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Median Scores (median + score)
Selected AbstractsDevelopment of a test to evaluate residents' knowledge of medical procedures,,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009Shilpa Grover MD Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source] The Impact of the Demand for Clinical Productivity on Student Teaching in Academic Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Todd J. Berger MD Objective: Because many emergency medicine (EM) attending physicians believe the time demands of clinical productivity limit their ability to effectively teach medical students in the emergency department (ED), the purpose of this study was to determine if there is an inverse relationship between clinical productivity and teaching evaluations. Methods: The authors conducted a prospective, observational, double-blind study. They asked senior medical students enrolled in their EM clerkship to evaluate each EM attending physician who precepted them at three academic EDs. After each shift, students anonymously evaluated 10 characteristics of clinical teaching by their supervising attending physician. Each attending physician's clinical productivity was measured by calculating their total relative value units per hour (RVUs/hr) during the nine-month study interval. The authors compared the total RVUs/hr for each attending physician to the medians of their teaching evaluation scores at each ED using a Spearman rank correlation test. Results: Seventy of 92 students returned surveys, evaluating 580 shifts taught by 53 EM attending physicians. Each attending physician received an average of 11 evaluations (median score, 5 of 6) and generated a mean of 5.68 RVUs/hr during the study period. The correlation between evaluation median scores and RVUs/hr was ,0.08 (p = 0.44). Conclusions: The authors found no statistically significant relationship between clinical productivity and teaching evaluations. While many EM attending physicians perceive patient care responsibilities to be too time consuming to allow them to be good teachers, the authors found that a subset of our more productive attending physicians are also highly rated teachers. Determining what characteristics distinguish faculty who are both clinically productive and highly rated teachers should help drive objectives for faculty development programs. [source] Breastfeeding duration and postpartum psychological adjustment: Role of maternal attachment stylesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2008pek Akman Aim: Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers. Methods: Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life. Results: All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) (P = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) (P < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status. Conclusions: This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery. [source] Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis: Results from the Norfolk Arthritis Register Study, a large inception cohortARTHRITIS & RHEUMATISM, Issue 4 2002M. Bukhari Objective To identify the relative contributions of clinical and laboratory variables, determined at baseline, in predicting the deterioration of radiographic damage 5 years after presentation in patients with inflammatory polyarthritis. Methods Data from 439 subjects who sought primary care for inflammatory polyarthritis were analyzed. All subjects had paired radiographs, of which the first was obtained within 24 months of presentation and the second at 5 years after presentation. The contribution of baseline clinical and laboratory variables in predicting the degree of radiologic severity as judged by the Larsen score was assessed at both time points. Additionally, the role of these factors in predicting change after adjustment for baseline severity was also measured. Results By 5 years, 49% of subjects had evidence of erosions. The median Larsen score on the first film was 2 (interquartile range [IQR] 0,10) and the median score on the followup film was 7 (IQR 1,25). These corresponded to a median deterioration of 3 (IQR 0,14) in all subjects, whereas those subjects with evidence of erosions at first film showed a median deterioration of 15 (IQR 6,29) on followup. The rheumatoid factor (RF) status, C-reactive protein levels, the presence of nodules, and number of swollen joints at baseline were all predictive of radiographic severity at first film. Not surprisingly, the baseline radiographic score was a predictor of severity of deterioration. However, after adjusting for baseline severity, a high titer of RF (>1:160) was also an independent predictor of deterioration over 5 years: individuals with an initial RF at that level had a progression in their Larsen score that was 2.3 times (95% confidence interval 1.7,3.2) higher than that in the RF-negative individuals. Apart from this, only age had an independent effect, after