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[Steadiness and progress. Medicine in Würzburg in the mirror of the centuries - a contribution to the foundation of the University of Würzburg 600 years ago].

In the year 1402 one of the first German universities was founded by bishop Johann von Egloffstein, but it had last in its full composition for only a few decades. Nevertheless, the 600th anniversary has a great importance, because in the 16th century, during the second foundation, there was an adequate tradition of university in Würzburg to lean on and go back to.Although, in a medical-history view, in 1402 this university had been without a greater importance, the medicine in Würzburg in the Middle Ages and the Early modern Times had been on a high level, what is shown by representatives like Ortolf von Baierland (13th century) and Berthold Blumentrost (14th century) or by documents like the 'Würzburger Wundarznei' at the end of the 15th century and the 'Nüttzlicher Bericht' by Walther Hermann Ryff, printed 1548 in Würzburg, as one of the first dental mongraphies.A lasting success was finally the university opened in the year 1582. In 1575/6 bishop Julius Echter von Mespelbrunn had reached, using the traditions of the university of 1402, a new privilege by the pope and the emperor. The medical faculty which was functional deeply connected with the Juliusspital as a kind of hospital right from the beginning, was determined by Wilhelm Schefferlein, Gottfriedt van der Steighe and Adriaen van Roomen. In the beginning of the 17th century the medical faculty turned pale, but two representatives of the philosophic faculty, Athanasius Kircher and Caspar Schott, accomplished remarkable outcomes in medical fields. Heavily stricken by the Thirty Years' War the medicine at the University of Würzburg was changed by the prince-bishops to the model of the University of Leiden, in order to improve the feeble position of the medical faculty. After not being successful in the beginning, the foundation of the blossom and of its worldwide importance had been laid in the last third of the 18th century. Karl Kaspar Siebold had, with the help of some of his fellows, students, and his family (like his sons Johann Barthel and Adadam Elias von Siebold), reorganized the medical faculty, which had brought her in the byname 'Academia Sieboldiana". In the beginning of the 19th century the recovery of the faculty moved on more and more: OUtstanding representatives like Ignaz Döllinger, Johann Lukas Schoenlein and Franz von Rinecker founded by their great medical-scientific and organizational achievements, the high reputation of the medical faculty of Würzburg. Especially in the second half of the 19th century the University of Würzburg was in a leading position in a lot of traditional disciplines and in the developing and establishing of new medical fields, shown by names like Franz Kiwisch Ritter von Rotterau and Friedrich Wilhelm Scanzoni von Lichtenfels, Cajetan von Textor and Wenzel von Linhart, Rudolf Virchow, Albert Kölliker, Franz von Leydig, Carl Joseph von Ringelmann, Johann Joseph von Scherer, Johann Georg Heine, Adolf Fick or Carl Gerhardt.

Germany↗

Hospital privileges for family physicians at university hospitals.

Of the more than 350 family practice residency programs in the United States, 72 are affiliated with a medical school. Seventy-eight percent of these university programs hospitalize all or some of their patients at a university hospital. These hospitals grant various privileges to family physicians with the following frequencies: general medicine (94 percent), adult intensive care (50 percent), coronary care (65 percent), general pediatrics (81 percent), pediatric intensive care (29 percent), normal newborn nursery (79 percent), intensive care nursery (12 percent), routine obstetrics (77 percent), and high-risk obstetrics (31 percent). Sixteen (22 percent) of the university-based programs do not use a university hospital at all, either because the university hospital is too far away or because there is no university hospital. Only one program does not use the university hospital because of difficulty in obtaining privileges. Family physicians are unable to obtain various hospital privileges because of political reasons at the following percentages of university hospitals: general medicine (2 percent), adult intensive care (33 percent), coronary care (40 percent), general pediatrics (8 percent), pediatric intensive care (31 percent), newborn nursery (8 percent), intensive care nursery (29 percent), routine obstetrics (13 percent), and high-risk obstetrics (17 percent).

