Global strategy for asthma management and prevention

To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today?s complex modern health systems. This information may be provided in a variety of forms ? ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

Health literacy : a prescription to end confusion

This paper - first published on-line in November 2008 - draws on data from an early version of the Google Flu Trends search engine to estimate the levels of flu in a population. It introduces a computational model that converts raw search query data into a region-by-region real-time surveillance system that accurately estimates influenza activity with a lag of about one day - one to two weeks faster than the conventional reports published by the Centers for Disease Prevention and Control. This report introduces a computational model based on internet search queries for real-time surveillance of influenza-like illness (ILI), which reproduces the patterns observed in ILI data from the Centers for Disease Control and Prevention. Seasonal influenza epidemics are a major public health concern, causing tens of millions of respiratory illnesses and 250,000 to 500,000 deaths worldwide each year1. In addition to seasonal influenza, a new strain of influenza virus against which no previous immunity exists and that demonstrates human-to-human transmission could result in a pandemic with millions of fatalities2. Early detection of disease activity, when followed by a rapid response, can reduce the impact of both seasonal and pandemic influenza3,4. One way to improve early detection is to monitor health-seeking behaviour in the form of queries to online search engines, which are submitted by millions of users around the world each day. Here we present a method of analysing large numbers of Google search queries to track influenza-like illness in a population. Because the relative frequency of certain queries is highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day. This approach may make it possible to use search queries to detect influenza epidemics in areas with a large population of web search users.

/pdf/detecting-influenza-epidemics-using-search-engine-query-data-3do2njl33s.pdf

Detecting influenza epidemics using search engine query data

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Asthma is a serious health problem throughout the world During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively However, recommendations for asthma care need to be adapted to local conditions, resources and services Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines The 2006 report contains important new themes First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised

https://erj.ersjournals.com/content/erj/31/1/143.full.pdf

Global strategy for asthma management and prevention: GINA executive summary.

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge.

Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.

Study objective:To determine current attitudes of patients, medical students, housestaff, and clinical faculty toward bedside case presentations. Design:Survey using multiple-choice questionnaire and open comments for students, housestaff, and faculty, and a structured interview of patients. Setting:Major teaching hospitals on the campus of a mid-western medical school, staffed by full-time faculty. Participants:136 medical students, 58 housestaff, 66 faculty, and 73 patients. Measurements and main results:85% of patients liked the case presentation discussion at the bedside, but 95% of both students and housestaff felt more comfortable with such discussion away from the patient. Attending faculty were about evenly divided in preference, with the younger staff preferring the conference room setting. Most patients (88%) opposed rounds in the ballway. Duration of rounds of one to two hours was felt desirable by most, but 50% of students preferred a duration of less than one hour. For length of new patient case presentation, 60% of learners again favored brevity, less than 5 minutes. Conclusions:Bedside rounds are an opportunity to sharpen diagnostic skills and to demonstrate the art of medicine. They are undervalued by learners and younger faculty but appreciated by patients. The authors recommend that faculty improve bedside rounds by assessing team members’ educational needs, by cultivating sensitivity and respect for the needs of all parties, and by assuring pertinence and brevity of bedside discussion.

Bedside case presentations: why patients like them but learners don't

The purpose of this study was to determine whether the level of influenza in a population correlates with the number of times that internet users access information about influenza on healthrelated Web sites. We obtained Web access logs from the Healthlink Web site. They contain information about the user and the information the user accessed, and are maintained electronically by most Web sites, including Healthlink. We developed weekly counts of the number of accesses of selected influenza-related articles on the Healthlink Web site and measured their correlation with traditional influenza surveillance data from the Centers for Disease Control and Prevention (CDC) using the cross-correlation function (CCF). We defined timeliness as the time lag at which the correlation was a maximum. There was a moderately strong correlation between the frequency of influenza-related article accesses and the CDC’s traditional surveillance data, but the results on timeliness were inconclusive. With improvements in methods for performing spatial analysis of the data and the continuing increase in Web searching behavior among Americans, Web article access has the potential to become a useful data source for public health early warning systems.

Analysis of Web access logs for surveillance of influenza.

Efficacy and tolerability of once-weekly rosuvastatin in patients with previous statin intolerance.

BACKGROUND Although several studies have addressed the effect of student gender on clinical performance evaluation, none has looked at the effect of preceptor gender or the interaction of preceptor gender and student gender. We investigated the possibility of gender effects in an ambulatory care clerkship where the preceptor-student ratio is usually one to one. METHOD Clinical grades given by preceptors to third-year students after a required one-month ambulatory care medicine clerkship were analyzed by student gender, preceptor gender, and preceptor-student gender pairs. The study was conducted from August 1990 to October 1992 at the Medical College of Wisconsin. A total of 121 preceptors (97 men and 24 women) and 375 students (233 men and 142 women) participated. Analyses of variance were used to detect significant differences. RESULTS On a scale of 0 to 4, the female students received a higher mean clinical grade than the male students (3.1 versus 3.0, p < .04). Preceptor gender had no effect on clinical grades until student gender was considered. The highest mean grade of 3.3 was given by male preceptors to female students, and the lowest mean grade of 2.9 was given by female preceptors to male students (p < .01). CONCLUSION The female students received higher clinical grades in the ambulatory care clerkship, especially when the preceptor was male. Perhaps gender interaction should be considered when assigning students to preceptors and evaluating grading practices.

Gary P. Barnas

Papers

Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.

Bedside case presentations: why patients like them but learners don't

Analysis of Web access logs for surveillance of influenza.

Efficacy and tolerability of once-weekly rosuvastatin in patients with previous statin intolerance.

Effect of student and preceptor gender on clinical grades in an ambulatory care clerkship.