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PubMed1991

The human vagina: normal flora considered as an in situ tissue-associated, adherent biofilm.

OBJECTIVE: A method that would allow in situ comparison of the degrees of adherence to genital epithelia by the biofilms of the normal flora. SUBJECTS: Four healthy women. SETTING: Departments of Biological Sciences, University of Calgary, and of Medicine, University of British Columbia. METHODS: In situ, scraped specimens were taken from the vagina and ectocervix before and after vigorous vaginal washes, and colony counts of associated bacteria were compared. In vitro, cells from the vulva, vagina and ectocervix were vortexed, centrifuged and sonicated and remaining associated bacteria quantitated by light microscopy. RESULTS: Anaerobic lactobacilli were notably tissue-adherent as colony counts of postwash specimens were comparable to those of their paired prewash specimens, but crucially were higher than those of their paired wash specimens (p less than 0.05, Wilcoxon signed rank test). However, vaginal and ectocervical coagulase-negative staphylococci and ectocervical Lancefield group B streptococci were loosely tissue-adherent, because counts in postwash specimens were lower than those in prewash or wash specimens (p less than 0.05, Wilcoxon signed rank test). In vitro, only vulvar scrapings and vaginal postwash specimens showed a significant decrease in associated bacteria after shear stressing (p less than 0.05, Wilcoxon signed rank test). CONCLUSIONS: The normal flora of the female genitalia features both avidly and loosely tissue-adherent bacterial biofilm populations whose adherence can be influenced partly by their location. Our scraping/washing method can contribute to further characterisation of this phenomenon. The superior adherence of anaerobic lactobacilli may reflect a potential in maintaining or restoring normality.

Bacteria↗
PubMed2000

Qualitative assessment of the impact of health care reform on the availability of clinicians for preclinical medical instruction.

PURPOSE: Over the past 5 years, Calgary clinicians experienced the restructuring of health care delivery and a move to a presentation-based curriculum at the University of Calgary. Course coordinators have noted increased difficulty in recruiting clinical lecturers at the preclinical undergraduate level. This study was designed to evaluate the relative importance of factors that may influence the time clinicians spend teaching at this level. SUMMARY: This descriptive survey was conducted within the University of Calgary, Faculty of Medicine, a teaching institution affiliated with the Calgary Regional Health Authority, which is responsible for the delivery of health care within the City of Calgary. Basic scientists, residents, and adjunct medical professionals were excluded from a list of lecturers for the academic year 1996-97, leaving a target population of 386. Respondents were stratified according to university appointment, specialty, type of medical training, and hours taught in the 1996-97 academic year. Dependent variables included the financial constraints, time constraints, health care reform, changes in the undergraduate medical education curriculum, and lack of recognition on availability for teaching. Written comments were also categorized and analyzed according to the same variables. A response rate of 79% (n = 305) was achieved. Of the respondents, 52% agreed that recent reform has made it more difficult to teach; full-time faculty were less likely to agree compared to non-full-time faculty (60% vs. 44%; nonparametric median test, chi 2 = 6.18, p = .046). Twice as many family physicians reported that financial constraint was a factor (66%) when compared to other specialists, whereas relatively few full-time faculty noted it to be a concern (12%) when compared to major part-time (43%) and non-full-time/major part-time appointees (66%; chi 2 = 23.4, p < .0001). Clinicians reporting the most teaching hours (more than 30) were most likely to describe an increase in teaching hours (61%). Nonfaculty members were less aware of the recent curricular changes (73%); however, more family physicians felt that these changes had a positive impact on willingness to teach (10%) compared to surgical (8%) and nonsurgical specialists (9%; chi 2 = 6.07, p = .048). Forty-five percent of respondents agreed that they would be more willing to teach if offered some from of recognition. Two thirds of written comments suggested that recognition should be nonmonetary (e.g., faculty promotion, acknowledgment). CONCLUSIONS: The experience at the University of Calgary suggests that availability of teachers for preclinical undergraduate medical education has diminished as a result of health care reform. Family physicians have been affected the most, and the clinical environment will make it even more difficult to involve this important group of teachers in undergraduate medical education.