Coronary Care Units↗

[Research and education in geriatrics at German universities and colleges].

To assess the situation of geriatric research and education at German universities, a questionnaire was sent out to all medical faculties (n = 37). The response rate was 91.9% (n = 34). There are five universities with a geriatric chair (14.7%), one with a department of geriatric medicine within internal medicine, and two departments of geriatric psychiatry. At 15 universities geriatric research is established (44.1%), but only 12 universities report that geriatric contents are implemented in the teaching of medical students. The comparison of universities with and without geriatric chairs and departments showed big differences. Whereas all universities with geriatric chairs or departments conduct geriatric research and offer education in geriatric medicine, the others failed to do so. Only 26.9% (n = 7) have geriatric research and 15.4% (n = 4) offer medical teaching in geriatrics. There is a strong link between geriatric chairs, research, and pregraduate teaching. Geriatric medicine is established only at few universities. To improve the overall situation of geriatrics in Germany the implementation of further geriatric chairs and departments at universities seems to be necessary.

Aged↗

Comparison of the usefulness between a new universal grading system for epithelial ovarian cancer and the FIGO grading system.

OBJECTIVE: The aim of this study was to compare the usefulness of a new universal grading system for ovarian cancer proposed by Shimizu et al. (Cancer 82 (1998), 893; Gynecol. Oncol. 70 (1998), 2) with that of the FIGO grading system as a prognostic factor of ovarian cancer. METHODS: We reviewed all paraffin-embedded tissues of epithelial ovarian cancer obtained from 130 women who underwent initial treatment including primary surgery in our hospital between January 1990 and December 2000. The scores of the specimens were obtained according to both the universal grading system and the FIGO grading system. RESULTS: Both the FIGO grading system and the universal grading system worked as significant prognostic indicators. Patients with Grades 1 and 3 of the universal grading system had high and low 5-year survival rates, respectively, compared to those of the FIGO grading system. Inconsistencies in histologic grade between the FIGO and universal grading systems were observed in 22 patients. The positive rate of lymph node metastasis in patients with Grade 3 of the universal grading system was significantly high compared to those of the FIGO grading system (P = 0.03). Patients with Grade 3 of the universal grading system with residual tumor of not less than 2 cm in diameter were observed more frequently than those of the FIGO grading system. C4ONCLUSION: The universal grading system was superior to the FIGO grading system in terms of the prediction of malignancies such as the potential of lymph node metastasis and invasion and the adaptability to clear cell cancer.

Adenocarcinoma, Clear Cell↗

A pilot survey of medical students' perspectives on their educational exposure to palliative care in two Canadian universities.

BACKGROUND: Graduating medical students from the class of 1999 from McGill University and the University of Alberta completed a self-administered, anonymous, pilot survey to determine students' perspectives on how their educational experience in common palliative care topics contrasted with their educational experience in the diagnosis and management of hypertension, non palliative aspects of breast cancer, and patients dying of acquired immune deficiency syndrome (AIDS). METHODS: A Likert scale ranging from "excellent," scored 1, "very poor," scored 5, was used. Students also estimated the number of hours they spent, during their training, in operating rooms, on home visits to terminally ill patients, and in interprofessional teaching. RESULTS: Sixty of 114 (53%) students from McGill University, and 53 of 110 (48%) students from the University of Alberta responded to the survey. The mean ratings of education experience in the various topics for both universities combined were as follows: hypertension, 2.03; breast cancer, 2.33; cancer pain, 3.42; communicating with dying patients, 3.32; and caring for patients with AIDS, 4.15. The average number of hours spent in the operating room, on home visits to terminally patients, and in interprofessional teaching for both universities combined were 155 hours, 4.2 hours, and 16 hours, respectively. Of the responding students from both universities 83% favored increased palliative care teaching. CONCLUSION: Despite the disproportionate number of hours spent in operating rooms compared to palliative care community exposure, only two students, one from each university, favored shortening surgical rotations to allow for increased time for palliative care education. Recommendations, including increasing palliative care education during clinical clerkships, are provided to improve medical students' perceptions of their educational experiences in palliative care education.

