Empathy training to improve physician-patient communication skills.
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Communication↗
Biomedical subjects
L Arnold
Publications and source records attributed to L Arnold.
Students' general learning approaches and performances in medical school: a longitudinal study.
PURPOSE: To examine the relationship between students' learning approaches and performances in a baccalaureate--MD degree program over six years, from orientation to the final year. METHOD: At the University of Missouri-Kansas City School of Medicine, the short-form Lancaster Approaches to Studying Inventory was administered to the matriculating classes of 1988 (100 students) and 1989 (102 students) at the beginning of the first and second semesters of years 1 and 2 and during the first semester of years 3 through 6 for the class of 1988 and years 3 through 5 for the class of 1989. Seven learning-approaches dimensions from the inventory were regressed against 16 academic and clinical performance measures. RESULTS: As anticipated, a consistent predictive pattern emerged. Students who scored high on achievement motivation (efficient study habits and an extrinsic need to succeed) but who scored low on reproducing orientation (rote memory) and globetrotting (a fragmented approach to studying) achieved higher grade-point averages in years 1, 2, and 4 than did their counterparts who scored low on achievement motivation and high on reproducing orientation and globetrotting. The utility of the remaining learning-approaches dimensions for performances in specific courses and clinical rotations varied. The data also indicated that the initial level of students' learning approaches is an important qualifier of the predictive capability of the dimensions for students' performances. CONCLUSIONS: The results prompted a revised model of how learning approaches relate to performance. The model incorporates students' initial scores on learning approaches as an element that influences students' perceptions of the educational context. In turn these perceptions have an impact on students' selections of learning approaches that are associated with performance.
Achievement↗
The perinatal evaluation center: a nurse practitioner service delivery model.
Efforts to reduce overall health care costs, improve efficiency and enhance patient and provider satisfaction have stimulated the design and evaluation of new models of practice. The Perinatal Evaluation Center, a nurse practitioner-staffed service providing triage and evaluation for obstetrical patients, was developed to address the competing demands of health care redesign. The service has yielded improved outcomes in measures of efficiency and satisfaction.
Ambulatory Care Facilities↗
Perinatal nurse practitioners and health care reform.
Health care delivery for pregnant women at high risk is changing in response to the nation's need to contain costs and improve care. Perinatal nurse practitioners can provide specialized care to women at high risk in a wide variety of settings. They provide quality, cost-effective care and can improve access to prenatal care for families at risk for untoward pregnancy outcomes.
Curriculum↗
Allogeneic BMT from a donor with fragile X syndrome: cytogenetic and molecular evaluation.
We report the first case of engraftment of bone marrow collected from a donor with Fragile X syndrome with subsequent cytogenetic and molecular evaluation. Engraftment was prompt and stable. Whilst the Fragile X abnormality could be detected initially by molecular techniques in the peripheral blood, it could not be detected cytogenetically while the patient was receiving CsA.
Adult↗
Metabolic effects of alterations in meal frequency in hypercholesterolaemic individuals.
It has been suggested that the metabolic consequences of a given diet may depend in part on the frequency with which meals are eaten. To investigate the effects of meal frequency on plasma lipid metabolism, 16 free-living hypercholesterolaemic men and women consumed their usual diet as 3 or 9 meals/day in random order for 4 weeks. Dietary macronutrient intake and body weight remained similar on the 2 regimens. Fasting plasma lipids were measured after 2, 3 and 4 weeks on each regimen and there were no significant differences in the fasting concentrations of plasma total, LDL, and HDL cholesterol, triglycerides, apolipoprotein A-I and B and the ratio of total: LDL and LDL:HDL cholesterol (HDL-C) on the two diets. The mean (+/- S.D.) fasting total cholesterol was 6.73 +/- 0.74 and 6.81 +/- 0.88 mmol/l on 3 and 9 meals/day, respectively and LDL-C was 4.77 +/- 0.66 and 4.87 +/- 0.78 mmol/l, respectively. There was also no significant variation in the response of plasma triglycerides or serum insulin to a high fat meal following a 3 week adaptation to regimens of 3 and 9 meals/day. Finally the 24 h urinary output of C-peptide was similar on each diet. The consumption of isoenergetic diets as 3 and 9 meals/day did not influence fasting plasma lipid levels, C-peptide excretion or the plasma triglyceride response to a high fat meal of a group of free living hypercholesterolaemic subjects.