Alberta↗
PubMed1993

Anaesthesia services and the education of anaesthetists in Nepal: a model for sustainable development?

In 1985 the University of Calgary in Canada and Tribhuvan University in Kathmandu, Nepal Jointly established the Diploma in Anaesthesiology (DA) programme in Nepal. To evaluate the impact of the DA Programme and provide a data base for long-term planning we conducted a national survey in 1992. We sought to describe anaesthesia manpower and workloads, and to make an inventory of facilities, equipment, and supplies in different sized hospitals. Twenty-seven hospitals providing surgical services were included, nine inside and 18 outside the Kathmandu valley. Seventeen of the 21 respondent hospitals had at least one specialist anaesthetist. The results identify both strengths and weaknesses in Nepal's anaesthesia services and provide important guidelines for planning. When the DA course was launched there were only seven specialist anaesthetists in Nepal. The shortage of anaesthetists was an important factor limiting surgical services, and after DA graduates were posted to zonal (50 bed) and regional (150-200 bed) hospitals the surgical case loads doubled. There are now about 40 specialist anaesthetists in the country, of which half are DA graduates, but many hospitals have only one anaesthetist. That isolation, plus lack of continuing education (CME), are important factors threatening quality of care. Recognizing the singular role of the DA programme in alleviating Nepal's shortage of anaesthetists, we conclude that it should be renewed and strengthened to meet the needs of the next decade. Techniques commonly used at the zonal level: regional, draw-over, and total IV anaesthesia, should be stressed. At the same time fresh initiatives are required in CME and higher education for the renewal of teaching staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1977

A Canadian commercial ovum transfer unit.

Mr. Bloxham received support from the Harry Steele-Bodger Memorial Fund towards the expenses of working at the Medical School of the University of Calgary, Alberta, Canada, where he was able to continue his researches on early implantation of mammalian blastocysts. He also took the opportunity to visit the commercial ovum transfer unit near the University of Calgary and has provided the following impressions of that part of his stay in Canada.

Animals↗
PubMedDate not supplied

A framework for planned change: achieving a funded PhD program in nursing.

This paper describes a process of planned change undertaken by a group of graduate nursing students of the University of Alberta. Their goal, a funded PhD program in Nursing, was realized fourteen months after their initial meeting. The message of their story is a simple yet significant one for all nurses who wish to influence their environment: Using a framework of planned change, a group of people who organize and commit themselves to a clear goal can become impossible to ignore. In the complexities and uncertainties of today's health care system, many nursing leaders wonder how to effectively insert themselves into the changes occurring in their environments. In this paper, the process of planned change is described through the story of one group of nurses who deliberately set out to reach a desired goal: a funded PhD Program in Nursing at the University of Alberta. Fourteen months later on December 21, 1990, a funded PhD Program in Nursing became a reality. In the early 1980's, several nurses attempted to establish doctoral education for nurses in Canada. The need was for nurse researchers and leaders with doctoral qualifications within the Canadian context. By 1986, the collaboration of nursing faculties at the University of Alberta in Edmonton and the University of Calgary was well under way. The work of Dr. Shirley Stinson, Dr. Janetta McPhail, and Dr. Margaret Scott-Wright with their colleagues resulted in academic approval for the first PhD Program in Nursing in Canada, at the University of Alberta in Edmonton. The starting date of the program, however, was subject to the availability of funding. Funding remained elusive for the next three years, and in the fall of 1989, the Nursing Graduate Student Association decided to form a committee to obtain funding for the doctoral nursing program. Nineteen graduate nursing students from the University of Alberta and the University of Calgary banded together to create the "Nursing PhD Program a Reality" group (NPPR). The group used a framework of planned change based on concepts found in the literature on power, politics, and political action.

Alberta↗
PubMed2004

Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine.

BACKGROUND: Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option. METHODS: A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables. RESULTS: Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice. INTERPRETATION: Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.

Adult↗
PubMed2000

Experience with the first 200 allogeneic blood cell transplants (BCT) in Calgary.

