Reported comfort with obstetrical emergencies before and after participation in the advanced life support in obstetrics course.

BACKGROUND AND OBJECTIVES: Prior research has demonstrated a change in Advanced Life Support in Obstetrics (ALSO) course attendees' reported comfort with managing specific obstetrical emergencies and procedures before and immediately after participation in an ALSO course. Assessment of longer-term stability of these changes has not been performed. This study measured changes in comfort with obstetrical emergencies and reported practice patterns 1 year after ALSO training. METHODS: ALSO course attendees (275) were given a grounded Likert scale survey measuring reported comfort with the management of specific obstetrical emergencies and procedures before, immediately after, 6 months after, and 1 year after participation in an ALSO course. Practice patterns were also surveyed. Paired data were analyzed using the Kruskal-Wallis one-way ANOVA test at a 95% confidence interval for two-tailed significance. RESULTS: ALSO course participants reported a significant increase in their comfort with the management of each of 15 obstetrical emergencies and procedures taught in the ALSO curriculum. Reported comfort remained high at 6 months' and 1-year follow-up and was accompanied by a statistically significant change in reported practice patterns; more participants performed, in their practice 1 year after completion of ALSO training, amnioinfusion, vacuum-assisted vaginal delivery, and ultrasound for determining fetal position and placental location. CONCLUSIONS: Affective learning is important in translating knowledge and skills into the practice of medicine. Our study demonstrates that participation in the ALSO course increases participants' knowledge in the affective domain of learning.

Influence of an interventional program on resource use and cost in pediatric asthma.

OBJECTIVE: Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cost are increasing. This study was performed to determine whether patient education and assignment to a primary care provider improve outcomes and cost in the management of pediatric asthma. STUDY DESIGN: A prospective pilot study of 61 patients was conducted with a retrospective review. Data were obtained from health and pharmacy records. PATIENTS AND METHODS: Sixty-one unassigned pediatric asthma patients who were noted to be frequent users of emergency department services and who had no primary care provider were identified. This cohort received asthma education and was assigned a provider trained in the national asthma guidelines. Hospital admissions, Emergency Department and clinic visits, use of beta 2 agonists and anti-inflammatory drugs, number of chest radiographs, and continuity of care were recorded for a mean of 58.1 months before and 11.2 months after the intervention. A cost analysis was done. RESULTS: All measured parameters showed favorable changes after intervention, with the decrease in the number of prescriptions of monthly inhaled anti-inflammatory drugs and chest radiographs ordered being statistically significant (P = 0.007 and P = 0.040, respectively). Monthly admissions, Emergency Department visits, and clinic visits declined after intervention when evaluated after 22.8 months of follow up. Annual resource savings after intervention was estimated to be $4845.29 per patient for this military hospital. CONCLUSIONS: A combined intervention consisting of provider and patient education and assignment to a primary care provider was associated with improved care and economic outcomes in this group.

Is interruption in residency training associated with a change in in-training examination scores?

BACKGROUND: Many military physicians interrupt their training to serve in the position of general medical officer (GMO) after completing their first year of postgraduate medical education. This study compares American Board of Family Practice In-training Examination (ITE) scores of military family practice residents who received continuous training (CFP residents) with those who did GMO tours (GMO residents). METHODS: Historical cohorts of CFP and GMO residents from Army and Navy family practice residencies were compared. The dependent measures were their ITE scores in each year of training. Paired data were analyzed using the Student's test. RESULTS: There were no significant differences in composite or clinical problem set scores between GMO and CFP resident groups. Power to detect a true difference between the groups was 74. CONCLUSIONS: Interruption in residency training is not associated with a significant change in the returning resident's ITE scores.

End-expiratory carbon monoxide levels as an estimate of passive smoking exposure aboard a nuclear-powered submarine.

Passive smoking is the involuntary inhalation of tobacco smoke by nonsmokers. The purpose of this study was to estimate the degree of passive smoking exposure sustained by smokers and nonsmokers in a nonventilated submarine through the measurement of end-expiratory carbon monoxide (EECO) levels. The initial and final EECO levels were compared for both smokers and nonsmokers. A simple linear regression equation was then used to compare the initial EECO levels in smokers (and their daily cigarette use) with the postsubmergence EECO levels in nonsmokers. Our results showed the postsubmergence EECO levels in the nonsmoking crew members approximated the initial EECO levels in crew members who smoked 21 cigarettes per day. Nonsmokers in a submerged submarine are exposed to significant levels of CO. Future studies are needed to determine the health consequences of this significantly increased level of exposure in nonsmokers.