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PubMed2001

Relationship between subjective grade and examination score in obstetrics and gynecology clerkships at community and university sites.

OBJECTIVE: To determine if there were differences in a medical student's subjective grade and obstetric-gynecologic (OB/GYN) test scores based upon the student's site of rotation, hospital type or presence of OB/GYN residents. STUDY DESIGN: We evaluated 521 students taking their third-year OB/GYN clerkship. The OB/GYN clerkship was eight weeks in length. The six sites (five community and one university) divided the OB/GYN rotations similarly. Five sites had OB/GYN residents; three had University of Illinois (UIC) residents. Comparisons were made between each student's subjective grade and OB/GYN final examination test score with respect to site, presence/absence of OB/GYN residents, community vs. university hospital and presence of UIC residents. Using the chi 2 test of association and regression models, we evaluated for relationships between the subjective grades, final examination scores and final grades. Significance was set at P < .05 for all evaluations. RESULTS: Examination scores lowered final grades for 9.4% of students trained at the university hospital as opposed to 11.5% of nonuniversity hospitals. Final examination scores were lower than subjective assessments more often than in the nonuniversity hospitals (27.6% vs. 16.2%, P < .001). Hospitals with OB/GYN residents had less of a reduction in grades than did those without residents (8.9% vs. 24.6%, P < .0001) as well as lower final examination scores (with respect to subjective grade) (21.5% vs. 40.3%, P < .0001). The presence of UIC residents further reduced the incidence of examination scores lower than subjective assessment (19.7% vs. 34.0%, P < .0001). A linear correlation was noted between subjective grade and final examination score (r = .243, P < .001); this was strongest at the university hospital. CONCLUSION: Students trained at a university hospital were less likely to have test scores lower than their subjective grades. Subjective assessments made in the presence of OB/GYN residents reduced the likelihood of a final grade reduction.

Clinical Clerkship↗
PubMed2002

[Centenary history of College of Medicine, National Taiwan University].

Orthodox medical education in Taiwan dates back to the beginning of the Japanese occupation. The Japanese first established a hospital in Taipei (Taihoku in Japanese), and created a "Medical Teaching Institute for Taiwanese", which was the embryonic form of medical education in the period of Japanese occupation. In 1899, a formal institution of medical education was established in the form of the Medical School of the Governor - Generalship of Taiwan. Later, in 1919, it was renamed the Medical College of the Governor - Generalship of Taiwan, and in 1922, its name was again changed to Taihoku Medical College. In 1936, Taihoku Imperial University created a school of medicine, which in 1945 after the liberation from the Japanese was renamed the College of Medicine, National Taiwan University, whose first dean was Dr. Tu Tsung - Ming. At the same time, Taihoku Imperial University Hospital was renamed National Taiwan University Hospital. The College of Medicine, National Taiwan University was the only institution of medical education after the island was restored to Chinese control. During the past 50 years, medical education has undergone major change and development. By 1990, the number of medical colleges in Taiwan had increased to eleven. This paper described the College of Medicine, National Taiwan University and its hospital before and after the restoration, the background and development of medical education in Taiwan. It also describes the College's achievements in the realm of education, research and healthcare trends.

Education, Medical↗
PubMed2003

[The correspondence between the clinical laboratory medicine and the core curriculum of national universities].

A model core curriculum for medical education is proposed to serve as the essential basis of material to be mastered at present and as a reference for curricula to be constructed by individual universities. The author carried out a questionnaire in departments of clinical laboratory medicine in the national universities in order to clarify the actual conditions of countermeasures of this education program for clinical laboratory medicine. As a result, 50% of universities satisfied this program's objectives and the remainder were insufficient. School hours are reduced by half. There were great differences in the methods of clinical laboratory training between universities. In the Toyama Medical and Pharmaceutical University, general clinical laboratory education is administered in the first semester of the 4th year. In clinical training, all the members should study compulsory fundamental laboratory technique in first semester of the 5th year and, in addition, 6th graders in the last 2 months should be able to choose an advanced clinical training course. To this basic curriculum addition of an elective curriculum will be required, providing individual or unique training programs based on student needs and the educational principles of each university.

