Joan M. Brewster

Rhythms and responses.

Rhythms are fundamental to behavior, but the control mechanism for timed responses is not known. Many theorists have assumed that there is a central clock coordinating behavior in all sensory modalities and response modes. We tested this hypothesis using a rhythmic tapping task in which university undergraduates first attempted to synchronize responses with brief auditory, tactile, or visual stimuli and then continued to tap at the same rate on their own. Performance was most variable with visual stimuli and least variable with auditory stimuli. The detailed results suggest that performances are not based on a common clock, but, rather, different strategies are employed when the task is presented in different modalities. We reject the hypothesis of a single timing mechanism as controlling behavior and, in doing so, question the validity of information processing models that are formulated without regard to temporal relations among their conjectured processes.

Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study

Objective To describe the characteristics at enrolment and outcomes of doctors in a substance dependence monitoring programme in Canada. Design Prospective descriptive study. Setting Provincial physician health programme, Canada. Participants All 100 doctors consecutively admitted to a substance dependence monitoring programme and followed until completion of monitoring or on leaving the programme. Main outcome measure Relapse during long term monitoring for five years. Results Ninety per cent of the doctors enrolled on the programme were men, 66% were married or living with a partner, 44% had had previous treatment for substance dependence, and 36% had had previous psychiatric treatment. Smokers were over-represented compared with the general population of US doctors (38% v 5%). During the monitoring period 71% of participants had no known relapse. An additional 14% went on to complete the programme, after some form of relapse. In total, 85% of the doctors successfully completed the programme. Conclusion In this cohort of doctors enrolled on the Ontario Physician Health Program for substance dependence, most were men who were dependent on alcohol or opioids. Smokers were over-represented compared with the general population of US doctors. Eighty five per cent successfully completed the programme.

Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers

Abstract: Background: Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. Purpose: To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. Methods: Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. Results: SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents’ checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP “did not act like a drinker” and was of a different social class than the typical clinic patient. Conclusions: Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians’ actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians’ poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians’ clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

On the Front Line of Smoking Cessation: Education Needs of Community Pharmacists

Background: Nicotine replacement therapy (NRT) is now available without prescription, and pharmacists have an opportunity to be the primary health care professionals advising patients who want to try this smoking cessation aid. Undergraduate pharmacy education in Canada incorporates some tobacco-related training, and continuing education opportunities are available. However, there are no published reports of the self-reported educational needs of a broad sample of practising Canadian community pharmacists with regard to smoking cessation. Methods: Practising community pharmacists in four Canadian provinces were surveyed about their tobacco-related education and knowledge, practice environment, practices related to helping people quit smoking, needs for further information and training, and methods by which this information might be delivered. Results: A corrected response rate of 72% was obtained, giving a weighted n of 960 responses. Most Canadian community pharmacists reported that they would find it helpful to receive additional information or training on a wide range of smoking cessation topics, such as behavioural counselling techniques and motivating patients to quit. Pharmacists who reported that they were familiar with aids such as Helping Your Patients Quit Smoking: A Cessation Guide for Pharmacists (Canadian Pharmacists Association) and who reported that the guide had led them to make changes in their practice were more likely to report that additional information or training would be helpful. Pharmacists who perceived their tobacco-related clinical and non-clinical roles to be important were more likely to report that additional training would be helpful than were those who perceived these roles as less important. Conclusions: Although most Canadian community pharmacists would find it helpful to receive additional smoking-related information and training, those who perceive this to be an important activity and who are already using available materials showed the most interest. The challenge to Canadian pharmacy educators is to encourage the enthusiasm of those already interested in helping their patients to quit smoking, while raising the level of interest and motivation among all community pharmacists.

Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation.

Objective. To evaluate the feasibility of an online training module, Certified Smoking Cessation Service Provider (CSCSP), developed for practicing pharmacists to equip pharmacy students with knowledge necessary for smoking cessation counseling and to assess the changes in student knowledge and skills regarding smoking cessation following training. Design. Sixty third-year and 80 fourth-year pharmacy undergraduates (N=140) were given access to an online module, the main intervention in the study. Two linkable questionnaires were administered to assess students’ preintervention and postintervention knowledge. For the third-year students, an additional role-play training component was incorporated, and student skills were assessed during week 14 with an Objective Structured Clinical Examination (OSCE). Assessment. Preintervention and postintervention knowledge assessments were completed by 130 (92.8%) students. Sixty-six students scored above 50% for the knowledge component postintervention, compared to 13 at preintervention, demonstrating significant improvement (x2(1, N=130)=32, p=0.003). All third-year students completed the intervention, and 66.7% were able to counsel excellently for smoking cessation, scoring more than 80%. Conclusion. The CSCSP online module developed for practicing professionals was found suitable for equipping pharmacy undergraduates with knowledge on smoking cessation topics. The module, along with role-play training, also equipped students with knowledge and skills to provide smoking cessation counseling.

Medical education needed for smoking cessation.

The editorial by Penz and colleagues rightly argues that governments can improve the health of populations by paying for smoking cessation. [1][1] Too often discussion of health care costs focuses on saving by reducing services to those who are sick, rather than by reducing the incidence of illness