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PubMed2000

Cost-effectiveness of universal compared with voluntary screening for human immunodeficiency virus among pregnant women in Chicago.

OBJECTIVES: To determine and compare the cost-effectiveness of implementing 3 screening strategies to detect human immunodeficiency virus (HIV) infection among pregnant women in Chicago, Illinois: no screening, voluntary screening, and universal screening. METHODS: A decision-analysis model was developed, using standard cost-effectiveness analysis from a societal perspective. Reference case estimates were derived from a surveillance project conducted by the Illinois Department of Public Health and studies were published in the medical literature. Costs included direct and indirect medical costs associated with identification of pregnant women infected with HIV and identification, prevention, and treatment of perinatally HIV-infected newborns. Specifically, for each screening option, the cost per pregnant woman screened, the resulting number of pediatric HIV infections, and the number of newborn life-years were calculated. All costs were adjusted to the 1997 dollar value and discounted at 3%. Sensitivity analyses were determined for all variables included in the decision model. RESULTS: The estimated prevalence of HIV infection among pregnant women in Chicago is .41%. For every 100,000 pregnant women, it is estimated that 104.6 children would be infected with HIV if no screening strategy were implemented and 44.8 children would be infected if voluntary HIV testing (assuming a 92.7% acceptance rate) were available. In comparison, if universal HIV testing was performed, the number of children infected with HIV would decrease to 40 cases. Sensitivity analysis across a maternal HIV prevalence rate of.01% to 2.2% found that universal screening would be cost-saving in communities where the seroprevalence is.21%. In Chicago, it would take an estimated 5. 2 months of screening pregnant women to avert 1 case of pediatric HIV. Taking into consideration the lifetime costs of treating a child with HIV infection, universal HIV testing of 100,000 pregnant women would result in a cost-savings of $3.69 million when compared with no screening, and $269,445 when compared with voluntary screening. We estimated that it would cost $11.1 million to screen 100,000 pregnant women in Chicago. The cost-savings produced with increased screening are the direct result of reduced cases of newborns infected with HIV. A 2-way sensitivity analysis was performed to examine how costs vary as a function of the voluntary rates for HIV-positive and HIV-negative women. When screening falls below 50% for HIV-positive mothers, universal screening becomes cheaper than voluntary screening even if no HIV-negative mothers were screened. CONCLUSION: Reference case analyses showed that universal HIV screening of pregnant women in Chicago would both decrease the number of HIV-infected newborns and save money in comparison to voluntary or no testing strategies. Sensitivity analysis was robust across all variables for the conclusion that universal screening was more effective than voluntary screening. For many communities that have HIV prevalence rates for mothers of >.21%, universal screening would also save money in comparison to voluntary screening. For communities with prevalence rates <.21%, the benefits of universal screening may outweigh the costs for screening as we found that desirable incremental cost-effectiveness ratios were found for prevalence rates as low as.0075%.

AIDS Serodiagnosis↗
PubMed1992

Comparison of the University of Wisconsin preservation solution and other crystalloid perfusates in a 30-hour rabbit lung preservation model.

The University of Wisconsin solution, which contains a high potassium concentration (120 mmol/L), was evaluated for rabbit lung preservation by comparing it with a modified University of Wisconsin solution with low potassium (4 mmol/L), a low-potassium dextran solution (4 mmol/L), and simple surface cooling. In the first three groups rabbit lungs were flushed in situ with the solution (n = 5 in each group); then the lung-heart block was harvested and stored at 10 degrees C for 30 hours. In the surface cooling group the lungs were harvested without flushing and then simply immersed in saline and stored. For assessment, the stored lung was ventilated with room air and perfused with fresh venous blood at a rate of 40 ml/min for 10 minutes. Assessment of lung function included gas analysis of effluent blood, mean pulmonary artery perfusion pressure, and peak airway pressure. Among these parameters, oxygen tension was most sensitive. Oxygen tension at 10 minutes' perfusion in the modified University of Wisconsin (95 +/- 6 mm Hg) and low-potassium dextran (99 +/- 4 mm Hg) groups was significantly higher than that in the surface cooling (61 +/- 7 mm Hg) and University of Wisconsin (51 +/- 7 mm Hg) groups. There was no difference between the modified University of Wisconsin and low-potassium dextran groups or between the surface cooling and University of Wisconsin groups. We conclude that the low-potassium University of Wisconsin solution is superior to the high-potassium University of Wisconsin solution and that the lactobionate and raffinose included in the University of Wisconsin solution as impermeants do not improve lung preservation in this model.

