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Assessing Allergy Knowledge in Internal Medicine Residents
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Assessing Allergy Knowledge in Internal Medicine Residents Brynn Everist, PGY3 Pediatric Resident1, Kim Baumann1, John B. Hagan, MD, FAAAAI2; 1Mayo Clinic, 2Mayo Clinic, Rochester, MN. RATIONALE: At Mayo Clinic, Rochester, Minnesota, the Division of Allergic Diseases hosts second-year internal medicine residents for a oneweek clinical experience. Pre- and post-rotation data was collected to assess the efficacy of the rotation’s curriculum. METHODS: On the first morning of the rotation, residents took a 34question quiz on pre-assigned reading regarding allergic rhinitis and asthma. Following was a half-day of clinical didactics covering venom and drug allergies, and a second quiz of 20 novel questions. The remaining week was spent in allergy clinic. A 35-question quiz covering all topics was given on the final day of the rotation. RESULTS: From July 2006 through June 2012, 275 residents (41.1% female, 58.9% male) completed the rotation and had documented scores for either the first, second, or final quiz; 97.9% of residents completed all three. The median score for the combined pre-rotation tests was 62.9% (Inter Quartile Range 55.6% to 70.4%). The median score for the final exam was 90.6% (IQR 81.2% to 93.8%). A high post-rotation score correlated with a high pre-rotation score, p value <.0001. There was no statistical significance of gender, number of days in clinic, or number of patients seen per day on final exam scores. CONCLUSIONS: A one-week outpatient allergy rotation was associated with an increase in knowledge, defined as positive responses on multiplechoice allergy-related questions. Pre-rotation scores may predict performance on post-rotation evaluations. Further research evaluating the educational needs and goals of internal medicine resident training should lead to the development of optimal allergy-specific clinical rotations for internal medicine residents.
Severe Atopic Dermatitis (SAD) and Quality of Life (QOL) in Children During Background Therapy (BT) Vladislava Derkach, PhD1,2, Tatiana Slavyanskaya, MD, PhD1,3; 1Institute of Immunophysiology, Moscow, Russia, 2Vladivostok State Medical University, Vladivostok, Russia, 3University of Russia, Moscow, Russia. RATIONALE: The study was aimed to estimate QOL in children with SAD during BT. METHODS: We have examined a total of 33 children from 7 to 18 years old with SAD (15 boys and 18 girls) having received BT (antihistamines, membrane stabilizers, enterosorbents, gastrointestinal medications and external local treatment) for 3 months. The QOL level was estimated using Dermatology specific quality of life questionnaire. Patients were interviewed at baseline and three months after BT. RESULTS: SAD symptoms were determined to significantly decrease QOL in children. Patients were mostly affected by pruritus, xerodermia, physical discomfort and sleep disorders. Cumulative value according ‘‘Activities of Daily Living Scale’’ at baseline was 2.5160.05, and 3 months after BT–2.0960.03 (p>0.05). There were significant gender differences in most relevant limitations of daily activities (p<0.001): boys were limited in physical activity and girls – in clothes and cosmetics choice. Social activity was reduced one-half. Disease symptoms kept children from making new acquaintances and limited their social life. Mean ‘‘Selfperception Scale’’ values were similar before and after BT (p>0.05). The most significant factors affecting QOL were mental anguish, confusion due to skin view, annoyance due to appearance, lack of confidence. Parameters of all 5 scales insignificantly improved after 3 months of BT (p>0.05). CONCLUSIONS: SAD strongly affects psychological welfare, physical and social activity in children. BT does not improve QOL in such children. It does not eliminate the underlying cause of allergic inflammation and is generally targeted on pathophysiological factors.
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A Variable Compass: Practice Parameters and Strength of Recommendation Data Taylor A. Banks, MD, Julia Savitz, Michael R. Nelson, MD, PhD, FAAAAI; Walter Reed National Military Medical Center, Bethesda, MD. RATIONALE: Practice parameters and guidelines shape and influence the method and manner in which medicine is practiced. With over 121 scales and methods of assessing and rating evidence, a comparison of practice parameters can appear daunting. An evaluation of the evidence engenders both a sense of the evolution of a specialty and a roadmap for the future. METHODS: We analyzed the practice parameters that guide AllergyImmunology (AI, 15), Otolaryngology (ENT, 8), Pediatrics (Peds, 14), and Internal Medicine (IM, 10), as they appeared on 30 August 2012. The strength of recommendation data were compared after making adjustments for differences in rating scales. RESULTS: The strength of recommendation was calculated for the AI practice parameters using Shekelle, et al’s (British Medical Journal, 1999) format, yielding: A (13.9%), B (24.4%), C (43.2%), D (16.4%), and E (2.1%). Randomized controlled trial evidence (strengths A and B), demonstrated considerable variability amongst individual AI practice parameters (range: 1.3%-100%). Evidence from randomized controlled trials was lower in the subspecialty communities, AI (38.3%), ENT (38.2%) than the primary care fields, Peds (55.6%), IM (86.1%). CONCLUSIONS: Considerable variability exists in the strength of recommendations within the Allergy-Immunology practice parameters. The guidelines created by the primary care fields rest upon a larger base of evidence collected from randomized controlled trials. However, rather than a detriment, this is likely reflective of the specialized nature of fields such as Allergy-Immunology. Furthermore, this analysis highlights the myriad opportunities for future research that are available for AI’s emerging practitioners and researchers.
