Guidelines on how to assess the validity of results presented in subgroup analysis of clinical trials

In observational studies, identification of associations within particular subgroups is the usual method of investigation. As an exploratory method, it is the bread and butter of epidemiological research. Nearly everything that has been learned in epidemiology has been derived from the analysis of subgroups. In a randomized clinical trial, the entire purpose is the comparison of the test subjects and the controls, and when there is particular interest in the results of treatment in a certain section of trial participants, a subgroup analysis is performed. These subgroups are examined to see if they are liable to a greater benefit or risk from treatment. Thus, analyzing patient subsets is a natural part of the process of improving therapeutic knowledge through clinical trials. Nevertheless, the reliability of subgroup analysis can often be poor because of problems of multiplicity and limitations in the numbers of patients studied. The naive interpretation of the results of such examinations is a cause of great confusion in the therapeutic literature. We emphasize the need for readers to be aware that inferences based on comparisons between subgroups in randomized clinical trials should be approached more cautiously than those based on the main comparison. That is, subgroup analysis results derived from a sound clinical trial are not necessarily valid; one must not jump to conclusions and accept the validity of subgroup analysis results without an appropriate judgment.

Knowledge of Glasgow coma scale by air-rescue physicians.

OBJECTIVE: To assess the theoretical and practical knowledge of the Glasgow Coma Scale (GCS) by trained Air-rescue physicians in Switzerland. METHODS: Prospective anonymous observational study with a specially designed questionnaire. General knowledge of the GCS and its use in a clinical case were assessed. RESULTS: From 130 questionnaires send out, 103 were returned (response rate of 79.2%) and analyzed. Theoretical knowledge of the GCS was consistent for registrars, fellows, consultants and private practitioners active in physician-staffed helicopters. The clinical case was wrongly scored by 38 participants (36.9%). Wrong evaluation of the motor component occurred in 28 questionnaires (27.2%), and 19 errors were made for the verbal score (18.5%). Errors were made most frequently by registrars (47.5%, p = 0.09), followed by fellows (31.6%, p = 0.67) and private practitioners (18.4%, p = 1.00). Consultants made significantly less errors than the rest of the participating physicians (0%, p < 0.05). No statistically significant differences were shown between anesthetists, general practitioners, internal medicine trainees or others. CONCLUSION: Although the theoretical knowledge of the GCS by out-of-hospital physicians is correct, significant errors were made in scoring a clinical case. Less experienced physicians had a higher rate of errors. Further emphasis on teaching the GCS is mandatory.

The impact of two education methods on knowledge of schistosomiasis transmission and prevention among schoolchildren in a rural community in northern Minas Gerais, Brazil

The objective of this study was to analyse the effect of using two health education approaches on knowledge of transmission and prevention of schistosomiasis of school children living in a rural endemic area in the state of Minas Gerais, Brazil. The 87 children participating in the study were divided into three groups based on gender, age and presence or absence of Schistosoma mansoni infection. In the first group the social representation model and illness experience was used. In the second group, we used the cognitive model based on the transmission of information. The third group, the control group, did not receive any information related to schistosomiasis. Ten meetings were held with all three groups that received a pre-test prior to the beginning of the educational intervention and a post-test after the completion of the program. The results showed that knowledge levels in Group 1 increased significantly during the program in regard to transmission (p = 0.038) and prevention (p = 0.001) of schistosomiasis. Groups 2 and 3 did not show significant increase in knowledge between the two tests. These results indicate that health education models need to consider social representation and illness experience besides scientific knowledge in order to increase knowledge of schistosomiasis transmission and prevention.

Patients' knowledge of Diabetes five years after the end of an educational program

We present a cross-sectional study that aims to describe the sociodemographic and clinical conditions of individuals with diabetes mellitus and to analyze their knowledge of treatment five years after the end of an educational program in which they took part. In 2010, 40 individuals who had participated in a diabetes educational program for 12 months in 2005 at a primary care service were interviewed. A form was used for data collection that included their knowledge of the notion, physiopathology, and treatment of the disease; exercise; nutrition; foot care; self-monitoring of capillary blood glucose at home; hypoglycemia; chronic complications; special situations; and family support. The results showed that the volunteers incorporated the information about the notion, physiopathology, and treatment of the disease; exercise; foot care; self-monitoring; care associated with hypoglycemia; chronic complications; and special situations. In contrast, nutrition and family support require further reinforcement. It is concluded that five years after the end of the educational program, the participants kept most of the information provided.