Allogenic peripheral blood stem cells transplantation (BCT, allo-PBSCT) have an established place in currently active protocols at the University of Calgary, we now use BCT as the third approach for acute myeloid leukemia (AML) in first complete remission (CR). For chronic myelogenous leukemia (CML) beyond first chronic phase (CP) and other hematological malignancies BCT gives outcomes at least equivalent to bone marrow transplantation (BMT). BCT recipients benefit from faster engraftment. However a tendency to develop more graft-versus-host disease (GVHD) is observed. Bone marrow is still the preferred source of stem cells for CML in first CP and for patients with non-malignant disorders. The ability to obtain high number of blood cells allows us to be able to perform haptoidentical transplants using T-cell depletion and to obtain engraftment in most cases. Refining tha latter technique however remains a challenge particularly with respect to immune reconstitution.

Acute Disease↗
PubMed1995

Influence of undergraduate and postgraduate education on recruitment and retention of physicians in rural Alberta.

The composition of practising physicians in Alberta, with respect to medical school of graduation, changed between 1986 and 1991. The percentage of graduates of the 2 Alberta medical schools increased, and the percentage of graduates of foreign medical schools decreased. Graduates of the University of Calgary increased their percentage in family practice in urban and rural communities except in Edmonton, while graduates of the University of Alberta increased their percentage almost everywhere except in communities with populations of < 4,000. Although graduates of Alberta medical schools are locating their practices in rural regions, the smaller communities continue to depend on foreign medical graduates. Retention is a problem in communities of < 4,000, with greatest mobility demonstrated by non-Albertan Canadian graduates and foreign medical graduates while Alberta graduates demonstrate less mobility. Overall, 85% of new Alberta physicians have had undergraduate or postgraduate experience in Alberta or Canada. Those with no medical educational experiences in Canada are more likely to locate in small communities. Those with postgraduate training in Alberta or Canada are more likely to locate in urban centres. When both undergraduate and postgraduate influences are considered, Alberta graduates appear to locate in non-urban regions to a greater extent than other Canadian or foreign graduates. For family physicians and specialists, the city where postgraduate training was obtained has a profound influence on the choice of urban practice locations.

Alberta↗
PubMed2003

Health technology assessment, research, and implementation within a health region in Alberta, Canada.

OBJECTIVES: To determine the need for and implement health technology assessment (HTA) to inform decision making and policy within a regional health care system in Calgary (Alberta, Canada). METHODS: Published literature and organizational materials for the Calgary Health Region (CHR) and HTA units worldwide were reviewed. Key individuals within the provincial health ministry (Alberta Health and Wellness), CHR, the University of Calgary (U of C), funding agencies, and HTA organizations were consulted in a structured fashion. A structure for a regional HTA program was developed, taking into account relationships between these organizations. RESULTS: A locally focused HTA and implementation unit was deemed desirable. The Calgary Health Technology Implementation Unit (CaHTIU) was established. The CaHTIU was designed to efficiently integrate with CHR planning as well as undertake independent research activities. HTA activities focus primarily on CHR needs and are managed by a Health Technology Advisory Committee (HTAC) that consists of CHR management and other key individuals. Working groups contribute to and coordinate HTAs and implementation under the leadership of the unit Director, and include content as well as management individuals. The unit cooperates where appropriate with extant Canadian HTA organizations. CONCLUSIONS: The Calgary HTA unit is unique in Canada, because it functions within a regional health care system as well as a research institution. Advantages include a local focus in terms of applied HTAs, a systematic process for implementation of recommendations, and a collaborative atmosphere for research within the U of C.

Alberta↗
PubMed1999

The Calgary Conjoint Nursing Program. Part I: Spirit of collaboration.

On January 26, 1993, a small but significant gathering in Calgary celebrated the government's approval of the Calgary Conjoint Nursing Program. In attendance were faculty and staff of the nursing education programs of the Foothills Hospital School of Nursing, Mount Royal College and the University of Calgary, as well as senior administrators from each of those sites, practising nurses and a member of Alberta's Legislative Assembly. The group was celebrating the culmination of six years of working together toward the realization of a co-operative, collaborative baccalaureate nursing education program.

Alberta↗
PubMed1976

Bridging the gaps between departments on community and family medicine: the Calgary experience.

