Essential areas for behavioral science training: a needs assessment approach.

The design of effective behavioral science curricula for graduate medical education is an important link in the delivery of high quality medical care. Despite the work that has gone into developing methods of teaching and evaluating behavioral science training, as shown by numerous published articles, practicing primary care physicians still show deficits in handling patients' psychosocial problems. In this study, the authors propose the use of a behavioral science needs assessment questionnaire to ascertain the needs of residents for content areas based on the residents' medical school backgrounds and preferences for training. The questionnaire can also be used to monitor the effectiveness of existing curricula. The questionnaire was administered to 40 family practice residents in four programs to determine essential content areas. It was then used for curriculum planning in one program with 19 residents. Results from this program identified areas not covered in medical school and reflected the resident's comfort/confidence in practice in areas emphasized in the residency curriculum.

Influence of cimetidine on oral diazepam elimination with measurement of subsequent cognitive change.

In a double-blind crossover design, the effect of cimetidine on oral diazepam pharmacokinetics and an evaluation of cognitive function change was studied in seven healthy volunteers. Subjects randomly received placebo or cimetidine 300 mg orally every 6 h for a total of five doses prior to diazepam 10 mg. A significant increase in diazepam elimination half-life from (mean +/- s.e. mean) 66.9 +/- 21.4 to 89.6 +/- 22.5 h (P = 0.006) and area under the plasma concentration-time curve from 5.06 +/- 1.47 to 8.93 +/- 1.88 micrograms ml-1 h (P = 0.028) was observed indicating a probable cimetidine induced inhibition of diazepam hepatic metabolism. Digit symbol substitution and visual analogue scales were used to measure the effect of an alteration of diazepam kinetics on cognitive function. An enhancement of pharmacological effect as reflected in digit symbol substitution scores and visual analogue scale measurements was not observed.

Antibiotic prescribing in a family medicine residency program.

A total of 227 ambulatory patients who received prescriptions for antibiotics in a family practice residency program was studied. The common infections treated were urinary tract infections, upper respiratory tract infections, impetigo, nonspecific vaginitis, and bronchitis. Cultures obtained in 21.1 percent of the patients were usually considered to be appropriate. Urinary tract infections were usually treated with co-trimoxazole or other drugs containing sulfonamides; upper respiratory tract infections with amoxicillin, ampicillin, or penicillin; impetigo with penicillin; nonspecific vaginitis with vaginal creams; and bronchitis with ampicillin or erythromycin. Most prescriptions (86 percent) were written generically at an approximate savings of $2 per prescription. A review panel audited the prescribing practices and often (32.2 percent) disagreed among themselves, yet they did determine 65.4 percent of the prescriptions to be appropriate. The rate of appropriate antibiotic prescribing practices among the residents was found to decrease as the level of supervision decreased (P less than 0.01).

A comparison of various types of patient instruction in the proper administration of metered inhalers.

The administration technique employed by 42 inpatients using metered inhalers were observed. Proper performance of the six steps recommended by the manufacturer provided the guidelines for correct administration. The degree of compliance with proper technique was defined as the number of steps correctly executed by the patient. The mean number of steps correctly performed was 2.9 out of the possible six (48.3 percent). Twenty-four patients were then randomized into one of three groups. Group I received the manufacturer's instruction sheet, Group 2 received counseling from a pharmacist, and Group 3 received both the manufacturer's instruction sheet and counseling from a pharmacist. There was a significant improvement in the postinstruction technique in Groups 2 and 3, while Groups 1 failed to demonstrate any significant improvement. Comparisons were then made among the three groups. No significant difference was found between Group 2 and Group 3. However, both Groups 2 and 3 were found to be significantly different (p less than 0.05) from Group 1. This study shows that pharmacist counseling can significantly improve the degree of patient compliance in the administration of metered inhalers.

Determining the "proper" gentamicin dosage in a hospital setting.

A method for determining a gentamicin dosage was applied to a patient in a community hospital setting. It was found that many factors, some beyond the practitioner's control, confused proper use of the drug. A case is used to illustrate the difficulties encountered in a community hospital setting when a seemingly straightforward protocol for gentamicin administration for therapy was initiated. The errors associated with each of five levels of personnel are illustrated which if summed could result in potentially serious consequences. In addition to reviewing the literature on gentamicin dosage schedules and making recommendations regarding future research in this area, specific guidelines are proposed for the use of gentamicin in clinical practice.

Statistical manipulation for normalization of data: in vitro thyroid function tests.

Interest in chemical and statistical methods chosen to define "normal" populations for the clinical significance of tests has grown recently. Because few clinical values are distributed in gaussian fashion, recommendations for smoothing of data by transforms have been prepared. In this paper we examine mathematical transformations as they are applied to in vitro tests of thyroid function and evaluate the use of multivariate regression analysis. Mathematical transforms used included square root, two parameter log, three parameter log, and inverse hyperbolic sine methods. Multivariate regression analysis was obtained by comparing test data for the T3 uptake, T4, and effective thyroxine ratio with clinical diagnoses as individual and aggregate weighting values for decision. None of the mathematical transforms resulted in complete elimination of diagnostic errors when compared with clinical diagnoses. The effective thyroxine ratio by itself had the highest correlation with patient findings. Additions of other commonly used in vitro function tests added little diagnostic accuracy.