Search PubMed⌕ Search

Biomedical subjects

R J Markert

Publications and source records attributed to R J Markert.

At least 55 records · Page 3Linked to original sources
PubMed1993

Internal medicine residents' perceptions of the balance between service and education in their night-call activities.

PURPOSE: To quantify the workload of residents on night call and to determine the residents' perceptions of the balance between service and education in their night-call activities. METHOD: Twenty-two internal medicine residents--nine first-year residents and 13 senior residents (i.e., in their second, third, or fourth year)--kept logs of their night-call activities for two periods of 16 days each in 1991-92, at a 772-bed teaching hospital affiliated with Wright State University School of Medicine. The residents used the following five-point scale to rate each activity: 1, strictly service; 3, even balance; 5, strictly education. They also recorded the total times spent on various activities. Data were analyzed by using the independent and paired t-tests. RESULTS: Ninety-eight percent of the logs were returned. The first-year and senior residents did not differ significantly in times spent on logged events. Both the first-year and the senior residents perceived many night-call activities to be weighted toward education, especially those involving evaluation of acutely ill patients being considered for hospital admission (overall mean rating of 3.3). There was no striking difference between the first-year and senior residents' perceptions of the balance between service and education in their activities. CONCLUSION: The residents' perceptions of the relationship between service and education indicate that there was an even balance between the two. The educational aspects of night-call duties can and should remain an integral part of residents' training.

Attitude of Health Personnel↗
PubMed1993

Medical student abuse: perceptions and experience.

A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

Attitude↗
PubMed1993

Operation Desert Shield and Storm: impact on undergraduate and graduate internal medicine education.

We evaluated the impact of mobilization during Operation Desert Shield and Storm on undergraduate and graduate internal medicine education. Surveys were sent to the 425 residency program directors and 128 chairs of departments of medicine of U.S. medical schools in February 1991. Among graduate programs (46% response), 1.6% of full-time faculty, 0.2% of voluntary faculty, and 0.1% of residents were mobilized. No full-time faculty, voluntary faculty, and residents were mobilized at 77%, 90%, and 93% of programs, respectively. Negative impact ranged from none (68%) to significant (2%). For undergraduate education (51% response), 1.2% of full-time faculty, 0.1% of voluntary faculty, and 0.3% of residents were activated. Sixty-three percent reported no full-time faculty, 97% no voluntary faculty, and 86% no residents activated. Negative impact ranged from none (53%) to significant (4%). The effect of mobilization was small, and program directors and chairs should feel comfortable supporting participation in reserve activities.

Education, Medical, Undergraduate↗
PubMed1993

Predicting the first-year performances of international medical graduates in an internal medicine residency.

BACKGROUND: Recent growth in the number of international medical graduates (IMGs)--i.e., graduates of non-U.S. and non-Canadian medical schools--who fill positions in internal medicine residencies requires examination of the predictive validity of selection criteria. METHOD: Data were analyzed for 46 foreign-born IMGs who entered the internal medicine residency at Wright State University School of Medicine between January 1985 and January 1991. The t-test and Pearson correlation were used to relate ten selection variables (age, gender, foreign clinical experience, U.S. clinical experience, clinical experience in the two years prior to residency, time between medical school graduation and residency, performance on the Foreign Medical Graduate Examination in the Medical Sciences--FMGEMS--Parts I and II, interview language skill, and interview rank category) to performance ratings the IMGs received in the first year of residency. RESULTS: Only performance on the FMGEMS Part I (p = .045) and clinical experience in the two years prior to residency (p = .005) were related significantly to subsequent performance in residency. CONCLUSION: The results suggest that recent clinical experience and performance on standardized examinations are the two selection criteria most predictive of foreign-born IMGs' first-year performances as internal medicine residents.

Adult↗
PubMed1993

A comparison of rural family practice in the 1930s and today.

Two hundred forty-four consecutive diagnoses and procedures appearing on the patient billing records between June 1934 and September 1935 of a general physician practicing in rural southwestern Minnesota were compared with 286 diagnoses and procedures taken from the billing records of patient visits made over a 2-week period to a modern family physician practicing in a comparable rural community in southwestern Ohio. The most common items on the billing records of the physician of the 1930s were follow-up incision and drainage of abscess, 26 (10.7%); diphtheria immunization, 24 (9.8%); follow-up drainage for mastoiditis, 17 (7.0%); and scrotal tap for epididymitis, 14 (5.7%). Many of these patient encounters were at the patient's home. The most common items on the records of the modern physician practicing in rural southwestern Ohio were upper respiratory tract infection, 13 (4.5%); hypertension, 12 (4.2%); hyperlipidemia, 11 (3.9%); and history-taking and physical examination (adult), 10 (3.5%). This study suggests that there are great differences between the diagnostic profiles of the first third of the 20th century and modern family physicians. Many of the common diagnoses seen by the physician of the 1930s required a procedure to be performed. Many of the problems treated by the contemporary family physician did not even exist for the early 20th century general physician. Some of the differences between the modern physician and his predecessor can be explained by the introduction of antibiotics in the late 1930s and early 1940s.