Adenosine↗
PubMedDate not supplied

[80 years' of internal medicine education at the medical school of the university in Belgrade (1922-2002)].

ORGANISATION OF TEACHING INTERNAL MEDICINE: The Department for Internal Medicine and Internal Clinics were founded in spring 1922. Dr. Radenko Stankovic and Dr. Dimitrije Antic were appointed as part-time Professors, while Dr. Aleksandar Ignjatovski, a former Full-time Professor of the Warsaw University, was appointed as professor under contract. A year later, Dr. Aleksandar Radosavljevic was appointed as Part-time Professor. In the General State Hospital and Military Hospital, certain wards were turned into clinics. II and III Internal Clinics were situated in the barracks, while the Propedeutic and I Internal Clinics were located in the Military Hospital. Upon the construction of the buildings of the Internal Clinic and General State Hospital, the Propedeutic and I Internal Clinics were permanently placed in the new building, and II and III Internal Clinics in the General State Hospital. Teaching of Internal Medicine started 31 October 1922. Dr. R. Stanko vic delivered a lecture in Propedeutics for students of the fifth term. This date marks the beginning of teaching internal medicine at the newly established School of Medicine, University of Belgrade. Dr. A. Ignjatovski started lecturing Internal medicine 23 March 1923, whereas Dr. D. Antic and and Dr. A. Radosavljevic also delivered lectures in the areas of Internal Medicine within their professional scope. At the beginning, the clinics belonged to the General State Hospital. It was impossible to teach successfully in hospital, therefore upon the professors' request, the clinics were separated and thus became the institutions belonging to the School of Medicine-educational institutions, while hospitals were health institutions. The rule was 'one professor--one clinic'. After the Second World War, teaching Internal Medicine was begun in demolished buildings in very difficult financial circumstances. The Propedeutic Internal clinic was renamed IV Internal Clinic, which continued dealing predominantly with cardiology. III and IV Internal Clinics were placed in the building of the Internal Clinic, II Internal Clinic remained in the General State Hospital and I Internal clinic was moved to the new building of the Institute for Oncology. REFORMS OF SCHOOL OF MEDICINE AND ITS CLINICS: Out of the School of Medicine, Veterinary Medicine, Pharmacy and Stomatology, the Grand Medical School was formed. After several years, it was closed down, and the schools were returned to the University. The most important alteration was made when, according to the Law, the Clinics were isolated from the School and proclaimed hospitals, health institutions and organised into the Clinical Centre of the School of Medicine, then University Clinical Centre, and finally the Clinical Centre of Serbia as the teaching base. Within city hospitals, later on Clinical Hospital Centres, the teaching bases for Internal Medicine and other subjects were established, with introducing self-management and the Law on Associated Labour with independent financing, there came hard times for the School of Medicine and Clinics. The Law had negative effects upon the Schools--University and it had to be abolished. The next step in the reform was merging of I and II Internal Clinics into the Internal B Clinic, within the Clinics, out of specialized departments for certain branches of Internal Medicine there were formed clinics (Clinic for Cardiology, Pulmonology, Endocrinology, Diabetes and Metabolic Diseases and so on). The Internal A Clinic was situated in the building of the General State Hospital and the Internal B Clinic in the building of the Internal Clinic, where there were also III and IV Internal Clinics. CONSTRUCTION OF CLINICAL CENTRE: After a long time, there were created conditions for constructing a new building for locating clinics--the Clinical Centre, the foundation stone was laid 20 October 1976, and the first phase including the polyclinics was completed 1 January 1983. The preliminary concept of the bed capacity of 30 to 50 at Internal Clinics was altered and the Institutes were established. Firstly, the Internal Clinics was altered and the Institutes were established. Firstly, the Internal A and B Clinics were joined into the Basic Organisation of Associated Labour Internal Medicine. Afterwards, certain specialized Internal Clinics with respective surgical branches were linked and the Institutes were established (Institute for Cardiovascular Diseases, Institute for Pulmonology and Tuberculosis, Institute for Endocrinology, Diabetes and Metabolic Diseases and so on). The Institutes were located at the former buildings of the clinics as well as the vacant buildings of the Military Medical Academy, which moved into the new modern building at Banjica. Thus, Internal Medicine was organisationally closed down, while assistants and professors were gathered at the Department for Internal Medicine which represented the organisation for teaching Internal Medicine. Professors and assistants from certain specialized Institutes taught certain disciplines, and at the Clinical Hospital Centre bases where teaching staff was deficient, the Clinical Centre professors were of assistance. A colossal Emergency Centre was established within the Clinical Centre, providing services for the whole of the Republic and beyond, which is completely illogical since it should be the Republic Health Institution rather than the part of the Clinical Centre. Also, the Clinical Centre as the health institution is enormous and represents the teaching base. The first directors were lawyers and, as of recently, professors of the School of Medicine. By separating Clinics from the School of Medicine, teaching and allied staff have a double working status as unique, so financially more potent health sector has gradually pushed aside the teaching one being rather underestimated in such organisation. Ministers for Health and Directors of the Clinical Centre great executive power for appointing directors. There started an uprecedented systematic degradation of teaching staff, since assistant professors or newly appointed associated professors were appointed as managers over their own teachers, full-time professors. It is unusual that those young people accepted their big, delicate roles to manage their professors in front of whom they had taken their board exams or defended their masters' and doctoral theses in not so distant past. There has only been one case of a junior professor refusing to be the director of his own professor. The stationary section of the Clinical Centre including the Internal Clinics was completely constructed but has not been equipped or occupied yet. Deans were authoriZed, by the University Law, to appoint professors and assistants. Thus, a large number of them were appointed without any high scientific and teaching quality standards, and afterwards promoted, while certain highly competent professors were dismissed from the University. By altering the system and passing the new University Law, the situation has improved and the University is returning to its roots. Today, such Clinical Centre as the teaching base of the School of Medicine and the School itself represent a big problem, primarily the financial one. Thus, it will be very hard to re-establish the right relationship between these two institutions.

