Biomedical subjects

Ronald J Markert

Publications and source records attributed to Ronald J Markert.

8 recordsLinked to original sources

PubMed2003

Student understanding of the relationship between the health professions and the pharmaceutical industry.

BACKGROUND: Pharmaceutical sales representatives and direct-to-consumer advertising may influence physician practices, particularly prescribing. Identifying the relevant knowledge and attitudes students possess about the pharmaceutical industry may help professional curricula address these influences. PURPOSES: To assess knowledge and attitudes toward pharmaceutical industry marketing, ethical principles guiding drug company interactions, pharmaceutical sales representatives as a source of drug information, and confidence level in addressing consumers seeking a prescription from a direct-to-consumer advertisement among senior-level medical, PharmD, and nurse practitioner students. METHODS: A cross-sectional survey design was used to assess student knowledge and attitudes of four domains associated with the pharmaceutical industry. RESULTS: Significant deficiencies were noted in student knowledge of pharmaceutical marketing expenditures, professional ethics regarding interactions with drug companies, and accuracy of drug information from sales representatives. CONCLUSIONS: Health professional students' knowledge and attitudes toward the pharmaceutical industry are formed prior to graduation. Professional curricula must address the influences of sales representatives before postgraduate training.

Attitude of Health Personnel↗

PubMed2002

Teaching EBM facilitation using small groups.

The problem-centered, learner-focused, small-group process (PLS) is used by faculty to train learners in evidence-based medicine (EBM). Few affordable and accessible courses exist to train faculty in the PLS process. The results of a novel course to train faculty in the PLS process are described. The course was a one-day workshop consisting of five small group sessions with two facilitators. The participants were seven clinicians and four medical librarians. The initial small-group session was a discussion of concepts and principles related to successful facilitation skills; the subsequent four small groups reinforced these concepts and principles with role-playing and case scenarios using different steps in the EBM process. The course, including the use of the PLS process, scored highly on participant evaluations. The authors conclude that the introductory course effectively taught the PLS process for use in EBM facilitation.

Education, Continuing↗

PubMed2002

Assessing the reliability and validity of the mini-clinical evaluation exercise for internal medicine residency training.

PURPOSE: The mini-clinical evaluation exercise, or mini-CEX, assesses residents' history and physical examination skills. To date, no study has assessed the validity of the mini-CEX (mCEX) evaluation format. The authors' objective was to determine the reliability and validity of the mCEX evaluation format. METHOD: Twenty-three first-year residents at Wright-Patterson Medical Center in Dayton, Ohio, were included in the study (academic years 1996-97, 1997-98, and 1998-99). Validity of the instrument was determined by comparing mCEX scores with scores from corresponding sections of a modified version of the standard American Board of Internal Medicine's (ABIM's) monthly evaluation form (MEF) and the American College of Physicians-American Society of Internal Medicine In-Training Examination (ITE). All ABIM MEFs were used without exclusionary criteria, including ABIM MEFs from months where a corresponding mCEX evaluation was not performed. RESULTS: Each resident in the study had an average of seven mCEX evaluations and 12 ABIM MEFs. Of the 168 required mCEX evaluations, 162 were studied. Internal consistency reliability was .90. Statistically significant correlations were found for the following: mCEX history with ABIM history; mCEX physical exam with ABIM physical exam; mCEX clinical judgment with ABIM clinical judgment, medical care, medical knowledge, and the ITE; mCEX humanistic attributes with ABIM humanistic attributes, and mCEX overall clinical competence with ABIM overall clinical competence, medical care, medical knowledge, and the ITE. Analysis of variance comparing sequential mean mCEX scores yielded no significant difference. CONCLUSIONS: This study suggests that the mCEX is a feasible and reliable evaluation tool. The validity of the mCEX is supported by the strong correlations between mCEX scores and corresponding ABIM MEF scores as well as the ITE.

Adult↗

PubMed2002

Retrospective analysis of missed advanced adenomas on surveillance colonoscopy.