Curriculum↗
PubMed2006

A Web-based assessment of bioinformatics end-user support services at US universities.

OBJECTIVES: This study was conducted to gauge the availability of bioinformatics end-user support services at US universities and to identify the providers of those services. The study primarily focused on the availability of short-term workshops that introduce users to molecular biology databases and analysis software. METHODS: Websites of selected US universities were reviewed to determine if bioinformatics educational workshops were offered, and, if so, what organizational units in the universities provided them. RESULTS: Of 239 reviewed universities, 72 (30%) offered bioinformatics educational workshops. These workshops were located at libraries (N = 15), bioinformatics centers (N = 38), or other facilities (N = 35). No such training was noted on the sites of 167 universities (70%). Of the 115 bioinformatics centers identified, two-thirds did not offer workshops. CONCLUSIONS: This analysis of university Websites indicates that a gap may exist in the availability of workshops and related training to assist researchers in the use of bioinformatics resources, representing a potential opportunity for libraries and other facilities to provide training and assistance for this growing user group.

Computational Biology↗
PubMedDate not supplied

[Indicators of educational assessment and prospects of improving university life].

INTRODUCTION: Five years after the establishment of the National Observatory for Assessment--now called National Committee for the Assessment of the University System--(L. 509/99), a critical analysis of the indicators chosen in relation to the aim suggested by the law itself becomes necessary. OBJECTIVE: To analyse the assessment system of the University Campus Bio-Medico as it has changed through time, in order to highlighten possible trends which have allowed a real improvement of the entire educational system. In these years our University has endeavoured to answer appropriately to the National Committee exhortations by creating its own system of self-assessment. This has strengthened the inner motivation to improve of all stakeholders of the educational process (students, teachers, tutors). The predominance of inner motivations on external ones is the essential feature in an university system which grants an educational model based on personal freedom and its related responsibility. This system, created and managed by the Department for Educational Research (DIE) of the University Campus Bio-Medico, is organized in three wider phases: planning of assessment tools and their administration; preparing the focus groups which address targeted groups of people so to evaluate the results and prepare new tools. RESULTS AND CONCLUSIONS: In our University assessment process certain values have acquired the structure of tracks along which it is possible to find concrete features: educational independence and planning governance as well as joint responsibility and cooperation. These are the key concepts which show the uniqueness and foundation of the entire educational system.

Educational Measurement↗
PubMed2006

[The community health diagnosis of life-way disease in Peking University Health Science Center].

OBJECTIVE: To study the basic information of life way disease and the corresponding risk factors of behavior in the community of Peking University Health Science Center, understand the background issue and social support system, and analyze the requirement for community health service so that the critical issue for health can be dealt with and the comprehensive program of prevention and treatment of the disease can be accordingly supplied. METHODS: The random face to face questionnaire about life way disease and risk factors in 1051 residents over 6 years of age in the community of Peking University Health Science Center was conducted according to the typical sampling principle in 1 primary school, 1 middle school, 1 university and its community, and the investigations of health data from the hospital and the police office in the community were also conducted through discussing about life ways risk factors. Accordingly , the data obtained by way of EXCEL were analyzed and processed using SPSS 11.5. RESULTS: Diagnostic data of demography, epidemiology, behavior environment, education and organization were obtained concerning the public health of the Peking University Health Science Center community. CONCLUSION: The key health issue in the Peking University Health Science Center community is significantly influenced by the bad way of life. And some behavior risk factors, such as fatness, lack of outdoor exercise in the community members. Thus, the major necessary health service of Peking University Health Science Center residents is to carry out a comprehensive management program of life way disease for the whole people.

Adolescent↗
PubMed2006

From bibliometric analysis to research policy: the use of SIGAPS in Lille University Hospital.

