Seeking Safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomatology

Aims To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post‐traumatic stress disorder (PTSD) for part of treatment‐as‐usual (TAU) improves substance use outcomes. Design Randomized controlled effectiveness trial. Settings Out‐patient Veterans Administration Health Care System SUD clinic. Participants Ninety‐eight male military Veterans with a SUD and co‐occurring PTSD symptomatology. Measurements Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3‐month follow‐up). Active coping was measured at treatment intake and following treatment. Findings SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use. Conclusions The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than ‘treatment as usual’ in male veterans with post‐traumatic stress disorder. However, the mechanism of its effect is unclear.     

Gender-Specific Computer-Based Intervention for Preventing Drug Abuse Among Girls

This study developed and tested a gender-specific intervention for preventing substance abuse among adolescent girls. Delivered on CD-ROM by computer, the program was compared with a conventional substance abuse prevention program delivered live in a group setting. Seventh-grade girls in New York City middle schools completed pretests, and, by school, were randomly assigned to receive either gender-specific computer intervention (GSI) or conventional intervention, and were posttested. Analyses of pretest to posttest gain scores showed GSI girls compared to girls receiving conventional intervention to possess a larger repertoire of stress-reduction methods, to report lower approval of cigarettes, alcohol, and drugs, to identify more unhealthy ways to deal with stress, to report lower likelihood of cigarette use or alcohol consumption if asked to do so by best friends, and to hold stronger plans to avoid cigarettes, alcohol, and drugs in the next year. These modest findings lend credence to the promise of gender-specific, computerized interventions for substance use prevention among adolescent girls.     

Bayesian analysis using fourier transforms of thallium-201 scintiscans to predict the presence of coronary artery disease

Bayes' theorem of conditional probability was applied to the diagnosis of coronary artery disease (CAD) using thallium-201 scintigraphy as the testing procedure. Thallium-201 scintiscans were evaluated with a discriminant function previously developed using the amplitude coefficients of the Fourier transforms of the scams. The technique was applied prospectively to a population of 100 patients undergoing diagnostic coronary arteriography and thallium-201 scintigraphy, including 83 patients with CAD (70% or greater stenosis of luminal diameter) and 17 control subjects. A pretest probability of CAD was determined for each patient from the patient's age, sex and anginal symptoms. The pretest probability was combined with the patient's discriminant score to determine a posttest probability for CAD. For patients with CAD, the mean posttest probability was 0.85. Moreover, 57 of 83 patients (69%) had posttest probabilities exceeding 90%, including 40 patients (48%) with posttest probabilities exceeding 99%. For control subjects, the mean posttest probability was 0.19, with 11 of 17 (65%) having a posttest probability of less than 10%. Overall, 68 subjects had a posttest probability either less than 10% or more than 90% of which 63 were correctly classified (93%). Using a 50% posttest probability as a cutoff for classification, the technique has an 89% sensitivity, an 82% specificity and an overall accuracy of 88%. Therefore, this method objectively distinguishes patients with CAD from control subjects and provides a measure of the certainty of diagnosis. In addition, the discriminant function avoids the problem of inter- and ihtraobserver variability in visually interpreting thallium-201 scans.     

Functional health status of persons with diabetes in a nurse-managed clinic

PURPOSE: The purpose of this psychometric analysis was to (1) describe the functional health status of medically underserved persons with diabetes participating in an exercise program; (2) examine the relationships between functional health status scores and physiologic measures for blood pressure, heart rate, and blood glucose levels; and (3) examine the reliability and validity of the Medical Outcomes Study SF-36 survey. METHODS: Data were collected from 31 men and women receiving diabetes disease management in a community-based nurse-managed clinic. The SF-36 survey was used to measure functional health status. Blood pressure, heart rate, and blood glucose also were measured (pretest/posttest). RESULTS: The SF-36 survey had good internal consistency in the total sample. Blood pressure and blood glucose levels decreased significantly and heart rate increased significantly from pretest to posttest. Functional health status was negatively associated with physiological parameters. CONCLUSIONS: Further research is needed on the use of the SF-36 survey in medically underserved persons with diabetes because this instrument lacked construct validity as a measure of functional health status in this population.     

Changes in knowledge, attitudes, and behavior as a result of a community-based AIDS prevention program

The study evaluates the outcome of a California-based AIDS prevention program, "Stop AIDS." Community discussion groups focusing on information, attitudes, and behavior associated with HIV infection and transmission were conducted in one-time, 3 1/2-hour sessions. Participants completed different versions of the AIDS Prevention Test before and after the discussion group. Significant positive shifts in information, attitudes, and behavior were observed as a function of the discussion group participation. Whereas pretest knowledge correlated with pretest behavior and posttest knowledge, only pretest behavior correlated with the crucial variable of posttest intended behavior. When changes from pretest to posttest were analyzed, both information and attitude change correlated to changes in behavior. The intervention and evaluation procedures are proposed as a replicable national model for community-based AIDS prevention programs.     

