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Biomedical subjects

G C Xakellis

Publications and source records attributed to G C Xakellis.

At least 19 recordsLinked to original sources
PubMed1998

Unique learning contributions of a family medicine preceptorship.

BACKGROUND: There is a belief among family medicine educators that a third-year family medicine rotation provides unique clinical learning experiences, but there is limited research to support this belief. This study identified clinical skills performed by third-year medical students only during a community-based family medicine preceptorship, even when the family medicine rotation occurs after all other required clerkships. METHODS: During 6 academic years (1990-1996), 87 third-year students completed the family medicine preceptorship as their final rotation and rated their experience with 80 clinical activities (preventive health care, clinical problem management, and procedures) after completing all required clerkships other than family medicine and again after the family medicine preceptorship. Ratings measured whether the activities occurred on the family medicine rotation, only on other rotations, or combinations of both. RESULTS: More than 50% of students who performed five preventive skills (health maintenance for adolescents, young adults, middle-aged adults, or senior citizens and weight control counseling) gained that experience only during the family medicine preceptorship. The majority of students actively managed six clinical problems (acute strains and sprains, low back pain, sinusitis, strep throat, acute bronchitis, and osteoarthritis) uniquely during the family medicine preceptorship. The preceptorship offered few unique opportunities to perform procedures. CONCLUSIONS: This family medicine educational experience was not merely a repeat of what is experienced on the traditional major rotations. The family medicine preceptorship provided a setting where students were able to perform several important ambulatory, primary care skills they had not performed during their core curriculum of traditional third-year rotations.

Clinical Competence↗
PubMed1997

Skills actively performed during a family medicine community-based preceptorship.

BACKGROUND: This study assessed the clinical learning experiences provided to third-year medical students during a 2-week, required, community-based family medicine preceptorship. METHODS: After completing the preceptorship, students classified their level of performance on 80 clinical activities. During 3 academic years, 486 third-year students completed the preceptorship. RESULTS: Delivery of well-child care was the only prevention skill in which a high percentage of students (more than 67%) received experience; students received moderate experience (34%-67% of students) with another seven prevention skills. Students received a high level of active experience with four clinical problems--upper respiratory tract infection, acute otitis media, sinusitis, and strep throat--and a moderate level of active experience on another 17 clinical problems. There were no procedural skills on which students received a high level of experience, but students received a moderate level of experience with 10 procedural skills. CONCLUSIONS: This brief family medicine preceptorship provided a clinical setting in which students actively engaged in several facets of ambulatory primary care. For accountability, programs need to more clearly articulate what exposure is to be gained in each clinical rotation, strive to enhance active practice, and document levels of student performance.

Clinical Competence↗
PubMed1997

Quality assurance programs for pressure ulcers.

Traditional medical quality assurance programs are beginning to incorporate the principles of continuous quality improvement pioneered by Juran and Deming. Strategies for incorporating these principles into a long-term care facility are described, and two examples of successful implementation of continuous quality improvement programs for pressure ulcers are presented.

Cost-Benefit Analysis↗
PubMed1997

Pressure ulcer healing: what is it? What influences it? How is it measured?

Defining healing requires a set of measurements that quantify the physical factors that change during healing. Such a list of measures gives a de facto definition of what constitutes pressure ulcer healing and what influences it. This paper attempts to answer a more specific question: Which measurements are strong candidates for inclusion in a tool for monitoring pressure ulcer healing? Three sets of clinical measurements are analyzed--the assessment proposed by the Agency for Health Care Policy and Research Guideline Development Panel for the Treatment of Pressure Ulcers; the recommendations of the Wound Healing Society; and the Pressure Sore Status Tool. The validity of the 11 clinical measures common across these assessment methods is examined using empiric evidence from studies of wound healing.

Anthropometry↗
PubMed1996

A break-even analysis of optimum faculty assignment for ambulatory primary care training.

BACKGROUND: The increased demand that faculty teach residents in ambulatory clinics necessitates the development of ambulatory care teaching models that are both educationally effective and financially viable. This study was designed to identify the resident-to-faculty ratios needed to provide financially viable faculty supervision of residents while maintaining acceptable resident waiting times for teaching. METHOD: A computer simulation was developed to estimate the number of residents one or two faculty teachers could supervise in a university-based primary care teaching clinic. The number of residents was calculated for three waiting-time constraints and three scenarios of faculty tasks. A financial analysis of each model was performed. RESULTS: With no non-teaching tasks, two teachers were able to supervise 11 residents and keep waiting times under two minutes, while one teacher was able to supervise only three residents with this waiting-time constraint. The financial break-even point was achieved by all of the two-teacher models, but by none of the one-teacher models. CONCLUSION: In all three scenarios, using two teachers resulted in more than double the number of residents supervised and in higher utilization of faculty time (higher productivity) than did using one teacher. The two-teacher models of ambulatory supervision allowed for sufficient numbers of residents to be supervised so that teaching costs could be covered from patient care revenues; the one-teacher models did not break even financially. These simulations offer a viable option for academic institutions that are struggling to maintain teaching quality in the face of financial constraints.

