpose of this study was to develop, produce, and test the effectiveness of a multi-media instructional module versus a traditional lecture format. The subject selected was geriatric care in relation to pharmacy practice. A pretest/posttest control group design was used, differing only in the method of presentation of the material. The control group received four fifty-minute traditional lectures, and the treatment group utilized the module for the acquisition of the information. An evaluation of the pretest scores showed that the groups were equal in knowledge (no significant difference at P = 0.05) before exposure to the information. A comparison of the posttest scores of the two groups showed that the module was as effective a learning strategy as the traditional lectures (no significant difference at P = 0.05). The comparison of the pretest and posttest scores within each group showed that significant improvement occurred following the utilization of both methods of instruction at P less than 0.05. The results of this project indicated that the module is an effective learning strategy when compared to a traditional lecture format. It was also evident that the multi-media module can be used as an instructional alternative in the education of pharmacy students.

Analysis of Variance↗
PubMed1999

A rational request behavior: the development of prediction instruments regarding thyroid function tests in primary care.

A prospective study was performed to encourage a rational thyroid-stimulating hormone (TSH) test request behavior of physicians, using prediction instruments. The latter give direct feedback about request adequacy on the basis of pretest probabilities of hyperthyroidism using patients' signs and symptoms. For instrument design, stepwise logistic regression was used on diagnostic data acquired through questionnaires, answered by 80 physicians and 668 patients for whom physicians requested a TSH test. Instruments were designed for clinical and subclinical hyperthyroidism and for clinical hyperthyroidism alone. Use of the instrument for clinical or subclinical hyperthyroidism on the selected group, at a 5% probability threshold, can result in a 37% reduction of unnecessary TSH test requests. With the instrument for clinical hyperthyroidism at a 5% probability threshold, the number of unnecessary test requests can be reduced by 57%. Therefore, it can be concluded that the instruments can determine TSH test request adequacy and encourage a rational TSH test request behavior of physicians at low pretest probability thresholds.

Adolescent↗
PubMed1999

Spontaneous ophthalmic lesions in young Swiss mice.

BACKGROUND AND PURPOSE: Outbred mice are frequently used in toxicity evaluation. Due to their small size, ophthalmologic examination of such animals is difficult with regard to restraint and use of instruments designed for human medicine. The clinical appearance and incidence of spontaneous ophthalmic lesions should be helpful in selecting mice for toxicity studies and allow distinction between intercurrent spontaneous ocular changes and those attributable to drugs or chemicals. METHODS: Pretest ophthalmologic examinations of about 3,000 4- to 5-week-old Swiss mice, Crl:CD1 (ICR)BR, conducted in 1995 and 1996, provided information about spontaneous ocular changes and their incidence. Eye evaluations were performed after pupil dilatation (0.5% tropicamide instillation), using indirect ophthalmoscopy, and when indicated, a portable slit lamp. RESULTS: Lenticular opacities and heterogeneity/prominence were the most common findings (up to 19%) in the anterior segment. Abnormalities of the cornea and iris were detected in up to 4% of mice. Hyaloid artery remnant, as well as isolated cases of floating bodies or hemorrhage, was observed in the vitreous of 12 to 17% of mice. Approximately 2 to 4% of mice had colobomatous fundus, retinal fold, or retinal atrophy. A few mice had chorioretinal atrophy, hemorrhage, or abnormal pattern of the retinal vasculature. Remaining findings consisted of incomplete palpebral fissure, microphthalmia, exophthalmia, ophthalmic hemorrhage, and scleral mass. CONCLUSIONS: Due to severity of the condition or interference with ocular examination, affected mice should be eliminated from experimental studies. Hence, pretest ocular examinations of mice are indicated in safety-assessment toxicity studies.

Animals↗
PubMedDate not supplied

[Validation of data collection for an American trypanosomiasis epidemiologic study in the State of Morelos, México].

The purpose of this paper is to show up the importance of the standardization concepts in American Trypanosomiasis epidemiological studies. The consistence in the measurement of some dwelling characteristics was evaluated. A validation of the Queretaro antigen for indirect hemagglutination reaction as a diagnostic test and the interobserver concordance for the serologic readings were also made. The observers were instructed in some sessions. The pretests were made in the laboratory with positive and negative sera, with sera from the studied population. Results show that the interobserver concordance after the instruction, for the dwelling variables ranged from 70% to 100%. Sensitivity of the Queretaro antigen was 100%, specificity 55%, the predictive value of a positive test 55%, and the predictive value of a negative test 93%. The interobserver concordance was 47%. The pretest and the pilot study are very important in getting the objectives of the principal study.

