Ken J. Kallail

Response Rate Comparisons of E-Mail- and Mail-Distributed Student Evaluations

Background: The proliferation of electronic information delivery systems has led to increasing use of e-mail as a rapid method of gathering information. Little research has been conducted on the use of e-mail for collecting curriculum evaluations. Purpose: To compare e-mailed and mailed educational evaluations for 4th-year medical students. Methods: Curriculum evaluations were sent to 4th-year medical students who were randomly assigned to receive the survey either by mail or e-mail. Results: Mailed evaluations yielded a higher return rate, fewer number of students omitting items, and shorter responses to an open-ended question than evaluations completed via e-mail. Conclusions: Although the findings have limited generalizability because of low response rates and small sample sizes, the results suggest caution when using e-mail to collect curriculum evaluations from 4th-year medical students

Repeat Abortion and Use of Primary Care Health Services

One-third (34%) of 2,001 women who sought an abortion in 1991-1992 in Wichita, Kansas, were repeat-abortion patients. Compared with first-time abortion patients, repeat-abortion patients were significantly older, more often black, and younger at their first pregnancy (p < .001). The two groups did not vary significantly by income or age at first intercourse. However, repeat-abortion patients were significantly more likely than first-time patients to have been using a contraceptive method at the time of conception (65% compared with 59%) and more likely to say they always or almost always used a method (63% and 53%, respectively). More than 40% of women in each group reported they had no personal physician. Further, 34% of repeat-abortion patients said they had no follow-up examination after their previous abortion, and 28% said they received no contraceptive counseling. Only half of women whose pregnancy was confirmed by their personal physician obtained an abortion referral from that physician.

An investigation of the counseling needs of male and female laryngectomees

A 25-item survey was developed to investigate the distinct counseling needs of male and female laryngectomees. Data were obtained from 120 subjects from across the country. The subjects were surveyed regarding their lifestyle changes, informational needs, and feelings about the surgery and its consequences. The results indicated that more and better pre- and postoperative counseling of laryngectomees was needed. Further, male laryngectomees differed from females in their feelings about the surgery, their emotional support systems, and their perceived usefulness of information presented by various counselors. Health-care professionals who counsel laryngectomees must make a concerted effort to meet the unique needs of each patient.

Multifactorial causes of adolescent driver accidents: Investigation of time as a major variable

This study examined all reported motor vehicle accidents with adolescent drivers, aged 18 and under, in Wichita, Kansas, during 1987. The analysis focused on several time variables that may influence the cause of an accident, including time of day, day of week, and school versus nonschool day. Data analysis from 1903 accident reports showed a predominance of accidents among male drivers, a higher accident prevalence on school days, and a cluster of accidents on school days before school, during lunch hours, and immediately after school. Accidents on weekends and nonschool days clustered later in the day, with alcohol-related and injury accidents occurring more frequently than on school days. These results have potential implications for health care professionals working with youths on health promotion/disease prevention, for policymakers who schedule school activities, and for those involved in driver safety and education.

Improving Pneumococcal Vaccination Rates in an Elderly Population by Patient Education in an Outpatient Clinic

Background: Invasive pneumococcal disease is a major cause of morbidity and mortality in elderly patients. This study investigated the impact of a patient education intervention on the pneumococcal vaccination rate in elders. Methods: Charts of all patients aged 65 years or older who visited a university ambulatory care clinic during a 3-month period were reviewed for pneumococcal vaccination status before the patients arrival for an office visit. Those who did not have the vaccination were provided patient education in the waiting room. Data were collected on age, sex, race, and immunization status. The reasons for refusing the vaccination before or during this intervention also were obtained. The charts of patients who consented were flagged for the attending physician to order the vaccination if appropriate. Results: Charts of 535 patients were reviewed for pneumococcal vaccination status. Of these patients, 291 had had a pneumococcal vaccination before the study. The cumulative vaccination rate increased significantly from 54 percent to 79 percent after the study intervention. The rate of pneumococcal vaccination was significantly lower among African-Americans than whites both before and after the patient education intervention. Conclusion: This study reports a substantial impact of patient education on improving pneumococcal vaccination rates in an elderly population. Most elders accept vaccination, and it can be delivered effectively without an additional visit.

Passive smoking and middle ear problems in Kansas public school children

Survey data from parents of Kansas school children identified as having middle ear problems were compared to data obtained from parents of children who passed their schools hearing screening tests. The results of the investigation revealed that there were no differences between the two groups of children for the presence of smoking, the amount and type of smoking, and the number of smokers in the home. Exposure to cigarette smoke in the home apparently was not a risk factor for middle ear problems in children.