Adult↗
Topoisomerase II-dependent novel antitumor compounds merocil and merodantoin induce apoptosis in Daudi cells.
Three photoproducts of merocyanine 540 have been isolated, chemically characterized and synthesized. Two of these photoproducts, merocil and merodantoin, show significant antitumor activity in vitro and in vivo while demonstrating minimal toxicity to normal cells and tissues. Treatment of lymphoma cells with these compounds resulted in a rapid decline in macromolecular synthesis, DNA fragmentation inhibitable by actinomycin D and cycloheximide, and a marked rise in intracellular calcium. In vitro analysis revealed that activity of these compounds is dependent on topoisomerase II. These results are discussed in terms of the novel class of topoisomerase II-dependent compounds for potential use in chemotherapy.
Antineoplastic Agents↗
Medical students' perceptions of stress: gender and ethnic considerations.
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Adaptation, Psychological↗
Major concerns of women after cesarean delivery.
OBJECTIVE: To identify women's major physiologic, psychologic, and life-style concerns at 2 and 8 weeks after cesarean delivery. DESIGN: Descriptive study with open-ended interviews. SETTING: Large urban hospital affiliated with a major university. PARTICIPANTS: One hundred six women who had unplanned cesarean deliveries and delivered live, full-term neonates. The mean maternal age was 28.7 years. MAIN OUTCOME MEASURES: The major physiologic, psychologic, and life-style concerns. RESULTS: Seven women reported no concerns at both data points. The number of physiologic concerns that the women expressed decreased markedly from 2 to 8 weeks postdelivery, but the number of psychologic and life-style concerns did not. CONCLUSIONS: These findings reinforce the need for prenatal teaching and postnatal follow-up regarding these concerns.
Activities of Daily Living↗
A randomized trial of early hospital discharge and home follow-up of women having cesarean birth.
OBJECTIVE: To determine the safety, efficacy, and cost savings of early hospital discharge of women delivered by unplanned cesarean delivery. METHODS: Using randomized assignment, 61 postpartum women were discharged from the hospital at the usual time, and 61 were discharged early and had nurse specialist home follow-up care. The latter group received comprehensive discharge planning, instruction, counseling, home visits, and daily on-call availability from the nurse specialists. Both groups were followed from delivery to 8 weeks postpartum. RESULTS: Women who were discharged early and received transitional home care services by clinical nurse specialists were sent home a mean of 30.3 hours earlier than the control group (P < .001). They had significantly greater satisfaction with care, more of their infants had timely immunizations at the end of follow-up, and they had a 29% reduction in health care charges compared to the control group receiving routine care. Although there were no statistically significant differences in maternal and infant rehospitalizations and acute-care visits, there were more maternal rehospitalizations in the control group than in the nurse specialist-followed group (three versus zero). No statistically significant differences were found between the groups in the outcomes of maternal affect and overall functional status. CONCLUSION: Early hospital discharge of women after unplanned cesarean birth, using the model of nurse specialist transitional home care, is safe, feasible, and cost-effective.
Adult↗
Paranoid psychosis due to neurosarcoidosis.
We present two patients with known sarcoidosis who developed neurosarcoidosis manifested by paranoid psychosis and clinical diabetes insipidus with hypernatremia. Both had gadolinium enhanced magnetic resonance imaging which demonstrated leptomeningeal and hypothalamic enhancement. Both had elevated protein and a lymphocytosis in their cerebrospinal fluid, which improved after corticosteroid therapy. The patients improved clinically with this therapy as well. We suggest that new onset psychosis in a sarcoid patient, particularly with symptoms of hypothalamic/pituitary involvement, should be evaluated for neurosarcoidosis with an MRI and CSF examination. If the results are consistent with neurosarcoidosis, the patient should be treated promptly with corticosteroids.
Adult↗
Proton NMR studies of manganese ion binding to tRNA-derived acceptor arm duplexes.