Acquired Immunodeficiency Syndrome↗

Cost-effectiveness of universal screening for chlamydia and gonorrhea in US jails.

Universal screening for the sexually transmitted diseases (STDs) of chlamydia and gonorrhea on intake in jails has been proposed as the most effective strategy to decrease morbidity in inmates and to reduce transmission risk in communities after release. Most inmates come from a population that is at elevated risk for STDs and has limited access to health care. However, limited resources and competing priorities force decision makers to consider the cost of screening programs in comparison to other needs. The costs and cost-effectiveness of universal screening in correctional settings have not been documented. We estimated the incremental cost-effectiveness of universal urine-based screening for chlamydia and gonorrhea among inmates on intake in US jails compared to the commonly used practice of presumptive treatment of symptomatic inmates without laboratory testing. Decision analysis models were developed to estimate the cost-effectiveness of screening alternatives and were applied to hypothetical cohorts of male and female inmates. For women, universal screening for chlamydia only was cost-saving to the health care system, averting more health care costs than were incurred in screening and treatment. However, for men universal chlamydia screening cost $4,856 more per case treated than presumptive treatment. Universal screening for both chlamydia and gonorrhea infection cost the health care system $3,690 more per case of pelvic inflammatory disease averted for women and $650 more per case of infection treated for men compared to universal screening for chlamydia only. Jails with a high prevalence of chlamydia and gonorrhea represent an operationally feasible and cost-effective setting to universally test and treat women at high risk for STDs and with limited access to care elsewhere.

Chlamydia Infections↗

Training for rural family medicine: a cooperative venture of government, university, and community in Alberta.

Training, recruiting, and retaining family physicians in rural areas are issues that have attracted the attention of governments, university training programs, medical governing bodies, and rural communities. In this article, the authors describe a cooperative venture between government, university, and community in the province of Alberta to train medical students and residents in rural areas. The Rural Physician Action Plan (RPAP) was developed in the early 1990s to improve the recruitment and retention of physicians in rural areas. The RPAP is coordinated by a committee composed of representatives of the Alberta government, the Alberta Medical Association, the College of Physicians and Surgeons of Alberta, and the faculties of Medicine at the University of Alberta and the University of Calgary. Residents in the University of Alberta Department of Family Medicine are required to do 20 weeks of blocktime training in a community practice, and under the auspices of the RPAP rural training sites were identified and rural rotations developed. Faculty development activities were developed for the community physicians who would host the residents. The RPAP funds 24 third-year residency positions, equally divided between the University of Calgary and the University of Alberta. Beginning in 1994, undergraduate medical students at the University of Alberta were required to complete a four-week family medicine rotation, with a majority of students being posted to rural training sites. The extent to which the RPAP has helped to recruit and retain physicians in rural areas is not clear. The provincial Ministry of Health evaluated the RPAP in 1995 and concluded that, at a minimum, without the RPAP the province would have suffered a net loss of rural physicians. The communities have been very accepting and supportive of the students and residents.

Alberta↗

[Polish historical collection at the University of Edinburgh].

