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PubMed2004

Decreased levels of interleukin-18 in peritoneal fluid but not in serum of patients with endometriosis.

OBJECTIVE: To determine the concentrations of interleukin-18 (IL-18) in peritoneal fluid and serum in patients with endometriosis in comparison with the control group. DESIGN: A prospective analytical study. SETTING: The obstetrics and gynecology department of an academic training hospital. PATIENT(S): Forty-four patients who underwent laparoscopic surgery for benign gynecologic diseases. INTERVENTION(S): Specimens of peripheral blood and peritoneal fluid were obtained before and during laparoscopic procedures, and the levels of IL-18 were analyzed. MAIN OUTCOME MEASURE(S): The concentrations of IL-18 in peritoneal fluid and serum were correlated with the presence of endometriosis, disease stage, and the phase of the menstrual cycle. RESULT(S): Interleukin-18 was detectable in 98% of the peritoneal specimens and 84% of the serum specimens of the patients tested. Peritoneal fluid IL-18 concentrations were statistically significantly lower in patients with endometriosis than in patients without endometriosis; the difference in serum IL-18 levels showed no statistically significant difference between the patients with and without endometriosis. The concentrations of IL-18 in peritoneal fluid and serum were not correlated with the stage of endometriosis or the phase of the menstrual cycle. CONCLUSION(S): Our results suggest that the decreased levels of IL-18 in peritoneal fluid in patients with endometriosis as compared with the control group may play an important role in the pathogenesis of this disease.

Adult↗
PubMed2004

Complications of abdominal urologic laparoscopy: longitudinal five-year analysis.

OBJECTIVES: To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period. METHODS: From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests. RESULTS: A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance (P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score (P = 0.01). CONCLUSIONS: Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Adrenalectomy↗
PubMed2003

Relationship between zona pellucida-induced acrosome reaction, sperm morphology, sperm-zona pellucida binding, and in vitro fertilization.

OBJECTIVE: To evaluate the possible relationships between sperm morphology, acrosome responsiveness to solubilized human zona pellucida, and sperm-zona binding potential among [1] consecutive andrology referrals and [2] randomly selected in vitro fertilization (IVF) cases. DESIGN: Prospective analytical study. SETTING: Academic training hospital.Randomly selected couples consulting for infertility. INTERVENTION(S): Acrosome reaction response to solubilized human zona pellucida was recorded. MAIN OUTCOME MEASURE(S): We determined the difference in the percentage of sperm that acrosome reacted after exposure to solubilized zona pellucida and spontaneous acrosome reaction. The results were expressed as percentage zona induced acrosome reaction (ZIAR). RESULT(S): Data were analyzed using correlation coefficients (r) and receiver operator characteristics (ROC curve analyses). The ROC curve analyses indicated ZIAR to be a sensitive indicator for fertilization failure during IVF therapy, with sensitivity and specificity of 81% and 75%, respectively. For andrology referrals, a positive and statistically significant correlation existed between ZIAR data and sperm morphology (r = 0.65) and sperm-zona binding (r = 0.57). CONCLUSION(S): ZIAR results provide further information regarding dysfunctional sperm and can be used as an additional diagnostic test. Our results predicted fertilization failure during IVF treatment.

Acrosome Reaction↗
PubMedDate not supplied

The use of the Mayo Clinic system for differential diagnosis of dysarthria.

The purpose of this study was to determine clinicians' attitudes toward the Darley, Aronson, and Brown (1969a, 1969b; 1975a) method of classification for differential diagnostic of dysarthria. A national telephone survey was conducted of 100 speech-language pathologists involved in the assessment and treatment of patients with dysarthria. Clinicians were questioned about their use of differential diagnosis as part of their service delivery to persons with dysarthria. Questions also focused on clinicians' perceptions of the helpfulness and difficulties of differential diagnosis. Results indicated that most clinicians use the Darley et al. (1969a, 1969b; 1975a) classification system for the differential diagnosis of dysarthria, stating that it is helpful in the design of a treatment protocol. A trend toward decreased perceived difficulty of differential diagnosis with increased years of work experience was observed. The clinical and academic training implications of these findings are discussed.

Data Collection↗
PubMedDate not supplied

The relationship of psychosomatic medicine to consultation-liaison psychiatry.

Consultation-liaison psychiatry arose in the mid-1960s from the matrix of psychoanalytically oriented psychosomatic medicine. The influence of psychoanalysis and psychoanalytically trained academic psychiatrists gradually waned. The liaison aspect of consultation-liaison psychiatry faded in the early 1980s, and most consultation-liaison services are now primarily high-quality consultation services that contribute much to university teaching hospitals. The consultation-liaison service at the University of New Mexico (UNM) and several others have eliminated the term "liaison." The consultation service at UNM sees relatively few patients with classic psychosomatic disorders. The majority of requests to UNM's consultation service relate to suicide attempts, delirium, complicated medical problems with psychiatric illness, substance abuse, burns, trauma, and competency evaluations.

Humans↗
PubMed2001

Biogerontology research in Israel.