adjusting for baseline severity, in predicting increasing radiographic joint damage. Conclusion High-titer RF is an important variable in predicting continuing severity of radiographic damage during the first 5 years after presentation with inflammatory polyarthritis. [source] Sacral nerve stimulation for faecal incontinence alters colorectal transport,,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2008H. B. Michelsen Background: Sacral nerve stimulation reduces the frequency of defaecation in patients with faecal incontinence. The aim of this study was to examine the mechanism behind the reduced number of bowel movements in incontinent patients treated with sacral nerve stimulation. Methods: The study included 20 patients with faecal incontinence and a positive percutaneous nerve evaluation test: 19 women and one man, with a median age of 63 (range 28,78) years. Colorectal scintigraphy was performed to assess colorectal emptying at defaecation before and after implantation. Segmental colorectal transit times were determined using radio-opaque markers. Results: The median frequency of defaecation per 3 weeks decreased from 56 (range 19,136) to 26 (range 12,78) (P < 0·002). At defaecation, antegrade transport from the ascending colon decreased from a median score of 8 (range 0,23) to 0 (range 0,11) per cent (P = 0·001), while retrograde transport from the descending colon increased from a median score of 0 (range 0,14) to 2 (range 0,30) per cent (P = 0·039). The median defaecation score was unchanged. There was a non-significant increase in median total gastrointestinal transit time from 2·5 (range 0·9,6·2) to 3·3 (range 0·8,6·2) days (P = 0·079). Conclusion: Sacral nerve stimulation reduces antegrade transport from the ascending colon and increases retrograde transport from the descending colon at defaecation. This may prolong colonic transit time and increase the storage capacity of the colon. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Implementation of kangaroo mother care: A randomized trial of two outreach strategiesACTA PAEDIATRICA, Issue 7 2005Robert C Pattinson Abstract Aim: To test whether a well-designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty-four hospitals in KwaZulu-Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress-monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29,22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08,21.13). Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation. [source] The Impact of the Demand for Clinical Productivity on Student Teaching in Academic Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Todd J. Berger MD Objective: Because many emergency medicine (EM) attending physicians believe the time demands of clinical productivity limit their ability to effectively teach medical students in the emergency department (ED), the purpose of this study was to determine if there is an inverse relationship between clinical productivity and teaching evaluations. Methods: The authors conducted a prospective, observational, double-blind study. They asked senior medical students enrolled in their EM clerkship to evaluate each EM attending physician who precepted them at three academic EDs. After each shift, students anonymously evaluated 10 characteristics of clinical teaching by their supervising attending physician. Each attending physician's clinical productivity was measured by calculating their total relative value units per hour (RVUs/hr) during the nine-month study interval. The authors compared the total RVUs/hr for each attending physician to the medians of their teaching evaluation scores at each ED using a Spearman rank correlation test. Results: Seventy of 92 students returned surveys, evaluating 580 shifts taught by 53 EM attending physicians. Each attending physician received an average of 11 evaluations (median score, 5 of 6) and generated a mean of 5.68 RVUs/hr during the study period. The correlation between evaluation median scores and RVUs/hr was ,0.08 (p = 0.44). Conclusions: The authors found no statistically significant relationship between clinical productivity and teaching evaluations. While many EM attending physicians perceive patient care responsibilities to be too time consuming to allow them to be good teachers, the authors found that a subset of our more productive attending physicians are also highly rated teachers. Determining what characteristics distinguish faculty who are both clinically productive and highly rated teachers should help drive objectives for faculty development programs. [source] Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5,6 in non-addicted infantsADDICTION, Issue 3 2010Urs Zimmermann-Baer ABSTRACT Objective The neonatal abstinence scoring system proposed by Finnegan is used widely in neonatal units to initiate and to guide therapy in babies of opiate-dependent mothers. The purpose of this study was to assess the variability of the scores in newborns and infants not exposed