Lengua familiar y conocimiento de la lengua escolar en Cataluña al finalizar la Educación Infantil = Home Language and Knowledge of the School Language in Catalonia at the end of Nursery School

La infancia extranjera se escolariza en Cataluña en un programa de cambio de lengua del hogar a la escuela. Las investigaciones afirman que este alumnado tarda un mínimo de seis años en equiparar sus habilidades lingüístico-cognitivas con sus pares autóctonos, no así las habilidades conversacionales, las cuales se adquieren antes de los dos años de residencia. Sin embargo, no existen estudios sobre los efectos de la escolarización en el parvulario del alumnado alófono, así como de su lengua familiar, en relación con la adquisición de la lengua escolar. El artículo es un estudio comparativo de la adquisición del catalán de 567 autóctonos y 434 alófonos, al final del parvulario, en 50 escuelas de Cataluña que escolarizan a alumnado de origen extranjero. Las lenguas del alumnado autóctono son el catalán, el castellano y el bilingüismo catalán-castellano y las lenguas del alumnado alófono son el árabe, el soninké y el castellano. Los factores utilizados más relevantes han sido el nivel socioprofesional y educativo de las familias, el tiempo de residencia y el momento de escolarización del alumnado, el porcentaje de alumnado catalanohablante y de alumnado alófono en el aula y el contexto sociolingüístico del centro escolar. Los resultados muestran que el alumnado autóctono sabe más catalán que el alumnado alófono, pero las diferencias desaparecen respecto a algunos factores, de los cuales los más relevantes son los relacionados con las características del alumnado de las aulas. La lengua familiar del alumnado alófono no incide en sus resultados

Knowledge of common pediatric cancers among medical students in northeast Brazil

BACKGROUND: In recent decades, early diagnosis of childhood cancer has taken an important place on the international agenda. The authors of this study evaluated a group of medical students in Recife, Brazil, regarding knowledge and practices related to early diagnosis of common childhood cancers. METHODS: Cross-sectional study with a sample of 82 medical students, from a total of 86 eligible subjects. Data were collected using self-completed questionnaires. Subgroups were defined according to knowledge of the theme and students' perceptions of their own skills and interest in learning. RESULTS: 74.4% of the sample demonstrated a minimum level of knowledge. The group without minimum knowledge or self-perceived competence to identify suspected cases (23.3%) was in the worst position to perform early diagnosis. All subjects expressed interest in learning more about this topic. CONCLUSIONS: Despite acceptable levels of knowledge among these medical students, the definition of central aspects of the teaching and learning processes would be useful for training physicians with the skills for diagnosing and treating pediatric cancers

Knowledge of Guidelines for Cardiopulmonary Resuscitation among Brazilian Medical Students

ABSTRACT Introduction Sudden death is a substantial public health problem, representing a major cause of mortality worldwide. Suitable initial care is essential for a good prognosis of these patients. Objectives To assess the knowledge of the 2010 guidelines for cardiopulmonary resuscitation (CPR) among medical students in their final year of undergraduate training. Methods This was a cross-sectional study with a sample of 217 medical students enrolled in the sixth year of accredited medical schools in Brazil. A structured questionnaire with 27 items was used to record the sociodemographic characteristics of the participants and to assess their knowledge base of the 2010 ILCOR guidelines for CPR. Results Only fifty (23.04%) out of 217 students achieved results considered as satisfactory in the written evaluation. The average score obtained was 56.74% correct answers. Seventeen percent of the students had never performed CPR maneuvers and 83.80% had never performed cardioversion or defibrillation. Conclusions The knowledge base of medical students regarding cardiopulmonary resuscitation is low. Considering these medical students are in their final year of medical school, this study reveals a worrisome scenario.

