Evaluation of a screening and counseling tool for alcohol misuse: a Virginia Practice Support and Research Network (VaPSRN) trial.

BACKGROUND: Surveys reveal limited screening and counseling for alcohol misuse by primary care physicians despite evidence-based recommendations. We developed and evaluated an alcohol screening and misuse counseling tool designed to assist clinicians at the point of care (POC). METHODS: This was a mixed methods, prospective cohort study conducted with licensed clinicians in a practice-based research network. A software tool was designed to guide clinicians through evidence-based alcohol misuse assessment and interventions. RESULTS: Participants (N = 12) used the tool an average of 3 sessions and 71% were satisfied with the tool. Participants increased their ability to differentiate between patients who are "at risk" drinkers versus those with alcohol use disorders including dependence/abuse (21%; t = 2.4; P = .04). Thematic analysis of interviews suggests that barriers to overall use included perceptions of alcohol use; clinical need to intervene; time; and issues with use of technology, most often at the POC. However, the tool added confidence and a valuable framework for interventions and was valued as an educational tool. Users felt that increased training and practice could increase comfort and impact future POC use. Increased POC usability also may be achieved through simplification of the tool and additional flexibility in options for POC use. CONCLUSIONS: A computer-assisted counseling tool for alcohol misuse and abuse can be implemented in primary care settings and shows promise for improving physician screening and interventions for alcohol misuse. To enhance utility in daily clinical practice we recommend design enhancements and strategies to enhance usage as described in this research.

Development and evaluation of an instrument for assessing brief behavioral change interventions.

OBJECTIVE: To develop an observational coding instrument for evaluating the fidelity and quality of brief behavioral change interventions based on the behavioral theories of the 5 A's, Stages of Change and Motivational Interviewing. METHODS: Content and face validity were assessed prior to an intervention where psychometric properties were evaluated with a prospective cohort of 116 medical students. Properties assessed included the inter-rater reliability of the instrument, internal consistency of the full scale and sub-scales and descriptive statistics of the instrument. Construct validity was assessed based on student's scores. RESULTS: Inter-rater reliability for the instrument was 0.82 (intraclass correlation). Internal consistency for the full scale was 0.70 (KR20). Internal consistencies for the sub-scales were as follows: MI intervention component (KR20=.7); stage-appropriate MI-based intervention (KR20=.55); MI spirit (KR20=.5); appropriate assessment (KR20=.45) and appropriate assisting (KR20=.56). CONCLUSIONS: The instrument demonstrated good inter-rater reliability and moderate overall internal consistency when used to assess performing brief behavioral change interventions by medical students. PRACTICE IMPLICATIONS: This practical instrument can be used with minimal training and demonstrates promising psychometric properties when evaluated with medical students counseling standardized patients. Further testing is required to evaluate its usefulness in clinical settings.

A PDA-based counseling tool for improving medical student smoking cessation counseling.

BACKGROUND AND OBJECTIVES: There is little research on training medical students in smoking cessation counseling (SCC). This study aimed to determine if a personal digital assistant (PDA)-based SCC tool can improve medical student SCC. METHODS: We conducted a randomized, controlled trial with third-year medical students. SCC behaviors, comfort, and knowledge were assessed using a validated survey before students attended a workshop on SCC. Student groups were then randomized to receive a paper-based reminder tool or the reminder plus a PDA-based SCC tool. The validated survey was repeated upon clerkship completion, and a videotaped standardized patient interview was assessed by trained reviewers using a 24-item SCC checklist. Focus groups assessed satisfaction with the PDA tool, usability, and barriers to use. RESULTS: SCC behaviors, knowledge, and comfort increased among all participants, with no statistical differences between groups. The PDA tool group performed 62% of key SCC activities during the videotaped interview, while the control group performed 69%. Students reported discomfort using the PDA with patients, lack of time, and lack of training as barriers to use of the tool. CONCLUSIONS: We demonstrated improvement of SCC skills by third-year medical students using a workshop combined with a supplemental reference tool. However, a PDA-based tool did not increase key SCC behaviors compared with a paper-based reminder. For a PDA intervention to be effective in this setting, the tool must be simplified and additional training provided.

Comparing cDNA and oligonucleotide array data: concordance of gene expression across platforms for the NCI-60 cancer cells.

Microarray gene-expression profiles are generally validated one gene at a time by real-time RT-PCR. We describe here a different approach based on simultaneous mutual validation of large numbers of genes using two different expression-profiling platforms. The result described here for the NCI-60 cancer cell lines is a consensus set of genes that give similar profiles on spotted cDNA arrays and Affymetrix oligonucleotide chips. Global concordance is parameterized by a 'correlation of correlations' coefficient.