A back-to-work strategy can protect your benefits.
Explore the source record for details and available documents.
California↗
Biomedical subjects
P Curtis
Publications and source records attributed to P Curtis.
Putting your life and finances back together.
Explore the source record for details and available documents.
HIV Infections↗
Does training location influence the clinical skills of medical students?
PURPOSE: To examine the benefits of the shift of medical education into ambulatory primary care settings by investigating whether medical students exposed to a common primary care problem (low back pain) in ambulatory care settings develop better clinical skills. METHOD: In 1995, the authors categorized 420 students from all four North-Carolina medical schools into groups that had previously encountered patients with low back pain in ambulatory primary care settings, tertiary care settings, both, or neither. The clinical skills of the groups were determined using data collected during standardized-patient examination in which students took the history of, physically examined, and chose a diagnostic strategy for patients with acute, uncomplicated low back pain. RESULTS: In general, there was no difference between the performances of the student groups associated with the settings of their previous encounters with low back pain. On average, the students failed to ask 35% of the history items and failed to perform 35% of the physical examination items. Many students chose inappropriate diagnostic strategies. CONCLUSION: The lack of difference between the groups' clinical performances indicates a need to more rigorously define and evaluate outcomes of education in ambulatory care settings. The generally poor clinical performance of all groups suggests that the current curriculum inadequately teaches clinical skills needed to assess and manage common problems. Clearer expectations of competencies and assurances that preceptors in ambulatory care settings will help students meet those learning objectives might lead to better outcomes.
Ambulatory Care↗
Counting the cost of an NRSA Primary Care Research Fellowship Program.
BACKGROUND AND OBJECTIVES: Concerns are often raised about the potential financial and logistical burdens that fellows (even those who receive federal funding) add to departmental budgets. METHODS: We collected data on patient care income, financial values of teaching, on-call and attending duties, and departmental costs for patient care overhead, administration, and supervision over a 1-year period for six fellows in the National Research Service Award (NRSA) Primary Care Research Fellowship Program at the University of North Carolina at Chapel Hill. RESULTS: Net receipts for clinical services ranged from $4,023 to $15,742, which, when adjusted for overhead costs, led to financial loss. However, assuming an academic dollar value of $15/hour, teaching, precepting, and on-call coverage were worth from $3,330 to $9,780 to a department, depending on level and specialty of the fellow. Overall, NRSA fellows imposed a financial burden consisting of practice-related costs and uncompensated faculty supervision and administration. Three factors can modify the estimate of this burden, including the calculation of patient care overhead, the estimated value of academic work, and whether fellows provide "replacement" or "additive" clinical functions to their departments. CONCLUSIONS: The NRSA Fellowship Training Program can be a cost-neutral but valuable resource for developing highly trained primary care researchers and new faculty. Increased administrative funding for these programs would be a low-cost strategy to compensate faculty time and program management in generalist departments.
Costs and Cost Analysis↗
A model system for detection and isolation of a tumor cell surface antigen using antibody phage display.
To establish a screening procedure for tumor cell-surface reactive Fabs, we used a model antigen/antibody system including the epidermal growth factor receptor (EGF-R) and the anti-EGF-R monoclonal antibody 425. The 425 Fab was displayed on the surface of M13 filamentous phage. In a screening assay for 425 phage binding to tumor cell surfaces, biotinylated 425-phage bound specifically to EGF-R-positive A431 epidermoid carcinoma cells and not to K562 non-expressor erythroleukemia cells. With a model library, the sensitivity of phage enrichment by phage binding to cell surfaces was one 425-phage in 20,000 unrelated phages after 4 rounds of panning on A431 cells. In a phage tissue screening assay, 425-phage, but not unrelated phage, bound specifically to melanoma cells expressing EGF-R. Epitope and idiotope specificity of 425-phage was demonstrated in phage competition assays, using as targets A431 cells and anti-idiotypic antibodies to monoclonal antibody 425, respectively. Finally, the EGF-R protein was directly isolated from A431 cell extracts, using biotinylated 425-phage. The data obtained with the 425 model library system demonstrate the usefulness of antibody phage display for the rapid identification and isolation of tumor or other disease-related cell surface antigens.
