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Cardiopulmonary disease in newborns: a study in continuing medical education.

A film emphasizing the importance of tachypnea as an early manifestation of congenital heart disease was shown to physicians and nurses at 27 hospitals as part of their regular continuing medical education activities. To evaluate the effects of the program, investigators developed a pretest-posttest design which included a nonequivalent control group. Pretest and posttest data were obtained through chart audit of referrals from subjects in experimental and control groups. Dependent variables used to test the hypothesis included the age at which infants were referred and the age at which tachypnea was noted. Analysis of the data yielded significant gain scores for the experimental group, while changes in the control group were not significant. The findings indicate that a need-oriented educational program can have a measurable impact on improving the quality of patient care.

Age Factors↗

A comparison of three educational techniques used in a venereal disease clinic.

The communications methods that could be used in educational programs for venereal disease patients were examined as to their relative effectiveness: a programed learning guide, an audiovisual (cinematographic) technique, and an interview method. An experimental design was used to study three groups of patients at a venereal disease clinic; (a) persons who were pretested, exposed to an educational method, and tested again, (b) a control group whose members were pretested and post-tested but not exposed to an educational method, and (c) another control group whose members were exposed to an educational method and then took a post-test. Each of those groups exposed to the educational techniques was further subdivided according to the technique applied. Analysis of the data collected from 443 subjects led to the following tentative conclusions: 1. Representation in the nine groups was demographically uniform as measured by age, sex, marital status, and ethnic origin. 2. All three educational techniques significantly raised the subjects' level of knowledge about venereal disease, as measured by their test scores. 3. All three techniques were favorably received by the subjects. The majority reported that the techniques were the right length (10 to 15 minutes), interesting, informative, useful, and anxiety-reducing. The three techniques apparently accounted for an increase of more than 20 percent in subjects' scores on tests about venereal disease, and the subjects perceived all three techniques as interesting and beneficial. The interview method proved significantly more effective than the other two techniques in raising the knowledge level. It was also the technique most favorably received by the subjects. As expected, those persons who entered the clinic with a low level of knowledge learned much more when exposed to an educational techniques than persons entering the clinic with a high level of knowledge. Reaction to the three methods did not differ significantly by the subjects' age or sex.

Achievement↗

Interpersonal skills training: evaluation in an internal medicine residency.

To determine the effectiveness of teaching interpersonal skills in a general internal medicine residency, a program was developed utilizing videotape feedback of house-staff/patient interactions, a modification of Interpersonal Process Recall (IPR). Fifty-one randomly selected house officers at different levels of training were included in a controlled, pretest-posttest study design. The major pre-post measures were three independent ratings of videotapes of actual first-visit interviews between resident and patient. House officers in the experimental group significantly increased the proportion of each interview devoted to psychosocial issues compared with controls, although the interviews remained predominantly medical; increased the use of effective responses; and improved their level of empathy with patients. Personality and attitude measures were found not to correlate with observed interpersonal skills on pretest or posttest videotapes. House officers rated the training program as being interesting, valuable, relevant, and nonthreatening. The data suggest that interpersonal skills can be effectively taught to internal medicine residents utilizing a videotape feedback training program.

Feedback↗

Endurance training and cardiovascular function in 9-and 10-year-old boys.

Thirty-two boys, 9 and 10 years old, were randomly divided into experimental and control groups in order to investigate cardiovascular responses to interval cycle training. The experimental group exercised on a cycle ergometer 5 days a week during their physical education periods. There were 4 work bouts of 4 minutes each, separated by 3-minute recovery intervals each day for 8 weeks. Loads were prescribed so that heart rates ranged from 170 to 195 for each bout (80--90% estimated maximum). The control group took part in a traditional sports-oriented physical education period during this time. Pretest steady-state values at HR130 were determined for oxygen consumption, heart rate, and cardiac output, after which the load was progressively increased to determine physical work capacity at heart rate 170. The tests were repeated after the 8-week training period, at work loads identical to pretest values. Analysis of covariance revealed that significant improvements in the experimental group occurred in stroke volume and oxygen pulse. The 6.5% increase in stroke volume was countered by a 6.8% decrease in heart rate, resulting in no differences in cardiac output. Increases in physical work capacity occurred in each group, but only that of the experimental group was significant. No differences were detected for either group in steady state oxygen consumption or calculated arteriovenous oxygen difference. It was concluded that children of this age level adapt readily to cardiovascular stress. It was suggested that if improvement in cardiovascular fitness is considered to be a valid goal of physical education, then the traditional sports and games should be supplemented by training procedures designed specifically for endurance.

Cardiac Output↗

Content and retention evaluation of an audiovisual patient-education program on bronchodilators.