Education, Medical↗
PubMed1996

Efficacy of oxygenated University of Wisconsin solution containing endothelin-A receptor antagonist in twenty-four-hour heart preservation.

BACKGROUND: The University of Wisconsin solution has been proven to be effective for prolonged heart preservation. However, 24-hour heart preservation by simple cold immersion in University of Wisconsin solution has been disappointing. We have performed hypothermic low-pressure continuous coronary perfusion with oxygenated University of Wisconsin solution for experimental prolonged heart preservation. However, the high potassium concentration of University of Wisconsin solution combined with prolonged ischemia has detrimental effects on endothelial function, which increases coronary tone during preservation and after reperfusion. The severe vasoconstriction and tissue edema result in damage to the coronary microcirculation. The purpose of this study was to determine whether hypothermic low-pressure continuous coronary perfusion technique with oxygenated University of Wisconsin solution containing a selective endothelin-A receptor antagonist (FR139317) would increase the effectiveness of the perfusion technique and improve postischemic cardiac function, both minimizing tissue edema and suppressing vasoconstriction. METHODS AND RESULTS: Preischemic and postischemic cardiac function of isolated rabbit hearts was evaluated with a Langendorff apparatus. The hearts were divided into three groups (n = 7 each): group I (hypothermic low-pressure continuous coronary perfusion with University of Wisconsin solution), group II (hypothermic low-pressure continuous coronary perfusion with oxygenated University of Wisconsin solution), and group III (hypothermic low-pressure continuous coronary perfusion with oxygenated University of Wisconsin solution containing 10 mg/L of FR139317). Preservation was performed for 24 hours. The initial perfusion pressure for continuous coronary perfusion was set at 5 mm Hg. Measurement of percentage of tissue water content and ultrastructural examination of the myocardium was then performed. In groups I, II, and III, the perfusion pressures at the end of the 24-hour preservation period increased from 5 mm Hg to 12.2 +/- 2.5, 8.1 +/- 1.3, and 5.4 +/- 0.8 mm Hg (p < 0.05), respectively. Percent recovery rate of cardiac output was 56.6 +/- 2.8, 82.3 +/- 8.2, and 93.3 +/- 6.0 (p < 0.05), respectively. And percent recovery rate of coronary flow was 55.5 +/- 8.1, 80.0 +/- 8.0, and 94.3 +/- 9.4 (p < 0.05), respectively. A significant inverse correlation was found between continuous coronary perfusion pressure at the end of preservation and the recovery rate of cardiac output (r = 0.85, p < 0.05). Tissue water content was significantly higher in group I than in groups II and III. These effects were inhibited by oxygenation of the University of Wisconsin solution (group II) and by the addition of the selective endothelin-A receptor antagonist (FR139317) (group III). Damage to coronary circulation was reduced by oxygenation and the addition of endothelin-A receptor antagonist during prolonged heart preservation. CONCLUSIONS: We concluded that hypothermic low-pressure continuous coronary perfusion technique with oxygenated UW solution containing endothelin-A receptor antagonist (FR139317) maintained coronary circulation by suppressing tissue edema and vasoconstriction during preservation, which improved postischemic functional recovery.

