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Biomedical subjects

E Gracely

Publications and source records attributed to E Gracely.

16 recordsLinked to original sources
PubMed2000

MedEthEx Online: a computer-based learning program in medical ethics and communication skills.

BACKGROUND: Bioethics education often focuses on lectures and discussions to set a foundation for ethical decision making. Our goal was to bridge the gap between classroom learning and bedside competence through computer-assisted instruction. This article assesses the efficacy of MedEthEx Online, a computer-based learning program as part of a required Bioethics course. DESCRIPTION: Of 173 American medical students, 89 in Section 1 attended 8 bioethics lectures and 8 small-group discussions. Eighty-four in Section 2 had a similar course, although two group discussions were replaced with computerized learning. We compared (a) final exam scores, (b) topic-specific question scores, (c) performance with standardized patients, (d) self-assessments, and (e) course evaluations. EVALUATION: Exam scores were comparable, although computerized-learning students scored higher in specific exam areas, felt somewhat more clinically prepared, and rated the course slightly better. Standardized patient interactions differed, although they were comparable overall. CONCLUSION: MedEthEx Online is a viable option for fostering effective communication and problem resolution skills.

Bioethics↗
PubMed1999

Oral versus intravenous corticosteroids in children hospitalized with asthma.

BACKGROUND: Previous studies have demonstrated that in the emergency treatment of an asthma exacerbation, corticosteroids used in conjunction with beta-agonists result in lower hospitalization rates for children and adults. Furthermore, orally administered corticosteroids have been found to be effective in the treatment of outpatients with asthma. However, similar data in inpatients is lacking. OBJECTIVE: The purpose of this study was to determine the efficacy of oral prednisone versus intravenous methylprednisolone in equivalent doses for the treatment of an acute asthma exacerbation in hospitalized children. METHODS: We conducted a randomized, double-blind, double-placebo study comparing oral prednisone at 2 mg/kg/dose (maximum 120 mg/dose) twice daily versus intravenous methylprednisolone at 1 mg/kg/dose (maximum 60 mg/dose) four times daily in a group of patients 2 through 18 years of age hospitalized for an acute asthma exacerbation. All patients were assessed by a clinical asthma score 3 times a day. The main study outcome was length of hospitalization; total length of stay and time elapsed before beta-agonists could be administered at 6-hour intervals. Duration of supplemental oxygen administration and peak flow measurements were secondary outcome measures. RESULTS: Sixty-six patients were evaluated. Children in the prednisone group had a mean length of stay of 70 hours compared with 78 hours for the methylprednisolone group (P =.52). Children in the prednisone group were successfully weaned to beta-agonists in 6-hour intervals after 59 hours compared with 68 hours for the methylprednisolone group (P =.47). Patients receiving prednisone required supplemental oxygen for 30 hours compared with 52 hours for the methylprednisolone group (P =.04). CONCLUSION: There was no difference in length of hospital stay between asthmatic patients receiving oral prednisone and those receiving intravenous methylprednisolone. Because hospitalization charges are approximately 10 times greater for intravenous methylprednisolone compared with oral prednisone, the use of oral prednisone to treat inpatients with acute asthma would result in substantial savings.

Administration, Oral↗
PubMed1998

Use of a paper-cut as an adjunct to teaching the Whipple procedure by video.

BACKGROUND: Medical students often experience difficulty comprehending anatomic relationships of complex operations to which they are exposed during surgical clerkship. Pancreaticoduodenectomy, the Whipple procedure, is one such operation. Although video recordings are available to facilitate the learning of the Whipple procedure, commercially available tapes are not self-explanatory to the uninitiated. Since we have previously demonstrated that third-year medical students could learn the operative steps of inguinal herniorraphy by a paper-cutting exercise, we set out to determine whether an exercise of similar design could enhance a student's comprehension of the Whipple procedure. METHODS: Using Adobe Illustrator 5.5 for MacIntosh, an exercise was developed on a 8.5 x 11-inch paper that could be distributed to students for self-administration. The exercise was performed using a #15 scalpel or an iris scissors. Thirty-seven students were randomized into two groups. Each student received a pretest of questions focusing on the Whipple procedure. Group I was shown an 18-minute commercially available teaching video on the Whipple procedure. Group II was given the Whipple origami exercise, which required 20 minutes to complete. A first posttest was administered to each group. Next, the groups switched exercises, and a second posttest was administered. RESULTS: There was no significant difference between the groups' pretest scores (two-tailed t test, P = 0.290). Group I improved its score from an average of 64.21 (SD 14.27) to 67.89 (SD 13.16) after watching the video, and further to 77.89 (SD 14.37) after completing the paper-cut exercise. Group II improved from 60.00 (SD 9.43) to 78.95 (SD 11.00) after performing the paper-cut, but derived no additional measurable benefit from watching the video, average score 74.74 (SD 18.37). After the first exercise, students who performed the paper-cut showed a significantly greater improvement in test scores compared with students who saw the video (P = 0.0035 by Mann-Whitney U). After both groups had completed the exercises, the mean changes from baseline were no longer significantly different (P = 0.58 by Mann-Whitney U). CONCLUSION: As a single educational intervention, the paper-cut exercise was a more effective teaching device than the video in the given time frame. The origami model may be generalized to a variety of surgical procedures and appears to be a valuable adjunct to traditional teaching.