Current emphasis on innovation in primary care has revealed conflicts between generalist clinicians and professionals in community medicine. Several problems are now evident in the combination of community medicine and family medicine. Three elements of a planned institutional approach to overcome problems in primary health care education at the University of Calgary, Faculty of Medicine, are discussed: the introduction of an integrated curriculum, de-emphasis of departments, and a center for ambulatory care.

Ambulatory Care↗
PubMed2006

Assessing the mini-Clinical Evaluation Exercise in comparison to a national specialty examination.

PURPOSE: To evaluate the reliability and validity of the Mini-Clinical Evaluation Exercise (mini-CEX) for postgraduate year 4 (PGY-4) internal medicine trainees compared to a high-stakes assessment of clinical competence, the Royal College of Physicians and Surgeons of Canada Comprehensive Examination in Internal Medicine (RCPSC IM examination). METHODS: Twenty-two PGY-4 residents at the University of British Columbia and the University of Calgary were evaluated, during the 6 months preceding their 2004 RCPSC IM examination, with a mean of 5.5 mini-CEX encounters (range 3-6). Experienced Royal College examiners from each site travelled to the alternate university to assess the encounters. RESULTS: The mini-CEX encounters assessed a broad range of internal medicine patient problems. The inter-encounter reliability for the residents' mean mini-CEX overall clinical competence score was 0.74. The attenuated correlation between residents' mini-CEX overall clinical competence score and their 2004 RCPSC IM oral examination score was 0.59 (P = 0.01). CONCLUSION: By examining multiple sources of validity evidence, this study suggests that the mini-CEX provides a reliable and valid assessment of clinical competence for PGY-4 trainees in internal medicine.

Adult↗
PubMed1999

The Calgary Conjoint Nursing Program. Part II: Successful political action.

When three calgary institutions decided to develop a collaborative nursing program to prepare for the transition to baccalaureate nursing education by the year 2000, the planners found that they had to overcome a broad range of political and institutional hurdles. Faculty from Mount Royal College, Foothills Hospital School of Nursing and the University of Calgary spent six years developing the curriculum and planning for the implementation of the Calgary Conjoint Nursing Program (CCNP). (See The Calgary Conjoint Nursing Program, Part I: Spirit of Collaboration, in the March 1999 issue of this journal.)

Alberta↗
PubMedDate not supplied

The Call-Centre: a child welfare liaison program with immigrant serving agencies.

Alberta, Canada, welcomed nearly 16,000 landed immigrants in 2003, of whom more than half came to the Calgary area. Approximately 200,000 immigrants of various ethnic and cultural groups now live in the region. Many of these new arrivals have no natural support networks while struggling with language, cultural, and economic barriers. Recognizing these difficulties, the Calgary and Area Child and Family Services Authority (CFSA) joined with several Immigrant Serving Agencies to develop guidelines and procedures to direct staff working with diverse cultures, including the Call-Centre pilot project, which provided CFSA staff with a one-stop telephone contact for information about an immigrant or refugee family, their culture, and available culturally-appropriate resources. The Call-Centre, which is currently being evaluated by researchers at the University of Calgary, will gradually expand to all CFSA sites in the region. This article describes the Call-Centre and the first phase of the evaluation.

Alberta↗
PubMed1990

Evaluation of a program to train Saudi Arabian physicians.

The authors evaluated a program at the University of Calgary, in Alberta, Canada, that provided residency training for 11 Saudi Arabian physicians. Through a series of semistructured meetings in 1989 involving the Saudi residents, other residents in the program, members of residency training committees, faculty, and program directors, the program was reviewed to assess whether the Saudi physicians were prepared for the program and progressed satisfactorily when compared with the other residents, whether the training and evaluation were equivalent to those of the other residents, the advantages of the program to the university, and whether the university should be pursuing opportunities to train other foreign nationals. The interviews showed that there was variability in the preparation and progress made by the Saudi residents but the benefits to the university in providing training to a small group of carefully selected foreign-trained physicians were greater than the disadvantages. The information gained during the review reinforced the need to do periodic examinations of training opportunities for foreign physicians and yielded recommendations for improving such training.

Alberta↗
PubMed1990

Outpatient health care utilization of patients with inflammatory bowel disease.