Adenocarcinoma↗
Having a baby: some disabled women's reproductive experiences.
OBJECTIVE: To explore some of the social barriers disabled women face when they think about having a child, become pregnant, come into contact with the maternity and related services, and become mothers. DESIGN: A qualitative study involving in-depth semi-structured interviews with 17 disabled women. This was a follow-up study associated with a large health authority commissioned survey on the 'maternity preferences' of women of childbearing age resident in one city. SETTING: One city in the north of England. Fifteen of the women were interviewed in their own homes and two were interviewed in their workplaces. PARTICIPANTS: The women who were interviewed had a wide range of impairments, and were at different stages in their reproductive journeys. FINDINGS: We report on three important themes which emerged through the analysis of the interview transcripts: issues of poor 'access' within the maternity services; inadequately met information needs; and the experience of receiving inadequate or inappropriate 'help' from health professionals and social care workers. KEY CONCLUSIONS: The study provides support for the claims made in Changing Childbirth (Department of Health 1993) that professional practice and other features of maternity services can place barriers in the paths of disabled women. IMPLICATIONS FOR PRACTICE: Midwives should respect the right of disabled women to be self-determining, for example, by first asking disabled women what their needs are and how assistance, if desired, can best be given.
Adaptation, Psychological↗
Pachydermoperiostosis in childhood.
We report a family with pachydermoperiostosis (idiopathic hypertrophic osteoarthropathy) spanning four generations with 10 affected individuals, four of whom are children although pachydermoperiostosis is rare in childhood. In this family, with intermarriage, the inheritance is autosomal recessive and it is possible that there are individuals who are homozygous for the pachydermoperiostosis gene. These individuals do not appear to be more severely affected, although one of them had a cleft palate and congenital heart defect which may be a manifestation of being homozygous.
Asthma↗
The educational value of an OSCE in a family practice residency.
PURPOSE: To assess the educational value of an objective structured clinical examination (OSCE) administered in three consecutive years (1992-93 to 1994-95) to first-year residents in a family practice residency. METHOD: Each year an OSCE was administered early in a family practice residency based at the University of North Carolina at Chapel Hill School of Medicine. The OSCE encompassed eight to ten stations, each 15 minutes long: ten minutes for tasks and five minutes for feedback. After the OSCE, focus groups with participating faculty and residents assessed the strengths and weakness of specific stations as well as the overall OSCE structure. Each year the residents' OSCE scores were correlated with their scores on the American Board of Family Physicians In-Training Examination (ITE). Pearson product--moment correlation coefficients were calculated for both the composite ITE scores and the clinical set problem scores. Test reliability was measured by Cronbach's alpha. In the spring of 1995 the faculty completed global evaluations of all the residents in the program at the time, including 16 of the 17 residents who had participated in the OSCEs. The faculty rated the residents in four areas, and a four-point scale was based on the percentile ranges a resident's rating could fall into for each area. Correlation coefficients were calculated for the OSCE scores and the faculty's perceptions of the residents' overall performance. RESULTS: The OSCE scores correlated significantly with the faculty's global assessments of knowledge and clinical skills, but not with in-training examination scores. Concurrent validity and reliability estimates did not support using an OSCE for decisions about the residents' competency. The faculty valued the opportunity to observe basic skills for the whole group of residents; the residents found the experience educational but stressful and valued the immediate performance feedback included at each station. CONCLUSION: The OSCE is a useful tool for teaching basic clinical skills and for forming initial impressions of interns' clinical styles and abilities, but it should be used with caution for summative assessments.
Educational Measurement↗
Collegial networking and faculty vitality.
