Biomedical subjects

Karen Mann

Publications and source records attributed to Karen Mann.

12 recordsLinked to original sources

PubMed2006

The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.

OBJECTIVE: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure. OPTIONS AND OUTCOMES: For persons in whom a high blood pressure value is recorded, a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the approach used to monitor blood pressure (office, ambulatory or home/self), and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating the overall risk of adverse cardiovascular outcomes requires an assessment for other vascular risk factors and hypertensive target organ damage. EVIDENCE: MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, the authors only included studies that had been published in the peer-reviewed literature and did not include evidence from abstracts, conference presentations or unpublished personal communications. RECOMMENDATIONS: The present document contains recommendations for blood pressure measurement, diagnosis of hypertension, and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension. Key features of the 2006 recommendations include continued emphasis on an expedited diagnosis of hypertension, an in-depth review of the role of global risk assessment in hypertension therapy, and the use of home/self blood pressure monitoring for patients with masked hypertension (subjects with hypertension who have a blood pressure that is normal in clinic but elevated on home/self measurement). VALIDATION: All recommendations were graded according to the strength of the evidence and were voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported herein received at least 95% consensus. These guidelines will continue to be updated annually.

Advisory Committees↗

PubMed2006

Learning in practice: experiences and perceptions of high-scoring physicians.

PURPOSE: To increase understanding of informal learning in practice (e.g., consulting with colleagues, reading journals) through exploring the experiences and perceptions of physicians perceived to be performing well. Objectives were to find out how physicians learned in practice and maintained their competence, and how they learned about the communication skills domain specifically. METHOD: Of 142 family physicians participating in a formal multisource feedback (360-degree) formative assessment, 25 receiving high scores were invited to participate in interviews conducted in 2003 at Dalhousie University Faculty of Medicine. Twelve responded. Interviews were 1.5 hours each, recorded, transcribed, and analyzed by the research team using accepted qualitative procedures. RESULTS: While formal learning appeared important to most, informal learning, especially through patients and colleagues, appeared to be fundamental. The physicians appeared to learn intentionally from practice and work experiences, and reflection appeared integral to learning and monitoring the impact of learning. Two findings were surprising: participants' conceptions of competence and perceptions that communication skills were innate rather than learned. CONCLUSIONS: These physicians' ways of intentional learning from practice concur with current models of informal learning. However, informal learning is largely unrecognized by formal institutions. Additionally, the physicians did not in general share notions of professional competence held by educators and others in authority. These findings suggest the need to make implicit content and learning processes more explicit. Additional research areas include exploring whether physicians across the range of performance levels demonstrate similar processes of reflective learning.

Adult↗

PubMed2005

A structured communication adolescent guide (SCAG): assessment of reliability and validity.

PURPOSE: To assess the reliability and validity of a Structured Communication Adolescent Guide (SCAG) in an undergraduate medical education setting using trained adolescent raters. METHOD: The SCAG is a 49-item, 6-section (A-F), protocol derived from the Calgary Cambridge Observation Guide that incorporates adolescent psychosocial data collection with the physician's communication skills. Four trained female adolescents scored 42 videotaped adolescent clinical encounters using the SCAG; a trained psychologist's rating for each videotape was used as the gold standard. RESULTS: Agreement among adolescent raters was determined by calculating intraclass correlation coefficients (ICC). The individual SCAG item scores, combined with the global ratings for each section, resulted in an overall ICC value of 0.93, indicating very strong agreement among the 4 raters. The global rating scores for the sections ('initiating the session', 'initiating separation', 'once adolescent is alone--lifestyle' and 'closure') produced an ICC range of 0.58-0.93. However, the ICC values for the 2 remaining sections ('how was information collected' and 'gathering information') global rating scores were below 0.30, signifying low agreement. Overall agreement between the adolescent raters and the gold standard resulted in an ICC value of 0.78. This is evidence of the SCAG's criterion validity. CONCLUSION: The SCAG is a reasonably valid tool for use in guiding an encounter with an adolescent patient. However, 2 sections require modifications to improve their reliability and thus the SCAG's overall performance. Our results suggest that the SCAG shows promise as a potentially useful teaching resource in undergraduate medical education in adolescent medical interviewing.

