Putting computer-based evidence in the hands of clinicians.
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Evidence-Based Medicine↗
Biomedical subjects
S R Messimer
Publications and source records attributed to S R Messimer.
Successful teaching of pediatric fluid management using computer methods.
OBJECTIVES: To identify and measure differences in knowledge of pediatric fluid management procedures between students taught by computer tutorial and others taught by lecture or seminar. DESIGN: Cohort analytic study. SETTING: Two community-based medical school pediatric teaching services. PARTICIPANTS: Eighty-nine third-year medical students with no prior pediatric fluid management experience. INTERVENTIONS: Forty-eight students at one community campus completed a microcomputer-based tutorial program that replaced all teaching sessions in pediatric fluid management. Forty-one students from a similar community campus were taught identical content by a pediatric critical care specialist using a seminar, reading material, and handouts. MAIN OUTCOME MEASURES: Scores on 2 free-answer problems on treatment of a dehydrated child, which were graded by a single evaluator blinded to the teaching method used, and scores on a 20-item multiple-choice examination. RESULTS: The computer instruction group achieved significantly higher test scores than the seminar group for both the multiple-choice examination (81.1% vs 62.2%; P<.001) and the free-answer test (85.4% vs. 61.0%; P<.001). CONCLUSIONS: The computer tutorial in fluid therapy has been an effective means of meeting the defined objectives of the pediatric clerkship. Compared with traditional methods, students taught using the computer achieved significantly higher scores on tests of both factual knowledge and practical problem solving.
Achievement↗
Do gastrointestinal symptoms accompanying sore throat predict streptococcal pharyngitis? An UPRNet study. Upper Peninsula Research Network.
BACKGROUND: The purpose of this study was to determine whether gastrointestinal (GI) symptoms are more common in streptococcal than nonstreptococcal pharyngitis, and, if so, whether these symptoms are useful diagnostic predictors. METHODS: Patients aged 4 and older presenting consecutively to one of three family practice clinics and one emergency department with the chief complaint of sore throat were invited to participate in the study. A nurse administered a brief symptom checklist; after documenting clinical signs, the clinician assessed and treated the patient. All patients were screened for group A streptococcus using the Abbott Test Pack Plus. Patients were enrolled from January 1996 through March 1996. Significant associations of signs and symptoms with streptococcal pharyngitis were determined by chi square, likelihood ratios were calculated, and logistic regression was used to compare diagnostic prediction models with and without GI symptoms. RESULTS: Six hundred fifty-seven consecutive patients with the presenting complaint of sore throat were enrolled in the study. The mean age of the patients enrolled was 19 years; the median age was 14. Thirty-two percent of the children (ages 4 to 18), 23% of the adults (ages 19 to 74), and 29% of all patients had streptococcal pharyngitis. Symptom frequencies for streptococcal and nonstreptococcal pharyngitis, respectively, were: nausea (39% vs 31%, P = .14); vomiting (14% vs 7%, P = .004); abdominal pain (27% vs 26%, P = .621); and any GI symptom (47% vs 41%, P = .45). When included in a predictive model with other significant predictors of streptococcal pharyngitis including age, palatal petechiae, absence of cough, and anterior cervical adenopathy, the addition of nausea or vomiting added slight predictive power to the models, but abdominal pain and "any GI symptom" did not. CONCLUSIONS: Nausea and vomiting are somewhat more common in streptococcal than in nonstreptococcal pharyngitis, but appear to have limited usefulness as clinical predictors of streptococcal pharyngitis.
Adolescent↗
A comparison of two antismoking interventions among pregnant women in eleven private primary care practices.
Despite the dangers of smoking during pregnancy having been widely publicized, few studies have actually examined the effectiveness of antismoking interventions among pregnant women in the private primary care obstetric setting. A randomized experimental study involving 24 private physicians and 109 pregnant smokers was conducted comparing the American Lung Association's Because You Love Your Baby smoking intervention (ALA) to a standard-of-care protocol (non-ALA). The non-ALA protocol was based upon the smoking interventions that study physicians said they commonly used among pregnant women. Self-reported smoking rates were obtained by questionnaire at the first prenatal visit, at 32 to 36 weeks' gestation, and at the six-week postpartum visit. By the time of the first prenatal visit, both groups reduced by half the number of cigarettes smoked. By 32 to 36 weeks, the groups decreased the daily average by an additional 2.3 (ALA) and 1.8 (non-ALA) cigarettes, a nonsignificant difference between the groups. Fifteen (28 percent) of the ALA group compared with 9 (16 percent) of the non-ALA group reported quitting at the 32- to 36-week visit (P = .10). Only 9 percent of the ALA group and 10 percent of the non-ALA were nonsmokers at the postpartum visit. Pregnancy alone is a powerful motivator for women to decrease their smoking. Although the difference between the ALA and non-ALA protocols did not attain statistical significance, the percentage of those who quit was comparable to the results obtained in other controlled trials. The ALA Because You Love Your Baby protocol should be used until more effective methods are available.
Adult↗