Factors affecting the educational diagnosis of diabetic patients.

An accurate determination of the educational needs of diabetic patients is based on a wide range of patient characteristics. In the development of an assessment instrument to determine the educational needs of patients, the relative importance of numerous patient characteristics was determined. A questionnaire was mailed to 1518 health professionals who are either members of the American Association of Diabetes Educators or community health nurses in the state of Michigan. Analyses of the responses to this questionnaire have provided information regarding the knowledge, psychosocial, and demographic characteristics of patients, which are thought to be important in an educational diagnosis. Questions to measure these identified characteristics will be incorporated into an instrument that will assess the educational needs of diabetic patients.

High blood pressure in older Americans. The First National Health and Nutrition Examination Survey.

Data from a representative sample of the U.S. adult population obtained during 1971-1975 were analyzed to provide a profile of blood pressure (BP) levels and related nutritional and sociodemographic factors. Older adults (aged 55-74 years) had a twofold greater prevalence of high BP than younger adults (25-54 years), and older black persons had the highest rates. Isolated systolic elevation was uncommon under 54 years of age, but occurred in 5% to 10% of adults over 55 years and was less common than systolic-diastolic elevation. In older adults, body mass (weight/height2) had the strongest relationship to BP of all the nutritional variables. Alcohol consumption and dietary calcium and phosphorus were associated with high BP, but dietary sodium and salt use were not. The serum calcium/phosphorus ratio and serum urate were significantly higher in older adults with high BP. In general, the variables associated with elevated BP in older adults were similar to those in younger adults, although the strengths of the associations differed. Associations of factors useful for nonpharmacologic prevention and management of high BP in older persons were suggested from this survey.

Resident selection: applicant selection criteria compared with performance.

One hundred three surgical house officers, 41 in general surgery and 62 in specialty surgery, entered the residency program from 1975 through 1979. Their application data, including the National Board of Medical Examiners test part I scores, preclinical course honors, clinical course honors, surgical clerkship honors, election to Alpha Omega Alpha (AOA), published research, medical school grading system, medical school rating, and National Resident Matching Program rank, were tabulated. Each house officer's performance was assessed by monthly faculty evaluation and by annual standard American Board of Surgery In-Training Examination (ABSITE) score through the second year of the program. The application data were compared with the performance data to determine significant indicators of success. Factor analysis computed on the monthly evaluation forms identified a knowledge factor and an interpersonal skills factor. Statistical analyses were used to study the relationships among the independent (preentry) variables and the knowledge, interpersonal skills, and ABSITE postentry variables. The results were significant (P less than 0.05) for medical school honors, election to AOA, and medical school grading system. No significance was found for the remaining preentry variables. The knowledge and interpersonal skill evaluation scores for the house officer I and II years were significantly correlated. Although the postentry assessment of knowledge correlated with certain applicant data, the assessment of interpersonal factors was not statistically related.

Effects of a CME program on physicians' transfusion practices.

A two-stage project was designed to assess physicians' transfusion practices and to evaluate the effectiveness of a continuing medical education (CME) lecture to change these practices. The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. The groups were matched for age and sex distribution and for procedure. The results suggested that the physicians accepted lower hematocrit levels for autologous-donor patients, did not request adequate amounts of autologous blood, overtransfused some patients with their own blood, and did not schedule the elective procedures far enough in advance to allow patients to deposit the requested amounts of autologous blood. A CME program developed to address the latter three problems was given to seven subspecialty groups in a grand rounds lecture format. Follow-up comparisons of the orthopedic surgeons' blood transfusion practices indicate that after the CME program they did significantly less underordering of autologous blood but still did not increase the time for patients to donate the requested amounts of blood.

Validity of three clinical performance assessments of internal medicine clerks.

PURPOSE: To analyze the construct validity of three methods to assess the clinical performances of internal medicine clerks. METHOD: A multitrait-multimethod (MTMM) study was conducted at the Case Western Reserve University School of Medicine to determine the convergent and divergent validity of a clinical evaluation form (CEF) completed by faculty and residents, an objective structured clinical examination (OSCE), and the medicine subject test of the National Board of Medical Examiners. Three traits were involved in the analysis: clinical skills, knowledge, and personal characteristics. A correlation matrix was computed for 410 third-year students who completed the clerkship between August 1988 and July 1991. RESULTS: There was a significant (p < .01) convergence of the four correlations that assessed the same traits by using different methods. However, the four convergent correlations were of moderate magnitude (ranging from .29 to .47). Divergent validity was assessed by comparing the magnitudes of the convergence correlations with the magnitudes of correlations among unrelated assessments (i.e., different traits by different methods). Seven of nine possible coefficients were smaller than the convergent coefficients, suggesting evidence of divergent validity. A significant CEF method effect was identified. CONCLUSION: There was convergent validity and some evidence of divergent validity with a significant method effect. The findings were similar for correlations corrected for attenuation. Four conclusions were reached: (1) the reliability of the OSCE must be improved, (2) the CEF ratings must be redesigned to further discriminate among the specific traits assessed, (3) additional methods to assess personal characteristics must be instituted, and (4) several assessment methods should be used to evaluate individual student performances.