Several RNA duplexes corresponding to the acceptor arms of different tRNAs have been analyzed with respect to their divalent metal ion binding capability by means of proton NMR spectroscopy using paramagnetic Mn2+ ions as probes. In particular, the role of GU wobble base pairs has been analyzed with reference to their potential for creating metal ion binding sites. It is shown that both the structural modifications induced by GU pairs in the A-RNA geometry and the sequence context seem to affect the metal ion binding capabilities.
Base Sequence↗
M13 and pUC vectors with new unique restriction sites for cloning.
Several vectors based on the widely used phage M13 and plasmid pUC were constructed. The vectors contain polylinkers (MCS) for DNA insertions with several new restriction sites (e.g., ApaI, NotI, StuI, SacII). Moreover, the NarI site in the nonessential part of the vector molecule was changed into a BssHII site, so that the NarI site in the MCS became unique.
Amino Acid Sequence↗
Inhibition of potato spindle tuber viroid (PSTVd) infection with DNA oligonucleotides.
The effects of DNA oligonucleotides complementary to potato spindle tuber viroid (PSTVd) on viroid infection were investigated. The oligonucleotides were used to form hybrids with PSTVd in the infection mixture. A 75% reduction of viroid infection was found when an oligonucleotide complementary to nucleotides 79-110 of PSTVd was hybridized with PSTVd at a molar ratio of approximately 5000:1, respectively. A total inhibition of PSTVd infection was observed using an oligonucleotide complementary to nucleotides 42-78 at the same molar excess of DNA over PSTVd, although a 200-fold molar excess was found to be sufficient for the complete blocking of infection by PSTVd. This oligonucleotide caused a significant reduction (about 83%) of viroid infection even if the hybridization was done at a low (30 degrees C) temperature. Shorter oligonucleotides containing 22 and 15 bases corresponding to position 42-62 and 63-78, respectively, exhibited a significant effect only at a high (80 degrees C) initial temperature of molecular hybridization. Heteroduplexes formed between PSTVd RNA and antisense DNA were found to be less stable in a crude nuclease extract from tomato leaves as compared with PSTVd RNA alone. RNase H was demonstrated to cleave the molecular hybrids in vitro.
Base Sequence↗
A view of medical practice in 2020 and its implications for medical school admission.
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Clinical Medicine↗
The empirical association between student and resident physician performances.
To further the understanding of the relationship between performances in a combined baccalaureate-MD degree program and in residency, the authors subjected their database of 298 study participants from the 1980-1983 entering classes of the University of Missouri-Kansas City School of Medicine to factor analysis and then to distribution-free statistical analyses. Distinct factors were identified among the performance measures from the combined-degree program; only one factor was identified among the measures of residency performance. Analysis of the relationship of performances in the combined-degree program and in residency indicated that almost half of the participants were in the same performance categories as students and as residents. The strongest association emerged between a clinical performance factor derived from performances in the combined-degree program and the residency clinical performance factor. However, the knowledge factor derived from performance measures in the combined-degree program was also associated with residency clinical performance. The associations were statistically significant but of limited strength; thus the present results resemble those of other investigators, despite the fact that they are based on distribution-free statistics and on purportedly cleaner and more homogeneous measures of performance. Various technical reasons may have caused this lack of strength, but it is also possible that empirical relationships between undergraduate and postgraduate performances are inherently limited because the performances expected of residents may not be mere extensions of those expected of medical students.
Achievement↗
Milk bank screening procedures.
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Female↗
Curricular integration at the University of Missouri-Kansas City School of Medicine.
In its combined Baccalaureate-M.D. degree program, the University of Missouri-Kansas City School of Medicine endeavors to foster interdisciplinary integration by intertwining the humanities, clinical medicine, and basic sciences throughout the curriculum. Analysis over 6 years (1986-1991) of 547 students' scores on comprehensive examinations and ratings of 464 to 478 graduates' clinical abilities suggest that the integrative elements of the curriculum have a counterpart in performance. Such experience would recommend possible steps to encourage interdisciplinary integration at other schools: allow students to acquire disciplinary understandings but offer early clinical exposure for context and relevance, arrange productive repetition of material, pair more with less advanced students for integrated learning, and choose faculty who model integration and expect students to do so.
Adult↗