Audiovisual Aids↗
PubMed1997

The impact of nonacademic variables on performance at two medical schools.

Recent research shows that nonacademic variables must be taken into account when analyzing the indicators of medical student success. However, most previous studies have been limited to a single institution or population. This study investigated the relationship between nonacademic variables and performance at two very different medical schools. The Noncognitive Questionnaire was administered to 104 students at School A (predominantly white and historically oriented toward women) and 102 at School B (predominantly black). Correlation and multiple regression analyses were conducted to determine the relationship among nonacademic variables, undergraduate academic variables (Medical College Admission Test, undergraduate grade point average, and college quality), basic science grades, and US Medical Licensure Exam Step I (USMLE 1) scores. At School A, leadership/decisiveness, expected difficulty, and motivation predicted higher USMLE I scores and higher basic science grades each semester. At School B, expected difficulty was correlated with higher first semester grades only. For School A women, initiative/commitment was positively associated with both higher grades and higher USMLE scores. For black students of School B, expected difficulty was positively associated with higher grades. Identifying school-specific nonacademic variables of performance is critical to developing improved student support services.

Achievement↗
PubMed1997

The effect of incorporating women's health into a PBL curriculum on students' tendencies to identify learning issues in an ambulatory care setting.

PURPOSE: To investigate whether the incorporation of women's health into problem-based learning (PBL) cases affects students' tendency to identify learning issues related to women's health as they encounter patients in an ambulatory care setting. METHOD: Students in the PBL curriculum at the Allegheny University of the Health Sciences, MCP-Hahnemann School of Medicine, participate in a nine-week primary care practicum at the end of their first year, during which they spend three half-days per week in an ambulatory setting examining patients and completing patient logs that include any learning issues identified. Patient logs from 23 first-year PBL students who had not been exposed to a new women's health education program prior to their practicum in 1993 and from 22 first-year PBL students who had been exposed to the program prior to their practicum in 1994 were reviewed. For each women's health learning issue identified, the sex of the student and the sex, specialty, and practice setting of the student's preceptor were recorded. Data were analyzed with several statistical methods. RESULTS: There was no statistically significant difference in the numbers of men and women students or preceptors between the two years. In 1993 an average of 59% of the patients seen per student were women; in 1994 the average was 61%. The mean numbers of total learning issues identified (including women's health learning issues) were similar in the two years, but the mean percentage of clinical women's health learning issues identified increased significantly between 1993 and 1994, as did the mean percentage of community/preventive health women's health learning issues identified. There was a significant student-sex-by-preceptor-sex interaction for the total number of women's health learning issues identified (p = .024): for both years, the students paired with a preceptor of the same sex identified a higher number of women's health learning issues than did the students paired with a preceptor of the opposite sex. CONCLUSION: The results suggest that PBL is an effective way to increase students' awareness of women's health issues in a primary care clinical setting. More studies are needed to define the effect of PBL on the kind of reading and learning students will do when they get to the clinical setting.

Adult↗
PubMed1994

Creation and assessment of a structured review course in physical diagnosis for medical residents.

OBJECTIVE: To evaluate the effects of a course in physical diagnosis on the knowledge, skills, and attitudes of internal medicine trainees. DESIGN: A controlled, prospective assignment of housestaff to a year-long curricular program, linked to a set of pre- and posttests. Houseofficers who could not attend the teaching sessions functioned as control subjects. SETTING: An internal medicine training program at an urban medical school. SUBJECTS: 56 (86.1%) of 65 eligible internal medicine housestaff (post-graduate years 1 through 3) participated in the intervention and assessment. A comparison group of 14 senior medical students participated in the pretest. INTERVENTION: 12 monthly lectures emphasizing skills useful in emergencies or validated by the literature. MEASUREMENTS: The pre- and posttests included: 1) a multiple-choice questionnaire to assess knowledge; 2) professional standardized patients to assess selected skills; and 3) Likert-type questionnaires to assess self-motivated learning and attitude toward diagnosis not based on technology. MAIN RESULTS: The residents expressed interest in the program and on a six-point scale rated the usefulness of lectures and standardized patients as 3.5 +/- 1.3 and 4.3 +/- 1, respectively. For no system tested, however, did they achieve more than 55.2% correct answers (range: 24.2%-55.2%, median = 41.04), and their performance did not differ from that of the fourth-year medical students. There was no significant difference in pre/posttest improvement between the control and intervention groups. CONCLUSIONS: These data confirm the deficiencies of physical diagnostic skills and knowledge among physicians in training. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experiential program made part of residency requirements.