On the basis of the normal life expectancy of inflammatory bowel disease patients, the early onset of their disease, and the variety of symptoms, inflammatory bowel disease patients were anticipated to be frequent users of outpatients services. This study assesses (1) the characteristics, (2) outpatient health care utilization, and (3) the degree of satisfaction with health care of inflammatory bowel disease patients compared to patients with other gastrointestinal disease. The study method was a secondary analysis of data collected on 395 patients attending the University of Calgary Gastroenterology Outpatient Clinic in 1988. Inflammatory bowel disease patients were significantly younger (P less than 0.001) and better educated (P less than 0.05) than other patients. During the past year inflammatory bowel disease patients consulted significantly more often with their gastroenterologist (P less than 0.001) and spent more time in hospital (P less than 0.05) than other patients. Inflammatory bowel disease patients also consulted more frequently with herbalists and naturopaths. Lastly, inflammatory bowel disease patients were as satisfied with the health care they received as other patients. These results provide information useful for health care planners as well as for those dealing directly with inflammatory bowel disease patients.

Adolescent↗
PubMed1991

Anaesthesia training and development in Nepal 1985-1990.

In 1985 a diploma program in anaesthesia was established in Kathmandu, Nepal, as a joint venture between the Institute of Medicine in Kathmandu and the University of Calgary. Development of the program and of the specialty in the capital city of Kathmandu was continuously documented during the next five years by local and visiting faculty. In 1990 teams of two Nepali and one Canadian anaesthetist also conducted a survey of each of the seven 50-100 bed zonal hospitals which did not previously have a trained anaesthetist and which are now staffed by graduates of the diploma program. In 1985 Nepal, with a population of 16 million, had seven trained Nepali anaesthetists all of whom worked in two hospitals in Kathmandu. By the end of 1989, 19 physicians had graduated. Seven of these continue to work in Kathmandu hospitals, nine work in zonal hospitals throughout the country and two are taking higher anaesthesia training in the United Kingdom. Additional Nepali anaesthetists have returned from training abroad, and the Society of Anaesthesiologists of Nepal, which joined the World Federation of Societies of Anaesthesiologists in 1988, now has 34 members. An annual anaesthesiology symposium is held, and weekly clinical meetings are organized in the major hospitals in Kathmandu. Anaesthetists who work in the zonal hospitals have limited supplies of drugs and equipment and opportunities for continuing medical education are virtually nonexistent.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Department, Hospital↗
PubMed2005

Use of a minimally invasive donor nephrectomy program to select technique for live donor nephrectomy.

BACKGROUND: Live donor nephrectomy (LDN) is a major surgical procedure with an accepted low mortality and morbidity. Minimally invasive donor nephrectomy (MIDN) has been shown to decrease the wound morbidity associated with the lumbotomy of the classic open technique. Transplant programs face the challenge of initiating their MIDN programs without jeopardizing the safety of the donor and the graft quality. We present the experience at the University of Calgary after the initiation of a MIDN program, with a preoperative selective approach using the 3 major techniques for LDN. METHODS: From December 2001 to May 2004, 50 consecutive, accepted, live kidney donors were evaluated and chosen to undergo nephrectomy by an open, laparoscopic, or hand-assisted technique. Patients were chosen for a particular technique based on the criteria of vascular anatomy, size of abdominal cavity, previous surgery, and technical implications for the recipient. RESULTS: A total of 15 open, 11 laparoscopic, and 24 hand-assisted nephrectomies were performed. There were no statistically significant differences in sex, age, or body mass index between the groups. There were statistically significant differences in surgical times (P < .001) and in the number of days spent in the hospital (P < .001). All kidneys had primary function. There were 2 conversions in the hand-assisted group and 1 blood transfusion in the open group. Death-censored graft survival was 100% with an observation time of 20 months (SD +/- 9 months; range = 3-32 months). One graft from the hand-assisted group was lost from patient death with functioning graft 8 months after transplant. CONCLUSIONS: The learning curve for MIDN does not necessarily need to impact donor or recipient outcomes. The initiation of an MIDN program can be implemented safely if the cases are selected carefully and the use of the classic open technique is kept as an alternative.

Adult↗