The effect of changing disease risk on clinical reasoning

Objective: To assess the ability of health care professionals to evaluate the effect of clinical test results in different settings. Design: Subjects were presented with a series of generic clinical scenarios in which information about the test performance and the pretest probability of disease was varied. The subject estimates of posttest probability were compared with those calculated on the basis of Bayes’ theorem. Participants: Fifty health care professionals, including 31 physicians and 19 nonphysicians, associated with a university teaching hospital. Measurements and main results: Under a variety of testing conditions, both the physicians and the nonphysicians inaccurately estimated the posttest probability of disease. Based on a logarithmic transformation, the error in probability estimation was divided into a portion related to the pretest probability of disease and a portion related to the test performance. Most of the error in posttest probability estimation was associated with the incorrect use of pretest probabilities. The subjects consistently overestimated the posttest probability of disease expected under Bayes’ theorem, with increasing error associated with decreasing pretest probability. Physician estimates of posttest probability increased with increasing likelihood ratios for each scenario. Nonphysician estimates of posttest probabilities increased with increasing likelihood ratios for a positive test, but the estimates associated with a negative test result were inconsistent. Conclusions: Physicians and nonphysicians overestimate posttest probabilities with increasing error associated with decreasing disease risk. Some nonphysicians may not fully understand the effect of test performance on risk estimation, particularly in the setting of a negative test. Health care professionals should receive training in the proper evaluation of test information, with particular emphasis on the influence of pretest disease risk on the posttest probability of discase. Received from the Department of Internal Medicine, University of South Florida College of Medicine, H. Lee Moffitt Cancer Center and Research Institute, and the James A. Haley Veterans Hospital, Tampa, Florida. Presented in part at the annual meeting of the American Society of Clinical Oncology, Orlando, Florida, May 16, 1993.     

Developing Gerontological Competency: A Curriculum Approach

This study describes a competency-based educational approach to course development, implementation, and evaluation. The course model is presented, including its philosophical base. The authors hypothesized that student participation in a competency-based graduate gerontology course would increase their perceived competency level. Results indicate that students (N?=?74 students; 2008–2011) rated their competency skill level as higher at posttest than at the pretest (paired t-tests, p < .01), as measured by the Geriatric Social Work Competency Scale II. In addition, pretest/posttest results on the Myths of Aging checklist and Expectations Regarding Aging survey supported increases of perceived knowledge of older adults at posttest (p < .01). This project illustrates the benefits of organizing and implementing competency-based curriculum so that students are better prepared to work with older adults when they graduate.     

Personalized nursing: an effective intervention model for use with drug-dependent women in an emergency room

One hundred and fifty five drug-dependent women in an urban hospital emergency room in Detroit, Michigan, were the subjects for this 3-year exploratory field study. Subjects were women who told the emergency room staff that while they wanted assistance with their presenting health problems, they wanted no assistance with their drug addiction. The women were randomly assigned to either the experimental or control study group. Both groups received a pretest in the emergency room, a posttest between 8 and 12 weeks after their emergency room visit, and a follow-up test 6 months after the posttest. In addition, the experimental women were seen by project nurses, primarily in their homes, for a maximum of eight visits on a once-a-week basis. The experimental women were treated using "Personalized Nursing," a nursing intervention model, which focused on providing assistance for client-identified concerns. It was hypothesized that interaction with the Personalized Nursing Intervention Model would be associated with: a decrease in daily drug cost and a decrease in perceived stress. Results show that while there were no differences between the study groups at the pretest interview, the experimental group reported a lower daily drug cost (F(1, 95) = 2.90; p = 0.09), a lower daily heroin cost (U = 165; p = .01), less perceived stress (F(1, 84) = 3.00; p = .09) and emotional distress (F(1, 83) = 3.70; p = .06) than control subjects at the 8-week posttest. The experimental subjects also reported less perceived stress (t(65) = -2.35; p = .02) at 6-month follow-up than control subjects. It was found that results could be improved if members of the experimental clients' social networks were treated simultaneously and if project nurses were correctly utilizing the model. Implications for substance abuse treatment programs are discussed. The encouraging results of this exploratory study warrant follow-up and replication.     

Joining the front line against HIV: an education program for adult probationers.