Chagas Disease↗
PubMed1999

A computer based intervention to reduce unnecessary serologic testing.

OBJECTIVE: Laboratory testing is important in the evaluation of patients with possible systemic rheumatic disease, but uncritical use of any test may result in misleading information and unnecessary costs. We attempted to reduce the number of unnecessary antinuclear antibody, rheumatoid factor, and complement level tests ordered by house officers at a large teaching hospital, where inpatient orders are written through a computer based order entry system. METHODS: We conducted a prospective cohort study of an interactive test ordering program. The intervention consisted of displaying post-test probability estimates during the usual physician order entry session. These estimates were based on pretest probabilities entered by the ordering physician and sensitivities and specificities derived from a literature review. Another group of test orders did not prompt the intervention and were considered controls. The outcome of interest was the percentage of tests canceled in the intervention group versus the control group. RESULTS: Eleven percent (11/99) of intervention orders were canceled, versus only one order among 236 controls (p = 0.001). However, there was no association between the physicians' pretest probability estimates and whether test orders were canceled (p = 0.59). Additionally, 43 of the 335 orders (13%) yielded positive tests, but only 4 patients (1%) were given new diagnoses of rheumatic disease. CONCLUSION: The computer based intervention significantly reduced orders for antinuclear antibody and rheumatoid factor levels by 10%. Further reductions without clinical harm are probably possible, since the yield of testing for new rheumatic diseases was low.

Adult↗
PubMedDate not supplied

The follow-up on the training course of pediatric advanced life support.

Two parts are included in this article. First, to improve the training course in pediatric advanced life support (PALS), we held a 2-day PALS training course on March 28 and 29, 1999. A pretest, posttest, and survey questionnaire were given to each participant. Of the 143 participating in the 2-day PALS course, 137 completed the study. The mean pretest score was 70.2 (SD = 11.5) and the mean posttest score was 86.9 (SD = 9.1). There was significant improvement noted after the 2-day PALS training course (p < 0.001). The 2-day PALS training course resulted in greater improvement in scores compared with the previous 1-day PALS training course in some certain groups of participants. The number of participants complaining that they were too rushed to get the best learning result declined from 71 of 106 (66.3%) taking the 1-day training course to 43 of 137 (31.4%) taking the 2-day training course. Second, a same written test was given to the 129 participants who had finished a 1-day PALS training course one year previously to evaluate the participants' retention of knowledge after 1 year. Of 82 responders who took the 1-year follow up test, 75 were from the medical center. The score of the follow-up test for these 75 participants showed a significant decline when compared with the posttest, except for those receiving another training course of advanced life support during the follow-up year. We conclude that the 2-day PALS training course is better than the 1-day PALS training course. Those who participate in the pediatric critical or emergent care had better receive the 2-day PALS training course. The participants receiving the 1-day PALS training showed a significant decline in their knowledge after 1 year, and they should reinforce their knowledge in the following years.

Child↗
PubMed2000

Design and analysis of a Web-based guideline tutorial system that emphasizes clinical trial evidence.

OBJECTIVE: To describe a Web-based guideline tutorial system and evaluate its features. METHODS: A Web-based tutorial system called SAGE (Self-study Acceleration with Graphic Evidence) was constructed to teach knowledge important for care after myocardial infarction. SAGE features a pretest, followed by an overview that coordinates studying resources for a set of learning objectives. Resources include pretest answers, guideline passages, and graphical presentations of clinical trial results. Data on the use of SAGE was obtained from 79 residents participating in a larger trial. Linear regression was used to correlate the amount learned with resource-use, and resource-use with user characteristics. RESULTS: On average, users accessed less than half of the guideline passages and very little of the graphic evidence. Greater use of guideline passages was correlated with greater immediate learning, but use of graphic evidence was not. CONCLUSIONS: Further research is needed to motivate more thorough self-study and to integrate clinical trial evidence with guideline-based education.

Computer Graphics↗
PubMed2001

Teaching cardiac auscultation using simulated heart sounds and small-group discussion.

BACKGROUND AND OBJECTIVES: Several educators have reported poor identification of abnormal cardiac sounds by primary care residents. Practice and review with cardiology patient simulators and prerecorded heart sounds has been shown to increase the accuracy of diagnosis by medical students and residents. METHODS: The participants were 15 members of an urban family practice residency. The residents were presented with simulated heart sounds and were asked to identify them in a pretest and posttest. Between the tests, participants were invited to three separate teaching sessions that involved a discussion of cardiac auscultatory findings and a review of audiotaped similar heart sounds. Residents who were unable to attend the teaching sessions formed a control group. RESULTS: The pretest identification rate was 36% for the heart sounds. This improved to 62% for all residents after the intervention. Higher rates of improvement were demonstrated by the residents who attended one or more teaching sessions, compared with the residents who attended no teaching sessions. CONCLUSIONS: Small-group discussion and repetitive auscultation of simulated heart sounds can improve the cardiac auscultatory proficiency of family practice residents.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Use of and satisfaction with a browser-based nurse teaching tool in a surgical intensive care unit.