A study was conducted to: (1) evaluate the effect of a slide-tape program on patients' short-term and long-term knowledge about their bronchodilator medications; and (2) determine it any differences exist in learning or retention patterns for different content areas of drug information. The knowledge of 30 patients was measured using a randomized sequence of three comparable 15-question tests. The first test was given before the slide-tape program was presented, the second test within 24 hours, and the last test one to six months (mean = 2.8 months) later. Scores attained on the first posttest were significantly higher (p less than 0.001) than pretest scores. Learning differences among drug-information-content areas were not evidenced on the first posttest. No significant difference was demonstrated between scores on pretest and last posttest (p = 0.100). However, retention patterns among content areas were found to differ significantly (p less than 0.05). Carefully designed audiovisual programs can impart drug information to patients. Medication counseling should be repeated at appropriate opportunities because patients lose drug knowledge over time.

Adolescent↗

Trainee attitudes toward disabled persons: effect of a special physical education program.

The effects of a university level training program in Special Physical Education on trainee attitudes toward disabled individuals were studied for the period of an academic year under three conditions: Information only (I group), Contact only (C group) and Information plus Contact (IC group). Complete pretest and posttest data on the Siller General Factor Disability Scale (DFS-G) were collected from a combined sample of 81 men and women subjects aged from 18-45+ years. Descriptive analyses revealed significant interactions between specific dimensions of the DFS-G and variables such as age, previous experience with disabled persons and educational status. Analyses of variance failed to uncover statistically significant posttest differences among the groups. Of the individual training conditions, IC impacted most positively on within-group attitude change. More unexpected was the significant pretest to posttest attitude score gains of the I group on four of the seven subscales, superior to those of the C group. Whereas attitude measurements do not establish discrete positive-negative parameters, it is unclear whether some attitude dimensions tend to plateau at positive levels or are inherently more implacable.

Adolescent↗

Progressive relaxation training in cardiac rehabilitation: effect on psychologic variables.

The purpose of this study was to investigate the effect of progressive relaxation training as a stress management technique for cardiac patients who were participants in a cardiac exercise program. After pretesting, 18 patients received 3 weeks of relaxation training in addition to their exercise therapy; a control group of 19 patients was not taught the technique. Pretesting used two instruments to measure stress levels-the Spielberger State-Anxiety Scale and selected dimensions of the Symptom Checklist-90-Revised. At the completion of the relaxation training program, both groups of patients were retested on stress-level measures. An analysis of covariance was used to test for the effects of the relaxation training program. The findings were: posttreatment mean anxiety scores for the treatment group were significantly lower (p less than .05) than that of the control group; and the posttest scores for the treatment group were significantly lower for the dimensions of (p less than .01) somatization and interpersonal sensitivity and (p less than .05) anxiety and depression than that of the control group. No systematic changes were induced in either the obsessive-compulsive or hostility dimension scores by the relaxation program.

Analysis of Variance↗

[Water metabolism in monkeys during 14-day anti-orthostatic hypokinesia].

Water balance parameters were measured in hypokinetic rhesus monkeys using tritiated water. During exposure the water content decreased by 18.4%, with 11.3% lost within the first 7 days. The rate of water renovation measured with respect to H3 half-life was decreased by a factor of 1.5 during the first week and increased by 10% during the second week, as compared to the pretest value. Daily water losses diminished by 30% during the first week and approached the pretest level during the second week. These findings are indicative of three phases in the time-course variations of water balance during head-down tilt.

Animals↗

[Diagnostic value of 201-thallium imaging following dipyridamole in patients with a normokinetic left ventricle].

In 100 patients with a normokinetic left ventricle 201-thallium imaging following administration of dipyridamole (0.50 mg/kg body wt. i.v.) showed a sensitivity of 67% (41/61) and a specificity of 95% (37/39) in diagnosing coronary artery disease. Exercise stress testing gave nearly equal sensitivity values (36/58 = 62%) with only slightly lower specificity (32/39 = 85%). The rate of true positive 201-thallium findings increased with the number of narrowed vessels (one vessel disease 50%, two vessel disease 63%, three vessel disease 94%); the extent of coronary artery disease was almost regularly underestimated with the scintigraphic method. Because of the low sensitivity a negative finding cannot exclude the presence of coronary artery disease, but the existence of three vessel disease can be considered improbable in patients in whom thallium scintigraphy findings are negative. Analysis following Bayes' theorem revealed the method to have a low diagnostic value in patients with either very low or high pretest probability for the disease; either a positive or a negative finding is of most use in a patient with low or average pretest probability of the disease (20-60%).