Analysis of Variance↗
PubMed1994

Changes in students' attitudes following a course on death and dying: a controlled comparison.

This study evaluated the effect of a death-education course on the death-related anxiety and attitudes toward death of 71 medical students not yet exposed to clinical rotations and four health care professionals. The Collect-Lester Fear of Death Scale and a semantic differential technique measuring attitudes toward the dying patient and his or her family were administered to course attendees before and after the course and to freshman students not taking the course. The 75 course attendees and the 93 controls completed the baseline measures, and 71 course attendees and 46 controls responded to the post-course evaluation. The course did not produce significant changes on the four Collett-Lester subscales, although there was an overall decline in anxiety when the two groups were combined (p = 0.035). Semantic differential scales showed no change for controls but a marked improvement in attitudes toward "treating the dying patient" and "dealing with the dying patient's family" for attendees (p < 0.001 for both). In summary, course participation resulted in improvement in students' attitudes toward dealing with death.

Adult↗
PubMed1993

The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.

OBJECTIVES: To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training. STUDY DESIGN: A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency. SETTING: All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs. PARTICIPANTS: Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students. INTERVENTIONS: Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events. MAIN OUTCOME MEASURES: The teaching and proficiency of cardiac auscultation at all levels of training. RESULTS: Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students. CONCLUSIONS: A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.

Attitude of Health Personnel↗
PubMed1992

Poor prognosis associated with thrombocytosis in patients with cervical cancer.

The medical records of 113 patients treated with radiation therapy for invasive cervical cancer between 1975 and 1985 were retrospectively reviewed. Patients with thrombocytosis (platelet count greater than 400,000/microliters) were compared with those with normal platelet counts. Thrombocytosis was present at the initiation of therapy in 20 (17.7%) of the 113 patients. The 5-year cumulative survival rate for the 93 patients with normal platelet counts was 65%, whereas it was 25% for the 20 with thrombocytosis (P less than 0.0001, log-rank test). Using Cox's proportional hazards model, thrombocytosis continued to correlate strongly with poor survival even when adjusted for histologic type, patient age, and disease stage (P less than 0.001). Thrombocytosis is an independent indicator of poor prognosis in patients with cervical cancer.

Female↗
PubMed1992

Morbidity among municipal waste incinerator workers.

Incinerator workers are exposed to many toxic compounds, most notably heavy metals. We evaluated medical and exposure monitoring data of an actively employed cohort of Philadelphia incinerator workers following an Agency for Toxic Substances and Disease Registry site survey and National Institute for Occupational Safety and Health (NIOSH) health hazard evaluation (HHE). Of the many airborne samples taken by NIOSH, only four of the personal breathing zone samples were above OSHA or ACGIH standards: one for lead, one for phosphorous, and two for total particulates. Because samples were taken during limited operations (only one of the two incinerators were operating), the results may underestimate historical exposures at this site. We limited our medical analysis to the 86 male workers who participated in the HHE out of the 105 active employees. The 86 employees were divided into potential high and low exposure groups based on a work site analysis done by an independent industrial hygienist. Eight individuals had at least one elevated biological index indicating exposure to a heavy metal. These elevations, however, were unrelated to the workers' exposure categories. Furthermore, no clinically significant mean blood or serum measurements were noted. Thirty-four percent of the workers had evidence of hypertension which increased the risk of significant proteinuria. Neither hypertension nor proteinuria were related to exposure group. Changes in pulmonary function related only to smoking status. Although there was some evidence of an increased risk of exposure to products of incinerator waste, we could not relate the few elevated biological tests to exposure classification. Additional studies are needed to assess the potential health effects of municipal waste incinerator by-products.

Adult↗
PubMed1992

A discriminant analysis applied to methacholine bronchoprovocation testing improves classification of patients as normal, asthma, or COPD.

