Multimedia versus written information for nocturnal enuresis education: a cluster randomized controlled trial.

OBJECTIVE: This study evaluated the impact of child-focused information provision using a multimedia software package 'All About Nocturnal Enuresis' and written leaflets containing the same information for bedwetting children. DESIGN: A stratified cluster randomized controlled trial with data on 270 children collected longitudinally. SETTING: Fifteen school nurse-led community enuresis clinics in Leicestershire, UK. MAIN OUTCOME MEASURES: The outcome measures were becoming and remaining dry and time to dry, non-attendance and dropout rates. The psychological measures completed by children were the impact of bedwetting and Coopersmith self-esteem scales. Parents completed the maternal tolerance scale. RESULTS: No significant intervention effect was found for any of the outcome measures recorded during treatment, at discharge or six-months post discharge. CONCLUSIONS: Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health-related conditions. However, our result suggests that multimedia is no more effective than traditional materials at effecting health-related behavioural change.

Impact of risk information in a patient education leaflet.

Informed consent requires the communication of information about possible adverse effects of treatment. Health professionals have expressed concern that increased provision of risk information may make patients unduly anxious and change their decisions about treatment. This study compared two patient leaflets about laparoscopy, one containing detailed information about potential side effects. Forty one consenting participants attending an outpatient gynaecology clinic and scheduled for an elective laparoscopic procedure were studied. They were randomly assigned to receive one of two leaflets after their consultation. Knowledge about laparoscopy, satisfaction with information provided, and anxiety were tested 2 days later, between the original consultation and their operation. Results showed that the leaflet containing detailed risk information was associated with greater knowledge about laparoscopy, higher satisfaction with information provision and no increase in anxiety. Provision of detailed information about possible adverse consequences of treatment can improve patients' understanding and satisfaction without inducing increased anxiety.

Identifying undergraduate medical students' attitudes towards communication skills learning: a pilot study.

Despite the wealth of literature surrounding communication curricula within undergraduate medical education, there is a dearth of research that identifies medical students' attitudes towards such curricula. To address this gap in the research literature, first-year medical students at the University of Nottingham in the United Kingdom were invited to discuss their attitudes towards communication skills learning. One audiotaped focus-group discussion was conducted with five medical students. The audiotape was transcribed in full and the transcript was analysed manually using theme analysis. Three attitude-related themes emerged from the focus group discussion: (1) students' positive attitudes towards communication skills learning; (2) students' negative attitudes towards communication skills learning; and (3) relationships between students' attitudes and their education, age and communicative abilities. The findings within each of these themes are discussed in this paper and their implications for further research are outlined.

Impact of facial paralysis on patients with acoustic neuroma.

OBJECTIVE: To assess the psychological distress, the ways of coping with that stress, and the self-esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored. STUDY DESIGN: Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self-esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis. PATIENTS: One hundred three patients with facial paralysis after surgical removal of acoustic tumors. RESULTS: Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = -0.28, P = .005). High levels of distress were associated with low levels of self-esteem, as shown by the significant negative correlation between level of distress and self-esteem (r = -0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self-esteem was the most important contributing factor (standardized coefficient beta -0.60, P = .0001), followed by age (beta -0.24, P = .006) and sex (beta -0.21, P = .04). This model explained 44% of the distress variance. CONCLUSION: Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self-esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self-esteem and decrease their distress, especially in these high-risk groups.

Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patient perception.

OBJECTIVE: To investigate whether ibuprofen was as well-regarded by patients as other non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN: Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING: General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS: Unselected patients receiving NSAIDs prescribed for all indications for use. MAIN OUTCOME MEASURES: Effectiveness of ibuprofen and other NSAIDs, possible drug related adverse events, patients' overall satisfaction with ibuprofen and other NSAIDs, factors associated with choice of ibuprofen, drug costs of ibuprofen and other NSAIDs. RESULTS: The main NSAIDs used were ibuprofen, diclofenac and naproxen. Ibuprofen use ranged from 1.0% of prescriptions in one practice to 69.1% in another. Although ibuprofen was generally prescribed in low doses, it was perceived by patients as being as effective as the other NSAIDs used, even after allowing for severity of the pre-treatment condition. Overall, 50.5% of patients rated their NSAID the best treatment they had received for their condition with no differences between individual drugs. CONCLUSIONS: Ibuprofen is as highly regarded as other NSAIDs when used in similar circumstances. Switching patients to ibuprofen may be a realistic way of reducing financial and medical costs associated with NSAIDs.

Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices.

AIM: To investigate the pharmacoepidemiology of NSAID usage in Nottingham general practices. DESIGN: Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING: General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS: Unselected patients receiving NSAIDs prescribed for all indications. MAIN OUTCOME MEASURES: Indication for treatment, differences in prescribing to different age groups, compliance and overall scheme drug exposure, drug effectiveness and tolerability, possible drug-related adverse events, patients' overall satisfaction with treatment and estimated costs of care. RESULTS: NSAIDs were used for a wide range of conditions and only a small number of patients had rheumatoid arthritis. The main drugs used were ibuprofen, diclofenac and naproxen. Patients making short-term use of NSAIDs had low compliance if they experienced adverse drug effects, whilst conversely in long-term users, those with high compliance reported more adverse drug effects. Calculated compliance did not vary with age although older patients (over 65 years) claimed in their questionnaires to be more compliant than younger patients. Half the patients reported good or complete symptom relief. Half of those questions (and two thirds of those with good or complete symptom relief) rated their NSAID as the best treatment they had received for their current condition. The frequency of gastrointestinal adverse events was higher in the young and the old, which correlated with the use of anti-ulcer drugs, and increased with the total number of medications used. CONCLUSIONS: NSAIDs are used for a wide-range of conditions. They give symptom relief to, and are perceived as effective by, most patients taking them.

