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Biomedical subjects

Mark A Graber

Publications and source records attributed to Mark A Graber.

14 recordsLinked to original sources
PubMed2005

Does simulator training for medical students change patient opinions and attitudes toward medical student procedures in the emergency department?

OBJECTIVES: To determine how simulator training impacts patients' preferences about medical student procedures in the emergency department. METHODS: A questionnaire was administered to a convenience sample of 151 of 185 patients approached (82% participation) seen in the emergency department of a midwestern teaching hospital. The questionnaire asked how many procedures they would prefer a medical student have performed after mastering the procedure on a simulator before allowing the medical student to perform this procedure on them. The procedures included venipuncture, placement of an intravenous line, suturing the face or arm, performing a lumbar puncture, placement of a central line, placement of a nasogastric tube, intubation, and cardioversion. These results were compared with those of a similar study asking about the same procedures without the stipulation that the skill had been mastered on a simulator. RESULTS: A high of 57% (venipuncture) and a low of 11% (placement of a central line) would agree to be a student's first procedure after simulator training. Except for intubating and suturing, participants were more likely (p < 0.05) to allow a medical student to perform a procedure on them after simulator training than without simulator training. Many patients prefer not to have a medical student perform a procedure no matter how many procedures the student has done (low of 21% for venipuncture, high of 55% for placement of a central line). CONCLUSIONS: Patients are more accepting of medical students performing procedures if the skill has been mastered on a simulator. However, many patients do not want a medical student to perform a procedure on them regardless of the student's level of training.

Adolescent↗
PubMed2005

The rigor of trials evaluating Rosacea treatments.

The Cochrane Collaboration is an international nonprofit organization that conducts systematic reviews of healthcare interventions. The organization has recently reviewed all studies meeting designated criteria on interventions for rosacea. To be included in the review, trials had to be randomized controlled trials (RCTs) that met the methodological criteria of the reviewers and that were conducted in an adult patient population with moderate to severe rosacea. The electronic databases searched included The Cochrane Skin Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, BIOSIS, and Science Citation Index. The reviewers tried to obtain details of unpublished and ongoing RCTs through correspondence with authors and pharmaceutical companies. After evaluating the included studies, the reviewers concluded there is evidence that topical metronidazole in 1% cream and 0.75% gel formulations and azelaic acid in 20% cream formulation are effective and safe. Furthermore, there is some evidence that oral metronidazole and tetracycline are effective. The reviewers also made suggestions about future rosacea research.

Anti-Infective Agents↗
PubMed2004

Informational content of official pharmaceutical industry web sites about treatments for erectile dysfunction.

BACKGROUND: In the last 5 years, several treatments have become available for erectile dysfunction (ED). During this same period, consumer use of the Internet for health information has increased rapidly. In traditional direct-to-consumer advertisements, viewers are often referred to a pharmaceutical company Web site for further information. OBJECTIVE: To evaluate the accessibility and informational content of 5 pharmaceutical company Web sites about ED treatments. METHODS: Using 10 popular search engines and 1 specialized search engine, the accessibility of the official pharmaceutical company-sponsored Web site was determined by searching under brand and generic names. One company also manufactures an ED device; this site was also included. A structured, explicit review of information found on these sites was conducted. RESULTS: Of 110 searches (1 for each treatment, including corresponding generic drug name, using each search engine), 68 yielded the official pharmaceutical company Web site within the first 10 links. Removal of outliers (for both brand and generic name searches) resulted in 68 of 77 searches producing the pharmaceutical company Web site for the brand-name drug in the top 10 links. Although all pharmaceutical company Web sites contained general information on adverse effects and contraindications to use, only 2 sites gave actual percentages. Three sites provided references for their materials or discussed other treatment or drug options, while 4 of the sites contained profound advertising or emotive content. None mentioned cost of the therapy. CONCLUSIONS: The information contained on pharmaceutical company Web sites for ED treatments is superficial and aimed primarily at consumers. It is largely promotional and provides only limited information needed to effectively compare treatment options.

Advertising↗
PubMed2003

Patient opinions and attitudes toward medical student procedures in the emergency department.

