Use of Harvey® the Cardiopulmonary Patient Simulator in Physician Assistant Training.

PURPOSE: The purpose of this study was to evaluate physician assistant students' confidence levels in detection of heart murmurs following instruction with Harvey(R) the Cardiopulmonary Patient Simulator compared with a classroom heart sounds activity. METHODS: Cohort 1 (n = 33) participated in the classroom heart sounds activity and then participated in the Harvey simulation exercise. Cohort 2 (n = 34) first participated in the Harvey simulation activity and then in the classroom heart sounds activity. All students completed preintervention and postintervention surveys to assess confidence in detecting heart sounds. A multiple-choice quiz was distributed to each group after participation in the first heart sounds activity. RESULTS: Sixty-seven students completed all surveys. Before either activity, 6% of students in Cohort 1 and 3% in Cohort 2 reported confidence in detecting abnormal heart sounds. After completing the first activity, 85% of the classroom heart sounds activity group (Cohort 1) and 53% of the Harvey simulation group (Cohort 2) reported confidence in detecting abnormal heart sounds. The mean score on the multiple-choice quiz was 62% in Cohort 1 and 24% in Cohort 2. CONCLUSION: Both cohorts reported confidence in learning abnormal heart sounds after participation in the Harvey simulation compared with baseline confidence. Students who participated in the classroom heart sounds activity before the Harvey simulation activity performed higher on the murmur identification multiple-choice quiz. The University of Texas Medical Branch PA faculty should consider continued use of both the classroom heart sounds activity and Harvey simulation.

Improved health-related quality of life for patients with active rheumatoid arthritis receiving rituximab: Results of the Dose-Ranging Assessment: International Clinical Evaluation of Rituximab in Rheumatoid Arthritis (DANCER) Trial.

OBJECTIVE: To evaluate the effect of rituximab treatment on health-related quality of life (HRQOL) in patients with active rheumatoid arthritis (RA), who have had an inadequate response to disease-modifying antirheumatic drugs, including biologic agents. METHODS: A randomized, multicenter, double-blind, placebo-controlled clinical trial involving 367 rheumatoid factor-positive patients was conducted. Patients received 2 infusions 2 weeks apart of placebo (n = 122), rituximab 500 mg (n = 123), or rituximab 1000 mg (n = 122), with or without glucocorticoids. All patients received stable doses of methotrexate (10 25 mg/wk). Measures included SF-36, assessed at baseline and at 24 weeks, as well as the HAQ and FACIT-Fatigue scale assessed at baseline and monthly for 24 weeks. Patients exceeding prespecified minimal clinically important differences (MCID) were examined. Clinical efficacy measurements (ACR20/50/70 and EULAR responses) were compared with HRQOL outcomes. RESULTS: At 24 weeks, the rituximab 500 mg and 1000 mg groups both reported statistically significantly greater improvements on the SF-36 physical component summary (4.37 and 4.89 points higher, respectively, vs placebo; p < 0.001). SF-36 physical function, bodily pain, vitality, social function, and role-physical subscale scores also statistically significantly improved vs placebo. At 24 weeks, 62.6% and 67.2% of the rituximab 500 mg and 1000 mg groups, respectively, exceeded the MCID of 0.22 in HAQ (p < 0.001). For FACIT-Fatigue, 55.3% and 65.6% of patients exceeded the MCID of 3.5 points compared with 35.2% of placebo over 24 weeks (p < 0.001). ACR20/50/70 and EULAR responders demonstrated greater improvements in mean baseline to 24 week changes in SF-36 and FACIT-Fatigue scores compared with nonresponders (p < 0.05). CONCLUSION: Both rituximab doses in combination with methotrexate were effective in improving all HRQOL outcomes in patients with active RA consistent with clinical efficacy.