Changes in sexual function secondary to medication effects.

Over 200 medications have been cited in case reports, prescribing literature or controlled studies as possibly impacting sexual function (1). Recognizing and treating these side effects is important for patient medication adherence and overall quality of care. The following article provides suggestions for evaluating the impact of medications on sexual function, as well as possible interventions. A table is included which lists medications suspected to cause changes in sexual function and the side effects with their relative frequencies.

Medications that may contribute to sexual disorders. A guide to assessment and treatment in family practice.

Approximately 15% to 25% of family practice patients have concerns about sexual function and are most comfortable discussing these issues with their family physician. While many physicians have avoided this topic in the past, citing lack of knowledge and skill, the family practice setting is ideal for a preliminary evaluation of sexual dysfunction and treatment for certain etiologies. This especially is true for changes in sexual function secondary to medication effects. This article provides basic guidelines designed to assist physicians in evaluating the effects of medications and other substances on sexual function. Also included are lists of medications known or suspected to have adverse effects on sexual function. Physicians are encouraged to address the sexual concerns of their patients and to incorporate these guidelines and the medication lists into their evaluation.

Understanding and addressing cognitive bias in medical education.

Cognitive biases can impede the utilization of logical/statistical strategies in clinical decision-making. This paper reports on research and educational findings using the Inventory of Cognitive Biases in Medicine (ICBM). The ICBM was administered to groups of medical students before their clinical years and to practicing physicians to determine (a) the extent of cognitive bias in medical decision-making and whether experienced physicians differed from novices, (b) whether cognitive bias varied by medical speciality and (c) whether awareness of cognitive bias in medical decision-making could be taught. Preclinical medical students' mean score (41 %) was near the chance level (42%). While practicing physicians scored higher (49%), they also demonstrated considerable susceptibility to cognitive bias. Cognitive bias varied by medical speciality with internal medicine physicians (57%) scoring best on the ICBM. A controlled educational research study with preclinical medical students showed that learners exposed to a seminar on cognitive bias in medical decision-making scored better on the ICBM than their peers (55% vs. 41%, p < 0.001). Susceptibility to cognitive bias was found to be present substantially among both novices and experts in medicine, but carefully crafted educational strategies in both classroom and clinical settings may lessen the problem.

Development of a test of cognitive bias in medical decision making.

PURPOSE: To develop an inventory to measure the influence of cognitive biases on medical decisions. METHOD: The Inventory of Cognitive Biases in Medicine (ICBM) consists of 22 medical scenarios in which respondents choose between alternatives that represent bias-prone or statistically based decisions. In 1992 and 1993 the ICBM was administered to 102 medical students and residents and 318 physician faculty at the Wright State University School of Medicine. RESULTS: The statistically correct decision was made in fewer than half the ICBM scenarios for both groups (students and residents, 41%; faculty, 49%); and only the faculty scored better than chance. Acceptable reliability (KR 20 = .62 for the faculty administration) and item discrimination (mean = .49) were achieved. Further, the results suggest that the ICBM has both content and construct validity. CONCLUSION: The rather poor performances of the students and residents and the faculty on the ICBM suggest that cognitive biases constitute an important detraction from reliance on logical and statistical strategies. The ICBM shows promise for use as a tool in both instructional and research endeavors attempting to minimize and elucidate this phenomenon.

Underestimates of student substance use by school personnel: a cause for concern?

The present study was designed to compare school personnel's (i.e., principals, counselors, teachers) estimates of student substance use with student self-reported data. Comparisons were made in 78 schools between 5431 student self-reports of tobacco, alcohol, and drug use and 170 school personnel's estimates of student substance use. The results indicated that a significant number of school personnel were unable to estimate student substance use. Personnel who did provide estimates typically underestimated the degree of substance use, in comparison to student self-reported substance use. School personnel did not significantly overestimate use in comparison to student self-reported substance use for any substance in any grade or geographic area. It is suggested that school personnel may resist the adoption of prevention programs because of a perceived lack of need due to underestimation of the substance use problem.

Patterns of cigarette and smokeless tobacco use among children and adolescents.

Although cigarette and smokeless tobacco use are recognized as major problems among school-age youth, few nationwide or statewide data exist on the prevalence and patterns of use. To determine the patterns of tobacco use among children and adolescents in Missouri, self-report information was obtained from a representative sample of 5,431 students in grades 5, 8, and 12. Both cigarette smoking and smokeless tobacco use were more common among males than females for each grade level except the 12th, where 30% of females and 28% of males had smoked during the previous week. Smoking prevalence was considerably lower among blacks than whites. Smokeless tobacco use was rare among both blacks and females. Smokeless tobacco use was more common than cigarette smoking in rural areas, where 17% of 8th-grade males and 31% of 12th-grade males had used smokeless tobacco during the previous week. The mean age at first use of cigarettes was slightly lower in the rural than the urban area, whereas the mean age of initial smokeless tobacco use was more than a year earlier in the rural area. Data regarding the perceived difficulty of quitting smoking and quit rates suggested that adolescent females have more difficulty quitting smoking than males. Male smokeless tobacco users appeared to be more addicted than male cigarette smokers. Smokeless tobacco brand preference indicated that users may switch to progressively stronger types of smokeless tobacco as they get older and a nicotine tolerance is developed. The current study emphasizes the urgent need for carefully targeted tobacco prevention and cessation efforts among school-age youth.