Richard A. Davidson

Source of funding and outcome of clinical trials

Because of recent concerns about conflicts of interest and published research, the author analyzed 107 controlled clinical trials. Studies were classified as favoring either a new therapy or a traditional therapy, and as being supported by a pharmaceutical manufacturer or as being generally supported. Seventy-one per cent of the trials favored new therapies; 43% of these were funded by pharmaceutical firms. Of the 31 trials favoring traditional therapy, only four (13%) were supported by a pharmaceutical firm. There was a statistically significant association between the source of funding and the outcome of the study (p=0.002). Few trials supported by pharmaceutical manufacturers favored traditional therapy; some reasons for this finding may include selection of drugs likely to be proven efficacious, Type II errors (false-negative studies), and fear of discontinuation of funding should such studies be submitted. Important clinical information may be lost if negative studies are not published.Because of recent concerns about conflicts of interest and published research, the author analyzed 107 controlled clinical trials. Studies were classified as favoring either a new therapy or a traditional therapy, and as being supported by a pharmaceutical manufacturer or as being generally supported. Seventy-one per cent of the trials favored new therapies; 43% of these were funded by pharmaceutical firms. Of the 31 trials favoring traditional therapy, only four (13%) were supported by a pharmaceutical firm. There was a statistically significant association between the source of funding and the outcome of the study (p=0.002). Few trials supported by pharmaceutical manufacturers favored traditional therapy; some reasons for this finding may include selection of drugs likely to be proven efficacious, Type II errors (false-negative studies), and fear of discontinuation of funding should such studies be submitted. Important clinical information may be lost if negative studies are not published.

Interprofessional collaboration: three best practice models of interprofessional education

Abstract Interprofessional education is a collaborative approach to develop healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine. Complex medical issues can be best addressed by interprofessional teams. Training future healthcare providers to work in such teams will help facilitate this model resulting in improved healthcare outcomes for patients. In this paper, three universities, the Rosalind Franklin University of Medicine and Science, the University of Florida and the University of Washington describe their training curricula models of collaborative and interprofessional education. The models represent a didactic program, a community-based experience and an interprofessional-simulation experience. The didactic program emphasizes interprofessional team building skills, knowledge of professions, patient centered care, service learning, the impact of culture on healthcare delivery and an interprofessional clinical component. The community-based experience demonstrates how interprofessional collaborations provide service to patients and how the environment and availability of resources impact ones health status. The interprofessional-simulation experience describes clinical team skills training in both formative and summative simulations used to develop skills in communication and leadership. One common theme leading to a successful experience among these three interprofessional models included helping students to understand their own professional identity while gaining an understanding of other professionals roles on the health care team. Commitment from departments and colleges, diverse calendar agreements, curricular mapping, mentor and faculty training, a sense of community, adequate physical space, technology, and community relationships were all identified as critical resources for a successful program. Summary recommendations for best practices included the need for administrative support, interprofessional programmatic infrastructure, committed faculty, and the recognition of student participation as key components to success for anyone developing an IPE centered program.

Predictors of cure of hypertension in fibromuscular renovascular disease

Patients with fibromuscular dysplasia (FMD) and hypertension are frequently treated with percutaneous transluminal renal angioplasty (PTRA). Because the goal of this procedure is the cure of hypertension, we reviewed the outcomes of 23 consecutive patients undergoing this procedure to determine factors associated with cure. Twelve (52.2%) of the patients were taking no antihypertensive medications at 6 months and were classified as cured. Using logistic regression, we found three variables to be independently associated with cure: level of systolic blood pressure before intervention (P = 0.02), duration of hypertension (P = 0.03), and age (P = 0.03). Younger patients with milder hypertension of a shorter duration were most likely to be cured. Analysis of the regression equation predicts that some patients with an extremely low chance of cure might be managed with a trial of medical therapy, because FMD is unlikely to progress to renal failure.

Evaluating evidence-based medicine skills during a performance-based examination.

Purpose To measure students’ competencies in evidence-based medicine (EBM) skills [clinical decision making using evidence from published literature (content) and in transmitting clinical information to patients (communication)] within the context of a performance-based examination (PBE). Method In 2002–03, under the direction of a Performance-Based Examination Oversight Committee, 16 EBM queries were developed for a pair of third-year PBEs. At the last station of the PBE, the standardized patient (SP) for that station asked a clinical EBM question relating to their “disease process.” Students were asked to develop an appropriate clinical question, perform a Medline search for appropriate articles, critically appraise a complete selected article, reach a conclusion to their question, and transmit the information to the SP. Each students clinical question, search terms, selected articles, and rationale were evaluated by faculty question-writers, clinical librarians, and the EBM course director using a five-point Likert scale, with 1 being inadequate performance and 5 being superior performance. The SP evaluated the communication skills using a checklist. Results Students’ performances were very good, with means of 3.7 to 4.0 in each area. Agreement between the course director and station developers was good. Seventy-five percent of the students performed adequate Medline searches. Students averaged over 93% on the performance of four communication skills. Conclusion The evaluation of EBM skills can be carried out during a performance-based examination. Results can assist in developing students’ skills and directing curricular efforts.

A Historical Overview of Interdisciplinary Family Health: A Community-based Interprofessional Health Professions Course

The Interdisciplinary Family Health course at the University of Florida Health Science Center is a course for beginning health profession students designed to teach core values, such as community-based family health, health promotion and disease prevention, and teamwork in the context of home visits. In addition, the course provides a valuable service to volunteer families by helping them identify useful community resources, and by formulating wellness care plans for prevention of illness and stabilization of chronic illness. In this article, the authors describe the historical development of the course, which began as a grant-supported pilot course for 20 medical students in 1996. After several additional grants helped fund an expansion involving other colleges, the course was given institutional support in 2001 and currently includes over 400 students and 70 faculty from four colleges working to improve the health status of over 150 local volunteer families. The theoretical constructs and objectives of the course were developed collaboratively by dedicated faculty from five Health Science Center colleges over seven years. In addition to benefiting the community and students, the course has encouraged an atmosphere of collaboration among faculty and colleges that has been a tangible benefit to the academic health center. The development and continuing support of this course demonstrates that barriers to such efforts can be overcome by dedicated faculty and administration.

Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

We analyzed the impact of a program that provides indigent patients with free primary care on inpatient admissions, emergency room (ER) visits, and resulting charges in 91 patients before and after admittance into the program.There was a decrease in ER visits after enrolling in the program (1.89 versus 0.83 visits per year; p < 0.0001). This difference translated into mean ER charges of

Changes in the Educational Value of Inpatients at a Major Teaching Hospital: Implications for Medical Education.

1174 vs.

The Simplified Captopril Test: An Effective Tool to Diagnose Renovascular Hypertension

717 (p = 0.0007), and a decrease in charges of

The role of veterinary medicine in an interdisciplinary family health course.

41,587 per year. The charges for the program (outpatient visits and laboratory) were

A simple ambulatory-care experience and students' residency choices and attitudes toward general internal medicine

23,141. Entry into the program had no effect on inpatient admissions, which averaged 0.07 admissions per year both before and after admission to the program.Indigent patients enrolled in a complimentary primary care program had significantly decreased per-year ER utilization rates and charges. The program had no effect on inpatient admissions. By conservative estimate, the program decreased ER charges by approximately