The Polish School of Medicine, a joint Scottish-Polish academic enterprise, established in 1941 at the University of Edinburgh for soldiers-students in the Polish Forces, ceased its activity in 1949, four years after the end of the war. Owing to the stalinist terror in occupied Poland most of the 227 graduates remained in the West. There was a deep feeling of gratitude towards the University on the part of the graduates of the Polish School. The 25th anniversary of the School in 1966 was an opportunity to convoke in Edinburgh a world reunion of the graduates. At the academic ceremony two gold medals were presented to the University. The warm reception extended by the University, prompted the resolution to hold quinquennial world reunions in Edinburgh. Since then world reunions were held in Edinburgh every 5 years with meetings with the University authorities and presentation of gifts. By 1980 the number of gifts accumulated to such extent that the seminar room in the Erskine Medical Library was selected for the permanent display of the gifts; this served to intensify the collection of exhibits. Gifts were chosen to remind of certain events in the Polish history of medicine, especially items reflecting Polish links with Scotland. The highest achievement in the Scottish-Polish links, was of course the creation of the Polish School of Medicine. The official opening of the Historical Collection took place in June 1986 on the occasion of a world reunion on the 45th anniversary of the School. It was marked by the unveiling of a memorial plaque. On this ocasion another venture was also initiated: the opening of the Polish School of Medicine Memorial Fund at the University of Edinburgh. It was funded by the graduates to provide scholarship for young doctors from Poland. Another venture was the creation of the "Professor Antoni Jurasz lectureship" for Edinburgh professors to lecture in Medical Academies in Poland. The Historical Collection of the Polish School of Medicine at the University of Edinburgh is a permanent memorial to the magnanimity of the University left by the graduates. It is at the same time a windowshow of a 300 years old Scottish-Polish history of medicine.

History of Medicine↗

University of Wisconsin versus histidine-tryptophan-ketoglutarate for tissue preservation in live-donor liver transplantation.

OBJECTIVES: University of Wisconsin solution has twice the cold hepatic preservation time as does Euro-Collins solution. Histidine-tryptophan-ketoglutarate has a lower potassium content than does University of Wisconsin solution and is used more frequently. To date, however, studies comparing University of Wisconsin and histidine-tryptophan-ketoglutarate in live-donor liver transplantation are lacking. We therefore sought to examine the hepatic function of live-donor liver transplantation allografts preserved in University of Wisconsin solution as compared with those preserved in histidine-tryptophan- ketoglutarate solution. MATERIALS AND METHODS: Between July 2003 and August 2004, 33 live-donor liver transplantations were performed at the University of Rochester Medical Center, Rochester, NY, USA. University of Wisconsin solution was used for the first 9 allografts, and histidine-tryptophan-ketoglutarate was used for the subsequent 24 allografts. Daily total bilirubin, aspartate amino transferase, amino alanine transferase, alkaline phosphatase, gamma glutamyl transpeptidase, and international normalized ratio levels were measured for the first 8 postoperative days. Peak values were compared between the groups. RESULTS: There was no primary graft nonfunction in either group. Two patients in the histidine-tryptophan- ketoglutarate group developed hepatic artery thromboses and underwent a retransplantation. Mean peak aspartate amino transferase and amino alanine transferase levels were higher in patients in the histidine-tryptophan-ketoglutarate group (aspartate amino transferase, 661+/-801 U/L; amino alanine transferase, 696+/-964 U/L) than they were in patients in the University of Wisconsin group (aspartate amino transferase, 439+/-415 U/L; amino alanine transferase, 464+/-376 U/L); however, this difference was not significant. Mean total bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase levels, and international normalized ratios were similar in both groups. CONCLUSIONS: University of Wisconsin and histidine-tryptophan- ketoglutarate solutions are both effective in preserving live-donor liver allografts. In the current study, patients in the histidine-tryptophan-ketoglutarate group had higher peak aspartate amino transferase and amino alanine transferase levels initially, but these became almost identical by postoperative day 8.

Adenosine↗

University of Wisconsin solution for lung graft preservation: which components are important?