Adenosine↗
PubMed1998

Compliance with universal precautions: knowledge and behavior of residents and students in a department of obstetrics and gynecology.

OBJECTIVES: To assess the knowledge of universal precautions for the delivery and operating rooms by residents and students and to evaluate their use of universal precautions. STUDY DESIGN: Obstetrics and gynecology (ob/gyn) residents (n = 30) and students (n = 31) from an inner-city, teaching hospital were polled by anonymous questionnaire to assess their knowledge of the appropriate barrier equipment for certain ob/gyn procedures. To determine actual compliance with universal precautions, 459 ob/gyn procedures were observed. We noted the use of appropriate barrier equipment for each procedure: gloves for pelvic exam and face shields, gowns, gloves, and booties for vaginal delivery, cesarean delivery, and dilation and curettage. The True Epistat statistical software program was used to perform simple regression analysis. RESULTS: Thirty residents (100%) knew the appropriate barrier equipment required for each type of procedure performed. One student (< 1%) did not know that booties were appropriate for the surgical procedures. Rationale for lack of compliance with universal precautions elicited by the questionnaire included time constraints (64%), inconvenience (52%), and presumption that patient was not infected (34%). The observed rate of compliance with universal precautions by participants indicates that individual compliance was inversely related to the years of experience (overall compliance rate of students was 96%; for first-year residents, 92%, second-year residents, 89%, third-year residents, 84%, fourth-year residents, 78%; r = -0.9918, P = 0.0009). CONCLUSIONS: Knowledge regarding universal precautions was nearly 100%, while overall observed compliance was only 89%. Compliance with universal precautions was better among students (96%) than among residents (88%). Compliance with universal precautions was inversely related to years of experience.

Clinical Competence↗
PubMed1995

Universal precautions training of preclinical students: impact on knowledge, attitudes, and compliance.

BACKGROUND: Little information exists regarding the impact of universal precautions training programs on preclinical students' knowledge, attitudes, and behavior. METHODS: We developed, implemented, and assessed an educational program in universal precautions for 2nd-year medical and preclinical physician assistant students. Students (n = 170) completed pre- and post-training questionnaires to assess universal precautions knowledge and to evaluate attitudes about their perceived risk for bloodborne pathogen infection, the importance of universal precautions procedures, and their willingness to provide care for human immunodeficiency virus (HIV)-positive or acquired immune deficiency syndrome (AIDS) patients. Phlebotomy, intravenous catheter insertion, and arterial blood gas sampling techniques were demonstrated, practiced, and evaluated during practical training sessions. Outcome measures included changes in pre- and posttraining knowledge scores and attitudes, as well as observed compliance with universal precautions during practical training. RESULTS: Universal precautions knowledge scores increased significantly after training (P < 0.0001). Personal assessments of the risk of developing HIV due to patient care significantly decreased (P < 0.0001) and willingness to provide care for AIDS patients increased (P = 0.004) following training. Importantly, students reported that high expected rates of contact with HIV-positive and other patient groups would not significantly affect their specialty choice. Observed compliance with universal precautions procedures during practical training ranged from 95 to 99% for glove use, 76 to 77% for direct sharps disposal without needle recapping, and 56 to 78% for handwashing after glove removal during phlebotomy and intravenous catheter insertion. CONCLUSIONS: This program is effective in increasing students' knowledge of universal precautions. Training favorably affects students' willingness to care for HIV-positive patients and their assessed risk of developing occupational bloodborne infection.

Blood Specimen Collection↗
PubMed1996

Alcohol and drug use in UK university students.