Family Practice↗
PubMed1992

Potential influences of residencies' health risk policies on their rankings by Ohio applicants.

Residents' health risks constitute an area of increasing concern for hospitals and residencies. This study examined the importance of health risk policies in the context of students' selection of residencies. In 1991, all 836 fourth-year students in six Ohio medical schools were surveyed about their attitudes regarding residencies' policies on drug screening, HIV (human immunodeficiency virus) testing, and smoke-free workplaces. Of 763 surveys able to be delivered, 341 (45%) were returned. Substantial subsets of the students indicated that they would rank lower or not at all a program that required pre-residency drug screening (22%) or HIV testing (31%). Conversely, almost half the students (48%) responded that they would rank a program higher whose institution has a smoke-free policy. A discussion of potential factors affecting these findings is presented, with recommendations for hospitals, residencies, and residency applicants.

AIDS Serodiagnosis↗
PubMed1992

Cefoxitin-induced antibiotic resistance in Enterobacter species in the community hospital.

The aim of this study was to determine whether beta-lactamases could be induced by cefoxitin in the community hospital, since this problem of antibiotic resistance has been shown to exist at the tertiary care level. One hundred sixty-six Enterobacter species isolated from patients in two community hospitals in Dayton, Ohio, were tested for cefoxitin induction of beta-lactamase production by a disk-approximation method. Piperacillin and cefoxitin disks were placed in approximation to each other on Mueller-Hinton plates inoculated with Enterobacter species with appropriate controls. Three Enterobacter strains (1.8%) showed truncation of the zone of inhibition (indicating beta-lactamase induction) with sensitivity to both cefoxitin and piperacillin. However, 84 strains (50.6%) showed truncation around the piperacillin disk with resistance to cefoxitin. One hundred fifty (90.0%) strains showed resistance to cefoxitin. These data indicate that cefoxitin induction of beta-lactamases in Enterobacter species is indeed a potential problem in incurring antibiotic resistance in the community hospital.

Cefoxitin↗
PubMed1991

Combining group psychotherapy and pharmacotherapy: a survey.

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.

Ambulatory Care↗
PubMed1991

Gender bias of Ohio physicians in the evaluation of the personal statements of residency applicants.

Sexism has been documented at every level of medical training as well as in the community of practicing physicians. Although there is speculation in the literature about sexist attitudes and perceived sexual discrimination influencing a medical student's choice of specialty, there are few data on gender bias in the evaluation of residency candidates applying in different specialties. In 1989, the authors created six personal statements of interest in a residency, each from a different type of fictitious residency candidate (three men, three women, at three levels of medical school achievement) and mailed one or another of the statements, chosen at random, to the 2,478 board-certified Ohio physicians practicing in six specialties in which U.S. women in residencies were underrepresented (less than 12%) compared with the percentage of women in medical schools, and to the 3,586 board-certified Ohio physicians in another six specialties in which women in residencies were overrepresented (more than 38%). The physicians consistently rated the women candidates more favorably than they did the men candidates.

Attitude of Health Personnel↗
PubMed1991

Cervical cancer: women aged 35 and younger compared to women aged 36 and older.

One hundred fifty-three patients with invasive cervical cancer were evaluated and treated at one of the two teaching hospitals of the Intergrated Ob-Gyn Residency Program of Wright State University, Dayton, Ohio, from 1 July 1983 to 30 June 1989. Sixteen patients with recurrent cervical cancer who initially had received their treatment elsewhere were excluded. Forty-one of the 137 newly diagnosed patients with cervical cancer were aged 35 years or less. This review was undertaken because of frequent reports of the increasing incidence of cervical cancer in women aged 35 and under. Some reports also reveal a worse prognosis for the younger age group. This investigation provided the opportunity to evaluate cervical cancer patients aged 35 and under and compare the results to the evaluations of women aged 36 and over. Evaluation of age, stage, presenting symptoms, number of positive lymph nodes, pap smear history, pregnancy within 1 year of diagnosis, treatment, and survival was carried out in patients aged 35 years and less and compared to their older counterparts aged 36 and over with cervical cancer.

Adult↗
PubMed1991

Why medical students change to and from primary care as career choice.