Adolescent↗

PubMed2005

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness.

PURPOSE: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback. METHODS: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. RESULTS: Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback. CONCLUSION: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlight questions for further study.

Attitude of Health Personnel↗

PubMed2005

The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk.

OBJECTIVE: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure (BP). OPTIONS AND OUTCOMES: For persons in whom a high BP value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of BP, the level of the BP elevation and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating overall risk of adverse cardiovascular outcomes requires an assessment of other vascular risk factors and hypertensive target organ damage. EVIDENCE: MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, only studies that had been published in the peer-reviewed literature were included; evidence from abstracts, conference presentations and unpublished personal communications was not included. RECOMMENDATIONS: This document contains recommendations for BP measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high BP. These include the accurate measurement of BP, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory BP monitoring, and the role of echocardiography for those with hypertension. Key features of the 2005 recommendations include an expedited diagnostic algorithm for hypertension and an endorsement of the use of home/self and ambulatory BP assessment as validated techniques in establishing the diagnosis of hypertension. VALIDATION: All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported in the present paper received at least 95% consensus. These guidelines will continue to be updated annually.

Blood Pressure Monitoring, Ambulatory↗

PubMed2004

Hidden curriculum in continuing medical education.

In developing curricula for undergraduate and graduate medical education, educators have become increasingly aware of an interweaving of the formal, informal, and hidden curricula and their influences on the outcomes of teaching and learning. But, to date, there is little in the literature about the hidden curriculum of medical practice, which takes place after graduation and certification. This article initiates that discussion with influences of the hidden curriculum on the actions physicians take or do not take in caring for patients. Hafferty's framework of institutional policies, evaluation activities, resource-allocation decisions, and institutional slang, along with our knowledge of health services research and the continuing medical education (CME) research literature, suggests that there is a hidden and powerful curriculum that affects physician performance. Determining whether the hidden curriculum conflicts with the messages that we are delivering through formal CME (courses, clinical practice guidelines, peer review journals) may contribute to improving our impact on physician performance.

Curriculum↗

PubMed2004

Autoimmune lymphoproliferative syndrome: a cause of chronic splenomegaly, lymphadenopathy, and cytopenias in children-report on diagnosis and management of five patients.

Autoimmune lymphoproliferative syndrome (ALPS) usually manifests in early childhood with splenomegaly, lymphadenopathy, and cytopenias. In most patients, it results from mutations in genes that regulate lymphocyte apoptosis via the Fas pathway. Here, we report five children with ALPS. All five children had splenomegaly, cytopenias, and hypertriglyceridemia at presentation; four had lymphadenopathy. Mutations in the Fas receptor gene were demonstrated in three children. Clinical picture is variable: in only one child manifestations are severe enough to require immunosuppressive therapy. Diagnosis of ALPS can be challenging and increased awareness of the disease can result in more directed diagnostic approaches as well as earlier initiation of treatment.

Autoimmune Diseases↗

PubMed2004

Orienting teaching toward the learning process.

Based on developments in educational psychology from the late 1980s, the authors present a model of an approach to teaching. Students' learning processes were analyzed to determine teacher functions. The learning-oriented teaching (LOT) model aims at following and guiding the learning process. The main characteristics of the model are (1) the components of learning: cognition (what to learn), affect (why learn), and metacognition (how to learn); and (2) the amount of guidance students need. If education aims at fostering one's ability to function independently in society, an important general objective should be that one learns how to fully and independently regulate his or her own learning; i.e., the ability to pursue one's professional life independently. This implies a transition from external guidance (from the teacher) through shared guidance (by the student together with the teacher) to internal guidance (by the student alone). This transition pertains not only to the cognitive component of learning (content) but also to the affective component (motives) and the metacognitive component (learning strategies). This model reflects a philosophy of internalization of the teacher's functions in a way that allows optimal independent learning after graduation. The model can be shown as a two-dimensional chart of learning components versus levels of guidance. It is further elaborated from learners' and teachers' perspectives. Examples of curriculum structure and teachers' activities are given to illustrate the model. Implications for curriculum development, course development, individual teaching moments, and educational research are discussed.

