Biomedical subjects
Publications and source records attributed to D Boudreau.
The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.
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Substances such as hemoglobin that interfere with analytical processes are recognized as a frequent source of error in laboratory medicine. Standard guidelines for assessment of test interferences assume that interference effects are not related to the concentration of the analyte being measured. However, previous investigations have demonstrated that interference effects can be markedly different, depending on the concentrations of interferent and analyte within the specimen. An experimental protocol for investigating these different types of interference effects has been developed. This protocol utilizes an orthogonally arranged matrix with progressively increasing concentrations of analyte and interferent. Evaluation of the measured analyte concentrations in specimens within the matrix using multiple regression analysis allows the magnitude, direction, and significance of each type of interference to be determined. Unfortunately, implementation of the interference data derived from the multiple regression analysis for judging the clinical acceptability of test results when an interferent is present is difficult. We describe a two-dimensional graphical format for evaluating the clinical acceptability of test results, based on criteria established under the Clinical Laboratory Improvement Amendments of 1988, in specimens containing hemoglobin-based oxygen carrier solutions.
Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.
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The aim of the study was to investigate the possibility that the scoring of breathlessness during histamine bronchial provocation testing might be used to identify asthmatic subjects who sense dyspnea poorly during spontaneous bronchoconstriction. The perception of dyspnea caused by asthma and histamine-induced bronchoconstriction was studied in 17 subjects (10 female and 7 male). All of the subjects had a positive histamine challenge test; the concentration of histamine required to cause a 20% fall in FEV1 (PC20) averaged 3.0 mg/ml. The histamine challenge test was performed with scoring of dyspnea on a modified Borg scale. The subjects subsequently recorded peak expiratory flows (PEF) and dyspnea scores (Borg scale) at home 4 times daily for a 7-d period. We found that the intensity of dyspnea sensed during histamine-induced bronchoconstriction was very variable among subjects. The Borg score for a 20% fall in FEV1 ranged from 0 to 9. However, there was a correlation between the minimum FEV1 and the corresponding Borg score (r = -0.63; p < 0.01). For most subjects, there was no correlation between the magnitude of breathlessness during spontaneously occurring bronchoconstriction and the accompanying decline in PEF. Among subjects there was no relationship between the ability to sense breathlessness during induced and spontaneous bronchoconstriction. Therefore, the sensation of breathlessness during histamine-induced bronchoconstriction cannot be used to identify the asthmatics who perceive dyspnea poorly.
An essential component of competency in respiratory medicine is the acquisition of consultative skills. The American Board of Internal Medicine (ABIM) and other certification bodies have recommended a greater emphasis on the evaluation of clinical skills by direct observation. In this study, consultative abilities are assessed using the format of an objective structured clinical examination (OSCE). A six-case, 160-min-long, examination was administered to three groups of physicians: faculty members, respiratory residents, and junior residents in internal medicine. The overall quality of the consultations was significantly better for the attending physicians when compared with the junior residents, and there was a systematic trend for the quality to improve with increased training. The educational value of the consultation improved significantly with the level of training. There was a tendency for physicians with greater experience to report less of the findings from the history and physical on their consultations. Patient satisfaction, as measured by the standardized patients using an ABIM patient satisfaction questionnaire, did not differ between groups of examinees. The test reliability for the overall quality of consultation score was 0.65. The reliability of a 14-station exam was estimated to be 0.81. This exam proved to be a useful, valid, and moderately reliable tool for assessing the consultative skills of physicians and could prove to be of benefit to clinical training programs.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.