Rat lung grafts were perfused with either Euro-Collins solution, University of Wisconsin solution, or one of six modified University of Wisconsin solutions that had been sequentially depleted of specific components (n = 5 each group). After storage at 4 degrees C for 6 hours, the isolated, ventilated pulmonary graft was reperfused for 1 hour with recirculating venous blood from a support animal. In a further group, lungs were reperfused immediately after explanation to provide control values. Grafts flushed with University of Wisconsin solution functioned at control levels with regard to oxygen tension: University of Wisconsin solution 128 +/- 2.7 mm Hg, control 126 +/- 5 mm Hg; graft blood flow: University of Wisconsin solution 9.9 +/- 0.4 ml/min, control 10.2 +/- 0.8 ml/min; peak airway pressure: University of Wisconsin solution 17 +/- 0.5 mm Hg, control 16.5 +/- 0.6 mm Hg; and weight gain: University of Wisconsin solution 0.12 +2- 0.1 gm, control 0.19 +/- 0.13 gm. In contrast, lungs treated with Euro-Collins solution functioned less well: oxygen tension 54 +/- 6 mm Hg, graft blood flow 3.5 +/- 0.42 ml/min, peak airway pressure 35 +/- 4 mm Hg, and weight gain 4.15 +/- 0.5 gm (p < 0.0001 all parameters). Sequential removal of hydroxyethyl starch, magnesium, allopurinol, adenosine, glutathione, and lactobionate from University of Wisconsin solution did not impair the efficacy of the solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

A reactionist professional association: the Provisional Council of University Schools and Departments of Nursing, 1942-1948.

From its inception in 1942, the Canadian Association of University Schools of Nursing (CAUSN) has developed into the accrediting agency for university nursing programs and the national voice for its 30 member schools. The current research examines the creation in 1942 of the Provisional Council of University Schools and Departments of Nursing, the forerunner of the CAUSN. The research is historical in design. Primary and secondary data were collected and analyzed inductively. Primary data consisted of archival documents located in the Queen's University Archives, Kingston, Ontario and the Canadian Nurses Association (CNA) Archives, Ottawa, Ontario. Secondary data augmented and corroborated analysis of primary data and included published histories of the CAUSN and the CNA, as well as books and articles about the development of university nursing education in Canada. The impetus for the inception in 1942 of the Provisional Council of University Schools and Departments of Nursing originated with the CNA. The Provisional Council subsequently achieved none of its stated goals. Instead, it focused on its relationship with the CNA and contested the need for its own existance. The Provisional Council was a reactionist association that reflected the uncoordinated nature of university nursing education and the inability of university nursing educators to set aside parochial differences.

Accreditation↗

Medical innovation and institutional interdependence: rethinking university-industry connections.

University-industry research collaborations have been key to a continued high degree of technological innovation in medicine. Recently, however, critical questions have been posed about the potential negative aspects of highly productive means of encouraging innovation. Concerns center on blurring roles between academic research and the commercial world and the implications of universities' newfound readiness to benefit financially from their intellectual property. The roles of both parties are often inadequately captured by considering members of university faculties as single-mindedly devoted to the advancement of fundamental knowledge and industrial firms as mere developers of university research. Rather, medical innovation depends on extensive interactions between universities and industry, with knowledge and technology transfer flowing in both directions. These interactions have had important public health and economic benefits. Yet, there is a risk to the university-industry relationship if the cultural and ethical principles of one partner overwhelm those of the other. Therefore, universities and industry need to maximize the upsides of collaboration and minimize the downsides by means of internal organizational change as well as formation of new models of collaboration, such as intellectual partnerships or virtual research organizations. This article reviews the numerous institutional patterns of innovation and draws implications for organizational and public policies.

Biomedical Research↗

[Current practices in obstetrical analgesia in German university clinics. Results of a 1996 survey. Part 2].