Prevalence and correlates of hospital-based autologous blood programs: a statewide survey.

To identify potential barriers to use of autologous blood procurement to minimize homologous blood transfusion needs during elective surgery, the authors conducted a telephone survey of 120 blood bank directors, representing 138 Ohio hospitals. The prevalence of autologous blood procurement facilities, estimated volume of autologous blood, and attitudes and perceptions of the directors toward autologous blood predeposit programs were assessed. Analysis of the data indicated that 30% of Ohio hospitals have autologous blood procurement facilities; larger hospitals were more likely to have this facility. Overall, 5.5% of transfusions involve predeposited autologous blood. No significant differences were found according to hospital bed size or whether the hospital had a procurement facility. Blood bank directors perceived surgeons to be knowledgeable about autologous predeposit; patient demand and surgical practice were felt to be more effective in promoting the use of autologous blood at the hospital than were blood bank efforts. Directors who had autologous predeposit procurement facilities perceived that the facility provided a marketing advantage. Respondents from larger hospitals were more likely to perceive that these programs could be financially self-sufficient. The authors conclude that an economic cost-benefit analysis of hospital-based autologous blood procurement programs is important. Positive findings may influence transfusion services to adopt autologous blood procurement programs, whereas negative findings may convince hospitals that community blood donor facilities can provide better autologous blood procurement.

A retrospective analysis of grand rounds in continuing medical education.

Grand Rounds activities are an integral component of medical education. They present clinical problems in medicine by focusing on current or interesting cases. Grand Rounds originated as part of residency training wherein new information was taught and clinical reasoning skills were enhanced. Today, Grand Rounds also are used in continuing medical education as an instructional method for maintaining and improving clinical skills of practicing physicians. This study reviewed 43 Grand Rounds activities conducted by 12 departments in five affiliated hospitals as part of a program in Continuing Medical Education. All the Grand Rounds activities were developed to meet Category 1 requirements. They included the departmental Grand Rounds and the more specialized divisional Grand Rounds. An analysis of the 1138 physicians who attended one or more of the 1079 meetings of these Grand Rounds produced a preliminary description of a "typical" Grand Rounds activity. Analyses of these data suggest that Grand Rounds provides an important educational activity for medical students and graduate medical trainees as well as practicing physicians. The Category 1 accreditation requirements may serve to improve the educational outcomes of these activities and they provide an excellent mechanism for faculty role-modeling and improving clinical problem-solving skills.

The effect of nonlinear transformations on a Likert scale.

The analysis of data collected from behavioral assessment instruments is typically conducted using parametric statistics, with little or no reference given to the underlying nature of the scale being used. If the nature of the distances between the scale points is not understood, the concept of normality of the distribution becomes clouded. An empirical approach to studying this problem was developed, using responses to a clinical performance evaluation instrument that uses a four-point behaviorally-anchored scale. Various combinations of nonlinear transformations were applied to the evaluation responses. The factorial structure of the fifteen items constituting the evaluation form was minimally affected by the transformations, suggesting that parametric statistics can be applied to behaviorally-anchored rating scales.

Tricyclic antidepressant prescribing habits: a comparison of family physicians and psychiatrists.

Because of persistent evidence that tricyclic antidepressants are generally underprescribed in respect to dosage and duration of treatment, a large group of family physicians attending a postgraduate course were asked specifically about their prescribing habits for these drugs. Their responses were compared to a group of psychiatrists. This study documented a tendency among family physicians, when compared to psychiatrists, to prescribe too low a dosage of tricyclics for treatment, to be hesitant to increase the dosage, and to discontinue maintenance prematurely. The family physicians overwhelmingly expressed the belief that 75 mg per day of imipramine or amitriptyline was sufficient for treatment maintenance, whereas 150 mg per day is ordinarily considered the minimum effective dosage. Proper use of tricyclic medication with a discussion of side effects and potential hazards is presented.

