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Patel J, Yao L, Vina E, Fleece D, Arundathi J, Caricchio R, Wu H. Phenotype Systemic Lupus Erythematosus Patients from EPIC Cosmos. Stud Health Technol Inform 2024; 310:159-163. [PMID: 38269785 DOI: 10.3233/shti230947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Systemic Lupus Erythematosus (SLE) is a widespread autoimmune disease for which early diagnosis is paramount in improving clinical outcomes. In this project, we used the de-identified patients from Epic Cosmos to retrieve the ICD code for SLE, checked data quality based on the EULAR/ACR classification systems, created an approach to determine the SLE patients, and performed statistical analyses on lab tests and clinical characteristics. Our preliminary results showed that clinical notes must be reviewed to improve the completeness, as structured EHR data fields provide limited information in determining if a patient meets the established classification criteria.
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Affiliation(s)
- Jay Patel
- Department of Health Services Administration and Policy, College of Public Health Temple University, Philadelphia, PA, USA
| | - Lixia Yao
- Department of Health Services Administration and Policy, College of Public Health Temple University, Philadelphia, PA, USA
| | - Ernest Vina
- Division of Rheumatology, Temple University School of Medicine, PA, USA
| | - David Fleece
- Temple University School of Medicine and Temple University Hospital, PA, USA
| | | | | | - Huanmei Wu
- Department of Health Services Administration and Policy, College of Public Health Temple University, Philadelphia, PA, USA
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Caricchio R, Gallucci M, Dass C, Zhang X, Gallucci S, Fleece D, Bromberg M, Criner GJ. Response to: 'Correspondence on 'Preliminary predictive criteria for COVID-19 cytokine storm'' by Tampe et al. Ann Rheum Dis 2023; 82:e72. [PMID: 33414184 DOI: 10.1136/annrheumdis-2020-219720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Roberto Caricchio
- Medicine, Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Marcello Gallucci
- Università degli Studi di Milano-Bicocca Facoltà di Psicologia, Milano, Lombardia, Italy
| | - Chandra Dass
- Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Xinyan Zhang
- Medicine, Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Stefania Gallucci
- Microbiology and Immunology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Fleece
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Michael Bromberg
- Medicine/Hematology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Gerard J Criner
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Caricchio R, Gallucci M, Dass C, Zhang X, Gallucci S, Fleece D, Bromberg M, Criner GJ. Preliminary predictive criteria for COVID-19 cytokine storm. Ann Rheum Dis 2021; 80:88-95. [PMID: 32978237 DOI: 10.1136/annrheumdis-2020-218323] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To develop predictive criteria for COVID-19-associated cytokine storm (CS), a severe hyperimmune response that results in organ damage in some patients infected with COVID-19. We hypothesised that criteria for inflammation and cell death would predict this type of CS. METHODS We analysed 513 hospitalised patients who were positive for COVID-19 reverse transcriptase PCR and for ground-glass opacity by chest high-resolution CT. To achieve an early diagnosis, we analysed the laboratory results of the first 7 days of hospitalisation. We implemented logistic regression and principal component analysis to determine the predictive criteria. We used a 'genetic algorithm' to derive the cut-offs for each laboratory result. We validated the criteria with a second cohort of 258 patients. RESULTS We found that the criteria for macrophage activation syndrome, haemophagocytic lymphohistiocytosis and the HScore did not identify the COVID-19 cytokine storm (COVID-CS). We developed new predictive criteria, with sensitivity and specificity of 0.85 and 0.80, respectively, comprising three clusters of laboratory results that involve (1) inflammation, (2) cell death and tissue damage, and (3) prerenal electrolyte imbalance. The criteria identified patients with longer hospitalisation and increased mortality. These results highlight the relevance of hyperinflammation and tissue damage in the COVID-CS. CONCLUSIONS We propose new early predictive criteria to identify the CS occurring in patients with COVID-19. The criteria can be readily used in clinical practice to determine the need for an early therapeutic regimen, block the hyperimmune response and possibly decrease mortality.