UNLABELLED: Obviously there is a world-wide trend towards regional analgesia for pain relief during delivery. Data on the current practice in Germany are lacking. METHODS: In 1996 questionnaires on obstetric anaesthesia and analgesia were mailed to all university departments of anaesthesia. RESULTS: All 38 university hospitals with obstetric units replied (100%). Mean annual delivery rate was 1156. Epidural analgesia (EA) (n = 22), intramuscular injection of opioids (n = 18), and non-opioids as a suppository (n = 17) were often used for pain relief during labour. Intravenous injections (n = 12) or pudendus anaesthesia (n = 7) were practised as well. Entonox (N2O/O2), paracervical blocks or transcutaneous electrical stimulation (TENS) was rarely used. EA for relief of labour pain was offered in all university hospitals. Twelve of them had an epidural rate of less than 10%, in nine the rate was 10-19%, in eight hospitals 20-29% and 30% or more in nine. Indication for EA was a demand by the parturient (n = 34), by the obstetrician (n = 26) or the midwife (n = 18), predominantly because of prolonged labour (n = 32) or significant pain (n = 21). Half of the university departments used an epidural combination of local anaesthetics (bupivacaine) and opioids (sufentanil (n = 12) and/or fentanyl (n = 9)). In all but one department the application of an epidural catheter was performed by anaesthesiologists exclusively. In some hospitals obstetricians (n = 10) or midwives (n = 4) were allowed to give epidural top-up injections. Of the 38 university departments 11 had an anaesthesiologists on duty 24 h a day responsible for the obstetric unit exclusively. CONCLUSION: In 1977, 14 of 18 university departments of anaesthesiology offered epidural analgesia for parturients. This option was available in all university departments in 1996. A mean rate of 10-20% epidurals for vaginal delivery is well within the limits reported from other countries, whereas the rate of regional anaesthesia for scheduled caesarean section (40%) still is rather low in Germany, as reported in part 1 of this survey (Anaesthesist 1998;47:59-63).

Adult↗

[2-year evaluation of a cooperation model between a surgical university clinic and a general hospital].

INTRODUCTION: On 1 January 1998 a cooperation between an university hospital and a peripheral general hospital was initiated with the aim of reducing waiting lists and health care costs. Surgical patients initially referred to the Department of Visceral and Transplantation Surgery of the University of Bern (Inselspital) were evaluated and selected in the outpatient clinic for an operation in the peripheral hospital Grosshöchstetten. The operation and postoperative care in Grosshöchstetten was performed by a team from the university department according to the standard concept also utilized at the university hospital. RESULTS: The 574 patients referred to the university and operated on in Grosshöchstetten during a 2-year period had a morbidity rate of 3.5%, a reoperation rate of 1.0% and a mortality rate of 0.15%. The mean hospital stay was 6.3 days. The quality evaluation performed by questionnaires to patients and physicians showed an overall satisfaction rate of 95%. The cooperation resulted in reduction of the overall costs in both hospitals, and the patients' involved health insurances profited from substantially lower costs per case. CONCLUSIONS: Health care costs in both hospitals as well as the waiting list at the university hospital were markedly reduced during this 2-years trial, with an overall satisfaction rate of 95%. This form of cooperation of an university with a peripheral hospital represents a new and valuable model for effective reduction of health care costs.

Adolescent↗

Risk of excess weight gain in university women: a three-year community controlled analysis.

A representative sample of university freshman women were compared to same-aged community women for rate of weight change. University women were found to gain a mean of .73 lbs/month, 36 times faster than community women. Analysis of variance showed that university women gained significantly more excess weight than did community women. The incidence of developing "treatable" excess weight was 26% and 9% for university and community women, respectively. University women were 2.6 to 5.2 times as likely as community women to gain 15% or more above ideal weight. Three-year follow-up of university women showed a stabilization and reduction in mean weight for sophomore and junior years. By the junior year, average weight returned to near baseline levels as entering freshman. Mean excess weight loss was associated with a move from mandatory dormitory housing and cafeteria food services. Young adult university women (and men) may be especially important nonclinical study populations for identifying behavioral factors involved in weight gain and self-correcting weight loss, which could be valuable for development of more effective obesity prevention programs.

Adolescent↗

[Contribution of german university departments of anesthesiology to the international literature].