BACKGROUND: Alcohol and illicit drug use are increasing among school children and young adults in the UK. Such increases have also been noted among university students and there is a need for a large survey across different universities and faculties. We report such a survey. METHODS: Information about drinking, use of cannabis and other illicit drugs, other lifestyle variables, and subjective ratings of anxiety and depression was obtained by questionnaire in a cross-faculty sample of 3075 second-year university students (1610 men, 1447 women, 18 sex not stated) from ten UK universities. The questionnaire was personally administered during scheduled lecture hours and almost all the students participated. The sample reflected the interfaculty and sex distribution and the proportion of non-white students at UK universities. FINDINGS: 11% of the students were non-drinkers. Among drinkers, 61% of the men and 48% of the women exceeded "sensible" limits of 14 units per week for women and 21 for men. Hazardous drinking (> or = 36 units per week for women, > or = 51 for men) was reported by 15% of the drinkers. Binge drinking was declared by 28% of drinkers. 60% of the men and 55% of the women reported having used cannabis once or twice and 20% of the sample reported regular cannabis use (weekly or more often). Experience with other illicit drugs was reported by 33% of the sample, most commonly LSD (lysergic acid diethylamide), amphetamines, Ecstasy (methylenedioxymethamphetamine), and amyl/butyl nitrate which had each been used by 13-18% of students. 34% of these had used several drugs. Drug use had started at school in 46% of the sample; 13% began after entering university. The overwhelming reason given for taking alcohol or drugs was pleasure. Subjective ratings of anxiety on the hospital anxiety depression scale were high, and sleep difficulties were common, but neither related to alcohol or drug use. INTERPRETATION: There is a need for better education about alcohol, drugs, and general health in universities. Such education should include all faculties. It remains unclear whether university students' lifestyles are carried over into later life.

Adolescent↗
PubMed2001

Unconventional medicine teaching at the Universities of the European Union.

CONTEXT: The recent rapid increase in demand for and use of unconventional medicine requires an adequate medical education. In the United States, 64% of medical schools offer undergraduate courses. No information is available about similar courses at European universities. OBJECTIVES: To document the incidence of educational courses on unconventional medicine offered by the European universities and their topic content. DESIGN: Mail survey, which consisted of two questionnaires and was conducted in 1999 (January-June). The first questionnaire was sent to the universities' Rectorats, the second one to the faculties or lecturers indicated by the replies to the first questionnaire. PARTICIPANTS: The Universities listed by the Confederation of European Union Rectors' Conference. MAIN OUTCOME MEASURES: Courses offered at European Universities, both at medical faculties and at other faculties. RESULTS: Five hundred and fifty (550) universities were contacted. Replies were received from 326 (59%); 141 have a faculty of medicine and 107 (76%) of them replied. We also received answers from 29 faculties of health sciences. In addition we received 190 (50%) answers from 380 other miscellaneous universities. Courses on unconventional medicine were offered by 43 (40%) medical schools, 21 (72%) health sciences faculties, and by 15 (8%) other faculties. Topics covered encompassed a wide range of techniques (33), from homeopathy to shamanism. CONCLUSIONS: Unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties.

Complementary Therapies↗
PubMed1995

Consultation in university-based and community-based infectious disease practices: a prospective study.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs. 1.8 per 100 discharges, respectively). Known or suspected bacterial pathogens accounted for more than half of all consultations in both practice groups. The three organ systems most commonly affected by infection were pulmonary (20% in university practice vs. 19% in community practice), skin and soft tissue (13% in university practice vs. 20% in community practice), and musculoskeletal (12% in university practice vs. 16% in community practice). Bloodstream infection, pneumonia, unexplained fever, osteomyelitis, urinary tract infection, and cellulitis were the six most common disease processes that led to consultation in both practice groups. The percentage of patients with noninfectious diseases and the percentage for whom a change in antimicrobial therapy was advised was nearly identical in both practice settings. Physicians in private practice performed more consultations on weekends (20% vs. 11% in university practices, P < .001) and between 6:00 P.M. and 7:00 A.M. (15% vs. 6% in university practices, P < .001). The scope and diversity of the work of consultants in community practices are nearly identical to those of their colleagues in university-based practices.

Communicable Diseases↗
PubMedDate not supplied

Six hundred years: Heidelberg University--crisis and achievements.

Throughout its 600 years, Heidelberg University has endured the social and political upheavals of history, repeatedly rising like a phoenix from the ashes of a series of disasters to fulfill its mission as a center of learning and research. Founded in 1386, and buffeted by wars, plaques, and diverse political and social systems ever since, the university has developed along lines determined as much by regional, European, and world politics as by the dynamics inherent in its disciplines. Its history may be divided into the following six historical phases: (1) the scholastic university of the late Middle Ages (1386-1556); (2) the Protestant university (1556-1685); (3) the Catholic university (1685-1807); (4) the university in the age of liberalism and nationalism (1803-1933); (5) the university during National Socialism (1933-1945); and (6) the contemporary university and its efforts to cope with the explosion of knowledge, steadily growing student numbers, and other problems related to growth, expansion, and diversification in all disciplines (1945 to the present).

