Scott H. Barnett

Teaching evidence-based medicine skills to medical students and residents

Introduction methodology. An excellent review by Bigby5 illustrates how this methodology can be used in a logical, stepThe rapid expansion of biomedical knowledge has made bystep manner to answer questions commonly seen in the challenge to acquire and evaluate new information quite dermatologic practice. formidable. Evidence-based medicine (EBM), a clinical As seen in Table 1, six guides can be used to distinguish problem-solving paradigm designed to help clinicians meet useful from useless or even harmful therapy.6 Sackett and the challenge of incorporating the best available external colleagues offer a striking illustration of how erroneous evidence in caring for patients, consists of four elements: conclusions can be reached when the last of these guidelines defining the clinical problem presented by the patient, is not adhered to. A study of surgical vs. medical therapy searching for the best evidence in the literature, appraising for bilateral carotid stenosis appears to demonstrate a the validity of this evidence, and applying it to the clinical significant risk reduction for ischemic attacks, stroke, or question.1 In a recent article in the International Journal death in the surgically treated group (P 0.02); however, of Dermatology, Ladhani2 presented an excellent overview the P value becomes 0.09 when the outcomes for 16 of EBM and underscored the importance of its application patients ‘‘not available for follow-up’’ (who died or had to dermatologic practice. strokes during initial hospitalization) are included in the calculations. Barriers and solutions

Absence and atonic seizures induced by piperazine

A previously healthy 2-year-old girl, who presented with transient neurologic dysfunction manifested mainly by absence and atonic seizures, was treated with large doses of the antihelminthic piperazine hexahydrate. The role of piperazine salts and piperazine-containing compounds in producing neurotoxic side effects is discussed. We suggest that these drugs be considered as a possible cause of transient encephalopathy and nonepileptic seizures in previously healthy individuals.

Effective Implementation of Continuous Quality Improvement Methodology to Expedite Clerkship Grade Submission

Background: Although continuous quality improvement (CQI) methodology is routinely used in corporate America, it has had limited application in medical education. Description: The purpose of this study was to decrease the length of time needed for submission of summative clerkship student grades and evaluations, including both the final grade and the narrative description of performance. Methods of CQI were used to define the extent of the problem regarding clerkship evaluation submission, to evaluate the cause, and to create an intervention strategy. Evaluation: Baseline data revealed that on average it took 10.1 weeks (range = 8.5� 15.2 weeks) for departments to submit clerkship evaluations. Following an in-depth prospective analysis, strategies were developed and implemented that decreased the average time to submission to 5.0 weeks (range = 4.0� 6.1 weeks). Conclusion: We conclude that CQI methodology can be used successfully in medical education.

Incubating syphilis in an adolescent female rape victim.

The risk of infection after rape is believed to be low. The use of presumptive treatment is, therefore, controversial. Some experts recommend treatment of all patients, and others suggest treatment if the doctor suspects infection, if the patient requests it, if follow-up examination of the victim cannot be ensured, or if the assailant has a known infection. No regimen will cover all possible pathogens. The Centers for Disease Controls empiric regimen for victims of sexual assault is effective against gonorrhea, chlamydia, and, most likely, syphilis. We present a case of incubating syphilis following rape, that did not respond to ceftriaxone.

Health literacy assessment and patient satisfaction in surgical practice

Background Limited health literacy has been associated with poorer health outcomes and increased morbidity and mortality. Though caring for surgical patients requires communication about complex topics, there is limited literature on health literacy competency in this population. The objective of this study was to assess health literacy in an adult surgical outpatient clinic population, to explore potential determinants of adequate health literacy, and to assess patient satisfaction with physician-patient communication. Materials and methods A prospective cross-sectional study was performed and anonymous data including health literacy, demographics, and patient satisfaction with provider communication were collected. The study population included adult patients who visited an outpatient surgical practice over a one-month period. Health literacy was assessed using the Newest Vital Sign while the satisfaction questions came from the Outpatient Satisfaction Survey (Press-Ganey Associates, Chicago, IL). Results 148 patients participated in the study. The mean age was 49 years, 41% of those who gender identified were male, and 76% were White/Caucasian. 34 (27%) of those who answered the question had received a four-year undergraduate/university degree. 55 (37%) of the patients were identified as having low health literacy. More years of education was significantly associated with adequate health literacy and those patients who were more educated and had adequate health literacy were more satisfied with provider communication. Conclusion Patients on average were highly satisfied with provider communication in this outpatient surgical clinic. Higher education levels were associated with better health literacy and patients with both characteristics were more satisfied with provider communication.