The Epidemiology Of Bacterial Meningitis

Background: The incidence by age and causative organism of bacterial meningitis are not known on a community basis. Methods: The epidemiology of bacterial meningitis in a metropolitan county was studied by identifying all cases admitted to a hospital from 1983 through 1987. Results: The overall incidence of bacterial meningitis was 5 per 100,000 person-years, but numbers of cases ranged from 40 per 100,000 for children younger than 5 years to 1.0 per 100,000 in adults aged between 16 and 64 years. No significant excesses of cases were found in male patients or in blacks. The predominant causative organism varied with age. Overall, Haemophilus influenzae was the most common causative organism, but 32 percent of cases were due to Streptococcus pneumoniae. Case fatality rates were high for S. pneumoniae (12.5 percent) and very high for the small number of elderly patients suffering from bacterial meningitis. Conclusions: Significant declines have occurred in the last decade in the incidence of bacterial meningitis in children, particularly in those younger than 5 years, and in disease caused by H. influenzae and group B streptococcus.

Maximizing the Use of a Web-Based Teaching Skills Curriculum for Community-based Volunteer Faculty

Background: The University of Kansas School of Medicine in Wichita created an Internet‐based faculty development curriculum for community‐based faculty. Because relatively few physicians use Internet‐based continuing medical education (CME), the most cost‐effective methods of encouraging use need to be identified. Method: Five interventions intended to increase use of the curriculum were assessed. The number of times the CME curriculum Webpages were accessed was correlated with the interventions. Results: Demonstrating the Website to faculty at a semiannual meeting elicited the most Website “hits.” Electronic mail and flyers also appeared to be effective in stimulating interest in the Website. Only four community‐based faculty applied for CME credit for completing the curricular modules. Findings: Multiple modalities should be used in advertising and stimulating interest in an Internet‐based faculty development curriculum. Demonstrating the Website to faculty at a meeting appeared to achieve the greatest return. Offering CME credit was not helpful in stimulating interest.

Utility of hemoglobin-A1C in nondiabetic women with polycystic ovary syndrome.

OBJECTIVEnHemoglobin A1c (A1C) ≥5.7% is now accepted as a biomarker for identifying individuals at risk for diabetes. Compared to the general population, women with polycystic ovary syndrome (PCOS) have a higher risk for diabetes. Our goal was to determine what glucose homeostasis abnormalities can be identified by A1C ≥5.7% in women with PCOS.nnnMETHODSnIn a cross-sectional study, nondiabetic women with PCOS (according to the National Institutes of Health [NIH] criteria) were divided into 2 groups based on A1C (<5.7% [n = 23] and ≥5.7% [n = 25]). Oral glucose tolerance tests (OGTT) and frequently sampled intravenous glucose tolerance tests (FS-IVGTT) were conducted, and body composition, cardiovascular risk factors, and sex steroid levels were assessed.nnnRESULTSnCompared to women with A1C <5.7%, those with A1C ≥5.7% were older (35.1 ± 1.1 years vs. 31.1 ± 1.1 years; P = .04), had higher glucose levels at fasting and during OGTT, and had a lower insulin sensitivity index (SI: 2.0 ± 0.2 vs. 4.2 ± 0.6; P = .0195) and disposition index (DI: 1,014 ± 82 vs. 1,901 ± 217; P = .011) during FS-IVGTT. They also had higher triglycerides, high-sensitivity C-reactive protein (hs-CRP), and fatty acid-binding protein 4 (FABP4) levels. There was no difference in serum androgen levels.nnnCONCLUSIONnA1C ≥5.7% identified the subgroup of PCOS patients with higher insulin resistance, inadequate compensatory insulin response, impaired glucose disposition, and increased cardiovascular risk factors. Thus, A1C represents an inexpensive and informative biomarker to identify PCOS patients at risk for metabolic abnormalities.

The Effect Of Pseudoephedrine On Blood Pressure In Patients With Controlled, Uncomplicated Hypertension: A Randomized, Double-Blind, Placebo-Controlled Trial

Pseudoephedrine is frequently used as a decongestant. Because of concern about the safety of pseudoephedrine in hypertensive patients, a clinical trial was conducted to determine whether blood pressure control was actually affected by this drug in a selected group of patients with hypertension. Twenty-nine patients with controlled, uncomplicated hypertension, who received drug therapy and ranged in age from 25 to 50 years, were randomized to a treatment or a control group. Subjects took either 60 mg of pseudoephedrine or placebo capsules four times a day for 3 days. From 0800 hours until 2200 hours each day, the subjects obtained hourly blood pressure measurements using a portable sphygmomanometer. An analysis of variance with repeated measures was calculated to determine group differences for systolic and diastolic readings. No statistically or clinically significant differences were found. Therapeutic doses of pseudoephedrine did not adversely affect control of hypertension in these selected patients.