Germany↗
PubMed1995

Bacteraemia in a community and a university hospital.

Four hundred and forty-one and 1048 episodes of bacteraemia were prospectively surveyed over a period of 18 months in two hospitals, a 450 bed community hospital and a 900 bed tertiary care urban university hospital. Incidence of bacteraemia was 2.18 per 1000 hospitalization days (10.1 per 1000 admissions) in the community hospital and 2.64 per 1000 hospitalization days (12.0 per 1000 admissions (P < 0.004)) in the university hospital. Sixty six and 62% of episodes of bacteraemia were community acquired. The majority of bacteraemic episodes originated on the internal medicine wards of both hospital--46.7% and 58.7% respectively; the incidence of bacteraemia in the medical divisions of both hospitals was 23.1 and 17.5 per 1000 admissions respectively (P < 0.01). Overall mortality rates were 22% and 26.7% respectively. 39.9% and 44% of all isolates were Gram-positive pathogens. Escherichia coli was the commonest Gram-negative pathogen in both hospitals, particularly the community hospital--47.5% vs 32.8% (P < 0.005) of all Gram-negative pathogens, while Pseudomonas spp. were significantly more common in the university hospital--18.5% vs 11.8% (P < 0.02). Non-enterococcal streptococci were more common in the community hospital while enterococci were far more common at the university hospital--15.1% vs 1% of all Gram-positive pathogens (P < 0.05). Staphylococcus epidermidis was more common among the community hospital Gram-positive bacteraemias--31.1% vs 18.6% (P < 0.005). For almost all genera and species, antibiotic resistance was higher at the university hospital. Twenty nine point four per cent of Staphylococcus aureus isolates from the university hospital were methicillin resistant compared to 2.4% at the community hospital (P < 0.005). 29.4% of all Streptococcus pneumoniae isolates at the university hospital were penicillin resistant while no resistance was found at the community hospital. A high resistance rate to ofloxacin was found at the university hospital among S. aureus and Pseudomonas sp. Sources of bacteraemia did not differ significantly between the two hospitals. In conclusion, although outcome did not differ significantly for the two hospitals, there were significant differences between blood culture isolates in these two different settings. These differences may influence clinical decision-making about antibiotic therapy for patients in these hospitals.

Adult↗
PubMed2001

The effects of a changing environment on relationships between medical schools and their parent universities.

Medical schools differ from other university graduate schools in that community settings, hospitals, and ambulatory care facilities are required for medical education, and most of these settings are either owned by or closely affiliated with the university. Thus, the extraordinary changes in recent years in the organization, delivery, and financing of health care have required the attention not only of the leadership of academic medical centers (i.e., medical schools and their owned or closely affiliated teaching hospitals) but also of the administrators and boards of their parent universities. Many university-wide structures and policies that previously served the medical school well in accomplishing these missions may now be viewed as inflexible by the faculty and administration of the school. Conversely, the historically distant governance and administrative oversight of the medical school has become a concern for some at the university, given the huge budgets of the school, its faculty practice, and its affiliated hospital(s). From information derived mainly from annual visits to 14 medical schools from 1996 through June 2000, the authors review the issues between medical schools and their parent universities and the strategies being used to resolve them. These strategies include changes in the governance, organization, and management of the medical school, such as unified authority for health affairs, reengineered administrative systems, and increased autonomy in decision making. The authors conclude that these strategies appear to be working on behalf of not only the medical school but, in some instances, the university at large. They also comment on possible negative implications of the greater separation of the medical school from its parent university.

Decision Making↗
PubMed2006

Free tissue transfer: comparison of outcomes between university hospitals and community hospitals.