Ambulatory Care↗
PubMed1995

Ambulatory medical education: teachers' activities, teaching cost, and residents' satisfaction.

PURPOSE: To assess faculty activities and costs in supervising ambulatory patient care at a family practice clinic, and to assess resident satisfaction with access to ambulatory care teaching. METHOD: This time-and-motion study was conducted in 1993 over two three-week periods (at the end of one academic year and at the beginning of another) in a family practice clinic affiliated with the University of Iowa College of Medicine. Observers recorded time spent by 14 faculty on teaching and non-teaching activities. Thirty-two residents were surveyed about their satisfaction with access to teaching. RESULTS: Over 59 half-days, 2,644 faculty service events were recorded; 47% were teaching events (supervising care delivered by residents) and 53% were non-teaching events (providing care for other clinic patients). Mean teaching time was greater for first-year residents; they consulted faculty more frequently and required more teaching time per consultation. The most common non-teaching activities were telephone calls out, telephone calls in, and inquiries from nurses and office staff. Ten percent of non-teaching activities interrupted teaching, and 17% of the residents reported their teaching had been interrupted. Eighty percent of the residents were satisfied with their access to teaching, but 12% reported they had had to postpone discussing pressing patient problems. Resident dissatisfaction correlated with longer perceived waiting time, interruption of teaching, and faculty inaccessibility. CONCLUSION: Faculty should plan to spend two to three times longer to teach lower-level residents than upper-level residents. By delegating some non-teaching activities to other personnel, faculty can reduce teaching costs and increase resident satisfaction.

Ambulatory Care↗
PubMed1995

Cost of pressure ulcer prevention in long-term care.

OBJECTIVE: To describe the total cost of pressure ulcer prevention, component costs of each intervention, and the relationship of costs to subjects' risk level. DESIGN: 3-month cohort trial. SETTING: A 600-bed, state-supported, long-term care facility. PATIENTS: A total of 539 war veterans, 83% of whom were male; mean age was 73 years. MAIN OUTCOME MEASURES: Cost to facility for using each of four preventive interventions: turning, pressure-reducing mattresses, chair cushions, miscellaneous preventive devices. RESULTS: Sixty-eight percent of subjects received a preventive intervention. Total 3-month facility cost of prevention was $132,114, and 97% of the cost was consumed by 30% of the subjects. Turning was the most expensive component, accounting for $99,567. The daily cost of turning for subjects who received it was $8.83 +/- 1.66. Cost increased with subject risk level. Low cost devices were instituted for lower risk subjects, whereas high cost interventions (turning) were reserved for the highest risk subjects. CONCLUSIONS: This long-term care facility expended substantial resources on prevention, and most resources (97%) were expended on less than half (30%) of subjects. Turning was, by far, the most expensive intervention, and the nursing staff reserved it for highest risk subjects. Strategies that substitute moderately priced mattresses for frequent turning may decrease the cost of prevention, as long as mattress cost is less than the daily turning costs it replaces. Future research to define the optimum combinations of preventive interventions for patients of various risk levels is needed.

Aged↗
PubMed1993

Dermal blood flow response to constant pressure in healthy older and younger subjects.

This study compared the dermal blood flow response to low levels of compressive pressure in healthy older and younger subjects. Dermal blood flow was measured over the left trochanter of 19 younger (21-45 yrs) and 22 older (> or = 60 yrs) subjects using a laser-Doppler velocitometer. Interface pressure, baseline flow, and flow during 60 minutes of left-side lying on an air mattress were measured. Baseline dermal blood flow did not differ significantly between the older and younger groups. Both groups showed a significant increase in blood flow over time during the 60 minutes of compression. The change in dermal blood flow over time was not significantly different between the two groups. This study demonstrated that healthy persons, regardless of their age, exhibited an increase in dermal blood flow over time at low levels of compressive pressure.

Adult↗
PubMed1993

The effects of prolonged pressure on skin blood flow in elderly patients at risk for pressure ulcers.

