Evaluation of two different poverty simulations with professional phase pharmacy students

BACKGROUND AND PURPOSE

Pharmacy students will interact with patients who struggle to receive the health care they need. Since attitudes can influence behavior, exposure to these struggles may positively improve patient care. This study evaluates a group of student responses to two different interventions approximately 9 months apart. The primary objectives of this study were to: (1) identify if SPENT, an online game, could alone improve students' attitudes towards those living in poverty, (2) determine if changes imparted by SPENT were retained for nine months, and (3) identify if CAPS, a live simulation, has an additional benefit.

EDUCATIONAL ACTIVITY AND SETTING

Student participants completed both the SPENT online game and the CAPS simulation. Students were asked to complete the Undergraduate Perceptions of Poverty Tracking Survey (UPPTS) before and after each simulation FINDINGS: Ninety-nine first year and second year professional phase pharmacy students completed both interventions and all surveys. The average pre-survey and post survey "scores" for the SPENT game were 133.52 and 135.54, a statistically significant improvement (p=0.046). When comparing the SPENT post "score" and the pre-survey score of CAPS (136.45) there was no significant difference (p=0.423). The average pre-survey and post survey "scores" for CAPS were 136.45 and 139.18, a statistically significant improvement (p=0.001). An analysis of the overall change showed a statistically significant improvement of 5.6667 (p<0.001).

DISCUSSION

Both the online SPENT game and CAPS live simulation interventions had positive effects on the students' empathy towards people living in poverty.

Use of an Online Game to Evaluate Health Professions Students' Attitudes toward People in Poverty

Objective. To determine baseline attitudes of pharmacy, physician assistant studies, and communication science and disorders students toward people in poverty and to examine the effectiveness of using the online poverty simulation game SPENT to affect these attitudes. Methods. Students completed pre/postassessments using the validated Undergraduate Perceptions of Poverty Tracking Survey (UPPTS). Students played the online, open access, SPENT game alone and/or in pairs in a 50-minute class. Results. Significant improvements in scale scores were seen in students after playing SPENT. Quartile results by prescore indicated that students with the lowest attitudes towards patients in poverty improved the most. Results suggested that most students found the experience worthwhile for themselves and/or for their classmates. Conclusions. The results of this study suggest SPENT may improve perspectives of undergraduate pharmacy and other health professions students.

Steroids or pentoxifylline for alcoholic hepatitis (STOPAH): study protocol for a randomised controlled trial

BACKGROUND

Alcoholic hepatitis is the most florid presentation of alcohol-related liver disease. In its severe form, defined by a Maddrey's discriminant function (DF) ≥32, the 28-day mortality rate is approximately 35%. A number of potential treatments have been subjected to clinical trials, of which two, corticosteroids and pentoxifylline, may have therapeutic benefit. The role of corticosteroids is controversial as trial results have been inconsistent, whereas the role of pentoxifylline requires confirmation as only one previous placebo-controlled trial has been published.

METHODS/DESIGN

STOPAH is a multicentre, double-blind, factorial (2 × 2) trial in which patients are randomised to one of four groups:1. Group A: placebo / placebo2. Group B: placebo / prednisolone3. Group C: pentoxifylline / placebo4. Group D: pentoxifylline / prednisoloneThe trial aims to randomise 1,200 patients with severe alcoholic hepatitis, in order to provide sufficient power to determine whether either of the two interventions is effective. The primary endpoint of the study is mortality at 28 days, with secondary endpoints being mortality at 90 days and 1 year.

DISCUSSION

STOPAH aims to be a definitive study to resolve controversy around the existing treatments for alcoholic hepatitis. Eligibility criteria are based on clinical parameters rather than liver biopsy, which are aligned with standard clinical practice in most hospitals. The use of a factorial design will allow two treatments to be evaluated in parallel, with efficient use of patient numbers to achieve high statistical power.

TRIAL REGISTRATION

EudraCT reference number: 2009-013897-42 ISRCTN reference number: ISRCTN88782125.

Timely follow-up among multicultural women with abnormal mammograms

OBJECTIVE

To examine factors influencing time from screening to final diagnosis among multicultural women with abnormal mammograms using the precede-proceed model.

METHODS

Staff of 58 clinics and a sample of 436 women served by these clinics were interviewed and their medical records examined.

RESULTS

Longer duration from screening to diagnosis was associated with speaking Spanish and having clinic staff make appointments. Ease of access to health care, provision of early morning screening services and higher levels of patient anxiety shortened the time to diagnosis.

CONCLUSION

The precede-proceed model is useful in delineating personal and structural factors that affect timely diagnosis.

Psychologic profiles as predictors of success in a cardiovascular risk factors life-style intervention program

The risk for cardiovascular events can be reduced by modifications in life-style. However, only a small percentage of subjects are able to adopt such changes. We determined whether psychologic profiles measured on entry into a life-style intervention program correlated with objective measurements of success after 1 year of enrollment. When compared with patients who had dropped out, patients still enrolled in the program after 1 year differed statistically on scales 1 and 6 of the Minnesota Multiphasic Personality Inventory, showing a lower level of paranoia and more concern about health issues. Among patients remaining in the program, psychologic profiles differed between those who met an objective measure of success (responders) and those who did not. In addition, profiles differed among responders as a function of the aspect of life-style that they successfully changed. These findings suggest that psychologic profiles can be used to identify which life-style changes an individual can easily adopt.