Vivienne O'Connor

Can simulation replace part of clinical time? Two parallel randomised controlled trials

Medical Education 2012

Do psycho-social factors contribute more to symptom reporting by middle-aged women than hormonal status?

Six hundred women aged between 45 and 54 were randomly selected from the electoral roll in Brisbane, Australia. A questionnaire addressing their symptoms, hormone status and psycho-social factors was successfully administered to 381 women (64% of the original sample; 83% of those contactable). Although cardiovascular symptoms were experienced by 25% of the sample, the most common (hot flushes) ranked only tenth on a list of recently experienced symptoms. The association of hormone status with symptoms was weak in comparison with other factors. Most symptoms were reported by women who were perimenopausal, had undergone a hysterectomy, or were currently using hormone replacement therapy. A poor mental health index was strongly associated with all groups reporting symptoms. It is concluded that clinicians responding to symptoms from middle-aged women should continue to address psychosocial factors just as vigorously as those related to their hormone status.

Predictors of hysterectomy: an Australian study

OBJECTIVE We evaluated the relative importance of predictors of hysterectomy. STUDY DESIGN A questionnaire survey of an Australia-wide sample of adult female twins was conducted; self-report data were validated against reports from treating physicians. RESULTS A total of 3096 women (94%) and 366 physicians (87%) responded. The sensitivity of patient report of hysterectomy was 98.2%. Best predictors of hysterectomy were endometriosis (odds ratio 4.85, 95% confidence interval 3.17-7.43), medical consultation for menorrhagia (odds ratio 3.55, 95% confidence interval 2.47-5.12), joint effects of fibroids with medical consultation for chronic or persisting pelvic pain (odds ratio 3.34, 95% confidence interval 1. 42 to 7.87), having smoked >40 cigarettes per day (odds ratio 3.24, 95% confidence interval 1.10-9.55), joint effects of fibroids with consultation for menstrual problems (odds ratio 2.61, 95% confidence interval 1.36-5.01), and tubal ligation (odds ratio 1.77, 95% confidence interval 1.31-2.39). Less-important predictors were age and higher education level (protective). CONCLUSION Consulting a physician about pelvic pain and menstrual problems, especially heavy bleeding, are recognized steps toward hysterectomy. Of particular interest for future genetic analyses are the high odds of hysterectomy for women with endometriosis, fibroids, or menorrhagia.

Simulation can contribute a part of cardiorespiratory physiotherapy clinical education: Two randomized trials

Introduction Simulated learning environments (SLEs) are used worldwide in health professional education, including physiotherapy, to train certain attributes and skills. To date, no randomized controlled trial (RCT) has evaluated whether education in SLEs can partly replace time in the clinical environment for physiotherapy cardiorespiratory practice. Methods Two independent single-blind multi-institutional RCTs were conducted in parallel using a noninferiority design. Participants were volunteer physiotherapy students (RCT 1, n = 176; RCT 2, n = 173) entering acute care cardiorespiratory physiotherapy clinical placements. Two SLE models were investigated as follows: RCT 1, 1 week in SLE before 3 weeks of clinical immersion; RCT 2, 2 weeks of interspersed SLE/clinical immersion (equivalent to 1 SLE week) within the 4-week clinical placement. Students in each RCT were stratified on academic grade and randomly allocated to an SLE plus clinical immersion or clinical immersion control group. The primary outcome was competency to practice measured in 2 clinical examinations using the Assessment of Physiotherapy Practice. Secondary outcomes were student perception of experience and clinical educator and patient rating of student performance. Results There were no significant differences in student competency between the SLE and control groups in either RCT, although students in the interspersed group (RCT 2) achieved a higher score in 5 of 7 Assessment of Physiotherapy Practice standards (all P < 0.05). Students rated the SLE experience positively. Clinical educators and patients reported comparability between groups. Conclusions An SLE can replace clinical time in cardiorespiratory physiotherapy practice. Part education in the SLE satisfied clinical competency requirements, and all stakeholders were satisfied.

Bleeding Pattern and Endometrial Changes During Continuous Combined Hormone Replacement Therapy