The article describes the special features of gerontology research that has been expanding for five decades in Israel, and outlines the research in the biology of aging, covering a wide spectrum of areas and topics. A variety of associations, institutes and centers that have been established over the years play an important role in furthering the research and academic training.

Geriatrics↗
PubMed2002

A survey on psychiatric patients' use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction.

OBJECTIVES: We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers' professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. DESIGN: Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. RESULTS: About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable 'customer loyalty' towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient's well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. CONCLUSIONS: Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their 'psychotherapeutic' attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.

Adult↗
PubMed2005

Taking a patient safety approach to an integration of two hospitals.

BACKGROUND: Consolidation of inpatient care between two acute care medical centers brings many challenges, including an increased risk of an untoward event during patient transfer and impaired hospital performance during the postintegration period. When the Jesse Brown Department of Veterans Affairs (VA) Medical Center in Chicago integrated two acute medical-surgical inpatient facilities, the challenges intrinsic to simultaneously integrating acute medical-surgical programs and academic training programs necessitated a novel approach. STRATEGIES USED: Several patient safety-related tools were used for the safe transfer of patients and for sustaining hospital performance after integration. These tools included Failure Mode and Effects Analysis (FMEA) of the move process, process action teams to bridge the differences in standard nursing unit operation, and an integration score card to monitor and evaluate the impact of the integration on organization performance. RESULTS: Patient care was not disrupted except for a transient reduction in elective surgical procedures during the week before the move. Postintegration data indicated reduced operating room cancellations, sustained inpatient capacity and access, and comparable findings in patient falls and methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci infections. CONCLUSION: The impact of several patient safety tools and interventions was reflected in the fact that performance remained constant or improved for the predefined measures of access and quality.

Chicago↗
PubMed2001

Theory and the organic bioethicist.

This article argues for the importance of theoretical reflections that originate from patients' experiences. Traditionally academic philosophers have linked their ability to theorize about the moral basis of medical practice to their role as outside observer. The author contends that recently a new type of reflection has come from within particular patient populations. Drawing upon a distinction created by Antonio Gramsci, it is argued that one can distinguish the theory generated by traditional bioethicists, who are academically trained, from that of "organic" bioethicists, who identify themselves with a particular patient community. The characteristics of this new type of bioethicist that are explored in this article include a close association of memoir and philosophy, an interrelationship of theory and praxis, and an intimate connection between the individual and a particular patient community.

Bioethics↗
PubMed1993

Behavior analysis applications and interdisciplinary research strategies.

The emergence of behavioral pharmacology as a basic and applied science owes its origin and development to the interactive methodological-conceptual advances that have characterized interdisciplinary research initiatives over the past half century. The resulting enhancement of academic training and research opportunities has broadened the application of behavior analysis principles to a range of clinical, educational, and industrial settings. The extent of this applied behavioral science outreach is unconstrained even by the challenges of inhospitable terrestial and extraterrestial environments.

Animals↗
PubMed2000

Neurosurgery at Fujita Health University, Japan.

Neurosurgery at the Fujita Health University began in 1972 with Dr. Tetsuo Kanno. In 1973, he was joined by Dr. Kazuhiro Katada and in the year 1976, an independent neurosurgery department was established with Dr. Kanno as the Chief of Neurosurgery. Under his guidance the department continued to grow and by 1978, a neurosurgical residency program recognised by the Japanese Board of Neurosurgery was established. Integration of laboratory research and clinical experience is the hallmark of this program. The current philosophy is directed towards subspecialization and academic training. This article provides a brief overview of the rapid development of a Neurosurgical Centre to reach international acclaim under the guidance of Prof. Tetsuo Kanno.

Hospitals, University↗
PubMed2005

[A historic case of Wegener's granulomatosis: the physicist who discovered the electromagnetic waves: Heinrich Hertz].

SUMMARY: A diary and an extensive correspondence of Heinrich Hertz and his family provide a meticulous documentation of his life, made available by Albrecht Folsing in 1997 through a carefully investigated biography, which permit the conclusion that H. Hertz died of Wegener's granulomatosis, 45 years before this disease had been explored. WEGENER'S GRANULOMATOSIS: The symptoms of the granulomatosis, that was first described by Friedrich Wegener in 1936 and 1939 are presented in short with literal quotations of the author: It begins with a refractory cold that will last until the end, then follow involvement of the paranasal sinuses, ears, mucous lining of mouth and pharynx, slight fever, weakness, in the final phase dissemination with nephritis, septic fever, arthritis, myalgia, paralyses leading to total immobility, exitus. The etiology is not fully understood but probably based on immunoreaction. H. HERTZ: CURRICULUM VITAE: Born in Hamburg, Germany, in 1857: after secondary school academic training in physics at Dresden, Munic and Berlin. 1885 professor of physics in Karlsruhe, then starting in 1889 at Bonn. 1887/88 exploration of the electromagnetic waves, now the basis for all radio communication, and exploration of the photoelectric effect, the basis of solar techniques. Numerous highranking distinctions. H. HERTZ: THE CASE HISTORY: The case history is presented in detail based on numerous literal quotations from personal letters and the diary. After a few banal affections involving the teeth and toes the systemic disease became manifest in summer 1892 with a refractory cold which remained the focus of treatment until death. Granulation tissue in the nose that was excised several times: no tuberculosis, no carcinoma. Otitis with purulent mastoiditis, in October 1892 mastoidectomy, persistent purulence. Early in 1893 diagnosis of nephritis. Extraction of a superior tooth, punturing of the maxillary sinus, then twice radical opening of the maxillary sinus. Painful ankylosis and paralyses ending in complete immobility, hyperthermy, exitus on Jan. 1 1894. DISCUSSION: The case history is repeated in short and discussed. At that time a diagnosis and an effective therapy were not available. Today the disease could have been kept under control applying immunosuppressive and antibiotic treatment.