Informed consent for blood transfusion as a transfusion medicine educational intervention.

The aim here was to determine the effectiveness of a transfusion medicine educational intervention in a medicine core clerkship program. Third-year medical students enrolled in their medicine core clerkship rotations at tertiary care hospitals affiliated with our institution underwent a two-part educational intervention that incorporated a transfusion medicine curriculum within the context of the medicolegal, ethical and educational elements of informed consent. Part one was a 1-h didactic session on standards of practice for red blood cell transfusion. Part two was a 90-min multidisciplinary workshop on informed consent. The effectiveness of the educational intervention was analysed by an objective structured clinical evaluation. The student group receiving the educational intervention scored significantly higher than in the comparison group (65.8 +/- 9.2 vs. 54.1 +/- 10.56, P < 0.001). When student scores were used to determine changes in student response patterns over time, the largest change occurred in identifying possible other options to allogeneic blood transfusion. These results suggest that a transfusion medicine curriculum using an informed consent model can be used effectively as an educational intervention in a medicine core clerkship programme.

A computerized cataloging management system for health science audiovisuals.

This paper describes the implementation of the Stanford Public Information and Retrieval System (SPIRES) by the University of Michigan Medical School Learning Resources Center. SPIRES is a bibliographic data base management system which offers on-line search capabilities and retrieval of data in programmable formats. The Learning Resource Center utilizes SPIRES for the interactive retrieval of cataloging data, bibliographical compilations, and book catalog production.

Correlates of community resource information needs of arthritis patients.

One hundred eighty-nine ambulatory arthritis patients were interviewed to assess needs for information about community resource services. Participants were asked how frequently they needed 66 specific information items. Three categories of resource needs in arthritis care were identified: general information, personal care and medical services, and assistive devices and equipment. In the first category, results indicated that the greater the impairment in functional ability, the greater the need for general information about arthritis. When functional ability was held constant, younger patients with lower family income displayed a greater need for arthritis resource information. Lower functional ability and family income were associated with a greater need for personal care and medical service information. Lower functional ability contributed the most to the need for information about assistive devices and equipment. We suggest that, as an essential component of the long-term care of patients with rheumatic diseases, individuals who provide educational counseling should clearly understand the community resource needs of patients, and should be able to match articulated needs with the existing services. Health professionals should be aware that certain patient characteristics (specifically, family income, functional ability, and age) are related to a need for this type of information. The large percentage of patients who could not name their rheumatic disease diagnosis (65%) presents a major concern and challenge to patient educators.

Assessment of hand function in Duchenne muscular dystrophy.

Eighteen boys with Duchenne muscular dystrophy (DMD) were assessed for their ability to perform tasks involving wrist and hand function. Each subject was assessed using the Jebsen Test of Hand Function, range of motion measurements, and muscle strength tests. Writing and simulated page turning were performed successfully by boys in all age groups. Boys over age 15 had difficulty completing simulated feeding and picking up large and small objects. The muscle strength of the wrist extensors and the radial deviation range of motion at the wrist were found to be strongly correlated with six of the seven tasks assessed. These two clinical assessments appear to be good indicators of overall wrist and hand function. Life expectancy with DMD is increasing with advances in respiratory care making preservation of wrist and hand function, the major activity remaining with advanced disease, increasingly important.

Blood pressure and nutrition in adults. The National Health and Nutrition Examination Survey.

To provide a contemporary profile of blood pressure and nutritional and sociodemographic relationships in the adult US population, data from the first National Health and Nutrition Examination Survey ( NHANES -I), 1971-1975, were analyzed. Systolic and diastolic blood pressures increased with increasing age, but trends were different by sex and race groups. Body mass index (weight/ height2 ) was the nutritional factor most strongly and consistently related to blood pressure. Among dietary constituents, alcohol consumption and calcium and phosphorus intake were the only variables having consistent and independent relationships to blood pressure. Sodium content of food and salt use had no relationship, and sodium/potassium food content had only an inconsistent association. Regarding serum nutritional measures, serum calcium was directly related and serum phosphorus was inversely related to blood pressure. Serum urate, serum aspartate aminotransferase, and hemoglobin were also independently related to systolic and diastolic blood pressures. There were few important differences by race or sex in these correlates. These observations from a representative sample of the US population have useful implications for prevention and treatment of high blood pressure.