The multimedia computer for low-literacy patient education: a pilot project of cancer risk perceptions.

OBJECTIVE: Inadequate reading literacy is a major barrier to better educating patients. Despite its high prevalence, practical solutions for detecting and overcoming low literacy in a busy clinical setting remain elusive. In exploring the potential role for the multimedia computer in improving office-based patient education, we compared the accuracy of information captured from audio-computer interviewing of patients with that obtained from subsequent verbal questioning. SETTING: Adult medicine clinic, urban community health center PATIENTS: Convenience sample of patients awaiting clinic appointments (n = 59). Exclusion criteria included obvious psychoneurologic impairment or primary language other than English. INTERVENTION: A multimedia computer presentation that used audio-computer interviewing with localized imagery and voices to elicit responses to 4 questions on prior computer use and cancer risk perceptions. MEASUREMENTS AND MAIN RESULTS: Three patients refused or were unable to interact with the computer at all, and 3 patients required restarting the presentation from the beginning but ultimately completed the computerized survey. Of the 51 evaluable patients (72.5% African-American, 66.7% female, mean age 47.5 [+/- 18.1]), the mean time in the computer presentation was significantly longer with older age and with no prior computer use but did not differ by gender or race. Despite a high proportion of no prior computer use (60.8%), there was a high rate of agreement (88.7% overall) between audio-computer interviewing and subsequent verbal questioning. CONCLUSIONS: Audio-computer interviewing is feasible in this urban community health center. The computer offers a partial solution for overcoming literacy barriers inherent in written patient education materials and provides an efficient means of data collection that can be used to better target patients' educational needs.

The computer-based lecture.

Advancing computer technology, cost-containment pressures, and desire to make innovative improvements in medical education argue for moving learning resources to the computer. A reasonable target for such a strategy is the traditional clinical lecture. The purpose of the lecture, the advantages and disadvantages of "live" versus computer-based lectures, and the technical options in computerizing the lecture deserve attention in developing a cost-effective, complementary learning strategy that preserves the teacher-learner relationship. Based on a literature review of the traditional clinical lecture, we build on the strengths of the lecture format and discuss strategies for converting the lecture to a computer-based learning presentation.

Unresectable stage IV nephroblastoma: a potential indication for fine-needle aspiration biopsy in children.

In the United States, the initial morphologic diagnosis of nephroblastoma is usually determined on a nephrectomy specimen prior to the initiation of any additional therapy. Such an approach, however, is not appropriate in all children; we believe that fine-needle aspiration biopsies (FNAB) should be the initial diagnostic procedure in a minority of patients with suspected Wilms' tumor. One such group of patients is those who present with stage IV disease, especially when it is considered unresectable. Herein we present two children with advanced Wilms' tumor to support our contention. The initial microscopic diagnosis in each was made by FNAB. Following chemotherapy, predominantly necrotic Wilms' tumors were excised. Both patients are alive with no evidence of residual disease or untoward affects from the aspiration procedure.

Treatment of occult or late overt testicular relapse in children with acute lymphoblastic leukemia: a Pediatric Oncology Group study.

PURPOSE: The Pediatric Oncology Group (POG) designed a randomized two-arm protocol (8304) to improve the survival of children with acute lymphoblastic leukemia (ALL) who experience an isolated testicular relapse and to evaluate the efficacy of teniposide (VM-26) and doxorubicin as intensification agents during second remission. The outcome and toxicity observed in 80 patients with isolated testicular leukemia treated on POG 8304 are presented. PATIENTS AND METHODS: The following are common features of POG 8304: (1) remission reinduction therapy with vincristine, prednisone, and doxorubicin; (2) bilateral testicular irradiation (2,600 cGy) during reinduction therapy; (3) CNS prophylaxis with intrathecal hydrocortisone, methotrexate (MTX), and cytarabine (Ara-C); and (4) continuation therapy (for 80 weeks) with alternating 6-week cycles of oral mercaptopurine (6-MP)/MTX and intravenous vincristine and cyclophosphamide. Treatment differences consisted of pulses (administered every 7 weeks) of either prednisone and doxorubicin (arm 1) or VM-26 and Ara-C (arm 2) during continuation therapy and a 4-week late intensification phase with either vincristine, prednisone, and doxorubicin (arm 1) or VM-26 and Ara-C (arm 2). RESULTS: Fifty-five boys with ALL had isolated microscopic testicular leukemia detected by an elective biopsy at completion of initial treatment, and 25 had a late (greater than or equal to 6 months off-therapy) isolated overt testicular relapse. All patients with overt testicular leukemia attained a second clinical remission, and no patient with microscopic testicular leukemia progressed during reinduction. Of 42 patients on arm 1, 11 have relapsed compared with 18 of 38 patients on arm 2 (log-rank analysis, P = .22), indicating no significant difference between an anthracycline and an epipodophyllotoxin-Ara-C combination in the treatment of testicular leukemia. The overall 4-year event-free survival (EFS) among boys with occult testicular relapse was 53% +/- 8%. Age greater than 10 years at initial diagnosis, a WBC count greater than 50,000/microL at diagnosis, and black race were associated with a worse outcome. The 4-year EFS for boys with a late overt testicular relapse was 84% +/- 10%, and these patients fared significantly better than patients with occult disease (P = .007). CONCLUSION: The treatment approach reported here can secure a prolonged second remission in many patients with occult or late overt testicular leukemia.