In French hospitals, the progressive setting up of the new rating systems has obliged the university hospitals to justify a certain amount of activities such as research, training or moreover recourse, which are specific missions of the university hospitals. In order to justify research activities, the Lille University Hospital has developed for now three years SIGAPS, a full-web bibliometric software which census and analyse, the scientific publications referenced in the Medline database. After data downloading, each article is classified on a 6 levels "quality scale derived from the impact factors. The system then performs, for a researcher or a team, a report allowing a quantitative and qualitative analysis. Started in Lille in November 2004, the inventory and analysis of data is now ending. For the period 2001-2004, 2814 articles have been published in 700 different journals. The total number of articles increased from 688 in 2001 to 757 in 2004. The mean impact factor was equal to 2.26 and 15.5 % of articles were classified as A, 20.9% as B. Those results confirm the high level of research of the University Hospital of Lille, in agreement with two other national studies which ranks our establishment at the 6th position for medical research activities among the French University Hospitals. Currently a similar evaluation has now began in the 9 other university hospital which have subscribed to the SIGAPS project. We works currently on new indicators as patents, thesis or conferences, or access to other databases as Sciencedirect or Scopus via the RIS format. The next step in the project is the implementation of a meta-base which will federate the information provided by each SIGAPS system. This meta-base will then allow us to perform comparisons between different hospitals, determine the national "sites of excellence" and create some clinical and research networks.

Bibliometrics↗
PubMed1993

Occupational exposure to bloodborne diseases and universal precautions: measurement of health care workers' self reported attitudes.

1. As the numbers of persons infected with bloodborne diseases continues to increase, it is paramount that all health care workers exhibit behaviors reflecting unerring compliance with universal precautions. 2. Physicians and RNs who are highly trained in bloodborne diseases and universal precautions, who have the tools available for universal precautions, and who are exposed to people with bloodborne diseases, are overwhelmingly not complying with universal precautions. 3. To better understand how attitudes impact behaviors, a valid and reliable tool was developed which measured health care workers' attitudes toward bloodborne diseases and universal precautions. 4. Training programs addressing attitudes and knowledge may help change health care workers' non-compliant behaviors into behaviors reflecting compliance with universal precautions.

Blood-Borne Pathogens↗
PubMed1998

Reactions of pediatricians to the recommendation for universal varicella vaccination.

OBJECTIVES: To determine the rate of self-reported adherence by pediatricians to the 1995 American Academy of Pediatrics and the Advisory Committee on Immunization Practices varicella immunization recommendations and to evaluate factors that might influence adherence. DESIGN: Mail survey. SETTING AND PARTICIPANTS: Washington State pediatricians. MAIN OUTCOME MEASURE: Logistic regression was used to identify demographic characteristics, attitudes about varicella vaccine, and previous experiences with the disease that were associated with self-reported adherence to universal varicella immunization recommendations. RESULTS: Completed surveys were returned by 76% of contacted pediatricians, of whom 42% reported following a policy of universal varicella immunization. In multivariate analysis, agreement with statements regarding the effectiveness of varicella vaccine in reducing rare but serious complications of the disease (odds ratio [OR], 4.90; 95% confidence interval [CI], 2.30-10.50) and in decreasing work loss by parents (OR, 4.21; 95% CI, 1.14-15.50) were associated with recommending universal immunization. Disagreement with statements concerning the lack of the need for varicella immunization because complications are rare (OR, 2.54; 95% CI, 1.12-5.74), it is not required for school entry (OR, 2.52; 95% CI, 1.37-4.64), and it is not medically cost-effective (OR, 2.25; 95% CI, 1.21-4.18) were also associated with universally recommending the vaccine. In addition, experience with varicella encephalitis was also associated with adherence to the recommendations (OR, 1.96; 95% CI, 1.06-3.65). Conversely, those who were concerned that varicella vaccine might not provide lifelong immunity were less likely to report recommending universal vaccination (OR, 0.36; 95% CI, 0.19-0.68). CONCLUSIONS: Fewer than 50% of responding Washington State pediatricians reported recommending universal varicella vaccination. Adherence to the recommendations appears to be influenced by personal experience, perceptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.