While many factors have been proposed to explain the specialty choice decisions of medical students, little has been reported on the reasons for change of career choice during medical school. The purpose of this study was to determine why medical students switched from primary care to nonprimary care as a career choice and why others changed from nonprimary care to primary care as a specialty preference. Of the 1981-1990 graduates of Wright State University School of Medicine (n = 832) investigated, 217 switched preference during medical school (53 to primary care, 164 to nonprimary care). Reasons relating to the medical school experience were more influential than personal or societal reasons, more so for students changing to nonprimary care than for those changing to primary care. Increased awareness of specialties and positive clinical experience in chosen specialties were indicated by 76% and 70% of those who switched. Among reasons selected less frequently, content and emphasis of the curriculum (19% versus 7%) and location of residency (17% versus 6%) were more likely to be cited by those switching to primary care than by those who switched to nonprimary care, while better financial opportunities were more important for those who switched to nonprimary care (17% versus 4%).

Career Choice↗
PubMed1991

Enterobacter bacteremia in the community hospital.

BACKGROUND: The purpose of this study was to examine the epidemiological and clinical characteristics of Enterobacter bacteremia in the community hospital, where nosocomial infections are not commonly studied. METHODS: The blood culture records of five community hospitals in the Dayton, Ohio, area were reviewed to find cases of Enterobacter bacteremia. The respective hospital charts were then reviewed. RESULTS: Seventy-five episodes of Enterobacter bacteremia were reviewed. Eighty percent (60) of the organisms were nosocomially acquired, and 20% (15) were community acquired. The median age of the patients was 64 years. In 39% (29) of the episodes, fever was not the primary manifestation. The mortality rate was 29% (22). In 30% of the cases, the portal of entry for the bacteremia was unknown. The most common known portals of entry were genitourinary, gastrointestinal or biliary, and peritoneal. The most common underlying disorders were malignancy, postoperative states, and diabetes mellitus. In 9% of the cases, no underlying disorder was detected. The organisms showed high sensitivity to chloramphenicol, aminoglycosides, piperacillin sodium, and cefotaxime sodium. High degrees of resistance were shown to ampicillin, first-generation cephalosporins, and cefoxitin. Eighty-four percent (46) of the patients treated appropriately survived, and 55% (11) of the patients treated inappropriately died. CONCLUSIONS: Enterobacter bacteremia is most commonly nosocomially acquired and appears to be a problem in the community hospital. Appropriate therapy improves rates of patient survival.

Adolescent↗
PubMed1990

Legal risk-management programs in nursing homes: who has them and do they work?

Legal risk-management systems are designed to identify, prevent, or mitigate the negative effects of situations that potentially expose a health care facility and its staff to avoidable legal and financial liability. This article reports findings on the current status of risk-management systems in nursing homes. The relative costs and benefits of such programs are also discussed.

Cost-Benefit Analysis↗
PubMed1990

Cardiac arrhythmias and electrocardiographic changes during upper and lower gastrointestinal endoscopy.

Ninety-two patients undergoing upper and lower gastrointestinal endoscopy were monitored with holter recording for electrocardiographic changes during the procedures. The electrocardiographic changes were seen in 20.6% of the patients. These included cardiac arrhythmias in 16.2% and ischemic ST-T changes in 4.4% of the patients. The incidence of these changes was more in patients with cardiac (36%) or pulmonary disease (25%) than in patients with no clinical cardiac or pulmonary problem (16%). The patients with baseline electrocardiographic abnormalities also showed higher incidence of such electrocardiographic changes during the endoscopic procedures when compared with patients with normal baseline electrocardiograms (32% vs. 16%).

Adult↗
PubMed1990

A comparative study of fecal occult blood tests for early detection of gastrointestinal pathology.

The question of what the most accurate and efficient fecal occult blood testing method is for the early detection of pathological gastrointestinal tract bleeding continues to be intensely debated. In this prospective study, the following five uniquely different slide tests were investigated in 120 patients who underwent gastrointestinal tract investigation: (1) a combination monoclonal antibody guaiac test (Monohaem); (2) an immunologic assay, enzyme-linked immunosorbent assay, with (3) a highly sensitive guaiac test (Fecatwin S/Feca enzyme immunoassay), (4) a popular guaiac test (Coloscreen III) (comparable with Hemoccult II), and (5) Coloscreen III/VPI (ie, with vegetable peroxidase) inhibitor. Computerized data show efficiency values for detection of fecal occult blood by Coloscreen III-Fecatwin S-Monohaem combined, 93%; Coloscreen III-Monohaem combined, 91%; Monohaem, 87%; Coloscreen III/VPI, 82%; Coloscreen III, 79 percent; enzyme-linked immunosorbent assay, 77%; and Fecatwin S, 68%. Results of sensitivity, specificity, false-positive and false-negative test results, tests' predictive value, simplicity, and costs of tests in this clinically based study suggests that the concomitant use of the monoclonal, monospecific test for human hemoglobin and an appropriately sensitive guaiac test is a potentially valuable approach to mass screening and early detection of occult bleeding gastrointestinal tract pathology, including colorectal cancer.

Antibodies, Monoclonal↗