BACKGROUND: This research explored the relationship between collegial networking and faculty "vitality" among graduates of the family medicine faculty development fellowship at the University of North Carolina at Chapel Hill. Faculty vitality was defined by retention in full-time teaching, job satisfaction, academic activity, and contributions to the discipline. METHODS: A questionnaire was mailed to 170 family physician graduates of the 1980-1992 fellowship classes. After a mail and telephone follow-up, the response rate was 85%. Data were collected on career history, professional interests, professional relationships, assessment of fellowship, and professional activities. RESULTS: Respondents with collegial networks were more likely to participate in several academic activities and were more likely to remain in full-time teaching. No association was found between collegial networks and satisfaction or contributions to the discipline. There were only small differences in effect between intra-departmental and extra-departmental collegial networks. Stratification by program type and gender revealed no evidence of effect modification or confounding. CONCLUSIONS: Collegial networks influence some aspects of faculty vitality, particularly retention in full-time teaching. Further research is needed to fully understand its impact.
Communication↗
Medical school culture and generalist education: perceptions of a medical school faculty.
BACKGROUND AND OBJECTIVES: As part of an initiative to promote the education of generalist physicians at the University of North Carolina, a series of meetings were held over a 12-month period between generalist senior faculty and faculty from a range of departments in the School of Medicine and other health professions schools. Through open discussion about generalist initiatives, we hoped to understand their issues, attitudes, and opinions regarding generalists and generalist education. The major themes arising from these dialogues were 1) uncertainty about the definition of the generalist physician, 2) beliefs about the poor clinical reputations of generalists, 3) lack of a scientific basis for generalist practice, and 4) beliefs that few new resources are needed to undertake and expand generalist education. We comment on the validity and possible reasons for these perceptions and suggest strategies that can enhance generalist culture in the medical school.
Attitude of Health Personnel↗
Prevalence of subtypes of low back pain in a defined population.
BACKGROUND: For two generations, some back care specialists have emphasized that clinical low back pain is composed of a number of specific syndromes, such as sacroiliitis or trigger points, but the prevalence of these syndromes outside of specialized clinics remains unknown. The purpose of this study was to describe the prevalence of subtypes of low back pain in a defined population. METHODS: The setting was a group model HMO with a population of 54,000. We used a formal group process involving clinicians from many disciplines, long interviews, critical appraisal of the literature, case discussions, and clinical audits to define a set of subtypes of low back pain. Trained physical therapists assessed subtypes in all patients referred for low back pain over a 9-month period, from July 1992 to April 1993. RESULTS: Of the 213 patients evaluated for low back pain, 72% had acute pain (< 3 months) and only 15% had work-related injury. After classification into subtypes, 32% had acute low back strain, 28% had radicular syndromes, 14% had chronic back strain, 10% had sacroiliac syndromes, 6% had posterior facet syndrome, and the remaining 10% included 12 different syndromes. Only about 10% had more than one clinical syndrome. CONCLUSIONS: A limited number of subtypes of low back pain make up the vast majority of low back pain seen in the population at large. Attention to subtypes may provide a way to improve primary care management of low back pain.
Adolescent↗
Clinical veterinary philosophy.
Explore the source record for details and available documents.
Humans↗
The quality of cervical cancer screening: a primary care perspective.
The bulk of cervical cancer screening is performed by primary care providers; mostly nurses and physicians. The literature regarding the quality of this screening is largely described from three perspectives; clinical, laboratory, and public health. This article describes the primary care perspective regarding issues of quality in cervical cancer screening and suggests areas for improvement. The authors discuss how effectiveness of the test, sampling methods, interpretation by the laboratory, and reporting results impact on the quality of cervical cancer screening. Other factors which influence the quality of screening such as access to care, recall intervals, communication with the patient, costs of testing, and organizational issues are also reviewed.
Communication↗
Consent form readability in university-sponsored research.
BACKGROUND: Consent forms are required in most biomedical research involving human subjects. In recent years, a number of studies from different disciplines have reported problems related to consent form readability. METHODS: We analyzed 284 consent forms submitted to and approved by five institutional review boards (IRBs) (schools of Medicine, Nursing, Academic Affairs, Dentistry, and Public Health) at one university and one IRB at another. We examined consent form readability scores and factors that might relate to readability. RESULTS: The average reading level of all consent forms was high: 12.2, which corresponds roughly to a 12th-grade reading level. Less than 10% of all consent forms were written at a 10th grade reading level or below. Thirty-two percent of all consent forms had no evidence of revisions, and less than 2% of consent forms were revised more than once. Readability scores were not related to consent form revisions, the type of IRB, the year of study, or the university where the research was conducted. CONCLUSIONS: Poor readability of consent forms probably occurs in all university-related research. We recommend that IRBs require readability checks for research consent forms before researchers submit their proposals to an IRB.