Coronary Disease↗

Central circulation of a normal man during 7-day head-down tilt and decompression of various body parts.

The effect of 7-d head-down tilt (-15 degrees) and decompression of various body parts (lower body--LBNP, upper body in the area of the hydrostatically indifferent point--UBNP, and local negative pressure applied to both calves--LNP) on central circulation was investigated on eight healthy test subjects who, for 10 d, had catheters (Swan-Ganz) implanted into the pulmonary and radial arteries. It was shown that, when calculated by square centimeter of the decompression area, the effect of UBNP on central venous pressure (CVP) and pulmonary artery pressure (PAP) was 3-4 times greater than that of LBNP or LNP. This indicates a high sensitivity of this body part to the exposure. During the 7-d study, CVP and PAP showed the most distinct changes. By the 7th hour of the head-down tilt study, CVP remained unchanged and systolic PAP increased by 5.5 mm Hg (27%) (p less than 0.05). This was paralleled by a decrease of plasma aldosterone and renin. By the 2nd day of the study, CVP and PAP were close to the pretest level; on the 3rd day, they began to decline and remained about 3 mm Hg lower than the pretest values to the end of the study (p less than 0.05). During this same period, the contractility of the right heart (the mean rate of right ventricular pressure increment) decreased by 34% (p less than 0.05) and its work by 27% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Interpretation of diagnostic data: 5. How to do it with simple maths.

The use of simple maths with the likelihood ratio strategy fits in nicely with our clinical views. By making the most out of the entire range of diagnostic test results (i.e., several levels, each with its own likelihood ratio, rather than a single cut-off point and a single ratio) and by permitting us to keep track of the likelihood that a patient has the target disorder at each point along the diagnostic sequence, this strategy allows us to place patients at an extremely high or an extremely low likelihood of disease. Thus, the numbers of patients with ultimately false-positive results (who suffer the slings of labelling and the arrows of needless therapy) and of those with ultimately false-negative results (who therefore miss their chance for diagnosis and, possibly, efficacious therapy) will be dramatically reduced. The following guidelines will be useful in interpreting signs, symptoms and laboratory tests with the likelihood ratio strategy: Seek out, and demand from the clinical or laboratory experts who ought to know, the likelihood ratios for key symptoms and signs, and several levels (rather than just the positive and negative results) of diagnostic test results. Identify, when feasible, the logical sequence of diagnostic tests. Estimate the pretest probability of disease for the patient, and, using either the nomogram or the conversion formulas, apply the likelihood ratio that corresponds to the first diagnostic test result. While remembering that the resulting post-test probability or odds from the first test becomes the pretest probability or odds for the next diagnostic test, repeat the process for all the pertinent symptoms, signs and laboratory studies that pertain to the target disorder. However, these combinations may not be independent, and convergent diagnostic tests, if treated as independent, will combine to overestimate the final post-test probability of disease. You are now far more sophisticated in interpreting diagnostic tests than most of your teachers. In the last part of our series we will show you some rather complex strategies that combine diagnosis and therapy, quantify our as yet nonquantified ideas about use, and require the use of at least a hand calculator.

Bayes Theorem↗

Educational package on hypertension for primary care physicians.

The usefulness of an educational package on hypertension that provides clinically important, up-to-date medical information and office "aids" to primary care physicians was tested in a randomized controlled trial. Fifty-six physicians completed a pretest multiple-choice questionnaire and were allocated at random either to a group that received the educational package (the "study group") or to a control group. There was a highly significant correlation between the pretest scores and the number of years since graduation (r = -0.55, p less than 0.0001), which indicated that younger physicians are more likely than older physicians to have an up-to-date knowledge of the management of hypertension. The increase in knowledge in the study group (17.5%) was significantly greater than that in the control group (2.7%). Furthermore, although the post-test scores in the control group were still significantly correlated with the number of years since graduation, those in the study group were not. It was concluded that although the older physicians knew less than their younger colleagues about hypertension, the use of the educational package significantly increased knowledge, and the increase was not limited by the physician's age.

Age Factors↗

Strengthening of human quadriceps muscles by cutaneous electrical stimulation.