OBJECTIVES: To determine emergency department (ED) patients' preferences about having medical students perform procedures as part of medical student clinical training. METHODS: A questionnaire was administered to a sequential sample of 150 patients of 196 approached (76.5% participation rate) in a teaching hospital ED. Patients were asked how many procedures a medical student should have performed on other patients before the participant would allow the student to perform the procedure on them. The procedures included venipuncture, starting an IV, suturing the face, suturing the arm, performing a lumbar puncture, starting a central line, inserting a nasogastric tube, intubation, and cardioversion. RESULTS: If they had their preference, only a minority of patients would allow medical students to perform their first procedure on them for any of the procedures (a high of 42% for venipuncture, with a low of 7% for a lumbar puncture). Many patients prefer that medical students never perform a procedure on them (a high of 56% for a central line and a low of 21% for venipuncture). Patient beliefs were independent of age, gender, or insurance status. CONCLUSIONS: Patients are reluctant to be a medical student's first patient when it comes to procedures in the ED. This has implications for medical training and informed consent.

Adult↗
PubMed2002

Pharmaceutical company internet sites as sources of information about antidepressant medications.

OBJECTIVE: To determine the informational content of nine pharmaceutical company websites about the antidepressant medication marketed by the company. METHOD: A structured, explicit review of materials found on pharmaceutical company websites about nine antidepressants for which no generic drug is available was conducted using eight popular search engines. The accessibility of these websites was also determined using these search engines. RESULTS: Of 72 searches (one for each drug using each search engine), 46 yielded the pharmaceutical company website within the top 10 links. When outliers were removed, the company website was found in the top 10 links for 45 of 56 searches. All of the websites contain information of an advertising and emotive nature. Of the nine company websites, three contain anecdotal information; only two mention electroconvulsive therapy and four mention other types of drug therapy; and only one mentions the tradenames of other drugs. None of the websites mention drug costs, only one has efficacy statistics for the company's drug and, although all of the websites mention at least one adverse effect of the company's drug, only one lists percentages for adverse effects. CONCLUSION: The information about drugs for treating depression on pharmaceutical company websites aimed at consumers is limited and makes it difficult for consumers to compare drugs.

Antidepressive Agents↗
PubMed2002

Reading level of privacy policies on Internet health Web sites.

OBJECTIVE: Most individuals would like to maintain the privacy of their medical information on the World Wide Web (WWW). In response, commercial interests and other sites post privacy policies that are designed to inform users of how their information will be used. However, it is not known if these statements are comprehensible to most WWW users. The purpose of this study was to determine the reading level of privacy statements on Internet health Web sites and to determine whether these statements can inform users of their rights. STUDY DESIGN: This was a descriptive study. Eighty Internet health sites were examined and the readability of their privacy policies was determined. The selected sample included the top 25 Internet health sites as well as other sites that a user might encounter while researching a common problem such as high blood pressure. Sixty percent of the sites were commercial (.com), 17.5% were organizations (.org), 8.8% were from the United Kingdom (.uk), 3.8% were United States governmental (.gov), and 2.5% were educational (.edu). OUTCOMES MEASURED: The readability level of the privacy policies was calculated using the Flesch, the Fry, and the SMOG readability levels. RESULTS: Of the 80 Internet health Web sites studied, 30% (including 23% of the commercial Web sites) had no privacy policy posted. The average readability level of the remaining sites required 2 years of college level education to comprehend, and no Web site had a privacy policy that was comprehensible by most English-speaking individuals in the United States. CONCLUSIONS: The privacy policies of health Web sites are not easily understood by most individuals in the United States and do not serve to inform users of their rights. Possible remedies include rewriting policies to make them comprehensible and protecting online health information by using legal statutes or standardized insignias indicating compliance with a set of privacy standards (eg, "Health on the Net" [HON] http://www.hon.ch).

Confidentiality↗
PubMedDate not supplied

An alternative method of determining standard of care in alleged cases of malpractice.

BACKGROUND: Physician experts hired and prepared by litigants provide most information on standard of care for medical malpractice cases. Because this information may not be objective or accurate, we examined the feasibility and potential value of surveying peer physicians to assess standard of care. METHODS: The survey method was evaluated for a medical malpractice case involving a patient hospitalized with abdominal pain. An abstract of the medical record was created that included the patient characteristics and physician decisions most likely to influence patient outcome. The abstract and questionnaire were sent to 16 academic family physicians and to 20 randomly chosen primary care physicians in Iowa who practiced in communities of similar size to the defendant's community. RESULTS: All 16 academic and 18 (90%) community physicians completed the survey. All respondents judged the patient as presenting with an acute abdomen, and 89% of the community physicians and 100% of the academic physicians judged the care as below standard. More than half the physicians surveyed listed the autopsy diagnosis (perforated ulcer) in their differential. CONCLUSION: Surveys of randomly selected physicians are feasible to perform for medical malpractice cases. A pro-physician bias has little if any influence on the results.

Adult↗