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A Qualitative Analysis of Health-Related Quality of Life and Treatment Satisfaction Associated with Rapid Push Scig Therapy Joanne Moreau, MD1, Vincent R. Bonagura, MD, FAAAAI2, Eugene Meyer, Psy. D.1; 1Cohen Children’s Medical Center, North Shore-LIJ Health System, Department of Pediatrics, Division of Allergy & Immunology, Great Neck, NY, 2Hofstra, Northshore-LIJ School of Medicine, Great Neck, NY. RATIONALE: Few studies examine health-related quality of life (HRQOL) and treatment satisfaction of patients with Primary Immune Deficiency Diseases (PIDD). Primary measures used previously include the Life Quality Index (LQI) to assess medical treatment satisfaction with intravenous immunoglobulin infusions; and the Medical Outcome Study Short Form-36 (SF-36). No prior studies incorporated the patient perspective of the disease and treatment experience or patient satisfaction in transitioning from weekly subcutaneous (ScIg) infusions to daily, rapid push ScIg therapy. Our data is the only qualitative, patient-oriented evaluation of continued use of these measures in PIDD. METHODS: Two participant arms (Groups A [n59] and B [n56]): Group A consists of patients who have not yet switched to rapid ScIg replacement therapy. They participate in 3 semi-structured, audio taped 60 minute interviews (1 prior to beginning treatment, 1 30 days after switching, and 1 approximately 3 months after initiation). Group B patients were enrolled after having already switched to rapid ScIg and participate in 1 semi-structured, audio taped 60 minute interview. The SF-36 and LQI were completed at each interview. RESULTS: Interview content and select questionnaire data are being summarized by qualitative content analysis. Descriptive statistics are used to summarize questionnaire and interview data. Preliminary data shows that these tools, particularly the SF-36, are too generic for assessing PIDD quality of life, given the complexity of these diseases. CONCLUSIONS: This study should provide improved understanding of PIDD patients’ expectations, experience, treatment satisfaction, and educational needs for rapid ScIg replacement. This may ultimately enhance treatment adherence and reduce illness-related costs.
SATURDAY
Abstracts AB35
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2
Assessing Allergy Knowledge in Internal Medicine Residents Brynn Everist, PGY3 Pediatric Resident1, Kim Baumann1, John B. Hagan, MD, FAAAAI2; 1Mayo Clinic, 2Mayo Clinic, Rochester, MN. RATIONALE: At Mayo Clinic, Rochester, Minnesota, the Division of Allergic Diseases hosts second-year internal medicine residents for a oneweek clinical experience. Pre- and post-rotation data was collected to assess the efficacy of the rotation’s curriculum. METHODS: On the first morning of the rotation, residents took a 34question quiz on pre-assigned reading regarding allergic rhinitis and asthma. Following was a half-day of clinical didactics covering venom and drug allergies, and a second quiz of 20 novel questions. The remaining week was spent in allergy clinic. A 35-question quiz covering all topics was given on the final day of the rotation. RESULTS: From July 2006 through June 2012, 275 residents (41.1% female, 58.9% male) completed the rotation and had documented scores for either the first, second, or final quiz; 97.9% of residents completed all three. The median score for the combined pre-rotation tests was 62.9% (Inter Quartile Range 55.6% to 70.4%). The median score for the final exam was 90.6% (IQR 81.2% to 93.8%). A high post-rotation score correlated with a high pre-rotation score, p value <.0001. There was no statistical significance of gender, number of days in clinic, or number of patients seen per day on final exam scores. CONCLUSIONS: A one-week outpatient allergy rotation was associated with an increase in knowledge, defined as positive responses on multiplechoice allergy-related questions. Pre-rotation scores may predict performance on post-rotation evaluations. Further research evaluating the educational needs and goals of internal medicine resident training should lead to the development of optimal allergy-specific clinical rotations for internal medicine residents.