The effectiveness of cutaneous electrical stimulation as a muscle-strengthening technique was evaluated by comparison with an isometric regime. Sixteen normal healthy subjects were randomly assigned to either an electrical group or an isometric group. A pretest was given of maximum voluntary force in the quadriceps (extensor) muscles, measured with a cable tensiometer. Subjects then trained (isometrically or by electrical stimulation) four days per week for three weeks. Training by electrical stimulation was via a square-wave pulse (75 Hz and 0.1 ms) with the voltage determined by subject tolerance for ten, 10-sec induced contractions (with 50-sec rest intervals). Isometric training consisted of ten, 10-sec maximal contractions (with 50-sec rest intervals) at each session. Feedback of the generated force was standardised for both groups. Post-training measures were then administered using the same protocol as the pretest. Both groups demonstrated a marked improvement in quadriceps strength of 22 +/- 5.3% for the electrical group and 25 +/- 6.9% increase for the isometric group (p less than 0.02). The change in strength was apparently not dependent on the magnitude of the stimulating voltage (5-10 V) nor on the tension induced. There was no significant difference in the strength gains achieved by the two regimes (p greater than 0.05). No pain, muscle lesions or other ill effects were observed with electrical stimulation. We conclude that cutaneous electrical stimulation is a viable strengthening technique. There are obvious practical applications of this technique to the rehabilitation of patients who are not able to maintain an effective voluntary contraction.

Adult↗

Training visual-spatial ability in EMR children.

Educable mentally retarded children were randomly assigned to either a visual-spatial training condition or a control group. The children who received training showed a gain from pretest to posttest on the Children's Embedded Figures Test that corresponds to approximately 4 years of maturation in nonretarded children. The performance of the children in the control group on the posttest was not significantly different from their performance on the pretest. Correlations between measures of visual-spatial ability and the employment adjustment of retarded persons obtained by other investigators suggest the potential importance of developing the visual-spatial skills of this population.

Adolescent↗

Teaching communication skills in rehabilitation medicine.

Helping communication skills are one of the main requisites for rehabilitation professionals to help patients become independent and solve problems. Twenty-two rehabilitation professionals were given a 45-hour communication skills course using the Human Resources Development Model. Pretesting and posttesting were performed with videotapes and written indexes. Pretest scores showed an ineffective level of helping skills, while posttest scores showed significant improvement to mininally effective levels. Postcourse questionnaires indicated that the trainees believed that the experience would make a lasting change in their communication and helping skills and that this type of training was important in rehabilitation.

Communication↗

Data collection techniques: mail questionnaires.

Questionnaire use, construction, content, wording, administration and pretesting are reviewed. Mail questionnaires gather large amounts of information at relatively low costs, but their design and administration affect the usefulness of the results. Many different aspects of a questionnaire survey will influence its effectiveness, including pre-contact and follow-up, cover letters, question sequence, and questionnaire appearance and length. The type of question to use depends on the level of measurement desired, suitability of the response form to the issue surveyed, and the ability of respondents to use and understand the response form. A small sample group should be used to pretest the questionnaire.

Methods↗

[Development and evaluation of self-study material for smoking prevention education].

A booklet for smoking prevention education was developed for junior high school students, which is a role-play activity book for self-study and discusses not only the harmful effects and dependency of smoking but also psychosocial factors affecting smoking behavior among students. The purpose of this material is to provide students with basic information needed to choose a non-smoking lifestyle even without a teacher's direct instruction. Process evaluation and impact evaluation studies were carried out between September 1991 and September 1992. Six hundred sixty-nine students and 9 teachers from three junior high schools in Osaka, Tokyo and Yamagata participated in the process evaluation study. More than 90% of the students were able to complete the material in one school hour and less than 4% students expressed difficulty in learning from the booklet. Nine hundred seventy-seven students from 2 junior high schools in Tokyo participated in an intervention study to evaluate the effectiveness of the material. There were 500 students in the experimental school and 477 students in the control school. All students were given a pretest and posttest, 2 months apart. Knowledge concerning smoking increased and attitudes toward smoking were modified significantly in the experimental school. However, intention to smoke and smoking behavior did not change significantly, due to the small numbers of students with intention to smoke at the time of pretest and because there was not enough time for their intention to change. This study demonstrates the effectiveness of the material in junior high school. However, teacher participation during the instruction is also seen to be necessary for greater effect.

Adolescent↗

Structured educational program for staff development.

The development of a mandatory continuing education program for the pharmacy staff of a 675-bed hospital with 10 decentralized pharmacy satellites is described. The therapeutic topics selected for presentation were antibiotics, immunology and adverse drug reactions, diabetes mellitus and acid-base disorders. The format for each subject included a pretest of basic knowledge, a comprehensive lecture, a tape recording, supplemental handout material and readings, and a posttest. Posttests were scheduled three to four weeks following lectures to allow preparation time. Questionnaires were used to evaluate acceptance of the program. Posttest scores for each of the four topics were significantly better than pretest scores (p less than or equal to 0.0001). Questionnaire responses indicated that 97% of the participants believed the program to be worthwhile, and 94% voted to continue the series. The success and acceptance of this approach to continuing education support its application to a comprehensive program of staff development.

Chicago↗