to opiates during the first 3 days of life and during 3 consecutive days in weeks 5 or 6. Patients and methods Healthy neonates born after 34 completed weeks of gestation, whose parents denied opiate consumption and gave informed consent, were included in this observational study. Infants with signs or symptoms of disease or with feeding problems were excluded. A modified scoring system was used every 8 hours during 72 hours by trained nurses; 102 neonates were observed for the first 3 days of life and 26 neonates in weeks 5,6. A meconium sample and a urine sample at weeks 5,6 were stored from all infants to be analysed for drugs when the baby scored high. Given a non-Gaussian distribution the scores were represented as percentiles. Results During the first 3 days of life median scores remained stable at 2 but the variability increased, with the 95th percentile rising from 5.5 on day 1 to 7 on day 2. At weeks 5,6 median values were higher during daytime (50th percentile = 5, 95th percentile = 8) than night-time (50th percentile = 2, 95th percentile = 6, P = 0.02). Conclusion Scores increase from days 1,3 to weeks 5,6 and show day,night cycles with 5,6 weeks. Values above 8 can be considered pathological. This data may help to raise suspicion of narcotic withdrawal and to guide therapy. [source] Improving the quality of clinical teaching in a restorative clinic using student feedbackEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2008Callum Youngson Abstract Introduction:, A large proportion of the undergraduate curriculum is spent within Restorative Dentistry at the University of Liverpool. As well as supportive "phantom head" courses the undergraduates receive significant amounts of teaching within the clinics themselves. In 2004, to help inform the clinical tutors as to their areas of strengths and weaknesses, undergraduates were invited to complete an anonymous questionnaire on the quality of teaching they received from their clinical supervisors. This process has been repeated subsequently in 2005 and 2006. Method:, A 19 parameter questionnaire, employing a 5-point Likert scale and space for open comments, was circulated to every clinical undergraduate student. Questionnaires were returned anonymously and all data collected by one researcher. Descriptive statistical analysis was performed and the staff provided with individual feedback within the context of the overall departmental profile. The pooled data from each of the years was then compared to determine if any changes had occurred. Statistical analysis used Kruskal Wallis tests to determine whether these were statistically significant. Results:, Although the range varied, median scores of 4 (agree) were gained for each question each year. Following statistical analysis 18 of the parameters showed a statistically significant improvement (P < 0.05) between 2004 and 2006 with only one remaining constant throughout. Conclusion:, It would appear that the use of a questionnaire based feedback system can result in a tangible and demonstrable improvement in the delivery of clinical teaching. [source] Health-related quality of life and symptom classification in patients with irritable bowel syndromeJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2010Graeme D Smith smith gd, steinke dt, penny ki, kinnear m & penman id (2010) Journal of Nursing and Healthcare of Chronic Illness2, 4,12 Health- related quality of life and symptom classification in patients with irritable bowel syndrome Background., Previous research has established that health-related quality of life can be adversely affected by irritable bowel syndrome IBS. Irritable bowel syndrome has been classified to subgroups by predominant bowel symptom: constipation, diarrhoea or alternating between the two. Little is presently known about the specific impact of irritable bowel syndrome on health-related quality of life within disease sub-groups across time. Aims., To examine the health-related quality of life in a cohort of individuals with irritable bowel syndrome to explore the association between quality of life and disease subtype classification. Setting., The general population of the UK. Design., Longitudinal cohort survey was conducted. Methods., Individuals with symptoms of irritable bowel syndrome were recruited via a UK-wide newspaper advertisement. The health-related quality of life was measured using a battery of validated questionnaires. Results., Data on 494 participants with a Rome II confirmed diagnosis of irritable bowel syndrome were examined. Measurement of generic health-related quality of life revealed lower median scores (poorer quality of life) in anxiety/depression and pain/discomfort domains of health. Conclusion., Health-related quality of life is impaired in community based individuals with IBS. Patients appear to fluctuate between sub-groups when irritable bowel syndrome is classified across time. This study suggests that the impact of irritable bowel syndrome may be