Do medical students and physicians understand probability?

Sir, We read with great interest the recent article by Dr Cahan andcolleagues regarding the inability of residents to accuratelydetermine probability.¹ Despite the recent surge in teachingEvidence Based Medicine (EBM) in medical     

Do we truly understand vaccine reactions and vaccinosis?

There is a crucial difference between vaccinosis and a vaccine reaction, which can have significant clinical implications. Unfortunately, in much of the discussion around vaccination, this distinction becomes blurred. A vaccine reaction, if properly managed, need have no adverse effects, but failure to recognise it and act accordingly can lead to the creation of a vaccinosis. Vaccinosis can also be established as a primary condition. The imperatives and protocols involved with vaccination vary considerably between the medical and veterinary professions, but our common homeopathic approach provides us with the means of assessing every situation from the perspective of the body's reaction, and thus to appreciate the true significance of what is happening to our patient.     

Are patient information materials too difficult to read?

This article describes a study that found much of the written patient information materials used during home visits may be too difficult for patients and caregivers to read and comprehend. A discussion of literacy and suggestions for selecting, developing, and analyzing health education and information materials that are easy-to-read and culturally appropriate are provided.     

Do statins lower blood pressure?

Hypercholesterolemia is present in many patients with hypertension and adds a significant component of cardiovascular risk. The 3-hydroxy-3 methyl-glutarylcoenzyme A reductase inhibitors (statins) lower low-density lipoprotein cholesterol but also inhibit many of the structural and functional components of the arteriosclerotic process. Structural effects include reductions in vascular smooth muscle hypertrophy and proliferation, fibrin deposition, and collagen cross-linking. Among the functional effects are improvements in endothelial function, reduction in inflammatory cytokines and reactive oxygen species, and down-regulation of angiotensin II and endothelin receptors. These would be expected to reduce blood pressure in patients with hypertension; 14 studies have shown statin-induced decrease in blood pressure, but 11 studies showed no effect. Many of the studies had no placebo controls, were of short duration, or had small sample sizes, or combinations of these. Despite predictions made on the basis of the vasoprotective actions of statins, the blood-pressure-lowering effects of statins are at best modest.     

False‐reactive microbiologic screening test results in Swedish blood donors—how big is the problem? A survey among blood centers and deferred donors

BACKGROUND: Screening of blood donors for markers of transfusion-transmissible infectious agents leads to a varying number of false-reactive test results and sometimes thereby temporary or permanent deferral of donors and also to loss of collected units. STUDY DESIGN AND METHODS: Data on false-reactive screening test results in 2002 and 2003 were collected from 19 blood centers in Sweden. A questionnaire was sent to donors deferred because of false-reactive screening test results to investigate their perception of the information and their reaction to the deferral. RESULTS: Testing of 21,189 samples from new donors and 423,543 donations from regular and/or repeat donors produced 1,059 false-reactive test results, mostly from hepatitis C virus antibody testing, and 299 deferrals. Six different human immunodeficiency virus tests led to between 0.02 and 0.2 percent false-reactive results. The deferral rate varied considerably between different counties. Of 204 deferred donors contacted, 180 (88%) answered the questionnaire. More than 80 percent were worried about their test results and worry was more common among those who did not feel sufficiently informed. CONCLUSION: The results imply that there is a need for a more standardized approach to the screening of blood donors and donations with the aim of minimizing the number of false-reactive screening test results. They also emphasize the importance of appropriate information and support to deferred donors.     

Do we really understand how to retain nurses?

AIM: To compare views of nurse executives with those of nurses who have left the profession on the importance of retention strategies. BACKGROUND: Although much has been written about nursing turnover, there continues to be dissonance among decision makers as to why nurses leave the profession and what the most crucial issues are for retention. METHOD: Factor analysis was undertaken to compare responses of nurse executives with those of nurses employed outside of nursing. RESULTS: Contract requirements represented the greatest discrepancy, 1.07, followed by legal and employer issues, 1.02; worklife/homelife balance, 0.91; external values and beliefs about nursing, 0.75; and professional practice, 0.29. CONCLUSIONS: A disparity exists between perceptions of nurse executives and those of nurses who have left the profession as to which issues are most critical in retention. We suggest that nurse executives ensure sufficient organizational support for nursing unit managers who are more likely to understand methods of retaining nurses at the clinical interface.     

Biospecimen repositories: are blood donors willing to participate?

BACKGROUND: Sponsored by the National Heart, Lung, and Blood Institute, the Retrovirus Epidemiology Donor Studies (REDS‐I/‐II) have conducted epidemiologic, laboratory, and survey research on volunteer blood donors. Some studies request additional permission to store biospecimens for future studies. The representativeness and applicability of studies performed using repositories may be reduced by low participation rates. STUDY DESIGN AND METHODS: Demographics from subjects consenting to participate in the 2007 REDS‐II Leukocyte Antibodies Prevalence Study (LAPS) repository were compared to “study‐only” subjects. Data from the 1998 REDS‐I survey of donor opinion regarding storage and use of biospecimens were also explored. RESULTS: Overall, 91% of LAPS subjects agreed to participate in the repository. Odds of repository participation were lower among African American and Hispanic donors, 35‐ to 44‐year‐olds, donors who had not completed high school, and donors from one geographic location, regardless of other variables. Survey data from 1998 revealed that 97% of respondents approved of long‐term storage of biospecimens, although only 87% indicated that they would personally participate. Many respondents would require notification or their permission be obtained before participation. Minority respondents would require permission or notification more often and were less certain they would personally participate in a repository. CONCLUSION: Blood donors are quite willing to participate in biospecimen repositories. Regional differences and lower odds of participation in the minority blood donor population may result in a reduced number of biospecimens available for study and a decreased ability to definitely answer specific research questions in these populations.