This article describes the implementation and evaluation of a human immunodeficiency virus (HIV) education program for adult offenders. Samples of Cook County (Chicago) probationers were educated about either HIV or heart disease in small group and in one-on-one sessions. The evaluation employed a 2 x 2 factorial design. Data were collected at 3 points in time: during a pretest, posttest, and follow-up. Results showed that offenders' knowledge of HIV was increased significantly at posttest and follow-up. Although the HIV presentation increased knowledge significantly, it had little impact on HIV-related behavioral intentions at posttest or on actual prevention behaviors at follow-up. The implications of these findings are discussed with respect to HIV education programs in criminal justice settings.     

Effects of a school-based prevention program for potential high school dropouts and drug abusers

This study tested the effects of a prevention program based on an integrated social support and psychoeducational model. A semester-long Interpersonal Relations (IPR) class was predicted to deter school drop-out problems and drug abuse among adolescents. Quasi-experimental designs were used to field test the IPR program with 264 high-risk students in one of two conditions: (1) pretest, treatment, and posttest; (2) pretest and posttest. All hypotheses were supported. Significantly more potential dropouts were retained in the treated (74%) versus the comparison group (61%); differences in daily attendance (F = 12.88) and GPA, school achievement (F = 16.89), were significantly better in the treatment group (p less than .0001); drug involvement declined significantly from pre- to posttreatment for IPR program participants (t = 4.61, p less than .0001). Implications for treatment and recommendations for future research are discussed.     

The Co-Relation of Alcoholics Anonymous Participation to Alcohol and Other Drug (AOD) Treatment Outcomes

A sample of 301 clients from a large substance abuse treatment facility was surveyed utilizing a pretest/posttest design. Participants completed measures both prior to participating in outpatient treatment and then approximately 7 months after discharge. Twelve-step participation was measured, along with effects of the individual 12 steps, to determine any contribution to treatment outcomes, including spirituality, health, mental health, and alcohol and other drug (AOD) outcomes. Analyses were conducted to determine if participation changed over the study period and whether it impacted outcomes after treatment. Results indicated that participation and the effects of the individual steps were not statistically significant in relation to many treatment outcomes. However, these factors were important in the development of client spirituality.     

The American Medical Association Older Driver Curriculum for Health Professionals: Changes in Trainee Confidence,Attitudes, and Practice Behavior

Few gerontology and geriatrics professionals receive training in driver fitness evaluation, state reporting of unfit drivers, or transportation mobility planning yet are often asked to address these concerns in the provision of care to older adults. The American Medical Association (AMA) developed an evidence-based, multi-media Curriculum to promote basic competences. This study evaluated reported changes in practice behaviors 3 months posttraining in 693 professionals trained via the AMA approach. Eight Teaching Teams, designated and trained by AMA staff, offered 22 training sessions across the United States in 2006 to 2007. Trainees (67% female; mean age 46) completed a pretest questionnaire and a posttest administered by mail. Physicians were the largest professional group (32%). Although many trainees acknowledged having conversations with patients about driving at pretest, few endorsed utilizing specific techniques recommended by the AMA prior to this training. The posttest response rate was 34% (n = 235). Significant improvements in reported attitudes, confidence, and practices were found across measured items. In particular, posttest data indicated new adoption of in-office screening techniques, chart documentation of driver safety concerns, and transportation alternative planning strategies. Findings suggest that a well-designed, one-time continuing education intervention can enhance health professional confidence and clinical practice concerning driver fitness evaluation and mobility planning. Targeted dissemination of this Curriculum (in-person and online) will allow more to benefit in the future.     

The American Medical Association Older Driver Curriculum for health professionals: changes in trainee confidence, attitudes, and practice behavior

Few gerontology and geriatrics professionals receive training in driver fitness evaluation, state reporting of unfit drivers, or transportation mobility planning yet are often asked to address these concerns in the provision of care to older adults. The American Medical Association (AMA) developed an evidence-based, multi-media Curriculum to promote basic competences. This study evaluated reported changes in practice behaviors 3 months posttraining in 693 professionals trained via the AMA approach. Eight Teaching Teams, designated and trained by AMA staff, offered 22 training sessions across the United States in 2006 to 2007. Trainees (67% female; mean age 46) completed a pretest questionnaire and a posttest administered by mail. Physicians were the largest professional group (32%). Although many trainees acknowledged having conversations with patients about driving at pretest, few endorsed utilizing specific techniques recommended by the AMA prior to this training. The posttest response rate was 34% (n = 235). Significant improvements in reported attitudes, confidence, and practices were found across measured items. In particular, posttest data indicated new adoption of in-office screening techniques, chart documentation of driver safety concerns, and transportation alternative planning strategies. Findings suggest that a well-designed, one-time continuing education intervention can enhance health professional confidence and clinical practice concerning driver fitness evaluation and mobility planning. Targeted dissemination of this Curriculum (in-person and online) will allow more to benefit in the future.     

