AOA continuing medical education

The effects of roxithromycin, a macrolide antibiotic, on neutrophil activities were investigated in six seriously handicapped patients with severe mental retardation. Neutrophil activities were evaluated by flow cytometry using a heparinized blood analysis method. All six patients showed decreased levels of neutrophil phagocytosis, intracellular killing, and CD11b expression. Treatment with roxithromycin in vitro selectively restored the decreased phagocytic and bactericidal activities of neutrophils in these patients. There was no significant restorative effect with cefaclor, ofloxacin, or aztreonam. These results suggest the need to consider therapeutic effects of antibiotics on neutrophil functions in patients at increased risk for bacterial infections due to decreased neutrophil activities.     

Satellite-delivered continuing medical education in Europe

There is increasing recognition of the need for continuing medical education in the medical profession. There are now many ways of delivering medical education including conferences, books, journals amongst others. This paper describes a novel method of delivering medical education using satellite transmission. This medium allows live medical education programmes to be broadcast to over 150 receiver sites in Europe. It also enables two-way live satellite links to be made between countries during the broadcast. EuroTransMed has an editorial board, in much the same way as a journal, which is representative of the differing medical societies in Europe. As the barriers between the various countries fall, EuroTransMed is an ideal medium to promote high quality, easily accessible, continuing medical education at a pan-European level.     

Surgical continuing medical education: format and impact

A survey of 140 continuing medical education (CME) offerings in surgery for 1975-1976 was undertaken. In no instance was there evidence of evaluation of learning or behavior changes after the experience on the part of the sponsors. Estimated cost from the data obrained, 83 courses, was approximated at two million dollars. There is no evidence that this modality achieves the objective of improved patient care. A change from the education-based existing system to a competency-based evaluation system is proposed. The latter, a multicomponent system, has an objective cognitive skills measurement and a measurement of behavior as major elements. Computer simulation-modeling using patient-problems is proposed to define deficits and to be used as an active participatory educational modality. Development of practice profiles, establishment of a data base for determining patient outcome, including morbidity and mortality data, and identification of measures to determine rate of adoption of innovation and loss of obsolescent concepts are required to define behavioral changes. Under the guidance of academic and professional societies working in the community, an effective competency-based educational system dedicated to improved patient care can be specified and implemented.     

Diploma of continuing education from the Society of Physician of Thüringia

A rapid and sensitive high-performance thin-layer chromatographic assay has been developed for the measurement of nimesulide in human plasma. Its use for pharmacokinetic studies has been evaluated. The method includes a single-stage extraction procedure without the use of an internal standard. Analysis was performed on plasma containing known amounts of the drug, on drug-free plasma, and on plasma containing an unknown quantity of the drug. Known amounts of extract and nimesulide (100 and 200 ng, as external standard) were spotted on precoated silica-gel 60F254 plates by means of a Camag Linomat IV autosampler. Quantification was achieved using a Camag TLC scanner 3. The recovery of the method was 97.10 +/- 2.22%. The method was applied for the determination of plasma levels and pharmacokinetic parameters of nimesulide after oral administration of two formulations (100 mg) in healthy volunteers. The method is a sensitive, economical, rapid and specific assay for nimesulide in human plasma, and is suitable for pharmacokinetic studies after therapeutic doses.     

A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes.

Objective: The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOPs) improved outcomes for alcohol-dependent patients. Method: Participants (N = 252) who completed 3 weeks of IOP were randomized to up to 36 sessions of TM (M = 11.5 sessions), TMC (M = 9.1 sessions), or IOP only (treatment as usual [TAU]). Quarterly assessment of alcohol use (79.9% assessed at 18 months) was corroborated with available collateral reports (N = 63 at 12 months). Participants with cocaine dependence (N = 199) also provided urine samples. Results: Main effects favored TMC over TAU on any alcohol use (odds ratio [OR] = 1.88, CI [1.13, 3.14]) and any heavy alcohol use (OR = 1.74, CI [1.03, 2.94]). TMC produced fewer days of alcohol use during Months 10–18 and heavy alcohol use during Months 13–18 than TAU (ds = 0.46–0.65). TMC also produced fewer days of any alcohol use and heavy alcohol use than TM during Months 4–6 (ds = 0.39 and 0.43). TM produced lower percent days alcohol use than TAU during Months 10–12 and 13–15 (ds = 0.41 and 0.39). There were no treatment effects on rates of cocaine-positive urines. Conclusions: Adding telephone continuing care to IOP improved alcohol use outcomes relative to IOP alone. Conversely, shorter calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial.

Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On-line literature retrieval as a continuing medical education course

The effectiveness of a mass separation technique, previously used for the extraction of larvae of lymphatic-dwelling filarial worms from batches of vector mosquitoes, was tested as a means of recovering infective-stage larvae of Onchocerca volvulus from Simulium ochraceum in Guatemala. Blood-engorged flies, collected from 10 infected human attractants, were maintained for 9 days to allow ingested microfilariae to develop to the infective stage. The numbers of Onchocerca larvae recovered after groups of these flies were crushed and washed into tissue culture fluid in Baermann funnels was compared with the numbers obtained by individual dissections of flies fed on the same subjects. The mass separation procedure gave a mean recovery rate of 0.03 larva/fly and detected larvae only in flies which had fed on those subjects with the highest microfilarial skin densities. Dissections yielded 0.50 larva/fly (a 16.7-fold increase) and detected larvae in flies collected from all test subjects. The explanation for the ineffectiveness of the mass separation technique may lie in the observed sluggishness of infective-stage Onchocerca larvae and a consequent inability to free themselves from the fly fragments in the Baermann funnel.     

Contingency management, self-control, and education support in the treatment of childhood phobic disorders: A randomized clinical trial.

This study evaluated the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition relative to an education support (ES) control condition for treating children with phobic disorders. Eighty-one children and their parents completed a 10-week treatment program in which children and parents were seen in separate treatment sessions with the therapist, followed by a brief conjoint meeting. Children in both the CM and SC conditions showed substantial improvement on all of the outcome measures. These gains were maintained at 3-, 6-, and 12-month follow-ups. Interestingly, children in the ES condition also showed comparable improvements at posttreatment and at 3-, 6-, and 12-month follow-ups. Implications of the findings are discussed with respect to knowledge development and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of contingency management delivered in the context of group counseling.

Objective: Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based outpatient treatment would increase attendance and drug abstinence relative to standard care. Method: Substance abusing patients (N = 239) initiating outpatient treatment at 2 community-based clinics were randomized to standard care with frequent urine sample monitoring for 12 weeks (SC) or that same treatment with CM delivered in the context of group counseling sessions. In the CM condition, patients earned opportunities to put their names in a hat based on attendance and submission of drug-negative samples. At group counseling sessions, therapists selected names randomly from the hat, and individuals whose names were drawn won prizes ranging from $1 to $100. Results: Patients assigned to CM earned a median of $160 in prizes, and they attended significantly more days of treatment (d = 0.25), remained in treatment for more continuous weeks (d = 0.40), and achieved longer durations of drug abstinence (d = 0.26) than patients randomized to SC. Group adherence and therapeutic alliance also improved with CM. In addition, HIV risk behaviors were significantly lower in CM relative to SC patients during early phases of treatment and at the 12-month follow-up. Conclusions: These data demonstrate that CM delivered in the context of outpatient group counseling can increase attendance and improve drug abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A randomized double blind trial of verbal NSAID education compared to verbal and written education

OBJECTIVE: We performed a double blind randomized controlled trial to investigate whether patients taking nonsteroidal antiinflammatory drugs (NSAID) knew more about these drugs at followup depending on whether they were randomized to receiving or not receiving an NSAID information sheet. The patients were unaware they were in a study. METHODS: All patients received verbal education on the side effects of NSAID that was standardized and always given by the same rheumatologist. Thirty patients randomly received an NSAID information sheet and 26 patients did not. At next clinic followup, after reading a letter of explanation about the study and signing a consent form, patients completed a questionnaire asking about their knowledge of NSAID. RESULTS: Outcome variables assessed within the questionnaire included whether NSAID : (1) can decrease inflammation; (2) help with pain; (3) cause stomach upset and bleeding in the bowels. None of these variables were statistically significant. The only variable that was statistically significantly different between the groups was their report of whether they had received an information sheet about NSAID (p<0.00004). A greater proportion of patients who received the NSAID information sheet correctly reported they had received one compared to those who had not received one and who said they had not received one (85% in the former group, 70% in the latter group). The group who received the NSAID information sheet were more apt to say that NSAID can help with their pain (odds ratio 6.1, p<0.05). Education level was positively correlated with knowledge (p<0.04). However, level of education explained only 11% of the variance in overall knowledge scores (r=0.34) among all patients. CONCLUSION: An information sheet may not add educational value over verbal information by a physician in a clinic setting.     

A population-based, randomized clinical trial on back pain management

STUDY DESIGN: Population-based randomized clinical trial. OBJECTIVES: To develop and test a model of management of subacute back pain, to prevent prolonged disability. SUMMARY OF BACKGROUND DATA: The present management of back pain seems inadequate, and development of innovative models has been urged. METHODS: A model for the treatment of subacute work-related back pain has been developed and evaluated in a population-based randomized clinical trial. Workers (n = 130) from eligible workplaces in the Sherbrooke area (N = 31), who had been absent from work for more than 4 weeks for back pain, were randomized, based on their workplace, in one of four treatment groups: usual care, clinical intervention, occupational intervention, and full intervention (a combination of the last two). The duration of absence from regular work and from any work was evaluated using survival analysis. Functional status and pain were compared at study entry and after 1 year of follow-up. RESULTS: The full intervention group returned to regular work 2.41 times faster than the usual care intervention group (95% confidence interval 1.19-4.89; P < 0.01). The specific effect of the occupational intervention accounted for the most important part of this result, with a rate ratio of return to regular work of 1.91 (95% confidence interval = 1.18-3.10; P < 0.01). Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups, compared with the trend in the usual care intervention group. CONCLUSIONS: Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain.