Factors associated with posttraumatic growth among the spouses of myocardial infarction patients
by Mithat Durak
Key Words: cognitive processing, environmental factors, individual factors, myocardial infarction patients, posttraumatic growth, spouses of myocardial infarction patients
To clarify the rationale behind Posttraumatic Growth (PTG), a model by Schaefer and Moos describes the relative... more To clarify the rationale behind Posttraumatic Growth (PTG), a model by Schaefer and Moos describes the relative contribution of environmental resources, individual resources, event related factors, cognitive processing and coping (CPC) on PTG. In the present study, this model was tested with the spouses of myocardial infarction patients with data from various hospitals in Turkey. A structural equation model revealed that neither individual nor environmental resources had indirect effects on PTG through the effect of event-related factors and CPC, while they showed direct effects on PTG. The findings were discussed in the context of the theoretical model.
Film Analizi Yöntemi ile Virginia Satir Aile Terapisi Yaklaşımına Bir Bakış
by Mithat Durak
Satir, family therapy, family homeostasis, communication within family and fi lm analysis
Virginia Satir, the women pioneer of family therapy, introduced an effective therapy to the treatment of various... more Virginia Satir, the women pioneer of family therapy, introduced an effective therapy to the treatment of various problems. In spite of the fact that applications of Satir Family Therapy in different cultures are exemplifi ed in the literature, there is limited number of research related with the applications of this approach in Turkey. In this context, this article mainly aims to review conceptual frame of Satir Family Therapy and to exemplify this approach with the method of fi lm analysis. In this direction, theoretical concepts, role of the therapist, evaluation of families, purpose of therapy and intervention techniques of Satir Family Therapy are described and exemplifi ed with a fi lm analysis of “One True Thing”. As a result, this article will be a resource for professionals either working or continuing their education through strengthening the theoretical frame of the Satir Family Therapy, and an example of the applications of this approach.
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Download (.pdf) Constipation in Children
for citation:
Al Hajeri A. Constipation in Children. Bahrain Medical Bulletin. 2011. 33(4):209-212.
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The Reliability of ABFM Examinations: Implications for Test-Takers
Royal, K. D., & Puffer, J. C. (2011). The Reliability of ABFM Examinations: Implications for Test-Takers. Annals of Family Medicine, 9(5), 463-464.
Article provides an overview of the psychometric property of reliability and discusses its implications for... more Article provides an overview of the psychometric property of reliability and discusses its implications for test-takers of the ABFM certification/recertification examination.
Performance on the American Board of Family Medicine (ABFM) Certification Examination: Are Superior Test-Taking Skills Alone Sufficient to Pass?
This article was published in The Journal of the American Board of Family Medicine 24 (2): 175-180 (2011). DOI: 10.3122/jabfm.2011.02.100162
Introduction: Certification examinations used by American specialty boards have been the sine qua non for... more
Introduction: Certification examinations used by American specialty boards have been the sine qua non for demonstrating the knowledge sufficient for attainment of board certification in the United States for more than 75 years. Some people contend that the examination is predominantly a test of superior test-taking skills rather than of family medicine decision-making ability. In an effort to explore the validity of this assertion, we administered the American Board of Family Medicine (ABFM) Certification to examinees who had demonstrated proficiency in taking standardized tests but had limited medical knowledge.
Methods: Four nonphysician experts in the field of measurement and testing were administered one version of the 2009 ABFM certification examination. Scaled scores were calculated for each examinee, and psychometric analyses were performed on the examinees responses to examination items and compared with the performance of physicians who took the same examination.
Results: The minimum passing threshold for the examination was a scaled score of 390, corresponding to 57.7% to 61.0% of questions answered correctly, depending on the version of the examination. The 4 nonphysician examinees performed poorly, with scaled scores that ranged from 20 to 160 (mean,
87.5; SD, 57.4). The number of questions answered correctly ranged from 24.0% to 35.1% (mean, 29.2%; SD, 0.05%). Rasch analyses of the examination items revealed that the nonphysician examinees were more likely to use guessing strategies in an effort to answer questions correctly. Distracter analysis suggest near-complete randomness in the nonphysician responses.
Conclusions: Though all 4 nonphysician examinees performed better than would have been predicted by chance alone, none performed well enough to even fall within 8 SE below the passing thresholds; their performance was far below that of almost all physicians who completed the examination. Given that the nonphysicians relied heavily on the identifying cues in the phrasing of items and the manner in which response options were presented, the results affirm the notion that the ABFM certification examination is not primarily a measure of generic test-taking ability but measures information critical
to the estimation of a family physician’s knowledge sufficient for certification. Item analysis confirmed that items were well written, provided minimal cueing, and required medical knowledge to answer correctly. (J Am Board Fam Med 2011;24:175–180.)
Demonstrating the Construct Stability of a Translated Exam for Family Medicine Residents
Citation: O'Neill, T. O., Raddatz, M. M., & Royal, K. D. (2011). Demonstrating the Construct Stability of a Translated Exam for Family Medicine Residents. The International Journal of Educational and Psychological Assessment, 6(2), 31-41.
The world is getting flatter and work is being outsourced to decrease cost and increase efficiency. For this to take... more The world is getting flatter and work is being outsourced to decrease cost and increase efficiency. For this to take place, some standardization of training is necessary. Tests are often used to ensure that equivalent standards are in place tests across all labor suppliers and for this reason, it is important that the test results have equivalent meaning across different forms of the test, even when those forms are translated into other languages. This study evaluated a low-stakes medical certification in-training examination that was translated from English to Spanish and administered in both languages. the construct equivalence between exams was compared using a Rasch measurement based Differential Item Functioning analysis. Results showed that the construct measured by each exam was in fact stable. As more high-stakes exams are translated between languages and cultures, it is necessary to ensure that exams are measuring the same constructs of interest.
Gastrointestinal adverse effects of varenicline at maintenance dose: a meta-analysis. Leung L. et al.
Lawrence K Leung l, Francis M Patafio and Walter W Rosser
BMC Clinical Pharmacology 2011, 11:15
Background
Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most... more
Background
Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most popular pharmacological options for smoking cessation. The purpose of this study is to critically evaluate the extent of gastrointestinal adverse effects of varenicline when used at maintenance dose (1mg twice a day) for smoking cessation.
Methods
We conducted a meta-analysis of randomised controlled trials published in PUBMED and EMBASE according to the PRISMA guidelines. Selected studies satisfied the following criteria: (i) duration of at least 6 weeks, (ii) titrated dose of varenicline for 7 days then a maintenance dose of 1mg twice-per-day, (iii) randomized placebo-controlled design, (iv) extractable data on adverse event - nausea, constipation or flatulence. Data was synthesized into pooled odd ratios (OR) basing on random effects model. Quality of studies was also rated as per Cochrane risk-of-bias assessment. Number need to harm (NNH) was calculated for each adverse effect.
Results
98 potentially relevant studies were identified, 12 of which met the final inclusion criteria (n=5114). All 12 studies reported adverse events on nausea, which led to an OR of 4.45 (95% CI=3.79-5.23, p< 0.001; I2 = 0.06%, CI=0%-58.34%) and a NNH of 5. Eight studies (n=3539) contain data on constipation pooled into an OR of 2.45 (95% CI=1.61-3.72, p< 0.001; I2 = 34.09%, CI= 0%-70.81%) with a NNH of 24. Finally, five studies (n=2516) reported adverse events of flatulence, which pooled an OR of 1.74 (95% CI=1.23-2.48, p= 0.002; I2 = 0%, CI= 0%- 79.2%) with a NNH of 35.
Conclusions
Use of varenicline at maintenance dose of 1mg twice a day for longer than 6 weeks is associated with adverse gastrointestinal effects. In realistic terms, for every 5 treated subjects, there will be an event of nausea, and for every 24 and 35 treated subjects, we will expect an event of constipation and flatulence respectively. Family physicians should counsel patients of such risks accordingly during their maintenance therapy with varenicline.