Our goal was to determine if a computerized teaching tool is an effective teaching method for nurses in a high-stress fast-paced intensive care unit. We also measured the level of satisfaction with this method of instruction. Thirty-six surgical intensive care nurses used a Web-based Microsoft PowerPoint presentation located on the intranet at nursing stations located on the surgical intensive care unit (SICU). The presentation was designed to provide instruction regarding the methodology and use of APACHE III prior to its implementation. Paired t-tests were performed to compare the results of a pretest and posttest. The questions were divided into two types: methodology and use. After the nurses completed their training sessions, they were asked to complete a questionnaire. The questionnaire questions were rated one a 1 to 5 scale. The average scores were higher on the posttest compared to the pretest (63.2% vs. 69.1%, p = 0.03). The methodology scores were higher on the posttest (74.3% vs. 88.2%, p = 0.001), while the use scores remained the same at 78.1% vs. 75.0%. Our Web-based teaching tool is an effective way to train nurses to understand the APACHE III medical system. The tool was effective at conveying the APACHE III medical systems methodology but was not effective in explaining the usefulness of the system. Most important, the nurses thought the browser-based teaching tool was easily accessible and an effective way to communicate new material to the medical staff.

APACHE↗
PubMed1998

Resident education outcomes and perception of a seminar format to teach female pelvic anatomy and procedures to correct pelvic prolapse.

Urologic residents need to learn basic and applied knowledge of female pelvic anatomy, a subject rarely taught beyond preclinical undergraduate medical education. This study tests the hypothesis that urologic resident knowledge of female pelvic anatomy and prolapse may be enhanced with a seminar. Twenty residents attended a one day seminar combining didactics and a cadaveric dissection related to female pelvic anatomy and female pelvic prolapse conditions. Resident knowledge was measured with a multiple choice test administered in a pretest-posttest experimental design. Resident attitudes toward the seminar were assessed by a 20 item survey using a strongly disagree to strongly agree scale. Pretest and posttest mean scores were 55% and 71% respectively, p=.0007 (Kuder-Richardson 20 coefficients were 0.7). Questionnaire responses indicated positive opinions regarding the educational value of the seminar. Urologic resident knowledge of female pelvic anatomy and pelvic prolapse conditions may be enhanced by conducting a one day teaching seminar.

Journal Article↗
PubMed2002

Anticalculus efficacy and safety of a novel whitening dentifrice containing sodium hexametaphosphate: a controlled six-month clinical trial.

This study was undertaken to establish the tartar control efficacy and long-term safety of a new dentifrice containing sodium hexametaphosphate. In a randomized, examiner blind, parallel group clinical trial, the experimental dentifrice with 7% sodium hexametaphosphate (5% hexametaphosphate anion), a non-abrasive cleaning agent that provides whitening and tartar control benefits, was compared to two currently marketed controls, a regular sodium fluoride dentifrice and a triclosan/copolymer dentifrice. The 8-month trial model included a 2-month pretest period to establish calculus formation after prophylaxis, and a 6-month test period to evaluate anti-calculus efficacy and safety. Following the pretest period, 551 subjects were allocated to one of the three treatment groups and then monitored for calculus accumulation and soft tissue tolerance. After 6 months, the sodium hexametaphosphate group exhibited superior calculus inhibition compared to the regular sodium fluoride dentifrice and triclosan/copolymer dentifrice (p < 0.01). Over the 6-month observation period, the sodium hexametaphosphate and the marketed control dentifrices were comparable in terms of adverse event type and severity, and no subject discontinued treatment due to an oral soft tissue adverse event.

Adolescent↗
PubMed2000

The Development of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN).

Measuring the nutritional risk of seniors living in the community has become increasingly necessary as more seniors in vulnerable states remain in their own homes. A few assessment tools are available for use in this population. To determine whether a tool is appropriate for a specific purpose, we must understand how it was developed. This article reviews the developmental process for Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN). This process, which combines clinimetric, psychometric, and criterion approaches, may help dietitians and other health researchers develop their own assessment tools. To assist dietitians and others with the systematic development or evaluation of health assessment tools a nine-step template is provided to: 1. determine what is being measured; 2. review the literature for tools; 3. critique tools for their development, validation, and reliability; 4. develop a construct for health measurement; 5. write the items, select items for the scale, and consult experts and a target group; 6. pretest items for readability; 7. pretest in a developmental sample; 8. validate the construct and measurement tool; and 9. ensure test-retest reliability.