Exploring Teacher Candidates’ Experience, Perception, and Knowledge of Multicultural Education in Two Ontario Universities

In this study, teacher candidates’ experiences, perceptions, and knowledge of multicultural education at 2 Ontario universities were used determine to the effectiveness of their teacher education programs in preparing them to teach in multicultural classrooms. The research also strived to highlight the most effective practices in these programs that contributed to the preparation of teacher candidates for employment in culturally, racially, and ethnically diverse classrooms in Ontario. A questionnaire and interviews were used to determine the effectiveness of the program in preparing them to teach in diverse classrooms. The findings revealed the need for a greater emphasis of multicultural education in teacher education programs at these universities. The data showed that teacher candidates were most critical of the courses and the delivery of the curriculum in relation to multicultural education. Teacher candidates were also concerned with the lack of multicultural education in their practicum placements. In addition, teacher candidates indicated in the questionnaire that they felt competent adapting instruction to the needs of students in multicultural classrooms. However, the results obtained from the interviews were more varied. The interviews highlighted that teacher candidates were hesitant about teaching in culturally diverse classrooms and less likely to state that they were prepared for these teaching environments. As well, many teacher candidates believed their peers were not prepared for multicultural issues. Teacher candidates believed the program could be improved in many ways including specific instruction across all classes, more diverse practicum experiences, guest speakers, case studies, and the creation of new courses that specifically address multicultural education.

Transfer of knowledge of the structural components of the model Q400 and Global Express: the case of Aerospace Bombardier, Querétaro

The aim of this paper is to analyze the knowledge transfer in the production of structural components of two aircraft:Q400 and Global Express of Bombardier Aerospace Company, Querétaro. Bombardier Aerospace is a pioneer company in the aviation sector in Mexico, and the third largest civil aircraft manufacturer. In 2005, Bombardier decided to invest in Mexico, creating Bombardier Aerospace de Mexico S. A. C. V. and transferring production lines from Japan and Toronto to Queretaro. The relocation strategy of both plants aims to reduce modular and general production costs facing other competitors. The relocation has been supported by the State Government funds, through a trust and the creation of Queretaro aerospace cluster. Among various benefits, the State of Queretaro donated seventy-eight acres of land where the Queretaro International Airport (QIA) and a training centre will be built to promote the development of this sector. The interest in this research is to analyze and describe the transfer of knowledge to the production of structural components of both aircraft models, thanks to the results of productivity and internal and external factors which have contributed along with this transfer

The “Fashionable Knowledge” of Management Consulting

In the evolution of strategic disciplines much of the knowledge produced has been widely diffused by the management consulting industry. But can this sector be regarded as knowledge intensive activity based on true structure of expertise knowledge? One way to understand if we can consider that sector as a source of knowledge dissemination is realizing its relationship with the market in terms of knowledge, rather than identify only as a set of static techniques to be applied as in most of times they have been doing. This article presents itself as a reflection about the real reasons for the increasing use ofmanagement consulting services, indicating simultaneously that can really be a true field of opportunities for the academic class if the study will focused in the establishment and institutionalization of micropractices (strategy-as-practice) that there are used and its implications in terms of organizational results.

Survey of hearing-impaired adults and parents of hearing-impaired children and their knowledge of the Americans with Disabilities Act

This paper discusses the results of a survey about awareness of the American with Disabilities Act.

Can knowledge of the state of the stratosphere be used to improve statistical forecasts of the troposphere?

Recent analysis of the Arctic Oscillation (AO) in the stratosphere and troposphere has suggested that predictability of the state of the tropospheric AO may be obtained from the state of the stratospheric AO. However, much of this research has been of a purely qualitative nature. We present a more thorough statistical analysis of a long AO amplitude dataset which seeks to establish the magnitude of such a link. A relationship between the AO in the lower stratosphere and on the 1000 hPa surface on a 10-45 day time-scale is revealed. The relationship accounts for 5% of the variance of the 1000 hPa time series at its peak value and is significant at the 5% level. Over a similar time-scale the 1000 hPa time series accounts for 1% of itself and is not significant at the 5% level. Further investigation of the relationship reveals that it is only present during the winter season and in particular during February and March. It is also demonstrated that using stratospheric AO amplitude data as a predictor in a simple statistical model results in a gain of skill of 5% over a troposphere-only statistical model. This gain in skill is not repeated if an unrelated time series is included as a predictor in the model. Copyright © 2003 Royal Meteorological Society