Adult↗
PubMed1996

Some observations on the subjective experience of neophyte group therapy trainees.

Neophyte group therapy trainees often encounter significant difficulties in their initial experiences as group therapists. In this article, we report and discuss the results of a semistructured interview conducted with each of 16 neophyte group therapy trainees in an academic training program. The interview focused on the trainees' subjective experiences related to their initial training and group therapy clinical practice, with particular emphasis on their satisfaction with their training, and the role and impact of supervision. All trainees reported strong emotional reactions to their group experience and numerous technical concerns. However, trainees reported a broad range of degrees of satisfaction with their training Overall satisfaction with training strongly paralleled satisfaction with supervision and the supervisory relationship. Recommendations for improving the group therapy training experience that emerge from the evaluation of the trainees' subjective experiences are suggested.

Education, Medical, Graduate↗
PubMedDate not supplied

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice.

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Adult↗
PubMed2006

Clinical benefits and risks of bilateral amplification.

Clinicians are in the unique position of continually developing a foundation of evidence-based practice each time they evaluate a patient. This is true not only in the field of audiology, but also in all healthcare professions. Typically, evidence-based practice (EBP) is assimilated from a combination of a systematic review of current practices, practitioner experience, academic training and ongoing continuing education through review of journals, textbooks and attendance at meetings as well as informal discussions with colleagues. Clinicians are inundated with information from these sources, and they need to extract the necessary information and apply it to their specific patient population. Evidence-based practice as it applies to the non-medical treatment of hearing loss (with hearing aids) will be discussed. In addition, several studies based on clinical observations are presented for discussion.

Aged, 80 and over↗
PubMed1999

Preparation for oncology settings: what hospice social workers say they need.

According to recent data, 78 percent of hospice social workers' direct practice hours are spent with patients and families diagnosed with terminal cancer. A national sample of 108 hospice social workers participated in an exploratory study investigating the influence of their formal academic training, informal on-the-job training, and related professional and personal experiences on their preparation for oncology social work. Findings suggest that social workers view both the generalist or core courses as well as the specialist and elective courses as important in preparing them for oncology social work. In addition, on-the-job training focusing on medical terminology, interdisciplinary, collaboration, death and dying and the integration of personal experiences are important for continuing growth and success in this work. Implications for social work practice, research, and formal and informal educational opportunities are discussed.

Attitude of Health Personnel↗
PubMed2005

The Distance Learning Courses in Occupational Medicine--20 years and onwards.

BACKGROUND: The first Distance Learning Course in Occupational Medicine was set up in 1984 at the Department of Occupational Health, University of Manchester. AIMS: This paper describes the progress of that course and developments within distance learning education in occupational health at The University of Manchester over the subsequent 20 years. It also looks at the future objectives and modes of teaching of occupational health at Manchester via distance learning. METHODS: Analysis has been undertaken of student demographics and matching between original forecasts and actual outcomes. RESULTS: Original forecasts of student uptake have been surpassed. There are indications of increases in the number of female and part-time students, and a corresponding decline in the number of general practitioners enrolling on the Advanced course. Response to developing circumstances has resulted in the Distance Learning Unit setting up additional courses. CONCLUSIONS: The farsightedness of those who predicted the need for academic training in occupational health by distance learning has been proved correct. Further evolution is essential to maintain and improve the value and success of the courses.

Education, Distance↗
PubMed1990

The association between students' research involvement in medical school and their postgraduate medical activities.

The authors examined the impact of students' research involvement during medical school on their postresidency medical activities. The three medical schools involved--The Pennsylvania State University College of Medicine (PSU), The University of Connecticut School of Medicine (UCONN), and The University of Massachusetts Medical School (UMASS)--have nearly indistinguishable applicant, matriculant, and curriculum profiles. However, at PSU a research project is a curriculum requirement for students who did not do medical research prior to entering medical school. Questionnaires were sent to all graduates from the classes of 1980, 1981, and 1982. A total of 567 graduates completed the questionnaires, an overall response rate of approximately 76%. Medical school research experience was reported by 83% (183) of the PSU graduates, 34% (52) of the UCONN graduates, and 28% (54) of the UMASS graduates. When compared on a school-by-school basis, the graduates from the three schools did not differ with respect to residency specialty training, fellowship training, academic appointments, career practice choices, or postgraduate research involvement. However, when all the graduates studied were examined as a single group, medical school research experience was found to be strongly associated with postgraduate research involvement.

Academic Medical Centers↗