Journal Article↗
PubMed2001

Microtensile bond strength of eleven contemporary adhesives to dentin.

PURPOSE: To evaluate the microtensile bond strength (microTBS) of eleven contemporary adhesives to dentin, including three one-step self-etch systems, four two-step self-etch systems, three two-step total-etch systems, and one three-step total-etch system. MATERIALS AND METHODS: Resin composite (Z100) was bonded to flat, mid-coronal dentin from 33 extracted human third molars using the adhesives strictly according to the respective manufacturer's instructions. After storage overnight in 37 degrees C water, the bonded specimens were sectioned into 3 to 6 slabs of approximately 1 mm thickness and 2.5 mm width. They were then trimmed into an hourglass shape resulting in an interface area of approximately 1 mm2, and subsequently subjected to microTBS testing with a crosshead speed of 1 mm/min. RESULTS: The microTBS varied from 30.0 MPa for the one-step self-etch adhesive Prompt L-Pop 2 (ESPE) to 63.1 MPa for the three-step total-etch adhesive OptiBond FL (Kerr), the latter being the only one that significantly differed from all other microTBS values. Although not significantly different, one-step self-etch adhesives tended to have lower microTBS than two-step self-etch and two-step total-etch adhesives. Specimen failures during sample preparation occurred with Prompt L-Pop 2 (4 pretesting failures out of 17 specimens) and NRC/Prime & Bond NT (7 pretesting failures out of 14 specimens). CONCLUSION: Adhesives with simplified application procedures, either following a total-etch or self-etch approach, produced lower bond strengths to dentin than a conventional three-step total-etch adhesive. Some concern exists regarding the consistency in bonding effectiveness to dentin of some self-etch adhesives.

Acid Etching, Dental↗
PubMed2002

[New trials for improving diagnostic accuracy of stress technetium-99m-tetrofosmin single photon emission computed tomography].

OBJECTIVES: This study evaluated the influence of extra-cardiac accumulation in technetium-99m-tetrofosmin myocardial single photon emission computed tomography (SPECT) imaging. METHODS: Technetium-99m-tetrofosmin myocardial SPECT was performed in 247 patients from 1997 to 1999. To evaluate the sensitivity, 42 patients with inferior infarction were selected. To evaluate the specificity, 32 patients with no significant perfusion defect and low pretest likelihood (< 15%) of coronary artery disease and 13 patients with normal coronary angiography were selected. Firstly, the SPECT raw data were evaluated according to the effects of diaphragm and breast, the position and the degree of accumulation of the liver, gall bladder and intestine. Then, the myocardial tracer uptake was scored semiquantitatively from 0 (normal) to 4 (perfusion defect) in the 13 segments of the left ventricle. RESULTS: The specificity was 86.7% and the sensitivity was 92.8%. Perfusion abnormality of the inferior wall was observed in 6 of 45 patients with a low pretest likelihood of coronary artery disease. These 6 patients were classified into the false positive group, and the other 39 patients were classified into the true negative group. The liver position and the liver accumulation on the stress images were significantly higher in the false positive group than in the true negative group (p < 0.001), but only the liver position on the rest images was significantly higher in the false positive group (p < 0.001). By estimating the defect 1 point lower for the high-positioned liver patients, specificity improved from 86.7% to 100% and sensitivity did not change. CONCLUSIONS: Inferior perfusion defect on technetium-99m-tetrofosmin myocardial SPECT of high-positioned liver patients needs to be evaluated with special caution.

Aged↗
PubMed2002

[The translation of questionnaires and of tests: techniques and problems].

OBJECTIVES: To summarize the difficulties involved in translating tests, to describe the translation methods and the test validation procedures, and to apply those to a personality test. METHOD: The revised Freiburg Personality Inventory (FPI-R) was translated, then subjected to the following test validation methods: backtranslation, pretest, and review by a carefully selected expert committee. RESULTS: We used a literature review to clarify FPI-R translation problems. These include in particular the different types of equivalence between the source language and the target language (for example, semantics and idioms, as well as experiential and conceptual equivalence). Statistical validation procedures are employed in principle only. CONCLUSION: The current method combining translation with backtranslation is not sufficient and must be used with, at least, a pretest and step-by-step review by an expert committee. The presence of unilingual experts to explain the smallest details of the target language, which bilingual experts could miss, seems to be mandatory.

Culture↗