Comprehension↗
Sex and sexuality.
Midwives' clinical focus on contraception may not be the only way of meeting women's needs after childbirth. When a woman does not return to full sexual function, the explanations available to her tend to emphasise natural/biological, physical and psychological factors. These explanations may fall short of describing the experiences of many women. Midwives need to facilitate opportunities for women to raise issues and concerns significant to them so that women may explore changes in their experience of their own sexuality. To help women to anticipate changes in their lives after childbirth more fully, midwives need to facilitate discussion of sexuality--not just sexual activity--during antenatal preparation and postnatally.
Female↗
Effect of maternal age on clinical outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET).
The purpose of this study was to assess the effect of age of IVF success in women undergoing in vitro fertilization and embryo transfer by comparing IVF outcome in two groups of patients: group 1-age < or = 35 years old and group 2-age > 35 years old. This retrospective study covered a one year period between January 1991-December 1991 and included 230 patients with 634 treatment cycles. The patients' mean age was 32 +/- 1.9 (range 20-38 years old). Inclusion criteria for treatment of patients with IVF-ET included patients with tubal disease and non-tubal disease who have failed conventional treatments. The majority of patients had infertility from tubal damage, unexplained infertility, and male infertility. This study showed that all pregnancy rates, ongoing pregnancy rates and implantation rates were found to be higher in the < or = 35 year old group. The pregnancy rate per ET, ongoing pregnancy rate and implantation rate were found to be 35.17, 27.58, 16.53 per cent respectively; while in the > 35 year old group, the pregnancy rate per ET, ongoing pregnancy rate, implantation rate were found to be only 17.93, 11.03, 8.07 per cent respectively. The miscarriage rate tended to be higher in the > 35 year old group (34.62%) compared to 15.69 per cent found in < or = 35 year old group. Multiple pregnancy rate and ectopic pregnancy rate were found to be 17.65 and 5.89 per cent respectively for the < or = 35 year old group but only 7.69, 3.85 per cent respectively for the > 35 year old group. From the statistical analysis comparing the outcome of pregnancy in these two groups, the pregnancy rate per ET, implantation rate, ongoing pregnancy rate and miscarriage rate were found to have statistical difference with P < 0.05. However, multiple pregnancy rate and ectopic pregnancy rate did not show any statistical significance in these two groups (P > 0.05). In conclusion, the results of this study indicated that maternal age especially when greater than 35 years old adversely affects clinical pregnancy and the spontaneous abortion rate.
Adult↗
The influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET).
The purpose of this study was to retrospectively examine the influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET) between July 1990-December 1991 at the Royal Free Hospital, London, United Kingdom. This study included three groups of patients: group 1-the number of embryo used for transferring was one embryo, group 2-the number of embryos used for transferring was two embryos and group 3-the number of embryos used for transferring was three embryos. This study demonstrated that the clinical pregnancy rate increased significantly when transferring two or three embryos compared to one. But this rate did not differ significantly when two embryos were compared with three embryos. The multiple pregnancy rate, miscarriage rate, and ectopic pregnancy rate did not differ significantly among the three groups studied but there was a risk of higher order multiple pregnancy if more embryos were transferred. In this study we found 3 triplets out of 35 pregnancies when 3 embryos were transferred (Group 3). In conclusion, this study demonstrates that when two or three embryos were transferred the clinical pregnancy rate increased significantly. Transferring two embryos instead of three did not alter the pregnancy rate. Moreover, triplets pregnancies were eliminated. Therefore, we suggest limiting the number of embryos to be transferred at two and the supernumerary embryos should be cryopreserved for future transfer.
Adult↗