BACKGROUND: In university hospitals, free tissue transfer has become a standard method of reconstruction for a broad spectrum of defects. Because of its complexity, free tissue transfer has not been routinely performed in a community hospital setting. This study reports the outcomes of two equal groups of free tissue transfer performed by the same surgeons, comparing the university versus the community hospital setting. METHODS: A total of 735 free tissue transfers were performed at one university hospital and six community hospitals in our region over a 10-year study period. Outcome parameters used in this study included wound complications such as infection, dehiscence, delayed healing, hematoma, and fat necrosis. RESULTS: A total of 674 operations were performed using 735 free tissue transfers: 386 free tissue transfers were performed at the university hospital (53 percent) and 349 (47 percent) were performed at the community hospital. Categories of free tissue transfer reconstruction included breast, lower extremity, head and neck, and upper extremity reconstructions. Most of the breast reconstructions were performed in the community hospital, whereas most of the lower extremity and head and neck reconstructions were performed at the university hospital. Fifty-one major postoperative complications occurred in the university hospital (14 percent), while 31 (10 percent) occurred in the community hospital. Complication rates did not differ significantly between settings; however, there was a trend toward more wound infections in the university hospital and more cases of fat necrosis in the community hospital, most likely reflected in the differing case mix between hospital settings. CONCLUSION: Free tissue transfer is an effective and practical method of reconstruction that has been safely performed in both university and community hospital settings.

Academic Medical Centers↗
PubMed2005

Can we generalise to other young people from studies of sexual risk behaviour among university students?

OBJECTIVE: Many studies of sexual behaviour and condom use are based on data collected from university students. The aim of this paper is to determine whether first-year university students and their same-age peers have different patterns of sexual behaviour. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 19,307 Australian men and women aged 16-59 years (response rate 73.1%), 920 of whom were aged 17-19 years. Comparisons were made between reports of sexual risk behaviours from first-year university students and reports of the same behaviours from their same-age peers. RESULTS: For female respondents, there were few differences in the sexual behaviour of first-year university students and their same-aged peers. For male respondents, there were some significant differences in the sexual behaviour of first-year university students and their same-aged peers and also different patterns of correlation between measures of sexual behaviour. Socio-demographic characteristics were related to whether 17-19 year-old respondents were first-year university students or engaged in other activities. CONCLUSIONS: The findings of studies of the sexual behaviour of university undergraduates should only be generalised to other groups with caution. The socio-demographic characteristics of the student population of a particular institution must be taken into account before generalisation to the broader population can safely be made from studies of single universities.

Adolescent↗
PubMed2006

Earning and learning: role congruence, state/trait factors and adjustment to university life.

BACKGROUND: Undertaking term-time employment is increasingly commonplace for university students. Much research suggests that combining 'earning and learning' may be detrimental to university life, generating role conflicts, increasing stress and reducing academic success, participation and overall adjustment to university. Potential positive effects of term-time employment on well-being are often neglected. AIMS: This study adopted a balanced perspective, investigating the relationship between role congruence in academic, social and career domains and adjustment, with state and trait psychological factors as mediators/moderators. METHODS: A questionnaire measuring perceived role congruence, adjustment to university life and psychological state and trait characteristics was mailed to all undergraduates at a Scottish university during term-time. SAMPLE: Results for a subsample of 625 university students currently in term-time employment were included in this paper. RESULTS: Findings suggested that students generally perceived employment and university roles to be in balance, and there was no difference in adjustment for students whether currently in term-time employment or not. However, psychological factors, particularly positive affectivity and stress were important mediators of the relationship between role congruence and adjustment. CONCLUSIONS: Since promoting role congruence may enhance students' adjustment and well-being, the study has implications for universities, student welfare organizations and employers offering term-time employment.

Adult↗
PubMed1992

[Kyongsong Imperial University Medical College].