Objective To establish the optimum oral daily dose of micronized medroxyprogesterone acetate, given in combination with a fixed oral dose of estrone (E1) sulfate as hormone replacement therapy, that provides endometrial protection and induces cessation of vaginal bleeding. Methods This multicenter, randomized, double-blind study was conducted for 2 years. Five hundred sixty-eight postmenopausal women were randomized to take E1 sulfate 1.25 mg daily and one of three doses of medroxyprogester one acetate (2.5, 5, or 10 mg) daily. Any vaginal bleeding was recorded by patients in a daily diary, and endometrial biopsies were performed at entry into the study and at 3, 12, and 24 months. Results Forty-two percent of all women reported some bleeding at month 3 of therapy. However, by month 6, 76.5, 80.1, and 80.9% of women were amenorrheic in the 2.5-, 5-, and 10-mg medroxyprogesterone acetate groups, respec tively. Over time, the percentage of women with no bleeding increased in each group, and by 24 months 91.5, 89.9, and 94.3% were amenorrheic in the 2.5- and 10-mg medroxypro gesterone acetate groups, respectively. Approximately 10% of women continue to have some bleeding, regardless of the dose of medroxyprogesterone acetate. There were no statistically significant differences in the number of women with bleeding at any time point between the three groups. There were no cases of endometrial hyperplasia reported in the study population over the 2 years. Conclusion All three studied doses of medroxyprogester one acetate, given in combination with 1.25 mg of E1 sulfate, provide adequate endometrial protection and render approximately 80% of women amenorrheic by 6 months of therapy

Women Teaching Women's Health: Issues in the Establishment of a Clinical Teaching Associate Program for the Well Woman Check

SUMMARY The impact of screening programs for cervical cancer would be increased with the greater participation of currently under-screened women. Training for medical students and doctors in the fine technical and communication skills required in breast and gynaecological examinations would improve participation by increasing the confidence and skill of doctors in raising the issue of screening, thereby making the examination a more positive experience for women. Gynaecology Teaching Associate (GTA) programs, using specially trained standardized patients, have been used in over 90% of American and Canadian medical schools for more than ten years to provide such training. Australia has been slow to adopt this teaching method. A Clinical Teaching Associates in Gynaecology program (CTA) was first established in 1996 by the Department of Obstetrics and Gynaecology at the University of Queensland, building on the Pap test program from Adelaide. Other medical schools subsequently introduced such programs and in 2000, the Department of General Practice, University of Melbourne, established a CTA program based on the Queensland program, with a grant from PapScreen Victoria. This paper describes the methods of recruitment and training of CTAs, use of CTAs in the medical course, preliminary evaluation, and ethical and other issues in the Melbourne and Queensland University programs.SUMMARY The impact of screening programs for cervical cancer would be increased with the greater participation of currently under-screened women. Training for medical students and doctors in the fine technical and communication skills required in breast and gynaecological examinations would improve participation by increasing the confidence and skill of doctors in raising the issue of screening, thereby making the examination a more positive experience for women. Gynaecology Teaching Associate (GTA) programs, using specially trained standardized patients, have been used in over 90% of American and Canadian medical schools for more than ten years to provide such training. Australia has been slow to adopt this teaching method. A Clinical Teaching Associates in Gynaecology program (CTA) was first established in 1996 by the Department of Obstetrics and Gynaecology at the University of Queensland, building on the Pap test program from Adelaide. Other medical schools subsequently introduced such programs and in...

Women teaching women's health: issues in the establishment of a clinical teaching associate program for the well woman check.

SUMMARY The impact of screening programs for cervical cancer would be increased with the greater participation of currently under-screened women. Training for medical students and doctors in the fine technical and communication skills required in breast and gynaecological examinations would improve participation by increasing the confidence and skill of doctors in raising the issue of screening, thereby making the examination a more positive experience for women. Gynaecology Teaching Associate (GTA) programs, using specially trained standardized patients, have been used in over 90% of American and Canadian medical schools for more than ten years to provide such training. Australia has been slow to adopt this teaching method. A Clinical Teaching Associates in Gynaecology program (CTA) was first established in 1996 by the Department of Obstetrics and Gynaecology at the University of Queensland, building on the Pap test program from Adelaide. Other medical schools subsequently introduced such programs and in 2000, the Department of General Practice, University of Melbourne, established a CTA program based on the Queensland program, with a grant from PapScreen Victoria. This paper describes the methods of recruitment and training of CTAs, use of CTAs in the medical course, preliminary evaluation, and ethical and other issues in the Melbourne and Queensland University programs.SUMMARY The impact of screening programs for cervical cancer would be increased with the greater participation of currently under-screened women. Training for medical students and doctors in the fine technical and communication skills required in breast and gynaecological examinations would improve participation by increasing the confidence and skill of doctors in raising the issue of screening, thereby making the examination a more positive experience for women. Gynaecology Teaching Associate (GTA) programs, using specially trained standardized patients, have been used in over 90% of American and Canadian medical schools for more than ten years to provide such training. Australia has been slow to adopt this teaching method. A Clinical Teaching Associates in Gynaecology program (CTA) was first established in 1996 by the Department of Obstetrics and Gynaecology at the University of Queensland, building on the Pap test program from Adelaide. Other medical schools subsequently introduced such programs and in...