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Affiliation(s)
- Roberto Caricchio
- Medicine/Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Marcello Gallucci
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chandra Dass
- Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Xinyan Zhang
- Medicine/Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Stefania Gallucci
- Microbiology and Immunology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Fleece
- Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Michael Bromberg
- Medicine/Hematology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Gerard J Criner
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Patel M, Gangemi A, Marron R, Chowdhury J, Yousef I, Zheng M, Mills N, Tragesser L, Giurintano J, Gupta R, Gordon M, Rali P, D'Alonso G, Fleece D, Zhao H, Patlakh N, Criner G. Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure. BMJ Open Respir Res 2020; 7:7/1/e000650. [PMID: 32847947 PMCID: PMC7451488 DOI: 10.1136/bmjresp-2020-000650] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023] Open
Abstract
Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission. This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group.
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Affiliation(s)
- Maulin Patel
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Andrew Gangemi
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Robert Marron
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Junad Chowdhury
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ibraheem Yousef
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Zheng
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Nicole Mills
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Lauren Tragesser
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Julie Giurintano
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rohit Gupta
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Gordon
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Parth Rali
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Gilbert D'Alonso
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Fleece
- Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Huaqing Zhao
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Nicole Patlakh
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Gerard Criner
- Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Lepore SJ, Collins BN, Coffman DL, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Taylor D, Fleece D, Godfrey M. Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial. Int J Environ Res Public Health 2018; 15:E1239. [PMID: 29895740 PMCID: PMC6025102 DOI: 10.3390/ijerph15061239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pediatricians following clinical practice guidelines for tobacco intervention (“Ask, Advise, and Refer” [AAR]) can motivate parents to reduce child tobacco smoke exposure (TSE). However, brief clinic interventions are unable to provide the more intensive, evidence-based behavioral treatments that facilitate the knowledge, skills, and confidence that parents need to both reduce child TSE and quit smoking. We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone. METHODS Pediatricians were trained to implement AAR with parents during clinic visits and reminded via prompts embedded in electronic health records. Following AAR, parents were randomized to intervention (AAR + counseling) or nutrition education attention control (AAR + control). Child TSE and parent quit status were bioverified. RESULTS Participants (n = 327) were 83% female, 83% African American, and 79% below the poverty level. Child TSE (urine cotinine) declined significantly in both conditions from baseline to 12 months (p = 0.001), with no between-group differences. The intervention had a statistically significant effect on 12-month bioverified quit status (p = 0.029): those in the intervention group were 2.47 times more likely to quit smoking than those in the control. Child age was negatively associated with 12-month log-cotinine (p = 0.01), whereas nicotine dependence was positively associated with 12-month log-cotinine levels (p = 0.001) and negatively associated with bioverified quit status (p = 0.006). CONCLUSIONS Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.
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Affiliation(s)
- Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
| | - Donna L Coffman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA 19122, USA.
| | - Jonathan P Winickoff
- Massachusetts General Hospital Division of Pediatrics, 125 Nashua St, Suite 860, Boston, MA 02144, USA.
| | - Uma S Nair
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
- Health Promotion Sciences Department, 3950 S. Country Club Rd, Suite 300, PO Box: Abrams 300, Tucson, AZ 85714, USA.
| | - Beth Moughan
- Temple Pediatric Care, Temple University School of Medicine, 3509 N. Broad St, Philadelphia, PA 19140, USA.
| | - Tyra Bryant-Stephens
- Roberts Pediatric Clinical Research Building, Children's Hospital of Philadelphia, 26 South St, 9th Floor, Philadelphia, PA 19146, USA.
| | - Daniel Taylor
- Department of Pediatrics, St. Christopher's Hospital for Children, Front and Erie, Philadelphia, PA 19134, USA.
| | - David Fleece
- Temple Pediatric Care, Temple University School of Medicine, 3509 N. Broad St, Philadelphia, PA 19140, USA.
| | - Melissa Godfrey
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
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Collins BN, Lepore SJ, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Davey A, Taylor D, Fleece D, Godfrey M. An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial. Pediatrics 2018; 141:S75-S86. [PMID: 29292308 PMCID: PMC5745677 DOI: 10.1542/peds.2017-1026k] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR. METHODS In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, >17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments. RESULTS Of providers, >80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44-2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51-9.52]). CONCLUSIONS The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
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Affiliation(s)
- Bradley N. Collins
- Departments of Social and Behavioral Sciences and,Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | | | - Uma S. Nair
- Departments of Social and Behavioral Sciences and
| | - Beth Moughan
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Tyra Bryant-Stephens
- Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Adam Davey
- Epidemiology and Biostatistics, College of Public Health, and
| | - Daniel Taylor
- Department of Pediatrics, College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - David Fleece
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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Lepore SJ, Winickoff JP, Moughan B, Bryant-Stephens TC, Taylor DR, Fleece D, Davey A, Nair US, Godfrey M, Collins BN. Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children. BMC Public Health 2013; 13:792. [PMID: 23987302 PMCID: PMC3844378 DOI: 10.1186/1471-2458-13-792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/28/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations. METHODS/DESIGN This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status. DISCUSSION This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. TRIAL REGISTRATION NCT01745393 (clinicaltrials.gov).