Attitude of Health Personnel↗
PubMed1994

Is universal neonatal hemoglobinopathy screening cost-effective?

OBJECTIVE: To determine whether and where universal neonatal screening for hemoglobinopathies, chiefly sickle-cell disease, could be performed at socially acceptable costs. METHODS: We made projections of the cost-effectiveness of nonuniversal and universal sickle-cell disease screening throughout the United States. We then compared the cost-effectiveness of universal sickle-cell disease screening with that of universal phenylketonuria screening. Finally, we asked if "high-cost" states, that is, those in which the cost of finding a case of sickle-cell disease exceeded one half the cost of finding a case of phenylketonuria, could enhance their cost-effectiveness by joining demographically complementary states in screening cooperatives. RESULTS: If all states conducted independent screening and if the value of finding a case of sickle-cell disease were no more than one half that of finding a case of phenylketonuria, seven of the 19 states that do not currently conduct universal screening for hemoglobinopathies would begin to do so, but six of the 34 that currently do so would stop. Of the six that would stop, three have already formed a screening cooperative, reducing their projected average costs for finding either sickle-cell disease or phenylketonuria or both; the other three could similarly improve cost-effectiveness through cooperative arrangements. Nineteen states realize economies of scale in six cooperative groups; more could do so. CONCLUSION: Universal neonatal hemoglobinopathy screening can be made available at socially acceptable costs to the citizens of demographically various states.

Cost-Benefit Analysis↗
PubMed1993

Extended cardiopulmonary preservation: University of Wisconsin solution versus Bretschneider's cardioplegic solution.

Application of the University of Wisconsin cold storage solution has rapidly expanded to include medium-term to long-term preservation of virtually all intraabdominal organs. Its use in intrathoracic organ transplantation has also been suggested. We therefore examined the efficacy of the University of Wisconsin solution in a primate allotransplantation model for preservation of hearts, and as a simple single-solution system for static preservation of heart-lung blocks, for periods of ischemia ranging from 6 to 24 hours. For comparison, we employed the histidine-tryptophane-ketoglutarate cardioplegic solution of Bretschneider. University of Wisconsin solution provided superior results with regard to clinical outcome and hemodynamic recovery of hearts after ischemic periods of up to 16 hours. This was in contrast to Bretschneider's solution, which allowed storage of hearts for periods of only up to 10 hours. Heart-lung blocks were equally well preserved with either University of Wisconsin or Bretschneider's solution after 6 to 12 hours, although the University of Wisconsin solution group exhibited a more notable increase in pulmonary water content. This was in accordance with histological data, which suggested that, although hemodynamic recovery of hearts stored for periods longer than 10 hours was poor, preservation of pulmonary ultrastructure was far superior using Bretschneider's solution as compared with University of Wisconsin solution after an ischemic period of up to 16 hours.

Adenosine↗
PubMed1994

An epidemiologic approach to predictors of elective coronary artery bypass mortality in a non-university hospital population.

This investigation was undertaken to determine whether perioperative variables present in patients scheduled for elective coronary artery bypass grafting (CABG) surgery, and documented in earlier studies at university programs, bear any significant relationship to mortality occurring in a population of prospectively monitored non-university hospital patients. The investigation sought to identify the risk factors that might be present in these patients. Toward this purpose, data from 1,095 patients having CABG surgery at four major non-university Pittsburgh hospitals were analyzed using univariate and multivariate analysis to develop a model for predicting survival. From this model, three variables, unstable angina or recent myocardial infarction (< 6 weeks); evidence of chronic heart failure at the time of the preoperative examination; and greater than 65 years of age were found to have high statistical significance (P < 0.02) in predicting mortality in this non-university-hospital population. In summary, the study demonstrated that three variables, previously confirmed as being valuable predictors of risk in university hospital populations, also have significant predictive value in elective non-university CABG survival.

Aged↗
PubMed1995

Extracellular and standard University of Wisconsin solutions provide equivalent preservation of myocardial function.