OBJECTIVE: According to the president of the "Wissenschaftstrat", Prof. W. Schulze, the university is in the center of research and scientific development. The contributions of the different anesthesia departments of all german universities in international anesthesia and intensive care medicine journals were studied in a descriptive analysis. METHODS: A Medline analysis covering the past 10 years was focused an all contributions from anesthesia departments from all german universities (n = 37). Contributions in important international anesthesiology and intensive care journals were separately analysed. RESULTS: Within the investigation period of 10 years contributions in all Medline-listed international journals increased (1988:55 contributions-1997:236 contributions). There was a wide variety in the activity among the different university departments ranging from no publication up to a total of 132 publications. Only a few university departments of anesthesia contributed to the increase in papers in international intensive care journals (1988: 11 publications-1997:35 publications). CONCLUSION: Marked differences in the numbers of publications of the different universities in anesthesia and intensive care medicine journals were observed. Universities from former East Germany are still less involved in international publications.

Anesthesiology↗

[Performance and costs of outpatient clinics of university hospitals for medical care, teaching, research activities].

BACKGROUND: Outpatient clinics of university hospitals (Hochschulambulanzen) play a significant role in the German health care system. Universities have in contrast to other hospitals the right to implement an outpatient clinic, but the health care services they can render are restricted to clinical research and teaching activities. The university outpatient clinic study evaluates the intensity of medical care, teaching, research activities, and the related costs. METHOD AND DATABASE: 6 university hospitals with 51 outpatient departments in Germany were included. The prospective documentation of consultations was restricted to 800 visits per department. A total of 26,312 consultations with approximately 40,000 diagnoses and 150,000 services were documented. Furthermore, data concerning costs, teaching activities and research facilities were documented. RESULTS: Clinical treatment without any correlation to research or teaching activities amounted to about 81 % of the working time in the outpatient department (research 11 %; teaching 8 %). The primary task of the university outpatient clinics takes up less than 20 % of the working time. The physicians documented that the disease of every fourth visit was in accordance with their main field of research. 6.9 % of the visits were asked to take part in clinical trials, of these 1.25 % were included for the first time, 3.7 % were already included. 6.5 % of the visits were addressed to participate in specific teaching activities. The average total costs per case added up to 149 Euro. No outpatient clinic could cover the total per case costs with the lump sum payments. On the average 31 % of these costs were covered by lump sum payments (without cases concerning research and teaching). CONCLUSION: Treatment in outpatient departments of university clinics is far beyond research and teaching activities required by law. However, the ability of outpatient departments of universities to provide excellent outpatient services should have a more dominant role in the health care system. Therefore access to care should be deregulated for the patients and reimbursement schemes should be adjusted to adjust for the present losses.

Biomedical Research↗

What determines the size of occupational health services in UK universities?

BACKGROUND: There is wide, largely unexplained, variation in occupational health (OH) provision between UK employers. AIM: To explain the variation in OH provision across the UK university sector. METHODS: Analyses of data from a survey of university OH services and from the Higher Education Statistics Agency. The outcome variable was clinical (doctor + nurse) staffing of the university's OH service. The explanatory variables examined were university size, income, research activity score and presence or absence of academic disciplines categorized by an expert panel as requiring a high level of OH provision. RESULTS: All 117 UK universities were included and 93 (79%) responded; with exclusions and incomplete data, between 80 and 89 were included in analyses. There was wide variation in clinical OH staffing (range 0-8.4 full-time equivalents). Number of university staff explained 34% of the variation in OH staffing. After adjusting for other factors, neither the research activity nor the presence of high-needs disciplines appeared to be factors currently used by employers to determine their investment in OH. CONCLUSIONS: Government or other guidelines for university employers should take organizational size into account. Employers may need guidance on how to provide OH services proportionate to specific occupational hazards or other OH needs.

Health Personnel↗