An evaluation of an inpatient cardiac patient/family education program

A study to (1) evaluate the impact of a patient education program on the patient's knowledge regarding his/her illness and (2) identify obstacles to compliance behavior after discharge was conducted over a 2-year period. A population of 342 patients with ischemic heart disease was assigned to an inpatient cardiac patient education program consisting of five daily 1-hour classes. The following patient data were gathered: (1) assessment of the individual's knowledge of his/her illness; (2) selected sociodemographic information, (3) measures of general intelligence and problem-solving ability, and (4) motivation to alter risk factors. A measure of compliance with the prescribed treatment plan was obtained by telephone for all patients 4 weeks after discharge. Patients were randomly assigned such that one group received a pretest and a posttest assessment of knowledge while a second group received only the posttest assessment. A difference score t test on knowledge scores was statistically significant. A regression analysis of predictors of overall compliance scores after discharge demonstrated that indicators of motivation were most highly correlated with compliance. It was concluded that additional research is needed to identify: (1) types of information that enhance the patient's awareness of his/her illness and (2) program structures and techniques that enhance patient motivation to comply with a prescribed treatment plan.     

Effectiveness of Computer-Based Dysphagia Training for Direct Patient Care Staff

Speech–language pathologists (SLPs) in medical settings are responsible for evaluating patients’ feeding and swallowing. Once an evaluation is completed, nursing staff typically provides hands-on care and supervision of meals. SLPs seek to improve outcomes for individuals with dysphagia by educating direct-care staff. This project sought to determine whether a computer-based swallowing safety module could produce changes in knowledge levels of nursing staff. This module was designed to replace inservices conducted by staff SLPs. Nursing staff would be required to complete the training when hired and as an annual assessment. The training module was designed and pilot-tested along with a pre- and posttest to assess changes in knowledge. Participants in the experimental group took the pretest, completed the computer training module, and then took the posttest. Participants in the control group took the pre- and posttest with no intervening training. Statistically significant differences were found between the two groups on posttest scores. Participants in the experimental group demonstrated increased test scores, while the scores of the control group did not change significantly. This study indicates that computer-based training for nursing staff related to swallowing safety and dysphagia is effective.     

An endoscopic training model to improve accuracy of colonic polyp size measurement

Purpose

Most studies of colonic polyps rely on visual estimation when regarding polyp size; however, the reliability of a visual estimate is questionable. Our study aims to develop a training model to improve the accuracy of size estimation of colonic polyps in vivo.

Methods

Colon polyps were recorded on 160 video clips during colonoscopy. The size of each polyp was estimated by visual inspection and subsequently measured with a flexible linear measuring probe. The study included a pretest, an intervention, and a posttest. The pretest included 160 video clips, which comprised the visual-estimation portion of the study. The intervention was an educational model consisting of 30 video clips which included a visual-estimation section and a linear-measuring-probe section, designed to help the endoscopists to compare their visual estimate of size with the measured size of the polyps. The posttest included the 160 video clips used in the pretest, presented in random order. Intraobserver agreement and diagnostic accuracy were compared before and after the training session.

Results

Eight beginners and four experienced colonoscopists were enrolled. The overall kappa (κ) values of intraobserver agreement for pretest and posttest were 0.74 and 0.85 for beginner group as well as 0.83 and 0.88 for experienced group, respectively. The overall diagnostic accuracy improved from 0.52 to 0.78 for beginner group and 0.71 to 0.87 for experienced group (P?<?0.05) after education with the training model.

Conclusions

This training model could help endoscopists improve the accuracy of measurement of polyps on colonoscopy in a short period. The durability of learning effect needs further investigation.     

Use of a continuing medical education course to improve fellows' knowledge and skills in esophageal disorders