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Affiliation(s)
- Stephen J Lepore
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Jonathan P Winickoff
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Beth Moughan
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
| | - Tyra C Bryant-Stephens
- Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Daniel R Taylor
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, USA
| | - David Fleece
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
| | - Adam Davey
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Uma S Nair
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Melissa Godfrey
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Bradley N Collins
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
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Aronoff SC, Evans B, Fleece D, Lyons P, Kaplan L, Rojas R. Integrating evidence based medicine into undergraduate medical education: combining online instruction with clinical clerkships. Teach Learn Med 2010; 22:219-23. [PMID: 20563945 DOI: 10.1080/10401334.2010.488460] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). DESCRIPTION During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. EVALUATION Paired data were available from 139 students. Postcourse test scores (M= 77.7; 95% CI = 59-96.4) were significantly higher than precourse scores (M= 66.6; 95% CI = 46.5-86.7), p< .001. Paired evaluations demonstrated an average improvement of 11.1 +/- 20.0 points. All of the students submitted 4 independently derived questions and successfully retrieved and appraised evidence. CONCLUSIONS Medical students successfully acquired and independently applied EBM skills following extended, online, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.
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MESH Headings
- Clinical Clerkship/methods
- Clinical Clerkship/organization & administration
- Clinical Competence
- Computer-Assisted Instruction/methods
- Confidence Intervals
- Curriculum
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/organization & administration
- Educational Measurement
- Educational Status
- Evidence-Based Medicine/organization & administration
- Faculty, Medical
- Health Knowledge, Attitudes, Practice
- Humans
- Online Systems
- Schools, Medical/organization & administration
- Students, Medical
- Translational Research, Biomedical
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Affiliation(s)
- Stephen C Aronoff
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, PA, USA.
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Abstract
OBJECTIVE Tinea capitis, a common pediatric infection in the United States, is caused mainly by Trichophyton species and affects many urban children. Although the current treatment of choice is oral griseofulvin, terbinafine has been shown to be variably effective in several comparative, randomized trials. The purpose of this study was to perform a meta-analysis of randomized, clinical trials comparing the efficacies of oral terbinafine and oral griseofulvin for the treatment of childhood tinea capitis. METHODS The Medline database was searched for randomized, clinical studies comparing griseofulvin and terbinafine for the treatment of tinea capitis. Acceptance criteria included oral administration of griseofulvin for at least 6 weeks and the identification of a pathogenic dermatophyte from the scalp at the time of enrollment in the study. Scalp culture status at least 8 weeks after enrollment was used as the outcome. The common odds ratio (OR) with 95% confidence intervals (CIs), the Cochran-Mantel-Haenszel test for significance, and the Breslow-Day test for homogeneity were calculated. RESULTS Six articles that satisfied all inclusion criteria were identified. These studies were combined by using outcomes at 12 to 16 weeks after enrollment. The common OR was 0.86 (95% CI: 0.57-1.27). When the 5 studies that identified Trichophyton species as the predominant pathogen were combined, using outcomes 12 weeks after enrollment, the results nearly favored terbinafine (OR: 0.65 [95% CI: 0.42-1.01]). For outcomes at 8 weeks after enrollment, no difference was found between the agents (OR: 0.84 [95% CI: 0.54-1.32]). Consclusions.A 2- to 4-week course of terbinafine is at least as effective as a 6- to 8-week course of griseofulvin for the treatment of Trichophyton infections of the scalp. Griseofulvin is likely to be superior to terbinafine for the rare cases caused by Microsporum species.
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Affiliation(s)
- David Fleece
- Department of Pediatrics, Temple University Children's Medical Center, 5th Floor, 3509 N Broad St, Philadelphia, PA 19140, USA.
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