OBJECTIVE: Miss rates of large polyp/cancer during colonoscopy are reported from tertiary centers where experts do the colonoscopies. This information is important for determining surveillance intervals for repeat colonoscopy, patient safety, and malpractice issues. We evaluated retrospectively the miss rates of advanced adenomas in the setting of a GI fellowship training where most colonoscopies are done by closely supervised fellows. METHODS: We reviewed the 235 patients who had at least one repeat colonoscopy after initial polypectomy, between 1992 and 1999, at the Dayton Veterans Affairs Medical Center. Advanced adenomas were defined as polyps 10 mm or greater in size with or without a villous component or high-grade dysplasia. Data of missed advanced adenomas on 122 patients who had complete colonoscopy with satisfactory preparation and the excluded patients are reported. RESULTS: Four advanced adenomas (one had intramucosal cancer) on second colonoscopy and two advanced adenomas on third colonoscopy were missed. The miss rate of advanced adenoma for 232 patients was 1.7%, and the miss rate for the 122 patients with complete colonoscopy and satisfactory colon preparation was 2.5% and 3.3% on second and third repeat colonoscopy, respectively. No cancer was missed. CONCLUSIONS: The present study shows an advanced polyp miss rate that is comparable with other studies even in a fellowship training setting. Prospective studies with tandem surveillance colonoscopy are needed to confirm our findings.

Adenoma↗

PubMed2002

Simulating a full-length psychiatric interview with a complex patient: an OSCE for medical students.

Brief encounters with standardized psychiatric patients have been reported. In contrast, a videotaped objective structured clinical examination designed to simulate a comprehensive psychiatric evaluation was used to evaluate all students assigned to three successive psychiatry clerkship rotations (N=52). Performance assessment was based on standardized patients' completion of a 36-item content checklist and a patient perception scale, and on students' completion of a written examination component. Checked independently, all three assessments correlated with the students' score on the NBME psychiatry examination, their ward grade, and their essay examination grade. Students' ratings were favorable for time allotted, usefulness, and believability.

Journal Article↗

PubMed2002

Characteristics of centenarians admitted to a community teaching hospital.

BACKGROUND: The "oldest old" are the most rapidly growing segment of society, and clinicians will increasingly encounter this age group in this century. METHODS: To describe the characteristics of a special subgroup of the oldest old, the centenarians, we conducted a retrospective case series analysis of all patients 100 years of age and above admitted to a large community teaching hospital. RESULTS: Thirty-nine patients with a mean age of 101.3 years were admitted a total of 57 times during the 5-year study period. The main reasons for admission were hip fracture, stroke, and urinary tract infection. Patients admitted from nursing facilities were taking more medications than community dwelling patients, and patients who were confused on admission were more likely to be readmitted. Only 2 patients died. CONCLUSIONS: Polypharmacy is common in centenarians, especially in institutionalized patients, and confusion may be a useful predictor of subsequent readmission. In-hospital mortality, however, is low in this population.

Age Factors↗

PubMed2002

Clostridium difficile-associated diarrhea and chronic renal insufficiency.

BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it increases mortality and morbidity. METHOD: We reviewed charts of 385 patients with diarrhea for CDAD, chronic renal insufficiency, mortality, and recurrence of CDAD. RESULTS: Seventy-seven patients had infection due to C difficile. There was no difference in the chronic renal insufficiency, mortality, and other comorbid conditions between patients who had C difficile infection and those who did not. The patients with CDAD and chronic renal insufficiency had significantly higher mortality and recurrence of CDAD than patients without chronic renal insufficiency. CONCLUSIONS: Chronic renal insufficiency is not a risk factor for CDAD, but its presence with CDAD increases mortality and recurrence of CDAD.

Clostridioides difficile↗

PubMedDate not supplied

A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy.

This longitudinal study investigated whether attitudes toward physician-assisted suicide (PAS) and euthanasia (E) are stable among patients with noncurable malignancy, and whether depression and various coping strategies were related to such attitudes. Thirty patients with noncurable malignancies completed questionnaires measuring attitudes toward PAS and E, depression, and coping. Three months later, and subsequently at six-month intervals, repeated measures were obtained from 24 patients. There was a trend for patients to become less supportive of legalizing PAS and E from the initial to last attitude measurement. Depression was unrelated to attitude change. There were significant changes on two coping dimensions: use of social support for emotional reasons and use of religious resources. Our findings should be considered in clinical, legislative, and ethical debates.

Adaptation, Psychological↗