Search PubMed⌕ Search

Biomedical subjects

D Diserens

Publications and source records attributed to D Diserens.

9 recordsLinked to original sources
PubMed1986

Measuring the problem-solving ability of students and residents by microcomputer.

Potential uses for microcomputers in medical education include evaluation of students and residents. A computer program developed at the University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia presents simulated patient cases and then scores participants' clinical problem-solving in the cases by comparing their performances with those of five faculty members. In the study reported here, the authors investigated the validity and reliability of this evaluation system. Total scores were significantly different among faculty members, residents, and third-year students on only the most difficult of the three cases included in the study. Performance was not related to the user's general analytic ability or to locus of control. This result suggested there is not a "type" of person who is better at medical problem-solving on a microcomputer. A prophecy formula was used to determine that nine cases would be needed to achieve an adequate level of reliability in measuring the ability of a student or a resident. Implications of selecting a battery of cases for the system are discussed.

Clinical Competence↗
PubMedDate not supplied

Integrating occupational health into the medicine clerkship using problem-based learning.

OBJECTIVE: To improve medical students' ability and willingness to obtain occupational histories from their patients. PARTICIPANTS: General medicine faculty and internal medicine teaching residents, who participated as instructors, and medical students during their required internal medicine clerkships. SETTING: The primary teaching hospitals of two medical schools. DESIGN: During alternate months, students participated in problem-based sessions that included occupational health objectives (intervention) or attended the standard small-group didactic sessions (control). Process evaluations were collected from students and faculty in the intervention group following each session. Outcome evaluation was performed using chart audit and multiple-choice testing to compare the intervention and control groups. INTERVENTION: Intervention students participated in at least one problem-based session incorporating occupational aspects of disease into clinical internal medicine. Instructors received information packets and materials but had no other expertise in occupational medicine. MEASUREMENTS AND MAIN RESULTS: The great majority of ratings on the process evaluations showed that the students were "moderately" to "extremely" interested in the session attended. No student rated any session to be a "waste of time," and over 90% of students would recommend the session being evaluated to a friend. Chart audit showed that students in the intervention group recorded slightly more occupational information than did those in the control group (an average of 2.97 vs. 2.37 pieces of information, p = 0.06). When the most commonly documented data (employment status and job title) were ignored, the difference between group means (1.1 vs. 0.91) was significant (p = 0.03), suggesting that intervention students were more likely to probe further into a patient's occupational history. Both groups of students collected less occupational information from women than from men (t = 3.22, p = 0.0035). Multiple-choice tests revealed no difference between the two groups in overall medical knowledge or occupational medicine knowledge. CONCLUSIONS: Problem-based learning with specific occupational content is well accepted by students and modestly improves their occupational history taking.

Clinical Clerkship↗
PubMedDate not supplied

Integrating residency training in geriatrics into existing outpatient curricula.

In recent years, the need for increasing the geriatrics component of residency training has been repeatedly addressed; however, there are still many programs that have been unable to meet this need. While alternative sites, such as geriatric evaluation units and nursing homes, may be the ideal sites to teach some aspects of geriatrics, this article argues that the ambulatory care program, required in all residency programs, is the appropriate setting for teaching many of the core skills needed to care for most older adults. Teaching geriatrics in the ambulatory setting, which eliminates the strategic and financial obstacles of developing non-hospital-based sites, can be accomplished with relatively modest additional resources. This article describes the methods used to integrate geriatrics into the ambulatory care component of one internal medicine residency program and the necessary faculty resources as well as the documentation, via chart audit, of the interns' compliance with recommended practice patterns in five categories. With the exception of vaccination status, interns documented 18% or less of possible pieces of information for their patients. While this assessment showed statistically significant improvement in interns' care of older patients after the program intervention, the overall level of performance was still low, underscoring the need for the integration of geriatrics principles in the ambulatory curriculum.

Ambulatory Care↗
PubMedDate not supplied

Anemia of chronic renal failure in dogs.

Seventeen dogs with chronic renal failure (CRF) were studied to evaluate the incidence, type, and etiology of anemia in CRF. A nonregenerative, normochromic, normocytic anemia was seen in 12 of 17 dogs (70.6%). There was a direct correlation between the degree of anemia and the extent of CRF as assessed by serum creatinine concentrations (P = .0386, r = .50923). Erythrocyte concentrations of 2,3-diphosphoglycerate (DPG) were significantly increased in anemic animals and showed a close correlation to the degree of anemia. The high DPG concentrations may compensate for the anemia by decreasing the hemoglobin-oxygen affinity and thereby facilitating tissue oxygenation at low hematocrits. Serum concentrations of erythropoietin (Epo) were in the low to normal range, despite mild to moderate anemia, documenting a deficiency of Epo in dogs with CRF. The nonregenerative nature of the anemia supports impaired hematopoiesis as a significant etiologic factor. Other factors, such as increases in serum parathyroid hormone and phosphorus, were not found to correlate significantly with the degree of anemia, although there were significant differences between their concentrations in anemic compared with non-anemic dogs. There was no change in erythrocyte osmotic fragility with uremia. The documentation of a nonregenerative, normochromic, normocytic anemia, with failure of an appropriate increase in Epo production, supports the therapeutic use of Epo in the management of the anemia seen in CRF in the dog.

2,3-Diphosphoglycerate↗
PubMedDate not supplied

Preventive care for the elderly.

While prevention has received a great deal of attention in the medical community in the last 15 to 20 years, little of this research or clinical activity has been addressed directly to the elderly population. Today, with an increasing emphasis on geriatric care, there is a rising awareness that clinicians' preventive efforts on behalf of the elderly can yield important benefits not only for individuals, by improving their quality of life, but also for society through potential cost savings. This chapter describes the effects of prevention strategies for the elderly.

Aged↗