The effects of different knowledge-dissemination interventions on the mastitis knowledge of Tanzanian smallholder dairy farmers

We developed three different knowledge-dissemination methods for educating Tanzanian smallholder farmers about mastitis in their dairy cattle. The effectiveness of these methods (and their combinations) was evaluated and quantified using a randomised controlled trial and multilevel statistical modelling. To our knowledge, this is the first study that has used such techniques to evaluate the effectiveness of different knowledge-dissemination interventions for adult learning in developing countries. Five different combinations of knowledge-dissemination method were compared: 'diagrammatic handout' ('HO'), 'village meeting' ('VM'), 'village meeting and video' ('VM + V), 'village meeting and diagrammatic handout' ('VM + HO') and 'village meeting, video and diagrammatic handout' ('VM + V + HO'). Smallholder dairy farmers were exposed to only one of these interventions, and the effectiveness of each was compared to a control ('C') group, who received no intervention. The mastitis knowledge of each farmer (n = 256) was evaluated by questionnaire both pre- and post-dissemination. Generalised linear mixed models were used to evaluate the effectiveness of the different interventions. The outcome variable considered was the probability of volunteering correct responses to mastitis questions post-dissemination, with 'village' and 'farmer' considered as random effects in the model. Results showed that all five interventions, 'HO' (odds ratio (OR) = 3.50, 95% confidence intervals (CI) = 3.10, 3.96), 'VM + V + HO' (OR = 3.34, 95% CI = 2.94, 3.78), 'VM + HO, (OR=3.28, 95% CI=2.90, 3.71), WM+V (OR=3.22, 95% CI=2.84, 3.64) and 'VM' (OR = 2.61, 95% CI = 2.31, 2.95), were significantly (p < 0.0001) more effective at disseminating mastitis knowledge than no intervention. In addition, the 'VM' method was less effective at disseminating mastitis knowledge than other interventions. Combinations of methods showed no advantage over the diagrammatic handout alone. Other explanatory variables with significant positive associations on mastitis knowledge included education to secondary school level or higher, and having previously learned about mastitis by reading pamphlets or attendance at an animal-health course. (c) 2005 Elsevier B.V. All rights reserved.

The knowledge of healthcare professionals regarding elderly persons' oral care

OBJECTIVE: The aim of this study was to compare the knowledge and views of nursing staff on both acute elderly care and rehabilitation wards regarding elderly persons' oral care with that of carers in nursing homes. SUBJECTS: One hundred nurses working on acute, sub-acute and rehabilitation wards for elderly people (Group 1) and 75 carers in nursing homes (Group 2) were surveyed. DESIGN: A semi-structured questionnaire. RESULTS: Similar percentages of each group of nurses were registered with a dentist (86% and 88% respectively), although more hospital-based nurses were anxious about dental treatment compared with the nursing home group (40% and 28% respectively). More carers in nursing homes gave regular advice about oral care than the hospital-based nurses (54% and 43% respectively). Eighteen per cent of each group thought that edentulous individuals did not require regular oral care. Eighty-five per cent of hospital-based nurses and 95% of nursing home carers incorrectly thought that dentures were 'free' on the NHS. Although trends were observed between the two groups, no comparisons were statistically significant (Chi-square; level p < 0.05). CONCLUSIONS: Deficiencies exist in the knowledge of health care workers both in hospital and in the community setting, although the latter were less knowledgeable but more likely to give advice to older people.

Knowledge of basic concepts in deaf/hard of hearing children

Basic concept knowledge of children who were deaf/hard of hearing was tested using the Bracken Basic Concept Scale: 3rd Edition. These children were given both the receptive and expressive portions of the test. Results indicate delays in overall basic concept knowledge in children who are deaf compared to their normal-hearing peers.