The deleterious effect of hyperkalemic cardioplegic solutions on coronary endothelium has been documented and has also been demonstrated with University of Wisconsin solution. We evaluated a new extracellular University of Wisconsin formulation for efficacy in heart preservation. Six neonatal piglet hearts were arrested with and stored in the standard intracellular University of Wisconsin solution (group 1: K+ 125 mEq/L, Na+ 29 mEq/L). Six piglet hearts were preserved for 24 hours with an extracellular University of Wisconsin solution that differed only in the concentrations of potassium and sodium (group 2: K+ 25 mEq/L, Na+ 129 mEq/L). Hearts underwent modified reperfusion with leukocyte-depleted aspartate-glutamate enriched blood cardioplegic solution followed by conversion to a left-sided working mode on a Langendorff circuit with perfusion from a support pig. Stroke work index was calculated at left ventricular end-diastolic pressures of 3, 6, 9, and 12 mm Hg. Sixty minutes after reperfusion, there was no significant difference in stroke work index between group 1 (16.4 +/- 1.9 x 1000 erg/gm) and group 2 (15.3 +/- 2.7 x 1000 erg/gm). There was also no significant difference in high-energy phosphate stores or myocardial water content between the two groups. Extracellular University of Wisconsin solution provides myocardial preservation equivalent to standard University of Wisconsin solution while preventing exposure of coronary endothelium to high levels of potassium, which justifies its use in clinical heart transplantation.

Adenosine↗
PubMed1996

Selective or universal neonatal BCG immunization: what policy for a district with a high incidence of tuberculosis?

In the United Kingdom, BCG immunization of neonates provides good protection against military and meningeal disease, and probably against other forms of tuberculosis, in all ethnic groups. Serious adverse reactions to BCG immunization are rare. Cost-effectiveness studies of BCG immunization in neonates have not been reported and "universal' BCG immunization is not recommended in the United Kingdom. The Department of Health does recommend immunization for children and infants of immigrants from countries with a high prevalence of tuberculosis. There are problems associated with such a "selective' policy, as determining what is "high' prevalence and thus defining "at risk' groups is difficult, and there may be political and practical difficulties in its implementation. This may result in low coverage in eligible groups. A "universal' policy of BCG immunization for all neonates may be politically more acceptable and easier to implement in districts with high tuberculosis notification rates. Although there is no cost-effectiveness data to determine at what tuberculosis notification rate a universal policy should be adopted, an universal policy has been suggested for districts with overall notification rate of greater than 40 per 100,000. Within districts there may be large variations in tuberculosis notification rates between different areas. This is becoming more common with the amalgamation and merger of smaller districts into new larger purchasing organizations. New River Health Authority is such a district formed by the amalgamation of the former districts of Haringey with a high tuberculosis notification rate, and Enfield with a lower TB notification rate. In order to maximize coverage in the "at risk' neonates, a different neonatal BCG policy has been adopted in the two areas. This has been possible because of the flexibility of the mechanisms for contracting with different provider units. Although the overall notification rate was not thought to be sufficiently high to justify a "universal' neonatal policy throughout the district, a "universal' policy has been instituted in the main provider unit in the former district Haringey. A "selective' policy, subject to ongoing evaluation to ensure high coverage, continues to be operated by the main provider unit in the former district of Enfield.

BCG Vaccine↗
PubMed1999

Low-potassium University of Wisconsin solution for cardioplegia: improved protection of the isolated ischemic neonatal rabbit heart.