Advanced esophageal endoscopic procedures such as stricture dilation, hemostasis tools, and stent placement as well as high‐resolution manometry (HRM) interpretation are necessary skills for gastroenterology fellows to obtain during their training. Becoming proficient in these skills may be challenging in light of higher complication rates compared with diagnostic procedures and infrequent opportunities to practice these skills. Our aim was to determine if intensive training during a continuing medical education (CME) course boosts the knowledge and skills of gastroenterology fellows in esophageal diagnostic test interpretation and performance of therapeutic procedures. This was a pretest–posttest design without a control group of a simulation‐based, educational intervention in esophageal stricture balloon dilation and HRM interpretation. The participants were 24 gastroenterology fellows from 21 accredited US training programs. This was an intensive CME course held in Las Vegas, Nevada from August 7 to August 9, 2009. The research procedure had two phases. First, the subjects were measured at baseline (pretest) for their knowledge and procedural skill. Second, the fellows received 6 hours of education sessions featuring didactic content, instruction in HRM indications and interpretation, and deliberate practice using an esophageal stricture dilation model. After the intervention, all of the fellows were retested (posttest). A 17‐item checklist was developed for the esophageal balloon dilation procedure using relevant sources, expert opinion, and rigorous step‐by‐step procedures. Nineteen representative HRM swallow studies were obtained from Northwestern's motility lab and formed the pretest and posttest in HRM interpretation. Mean scores on the dilation checklist improved 81% from 39.4% (standard deviation [SD]= 33.4%) at pretest to 71.3% (SD = 29.5%) after simulation training (P < 0.001). HRM mean examination scores increased from 27.2% (SD = 16.4%) to 46.5% (SD = 15.8%), representing a 71% improvement (P < 0.001). Pearson's correlations indicated there was no correlation between pretest performance, medical knowledge measured by United States Medical Licensing Examination examinations, prior clinical experience, or procedural self‐confidence and posttest performance of esophageal dilation or HRM interpretation. The education program was rated highly. This study demonstrated that a CME course significantly enhanced the technical skills and knowledge of gastroenterology fellows in esophageal balloon dilation and HRM interpretation. CME courses such as this may be a valuable adjunct to standard fellowship training in gastroenterology.     

Effect of the BACE intervention on agitation of people with dementia

PURPOSE: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. DESIGN AND METHODS: A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person's high-arousal and low-arousal states. The outcome measure was observed agitation. RESULTS: When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction, F(1, 69) = 4.26, p =.043, with a partial eta(2) =.06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of.7. IMPLICATIONS: The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.     

Ai/learn/rheumatology. a comparative study of computer-assisted instruction for rheumatology

Objective. To assess the effectiveness of AI/ LEARN/Rheumatology, a computer-controlled interactive videodisc system for teaching. Methods. We assessed improvement in knowledge about rheumatic diseases, using a pretest and posttest in a control year and a treatment year. The subjects were medical students and postgraduate trainees taking the rheumatology elective. The control year used traditional lectures and the standard rheumatology curriculum. The treatment year used AI/LEARN/ Rheumatology in place of lectures on rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Results. The trainees showed significant improvement in knowledge in both the control year and the treatment year (P < 0.0001 for both). The average time spent using AI/LEARN/Rheumatology was similar to the time spent in lectures (3 hours). The number of patient consultations in which trainees participated was lower in the treatment year than in the control year; however, the adjusted posttest scores using the pretest as a covariate tended to be higher in the treatment year (P = 0.10). Analysis of covariance of the adjusted posttest scores for the treatment year only showed that the trainees who spent more time using AI/LEARN/Rheumatology learned more (r = 0.57). Trainees felt that AI/LEARN/Rheumatology was the most helpful educational experience of the elective. Conclusion. AI/LEARN/Rheumatology is an effective means of teaching about the rheumatic diseases. It has many advantages: availability for independent study, effective use of trainee's time, and liberation of faculty time from lectures. Trainees enjoyed using AI/LEARN/Rheumatology.     

Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers

Background and aimsPrevention and management of diabetic foot ulcer have essential effects on the quality of life of patients. Accordingly training the care providers can play an essential role in reducing complications foot ulcers and lead to an increase in the effectiveness and efficiency of patient health cares. We conducted a study to survey the impact of the diabetic foot workshop on the knowledge of nurses and physicians about diagnosis and managing diabetic foot.MethodsThe present study is a quasi-experimental which compare the knowledge of non-randomized group of nurses and physicians about diabetic foot care. The leaning objectives, agenda, contents and evaluation methods of the diabetic foot care workshop was designed by a multidisciplinary team members in form of 2 days workshop. Each topic of the workshop presented theoretically and practically using educational cases and real patient with diabetic foot ulcer. A valid and reliable questionnaire with 20 Multiple Choice Questions used for the evaluation of workshopin form of the pretest and posttest.ResultsIn this study, 396 registered nurses and physicians participates in the diabetic foot workshop series. The results of this study showed that this increase in the level of knowledge was meaningful after the educational intervention since the mean of the posttest score increased more than 20% comparing with pretest.ConclusionThe promotion of knowledge of health care providers as shown in the study may almost be due to training by real patient, team-working, and using educational movies for the education of diabetic foot diagnosis, management and rehabilitation.