UNLABELLED: Two discriminant functions, incorporating baseline measurements of pulmonary function and measures of airway responsiveness, were developed to improve patient classification into groups of normal, asthma, or COPD. Accuracy of group classification was compared between the usual laboratory method (single discriminating cut-off) and these new mathematically developed functions. Forty-five normal subjects, 27 asthmatic patients, and ten well-defined COPD patients were entered into the analysis. Measurements of airway responsiveness were determined by measurement of both specific airway conductance (SGaw) and spirometry (FEV1) after sequential inhalation of methacholine. RESULTS: A single discriminant cut-off using measures of SGaw (PD35) or FEV1 (PD20) does not sufficiently discriminate asthma from groups that contain normal and COPD subjects (67 to 71 percent predictive value). On the other hand, our discriminant functions demonstrated improved patient classification (positive predictive value, 88 to 89 percent). We conclude that bronchoprovocation tests used to evaluate the diagnosis of asthma should incorporate measures of baseline lung function into the analysis. This, we believe, is especially necessary when baseline lung function demonstrates minimal airflow obstruction and the possibility of other causes of airway disease exist.

Adult↗
PubMed1990

Frequency and clinical implications of monoclonal antibody detection of tumor-associated antigens in serum of patients with lung cancer.

We previously showed that a panel of monoclonal antibodies (MAb) (5E8, 5C7, and 1F10) that detect serum tumor-associated antigens (TAA) could distinguish patients with lung cancer from those without to a highly significant degree. However, among patients with lung cancer, the frequency and clinical importance of serum TAA expression were not established. Therefore, we analyzed the serum and initial clinical characteristics of 52 Philadelphia VA patients with newly diagnosed lung cancer seen over a 13-month period. A modified semiquantitative ELISA was employed to determine MAb reactivity. Our cohort was characterized by a mean age of 65 +/- 9 year (SD) and mean Karnovsky score of 74 +/- 10; marked weight loss was present in 28 subjects, and 39 presented with either Stage III or IV disease. The panel detected TAAs in 38 of 52 cases (sensitivity 73%; 95% Cl, 60-83%), including 13 of 22 squamous cell, 9 of 12 adenocarcinoma, 10 of 11 undifferentiated, and 6 of 7 small cell carcinomas. No significant differences were found between the reactive and nonreactive patients in terms of age, stage at presentation, histologic subtype, performance status, or weight loss. However, 1F10 and 5C7 were each associated with a greater risk of early death by Cox proportional hazard analysis (p = 0.017 and 0.006, respectively) even when other prognostic variables are accounted for. We conclude that specific serum TAA can be detected in the majority of lung cancer patients with all major histologic subtypes in a cohort with advanced tumors and poor prognostic indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

The development of sex role stereotypes in the third year: relationships to gender labeling, gender identity, sex-typed toy preference, and family characteristics.

The onset and development of preschoolers' awareness of sex role stereotypes, gender labeling, gender identity, and sex-typed toy preference were explored in 26-, 31-, and 36-month-old children. Gender labeling, gender identity, sex-typed toy preferences, and awareness of adult sex role differences were observed in significantly more 26-month-old children than would have been expected by chance. Verbal gender labeling was observed in a majority of 26-month-olds, while verbal and nonverbal gender identity were observed in a majority of 31-month-olds. Nonverbal gender labeling and awareness of adult sex role differences were observed in a majority of children by 36 months. No evidence of awareness of sex differences in children's toys was found in the majority of children at any age. Awareness of sex role differences in children's toys was not related to awareness of adult sex role differences. Brighter children were more aware of adult sex role differences. Sex-typed toy preference was not related to awareness of sex role differences but was related to gender identity. Predictors of sex role development included the mothers' employment, and the father's personality traits, attitudes toward women, and sex-typed activities in the home. Implications for theories of early sex role development are discussed.

Awareness↗
PubMedDate not supplied

Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey.

BACKGROUND: Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obligations. METHODS: Primary care physicians were asked about the impact of managed care on: (1) physician-patient relationships, (2) the ability of physicians to carry out their professional ethical obligations, and (3) quality of patient care. In 1996 we surveyed 1011 primary care physicians in Pennsylvania. The survey group's responses were graded on a Likert scale. Space was provided for respondents to include written comments. The SPSS statistical software (SPSS Inc, Chicago, Ill) was used to analyze the data. RESULTS: The response rate was 55%. Most respondents indicated that under managed care physicians are less able to avoid conflicts of interest and less able to place the best interests of patients first. The majority responded that quality of health care is compromised by limitations in location of diagnostic tests, length of hospital stay, and choice of specialists. A significant minority (27%-49%) noted a decrease in the physician's ability to carry out ethical obligations, to respect patient autonomy, and to respect confidentiality in physician-patient communication. Most physicians expressed that managed care made no impact on ability to obtain informed consent or to provide information. There were small but statistically significant sex differences, with female physicians more negative toward managed care. CONCLUSIONS: Many physicians surveyed believe managed care has significant negative effects on the physician-patient relationship, the ability to carry out ethical obligations, and on quality of patient care. These results have implications for health care system reform efforts.

Attitude of Health Personnel↗