Recovery of cardiac function and high-energy phosphates following ischemia and reperfusion were determined for hearts perfused with low potassium University of Wisconsin solution, high potassium University of Wisconsin solution, St Thomas' solution, or subjected to hypothermia alone. Isolated hearts were arrested for either 3 h at 15 degrees C or 6 h at 20 degrees C (n = 7 for each group) with one of the four solutions and then reperfused. Aortic flow after ischemic arrest at 20 degrees C was 40.3 +/- 13.3%, 79.3 +/- 10.0%, 64.3 +/- 11.9% and 43.9 +/- 15.9% of control values for high potassium University of Wisconsin solution, low potassium University of Wisconsin solution, St Thomas' solution and hypothermia alone, respectively. Similar results were observed in hearts subjected to ischemic arrest at 15 degrees C. Myocardial adenosine triphosphate and creatine phosphate after reperfusion tended to be higher in the low potassium University of Wisconsin solution group. It is concluded that low potassium University of Wisconsin solution may provide reliable cardioplegia during surgery that requires prolonged cardiac arrest in neonates and infants.

Adenosine↗
PubMed2000

Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome.

AIMS: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor-based screening programme with a universally based one. METHODS: Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glucose challenge test performed and if their plasma glucose at 1 h was > or = 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed. RESULTS: Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P<0.03). Universal screening facilitated earlier diagnosis than risk factor screening - mean gestation 30 +/- 2.6 weeks vs. 33 +/- 3.7 weeks (P<0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group. CONCLUSIONS: Universal screening for GDM is superior to risk factor based screening-detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.

Blood Glucose↗
PubMedDate not supplied

[Impact of universal varicella vaccination in Germany: an epidemiological and economic analysis].

Varicella is a highly contagious viral disease which mainly affects young children and usually is perceived as infection with a mild disease course. However, there is increasing evidence indicating that the morbidity and mortality as well as the economic impact associated with varicella are significant. While universal childhood vaccination against varicella is currently not recommended in Germany, the availability of safe and efficacious vaccines offers the opportunity for preventive intervention. Detailed and reliable data on the consequences of varicella and the possible impact of a universal vaccination program are missing to date for Germany. In order to generate this information, we conducted a comprehensive evaluation. The objective was to quantify the medical consequences and the economic impact of varicella on third-party payers and the society by means of a model analysis, and particularly to assess the effects of various universal vaccination strategies. The study confirms that varicella represents a significant health and economic burden in Germany. Following mathematical modelling, universal varicella vaccination for children at the age of 12-18 months could prevent more than 82 % of cases and complications on average per year. Economically, universal vaccination would lead to net cost savings not only for the society but also for the third-party payers. From these findings it can be concluded that universal varicella vaccination is a strategy which should be encouraged, from a medical, epidemiological, but also economic viewpoint.

Chickenpox↗
PubMed1995

Potential effects of managed care on specialty practice at a university medical center.

BACKGROUND: The growth of managed care presents a challenge to academic medical centers, because the demand for the services of specialists is likely to continue decreasing. We estimated the number of enrollees the University of Michigan Medical Center would need in its health maintenance organization (HMO) system in order to provide revenue equivalent to the total revenue it received for professional specialty care in 1992. METHODS: Rates of utilization and payment were based on the medical center's experience with managed care in 1992 in its independent practice association HMO, in which 25,000 members had capitated coverage and received primary and all specialty care from university physicians, and 15,000 members received primary care and most specialty care from physicians outside the university. We assumed that persons not enrolled in Medicare were all enrolled in managed-care plans. Primary care activity was excluded from the calculations of expense, revenue, and numbers of faculty members. RESULTS: If all specialty services were provided by the university to HMO members, all the 21 specialties examined except obstetrics and gynecology and emergency services would require an enrollment of more than 250,000 to support the 1992 level of professional revenue and maintain the number of faculty members. If university services were provided only for referrals from a loosely affiliated network of community physicians in the HMO system, all the 19 specialties examined except plastic surgery would require an HMO enrollment of more than 1 million. In a combined model in which all specialty services were provided to 100,000 HMO members and network referrals were provided to 500,000 members, substantial changes in faculty composition would be needed in all the departments studied. CONCLUSIONS: Because of the large number of HMO members required, unless other changes occur, it is unrealistic to expect that the University of Michigan Medical Center could create an HMO or network large enough to support the specialty practice of the current number of faculty members at the 1992 level of financing.

Academic Medical Centers↗