Cognition↗

PubMed2003

Videoconferencing for practice-based small-group continuing medical education: feasibility, acceptability, effectiveness, and cost.

INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Attitude of Health Personnel↗

PubMed2003

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

BACKGROUND: A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence-based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. METHODS: This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence-based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis (http://www.ti.ubc.ca/canadadrugguide). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. RESULTS: Eighty to 90% of patients reported that the guides were 'very easy' to understand. Fifty six per cent/47%/38% (sore throat/heartburn/osteoporosis) of patients rated the guides as 'very' or 'extremely' useful. Seventy-two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. INTERPRETATIONS: Patients found these evidence-based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision-making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence-based guides to patients can impact on prescribing and patient outcomes.

Adult↗

PubMed2002

What patients want to know about their medications. Focus group study of patient and clinician perspectives.

OBJECTIVE: To describe what patients want to know about their medications and how they currently access information. To describe how physicians and pharmacists respond to patients' information needs. To use patients', physicians', and pharmacists' feedback to develop evidence-based treatment information sheets. DESIGN: Qualitative study using focus groups and a grounded-theory approach. SETTING: Three regions of Canada (British Columbia, Nova Scotia, and Ontario). PARTICIPANTS: Eighty-eight patients, 27 physicians, and 35 pharmacists each took part in one of 19 focus groups. METHOD: Purposeful and convenience sampling was used. A trained facilitator used a semistructured interview guide to conduct the focus groups. Analysis was completed by at least two research-team members. MAIN FINDINGS: Patients wanted both general and specific information when considering medication treatments. They wanted basic information about the medical condition being treated and specific information about side effects, duration of treatment, and range of available treatment options. Physicians and pharmacists questioned the amount of side-effect and safety information patients wanted and thought that too much information might deter patients from taking their medications. Patients, physicians, and pharmacists supported the use of evidence-based treatment information sheets. CONCLUSION: Patients and clinicians each appear to have a different understanding of what and how much information patients should receive about medications. Feedback from patients can be used to develop patient-oriented treatment information.

Drug Therapy↗

PubMed2002

The 2001 Canadian recommendations for the management of hypertension: Part one--Assessment for diagnosis, cardiovascular risk, causes and lifestyle modification.

OBJECTIVE: To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure. OPTIONS: For persons in whom a high blood pressure value is recorded, hypertension is diagnosed based on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases must be assessed to determine the urgency, intensity and type of treatment. For persons receiving a diagnosis of hypertension, defining the overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients. OUTCOMES: The outcomes were: the identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension. EVIDENCE: Medline searches were conducted from one year before the period of the last revision of the Canadian recommendations for the management of hypertension (May 1999 to May 2001). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts. In addition to an update of the previous year's review, new sections on assessing overall cardiovascular risk and endocrine causes are provided. VALUES: A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and of persons with identifiable causes of hypertension. BENEFITS, HARMS AND COSTS: The identification of persons at higher risk of cardiovascular disease will permit counseling for lifestyle manoeuvres and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. In certain subgroups of patients, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity or mortality. RECOMMENDATIONS: The present document contains recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, the role of echocardiography and lifestyle modifications. VALIDATION: All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only those recommendations achieving high levels of consensus are reported. These guidelines will be updated annually. ENDORSEMENT: These guidelines are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control, Health Canada.

Antihypertensive Agents↗