Educating patients about malignant melanoma: computer-assisted learning in a pigmented lesion clinic.

This prospective controlled study aimed to evaluate the effectiveness and acceptability of a computer program (CAL) designed to educate patients about skin protection including signs of melanoma. Two hundred and twenty-seven patients were recruited either from the Pigmented Lesion Clinic (PLC) or the Orthopaedic Fracture Clinic (OFC). A baseline measure of anxiety was obtained and subjects were allocated to either non-interactive, interactive or control conditions. Measures of anxiety and knowledge about malignant melanoma and skin protection were obtained prior to discharge from the clinic and knowledge was assessed again at 1-week follow-up. Results indicate that, although anxiety in the PLC subjects decreased significantly more than in the OFC patients, there was no significant effect of intervention. There was a significant effect of intervention on knowledge (F = 81.06, d.f. 2, 218, P < 0.0001) with participants having better knowledge on leaving the clinic in the interactive CAL condition than in both the Non-interactive condition and control. Non-interactive CAL was associated with higher knowledge than control. Knowledge gains were maintained at 1-week follow-up.

Using multimedia for patient information--a program about nocturnal enuresis.

OBJECTIVES: To identify the information needs of children with nocturnal enuresis, and to design, produce and evaluate an interactive computer program to provide this information. SUBJECTS AND METHODS: The program was developed over an 18-month period using information provided by children, parents and professionals, and was evaluated in a hospital-based enuresis clinic in 65 children. Usability and knowledge gained were also evaluated in 43 healthy children aged 8-10 years attending a local inner-city primary school. RESULTS: An interactive program about nocturnal enuresis was developed, which runs on a personal computer and uses sound, voice, cartoon drawings and animation in a modular design. Knowledge scores increased in clinic attendees and in schoolchildren after using the program (Wilcoxon matched pairs test, P < 0.001). This improvement was maintained when the program was re-tested 6-10 months later. CONCLUSION: This interactive computer program holds children's attention and increases their understanding of enuresis. Interactive multimedia may be useful to complement the information provided by health professionals. This method of communication may be particularly useful for children with a low level of literacy.

Non-verbal communication: evaluation of a computer-assisted learning package.

A computer-assisted learning (CAL) package was developed on non-verbal communication. Its effectiveness was evaluated by comparing learning based on use of the package with that based on a didactic lecture covering the same topic. A class of 151 first-year medical students was divided into two groups, balanced for gender and home/overseas students. One group was asked to use the CAL package, the other group attended the lecture. Knowledge was assessed one week later by a written test, and reactions to using the CAL package were obtained via a questionnaire. Each group was then allowed and encouraged to use the other resource and then asked about their preferences for type of resource at the end of term. Mean score on the knowledge test was reliably better in the CAL group. In addition, scores increased as the time spent using the CAL package increased: this relationship was highly significant. Use of the CAL package varied from 15 to 120 minutes (median 45). Users reported that it was easy to operate, was an adequate or good resource for learning about the subject, and was a good or reasonable use of their time. After using both types of learning resource half the students judged the CAL package more useful for learning about the subject, and half preferred it to the lecture (the other half had the opposite judgement and preference). This study provides evidence that a CAL package can effectively substitute for traditional didactic teaching in a medical school. Good quality CAL, however, requires substantial resources and high calibre staff to develop and maintain it.

Counselling needs and experience of junior hospital doctors.

A sample of 106 senior house officers who had graduated from Nottingham University in 1987 was surveyed about their experience of and need for careers guidance, performance appraisal, and stress counselling. Of the 80 who replied, a quarter had received no careers guidance and a quarter no feedback about their work performance. Many reported having had difficulties in their post, but few had received help from senior staff or their consultant. The perceived needs for counselling were considerable. Careers counselling was thought to be essential in the preregistration year by all of the doctors and in senior house officer posts by three quarters. Nearly all would have chosen regular appraisal and nearly half wanted counselling for particular difficulties. Doctors in the training grades clearly believed that they needed counselling, but in most cases they did not receive it.

Successful overshadowing and blocking in hippocampectomized rats.

Overshadowing (Experiment 1) and blocking (Experiment 2) were investigated using a conditioned suppression paradigm in rats. Neither hippocampectomy nor cortical control lesions affected the extent to which a salient stimulus overshadowed a less salient one. Nor did the lesions affect the extent to which a stimulus that was highly correlated with shock overshadow a stimulus that was less well correlated with shock. Finally, the lesions did not alter the extent to which a previously reinforced stimulus blocked conditioning to another stimulus when both were presented as a reinforced compound stimulus. It is thus possible for hippocampectomized rats to show apparently normal overshadowing and blocking, at least under some testing conditions.

The effects of chlordiazepoxide HCl administration upon punishment and conditioned suppression in the rat.

Rats were trained to lever press for sucrose on a random interval (RI) 64-s schedule. During a 55 min session there were four 3 min "intrusion periods" signalled by a flashing house-light. In experiment 1 there were two groups matched for baseline response rate. During the intrusion periods one group received response-independent footshock on an independent RI 64 schedule; the other group received response-contingent shock on this schedule. Shock intensity was varied for each rat to match degree of response suppression between the two groups. Chlordiazepoxide HCl (CDP) in doses 0.5-5 mg/kg alleviated response suppression equally in both groups. Experiment II followed the same procedure, except that all animals had the same shock intensity, producing greater response suppression in the response-contingent shock groups. CDP alleviated response suppression more in the response-contingent shock groups, significantly so at 5 mg/kg, nonsignificantly at 1 mg/kg. These results suggest that previous reports that CDP differentially alleviates the response suppression produced by response-contingent shock are an artefact of rate dependency.