Although the physiological effects of pressure on tissue have been demonstrated in the animal model, little is known about its effect in ill, elderly patients who are at risk for pressure ulcers. This study describes the pattern of dermal blood flow during a period of constant, low-level, compressive pressure in this population of patients. Dermal blood flow was measured over the trochanter of 16 elderly (> 60 years) subjects who were defined as at risk for pressure ulcer development by the Braden Scale for Predicting Pressure Ulcer Risk. Using a laser-Doppler velocitometer, blood flow at baseline and during 60 minutes of left-side lying on an air mattress were measured. Mean blood flow at baseline was 0.79 (SD 0.43). Following 60 minutes of compressive pressure, mean blood flow was 0.65 (SD 0.87). Blood flow tracings during the 60-minute period of continuous, compressive pressure revealed an inconsistent pattern of response; the flow increased, decreased, or showed no change. This distribution of responses suggests that significantly more variability in blood flow response exist in at-risk individuals than was previously believed.

Age Factors↗
PubMed1992

A comparison of patient risk for pressure ulcer development with nursing use of preventive interventions.

OBJECTIVE: (1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention. DESIGN: Cross-sectional study. SETTING: Six hundred-bed, state-supported, long-term care facility. PATIENTS: War veterans who were 82% male and 97% caucasian, mean age 73. MEASUREMENTS: (1) Patients were categorized as at-risk or not-at-risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at-risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependent variable. RESULTS: Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at-risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at-risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention. CONCLUSIONS: The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment.

Aged↗
PubMed1992

Hydrocolloid versus saline-gauze dressings in treating pressure ulcers: a cost-effectiveness analysis.

The cost effectiveness of using hydrocolloid dressings versus nonsterile saline-gauze wet-to-moist dressings for treatment of pressure ulcers in a long-term care setting was evaluated. During 21 months, 39 subjects were enrolled, and treatment was randomly assigned. Eighty-nine percent of the hydrocolloid subjects and 86% of the saline-gauze subjects healed. Median healing time was shorter for the hydrocolloid group (nine days) than for the saline-gauze group (11 days), although the difference did not reach statistical significance (p = .12). Presence of exudate at baseline was associated with a prolonged time to healing. For the hydrocolloid treatment, the median nursing time was one eighth that of the saline-gauze treatment, but its materials cost was 3.3 times higher. Using local nursing wages, median total cost for treatment with hydrocolloid dressing was $15.58; for the saline gauze, it was $22.65. Using national nursing wages, these costs were $15.90 and $25.31, respectively. The cost savings of the hydrocolloid treatment using local wages did not reach statistical significance. However, using national wages, the cost of the hydrocolloid treatment was significantly less expensive. Nursing home treatment of pressure ulcers was inexpensive overall. Consequently, the absolute cost savings of using hydrocolloid dressings instead of nonsterile saline-gauze dressing, although real, was relatively modest. Physicians can use local nursing wages to calculate the magnitude of savings in their area.

Aged↗
PubMed1992

Expectations and satisfaction of runners with injury treatments.

Seventy-eight runners competing in three Iowa races were surveyed concerning their most recent running injury for which they sought medical care from a family physician, an orthopedic surgeon, or a podiatrist. Their reasons for choosing a doctor, expectations of care, and satisfaction with treatment received were assessed. Most patients selected the orthopedic (50%) or podiatric (42%) physicians upon the recommendation of other runners; only 13% of the family physicians were selected from recommendations. Orthopedic and podiatric patients were more likely than family physician patients to expect x-rays. There was no difference in overall patient satisfaction with treatment received from the three groups of physicians. The runners felt that all physician groups treated their running injuries equally well.

Athletic Injuries↗
PubMed1991

A comparison of changes in the transcutaneous oxygen tension and capillary blood flow in the skin with increasing compressive weights.

Two measures are being advocated to evaluate physiologic changes associated with compression of skin: transcutaneous oxygen tension (tcO2) and laser-Doppler blood flow. This study asked: 1) What changes occur in tcO2 and laser-Doppler blood flow with increasing compressive weight; and 2) do these measures respond differently to increasing weight? An indenter was used to apply incremental weight to the trochanter of healthy volunteers. During the first session, tcO2 was measured, and laser-Doppler blood flow was measured during the second session. The mean values of tcO2 and laser-Doppler blood flow were analyzed for significant changes over the range of applied weight. If significant change occurred, the polynomial that best described the data was determined. Mean values for tcO2 showed a significant decrease with increasing compressive weight. Its decrease was described by a second degree polynomial (quadratic). The weight that resulted in the tcO2 reaching zero for individual subjects ranged from 400-1000. Mean values for laser-Doppler blood flow showed a significant decrease with increased weight. The decrease was best described by a first degree polynomial (line), which is a different pattern from the tcO2. Laser-Doppler blood flow continued to decline with increasing weight beyond the point where tcO2 reached zero. During low-flow states, tissue oxygen utilization may exceed oxygen delivery and lead to ischemia even though capillary closure has not occurred.

Adult↗