Japan annexed Korea in 1910 and with the promulgation of the Chosen Kyoyuk Ryong (the Korea Education Decree) in 1911, it began to conduct education for the Korean people. However, this was only a matter of formality and a policy for liquidating the spirit of the Korean people. It finally resulted in the uprising of March 1, 1919 of the Korean people that has a cultural tradition of a high level. This event served as a cause of widely spread censure among the Korean people as well as the people of the whole world. Even in Japan voice of criticism rose high. Such being the situation, Japan amended the Korean educational law under the pretext of shifting to a so-called civil-rule policy. The Japanese authorities adopted the same educational system as was practiced in Japan proper, for primary and middle school education. As for higher education, they placed under a strict control the educational facilities already established by Korean people and foreign missionaries, suppressing even minor expansions of existing facilities. However, the movement by some Korean educators to establish a private university and efforts by some missionaries to integrate the existing educational organizations into a university made it inevitable for the Japanese authorities to set up a university of their own in Korea. Thus, they hurriedly established the Kyonsong Imperial University in which was included a medical college that was an indispensable organization for colonial education. They professed that the medical college was established for the purpose of providing equal opportunities and privileges to Korean and Japanese students, but, on the contrary, the operation of the college was done strictly under their colonial policy. The system of the Kyongsong Imperial University was enforced acording to the Japanese Imperial University Law, and all the faculty members and the administratial officials were Japanese. As for Koreans, a few graduates of the university was named nonpaid deputy assistants, and graduates of other colleges were employed as nonpaid subdeputy assistants. In most cases, Koreans, finally handicapped compared with Japanese, could not continue their study and research. A few of them who could conduct continued study and research were placed under strict restraints and, accordingly, their opportunities to achieve academic and social promotion were quite limited. During the history of 20 years of the Kyongsong Imperial University Medical College Yun Il Son and Ko Yong Sun served as assistant professors for 13 months and three days respectively. In addition, there were 12 Koreans who worked as temporary assistants, the periods of their service varying from two days to 10 years. The rate of graduates for Koreans was less than 30% and the rate for Koreans who received a degree of doctor of medical science was only 25%. From 1940, the course of the medical college was shortened to three years and same months under the war-time system, and with Japan's unconditional surrender to the Allied Forces on August 15, 1945, the entire faculty of the medical college was discharged by the U.S. Military Government on November 5, 1945.

Colonialism↗
PubMed2003

Illicit drug use among Canadian University undergraduates.

The purpose of this study was to examine rates and patterns of illicit drug use among Canadian university undergraduates, to compare these rates with those for non-university samples, and to describe drug-use trends among university undergaduates in the province of Ontario between 1988 and 1998. A national mail survey was carried out based on stratified 2-stage sample design. The sample comprised 7,800 Canadian undergraduates from 16 universities (52% of eligible respondents). Approximately 47.5% reported use of illicit drug durning their life, 29.6% in the previous 12 months, and 18.7% since the beginning of the academic year. Cannabis was by far the most widley used drug (47.0%, 28.7%, and18.2%, respectively). Many of the gender and regional associations were similar to those found in general-populations surveys. Comparisons to non-university peers did not indicate elevated rates among university students. Among Ontario university undergraduates the use of cannabis, hallucinogens, methamphetamines, crack, and herion remained stable between 1988 and 1998. The use of cocaine declined from 4.8% to 1.7%. Rates of illicit drug use were not appreciably higher than those among their non-university peers. Other public-health issues, such as heavy drinking and poor mental health, override those related to illicit drug use.

Adult↗
PubMed1999

[Polish School of Medicine at the University of Edinburgh, in the years of World War II. (50th anniversary of closure)].

Half a century ago the activity of the Polish School of Medicine at the University of Edinburgh came to an end. It seems a good occasion to recall its beginnings and recognise its merits for Poland and for medical education. The school was a Scottish-Polish academic enterprise, unique in the history of universities, presenting an example of international academic co-operation. It was then the only legal Polish medical school in the years of World War II. The founders of it were: Lt.Col. Professor Francis A. E. Crew, Commanding Officer of the Military Hospital at Edinburgh Castle, who conceived the idea of a Polish medical school as a part of the University of Edinburgh, the Dean of the Medical Faculty, Professor Sidney Smith, who along with Sir Thomas Holland, the Principal of the University put the idea into motion through the University authorities on the Scottish side-and the Commander in Chief of the Polish Forces and Prime Minister General Władysław Sikorski, who gave his whole-hearted support and Lt.Col. Dr Antoni Jurasz, Professor of Surgery at the University of Poznań, who became the main organiser and first dean of the Faculty-on the Polish side. It was an independent Polish academic institution being simultaneously an integral part of the University. The medical training underwent 337 undergraduates, 227 out of whom obtained the degree M.B.Ch.B. and 19 degrees of Ph.D. after submission of doctoral thesis. The majority of them had served in the Polish troops being referred by the Military authorities and many of them took later part in the war campaigns. Much emphasis is put on the activity of Wiktor Tomaszewski, Associate Professor of medicine, ex-Senior Lecturer of the School, explorer of historical bounds between two nations, and above all, the organiser of the anniversary celebrations, so much animated by a passion for unceasing memory of the school. He was honored by granting F.R.C.P. (Ed.) and honorary doctorship of the University.

History, 20th Century↗