greatly underestimated. Relevance for clinical practice., The use of sub-group classification and understanding of predictive factors may allow for a more flexible and efficient approach to healthcare assessment and patient care for people with irritable bowel syndrome. [source] Perception of risk of adverse drug reactions by medical students: influence of a 1 year pharmacological courseBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2007G. Durrieu What is already known about this subject ,,Previous studies have pointed out the question of effective training and information for health professionals on adverse drug reactions (ADRs). ,,This lack of training is known to induce inadequate use of drugs and noncompliance of patients. What this study adds ,,Our study was the first to evaluate the perceived risk of ADRs among young medical students and to investigate the impact of university pharmacology courses on their perception of this risk. ,,The aim of our study was not to assess a definite level of perception of risk for the different drug classes but to determine whether the perceived risk of ADRs differs after attending pharmacology courses. ,,Our results show that the pharmacological training allows young medical students to be aware of potentially serious ADRs, especially related to drugs considered as relatively safe, such as NSAIDs and aspirin. Aims To investigate how adverse drug reactions (ADRs) to several classes of drugs are perceived by young medical students before and after a 1 year pharmacology course. Methods The whole cohort of 92 medical students (63 females and 29 males) was questioned during their third year. A visual analogue scale was used to define a score (ranging from 0 to 10) of perceived risk of ADRs associated with each drug class before and at the end of the pharmacological training period. Results Before the pharmacology course, hypnotics were ranked as the most dangerous drugs by the medical students, followed by antidepressants and anticoagulants. Contraceptive pills were listed in the last position. After pharmacological training, antidepressants moved into the first position, followed by anticoagulants and hypnotics. When all different drug classes were taken as a whole, the mean (±SD) of median scores of the perceived risk were 4.8 (±1.3) before and 5.8 (±1.5) at the end of the pharmacology course (P < 0.0001). Except for antidiabetics, antihypertensive drugs, tranquillizers, corticosteroids and hypnotics, the perceived risk significantly increased after the pharmacology course for the other drugs. The highest increases were observed for contraceptive pills (+104%, P < 0.01), NSAIDs (+86%, P < 0.01) and aspirin (+56%, P < 0.01). Conclusions Pharmacological training allows young medical students to be aware of potentially serious ADRs associated with drugs, in particular with drugs considered relatively safe (such as NSAIDs and aspirin) by nonhealth professionals. [source] Effects of epidermal growth factor receptor inhibitor-induced dermatologic toxicities on quality of life,CANCER, Issue 16 2010Smita S. Joshi MD Abstract BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors frequently result in dermatologic toxicities, including rash, xerosis, pruritus, and paronychia. Although the frequency and severity of these events have been described, their effect on health-related quality of life (QoL) remains poorly understood. By using a dermatology-specific questionnaire, the authors examined the effect of these toxicities on QoL. METHODS: Patients completed the Skindex-16, a questionnaire that measures the effects on 3 domains of QoL: symptoms, emotions, and functioning. The severity of dermatologic toxicities was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0 (NCI-CTCAE). Correlations of dermatology QoL scores with NCI-CTCAE grade, skin phototype (SPT), sex, age, type of EGFR inhibitor, and cancer type were investigated. RESULTS: Concordant with greater severity of rash grade, there was an increase in median scores for symptoms (P = .0006), emotions (P < .0001), function (P = .001), and overall score (P < .0001). There was an inverse correlation between age and emotions (r = ,0.26; P = .03) and overall score (r = ,0.25; P = .04). There was a significant difference between patients aged ,50 years and patients aged >50 years with regard to symptoms (P = .02), emotions (P = .03), functioning (P = .04), and overall score (P = .02). There were no significant differences between QoL and SPT, sex, treatment type, or cancer type (P > .05). CONCLUSIONS: Toxicities, including rash, xerosis, paronychia, and pruritus, adversely affected QoL, and rash was associated with a QoL greater decrease. Younger patients reported lower overall QoL than older patients who had the same toxicities. The current results support using the NCI-CTCAE as a correlative tool for measuring the effects of rash on dermatology-specific QoL. Cancer 2010. © 2010 American Cancer Society. [source] | ||||||||||