Severe Atopic Dermatitis (SAD) and Quality of Life (QOL) in Children During Background Therapy (BT) Vladislava Derkach, PhD1,2, Tatiana Slavyanskaya, MD, PhD1,3; 1Institute of Immunophysiology, Moscow, Russia, 2Vladivostok State Medical University, Vladivostok, Russia, 3University of Russia, Moscow, Russia. RATIONALE: The study was aimed to estimate QOL in children with SAD during BT. METHODS: We have examined a total of 33 children from 7 to 18 years old with SAD (15 boys and 18 girls) having received BT (antihistamines, membrane stabilizers, enterosorbents, gastrointestinal medications and external local treatment) for 3 months. The QOL level was estimated using Dermatology specific quality of life questionnaire. Patients were interviewed at baseline and three months after BT. RESULTS: SAD symptoms were determined to significantly decrease QOL in children. Patients were mostly affected by pruritus, xerodermia, physical discomfort and sleep disorders. Cumulative value according ‘‘Activities of Daily Living Scale’’ at baseline was 2.5160.05, and 3 months after BT–2.0960.03 (p>0.05). There were significant gender differences in most relevant limitations of daily activities (p<0.001): boys were limited in physical activity and girls – in clothes and cosmetics choice. Social activity was reduced one-half. Disease symptoms kept children from making new acquaintances and limited their social life. Mean ‘‘Selfperception Scale’’ values were similar before and after BT (p>0.05). The most significant factors affecting QOL were mental anguish, confusion due to skin view, annoyance due to appearance, lack of confidence. Parameters of all 5 scales insignificantly improved after 3 months of BT (p>0.05). CONCLUSIONS: SAD strongly affects psychological welfare, physical and social activity in children. BT does not improve QOL in such children. It does not eliminate the underlying cause of allergic inflammation and is generally targeted on pathophysiological factors.
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A Variable Compass: Practice Parameters and Strength of Recommendation Data Taylor A. Banks, MD, Julia Savitz, Michael R. Nelson, MD, PhD, FAAAAI; Walter Reed National Military Medical Center, Bethesda, MD. RATIONALE: Practice parameters and guidelines shape and influence the method and manner in which medicine is practiced. With over 121 scales and methods of assessing and rating evidence, a comparison of practice parameters can appear daunting. An evaluation of the evidence engenders both a sense of the evolution of a specialty and a roadmap for the future. METHODS: We analyzed the practice parameters that guide AllergyImmunology (AI, 15), Otolaryngology (ENT, 8), Pediatrics (Peds, 14), and Internal Medicine (IM, 10), as they appeared on 30 August 2012. The strength of recommendation data were compared after making adjustments for differences in rating scales. RESULTS: The strength of recommendation was calculated for the AI practice parameters using Shekelle, et al’s (British Medical Journal, 1999) format, yielding: A (13.9%), B (24.4%), C (43.2%), D (16.4%), and E (2.1%). Randomized controlled trial evidence (strengths A and B), demonstrated considerable variability amongst individual AI practice parameters (range: 1.3%-100%). Evidence from randomized controlled trials was lower in the subspecialty communities, AI (38.3%), ENT (38.2%) than the primary care fields, Peds (55.6%), IM (86.1%). CONCLUSIONS: Considerable variability exists in the strength of recommendations within the Allergy-Immunology practice parameters. The guidelines created by the primary care fields rest upon a larger base of evidence collected from randomized controlled trials. However, rather than a detriment, this is likely reflective of the specialized nature of fields such as Allergy-Immunology. Furthermore, this analysis highlights the myriad opportunities for future research that are available for AI’s emerging practitioners and researchers.
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A Qualitative Analysis of Health-Related Quality of Life and Treatment Satisfaction Associated with Rapid Push Scig Therapy Joanne Moreau, MD1, Vincent R. Bonagura, MD, FAAAAI2, Eugene Meyer, Psy. D.1; 1Cohen Children’s Medical Center, North Shore-LIJ Health System, Department of Pediatrics, Division of Allergy & Immunology, Great Neck, NY, 2Hofstra, Northshore-LIJ School of Medicine, Great Neck, NY. RATIONALE: Few studies examine health-related quality of life (HRQOL) and treatment satisfaction of patients with Primary Immune Deficiency Diseases (PIDD). Primary measures used previously include the Life Quality Index (LQI) to assess medical treatment satisfaction with intravenous immunoglobulin infusions; and the Medical Outcome Study Short Form-36 (SF-36). No prior studies incorporated the patient perspective of the disease and treatment experience or patient satisfaction in transitioning from weekly subcutaneous (ScIg) infusions to daily, rapid push ScIg therapy. Our data is the only qualitative, patient-oriented evaluation of continued use of these measures in PIDD. METHODS: Two participant arms (Groups A [n59] and B [n56]): Group A consists of patients who have not yet switched to rapid ScIg replacement therapy. They participate in 3 semi-structured, audio taped 60 minute interviews (1 prior to beginning treatment, 1 30 days after switching, and 1 approximately 3 months after initiation). Group B patients were enrolled after having already switched to rapid ScIg and participate in 1 semi-structured, audio taped 60 minute interview. The SF-36 and LQI were completed at each interview. RESULTS: Interview content and select questionnaire data are being summarized by qualitative content analysis. Descriptive statistics are used to summarize questionnaire and interview data. Preliminary data shows that these tools, particularly the SF-36, are too generic for assessing PIDD quality of life, given the complexity of these diseases. CONCLUSIONS: This study should provide improved understanding of PIDD patients’ expectations, experience, treatment satisfaction, and educational needs for rapid ScIg replacement. This may ultimately enhance treatment adherence and reduce illness-related costs.
SATURDAY
Abstracts AB35
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2