Frequency and circumstances of placebo use in clinical practice- a systematic review of empirical studies
Fassler M, Meissner K, Schneider A, Linde K. Frequency
BMC Med 2010;8:15.
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الوقاية ضد سرطان الثدي في الرعاية الصحية الاولية
For citation: Al Hajeri A. Breast Cancer Prevention in Primary Health Care. Bahrain Medical Bulletin. 2011. 33(3):154-157.
Odorous vaginal discharge - A case study for thorough investigation. Cernat G, Leung L.
Aust Fam Physician. 2011 Aug;40(8):611-3
Odorous vaginal discharge is a common presentation to general practitioners, and a frequent presentation for bacterial... more Odorous vaginal discharge is a common presentation to general practitioners, and a frequent presentation for bacterial infections and sexually transmissible diseases. Busy GPs may be tempted to make a diagnosis from the clinical history and symptoms, and prescribe antibiotics as a first line treatment. This case highlights an unusual cause of persistent odorous vaginal discharge. If a thorough examination had not been conducted, the cause would have been overlooked, first line antibiotics would most likely have been ineffective, and potentially life threatening consequences may have occurred.
Treating common warts - options and evidence. Leung L.
Aust Fam Physician. 2010 Dec;39(12):933-7
BACKGROUND:
Nongenital warts are a common condition seen in general practice, affecting patients of all ages.... more
BACKGROUND:
Nongenital warts are a common condition seen in general practice, affecting patients of all ages. There are many treatment options and patients often self medicate with remedies from folklore or tradition before presenting to their doctor.
OBJECTIVE:
This article attempts to summarise the quality of different treatments and to provide recommendations and a quick reference for treating common warts.
DISCUSSION:
Many common warts will resolve spontaneously but others are recalcitrant and often require ongoing treatment beyond first line measures. Without definite guidelines for treating recalcitrant warts, it is important for the general practitioner to consider the available evidence for efficacy and contraindication of the various treatment options.
Clinical Roundup: How do you treat insomnia in your practice? - Part 1
Alternative and Complementary Therapies 2010 Aug;16(4):242-5.
Recalcitrant nongenital warts. Leung L.
Aust Fam Physician. 2011 Jan-Feb;40(1-2):40-2
Nongenital warts are a common presentation in general practice. Despite treatment according to evidence based... more Nongenital warts are a common presentation in general practice. Despite treatment according to evidence based guidelines, a significant proportion of common warts fail to resolve, becoming recalcitrant. This poses a problem in clinical management. The recommendations for treating recalcitrant warts are unclear and there is a wide range of second line treatments available. This article reviews the available methods of treatment for recalcitrant nongenital warts as described in the medical literature.
Chronic constipation: an evidence-based review. Leung L, Riutta T, Kotecha J, Rosser W.
J Am Board Fam Med. 2011 Jul-Aug;24(4):436-51
BACKGROUND:
Chronic constipation is a common condition seen in family practice among the elderly and women. There... more
BACKGROUND:
Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly.
METHODS:
To update our knowledge of chronic constipation and its etiology and best-evidence treatment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy.
RESULTS:
The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported.
CONCLUSIONS:
Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment
An odd looking lesion. Leung L, Amyot S.
Aust Fam Physician. 2011 Mar;40(3):125-6
Mark, 54 years of age, has a nontender lump on his praecordium that has been present 'for a long time'. He vaguely... more Mark, 54 years of age, has a nontender lump on his praecordium that has been present 'for a long time'. He vaguely recalls a smaller lump at the same site years ago, which he squeezed, with subsequent resolution. Mark denies any bleeding, however, he has noticed occasional yellowish-brown stains on his shirt.
Genomics and general practice: the next 10 years. Leung L.
Aust Fam Physician. 2010 May;39(5):339-40