A comparison between lecture and videotape inservice for certified nursing assistants in skilled nursing facilities.

OBJECTIVE: Certified Nursing Assistants (CNA) provide most of the direct patient care in skilled nursing facilities (SNF). CNAs undergo mandatory inservice education regarding a variety of clinical conditions, but high CNA turnover and diverse cultural and educational backgrounds are persistent obstacles to overall staff education. A standardized, easily administered, highly reproducible training intervention would be valuable. We compared the efficacy of videotape versus standard lecture for inservice education relating to topics of dementia care, restraint use, and falls. DESIGN: A prospective randomized study. SETTING: Certified Nursing Assistants were recruited from three SNFs in San Diego County California between November 1997 and August 1998. PARTICIPANTS: The 82 CNAs who participated in the study were all CNA certified in California, employees of the study SNFs, and provided direct clinical care to SNF residents. All participants received regular inservice training. INTERVENTIONS: (1) Standard inservice lecture, (2) Videotape of inservice lecture material supplemented with brief clinical video vignettes. MAIN OUTCOME MEASURES: Scores on a 72-item multiple choice/true-false examination. MAIN RESULTS: Both lecture and video inservice education were effective in this CNA population. Test scores were significantly higher for both inservice groups compared with the control group (P < 0.001). There was no statistically significant difference between test scores for the two intervention groups (control = 63.1 +/- 8.2%, lecture = 78.2 +/- 8.9%, video = 77.9 +/- 11.2%). Knowledge retention was similar between the two intervention groups at 4 months. Lecture subjects who scored highest were more likely to have family members with dementia (P = 0.037), and video subjects who scored highest were younger (P = 0.007). CNA video subjects who scored highest on the examination were more likely to have English as their primary language compared with the highest scoring CNA lecture subjects (P = 0.012). CONCLUSIONS: Compared with control group scores, videotape and lecture inservice interventions were equally effective at increasing and maintaining test scores. The ease of frequent video intervention and the identification of learner characteristics most suited to the video format make audiovisual education a potentially powerful medium for CNA training. These data have important implications for future educational interventions in the SNF.

Plasma level and broncholytic effect of choline theophyllinate after a single dose of a press-coated tablet formulation.

The broncholytic effect and plasma concentrations of theophylline in 10 asthmatic patients were studied for 8 hours after a single dose of 600 mg choline theophyllinate in press-coated 200 mg tablets. Therapeutic concentrations of theophylline were rapidly achieved and the plasma peak averaged 10.4 mug/ml after 2 hours. The broncholytic effect was closely related to the plasma level of theophylline. The largest change was in FEV1, which was significantly increased 1 to 6 hours after the dose. No patient complained of adverse effects. A theophylline concentration of 7 mug/ml plasma was adequate for a broncholytic effect, but a higher level was required for a maximal response. The results provide a basis for further studies to establish a dosage schedule suitable for prolonged therapy.

Plasma theophylline level and ventilatory function in chronic obstructive pulmonary disease during prolonged oral treatment with choline theophyllinate.

Plasma levels of theophylline and broncholytic activity have been studied in 12 patients with chronic obstructive pulmonary disease during prolonged oral treatment with choline theophyllinate, administered as a press-coated tablet (BrondaxinR). The plasma levels determined immediately before and 80 minutes after each dose showed very good agreement with those calculated on the basis of data from a previous single dose study. The plasma concentration and improvement in ventilatory function were closely correlated throughout the 48 hours of the study. A tendency towards further reduction of bronchial obstruction was observed during the second day, despite essentially unchanged plasma levels of theophylline. The results provide a rational basis for determination of an optimal dose schedule for oral treatment with choline theophyllinate to reduce the symptoms of obstructive bronchial disease.

Predominantly unilateral asthma studied with 133Xe-radiospirometry.

Regional lung function in the supine position was studied with 133Xe-radiospirometry in 10 asthmatic subjects in remission, before and after inhalation of specific allergens in the right lateral decubitus position. Regional ventilation and regional lung volume showed a significant decrease in the right lung. The decrease in ventilation was most pronounced in the diaphragmatic half of the lung. The regional perfusion of the right lung decreased less than the ventilation. The change in perfusion, however, became greater with time, whereas the decrease in ventilation remained the same as shortly after the provocation. Predominantly regional asthma could thus be provoked in the regions that receive most of the allergen in the right lateral position. The asthma was easily controlled and caused little discomfort.