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PubMed1991

Trauma care at the University of Mississippi Medical Center: economic & other realities.

There are a number of complicating factors which do, or have the potential to, impact trauma care at the University of Mississippi Medical Center and the University Hospital. These are (Exhibit 6): Number of Trauma Patients. There are more trauma patients in Mississippi than any single hospital or group of physicians can care for under present circumstances. Type of Trauma Patients. The only Level I center is constantly stressed with trauma patients, many of whom could be adequately treated at other facilities. Hospital Resources. Resources are frequently stretched beyond reasonable limitations. Primary examples include the SICU and nursing personnel on numerous units. Lack of a Trauma Network. The effects of the first three factors are compounded by the lack of a trauma network in the State of Mississippi. Trauma Funding. The lack of trauma funding, on a statewide basis, for equipment and other needed resources impairs the ability of all hospitals (including the University Hospital) to meet the needs of trauma patients. Patient Finances. Tied to the lack of specific funding is the financial case mix of trauma patients. It is simply not financially worthwhile for hospitals or physicians to involve themselves, on a regular basis, in the care of these patients. These issues are related to one another in a complex fashion. Many are beyond the scope of the University Hospital and the University of Mississippi Medical Center to resolve. But, they adversely impact our facilities, and others throughout the state, on a daily basis. As these issues are reviewed and thought about, one final fact should be kept in mind.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗

PubMed1990

Prolonged cardiac preservation. Evaluation of the University of Wisconsin preservation solution by comparison with the St. Thomas' Hospital cardioplegic solutions in the rat.

The University of Wisconsin solution differs from other types of solutions used for organ preservation because it contains high-energy phosphate precursors (adenosine and phosphate), impermeants (lactobionate and raffinose), an oncotic agent (pentafraction), and antioxidants (allopurinol and glutathione). These components have the potential to enhance the preservation of ATP, reduce intracellular and extracellular edema, and attenuate free-radical-mediated injury. The University of Wisconsin solution has been demonstrated to enhance and extend the preservation of the liver, pancreas, and kidney, but its potential role in the heart remains unproven. We have evaluated the University of Wisconsin solution (Du Pont) by comparing it with the St. Thomas' Hospital cardioplegic solutions No. 1 and No. 2 (Plegisol), which are used in Europe and the United States for routine cardiac surgery and transplantation. For each solution, 10 isolated working rat hearts were arrested by 10 ml of the solution (at 4 degrees C) and then maintained immersed in the same solution for 4 hours at 4 degrees C. Mean recovery of functional indexes (expressed as a percentage of their preischemic control values) after use of the University of Wisconsin solution were as follows: peak aortic pressure, 90.6 +/- 1.0; dP/dt, 71.5 +/- 5.5; aortic flow, 81.6 +/- 4.7; coronary flow, 87.5 +/- 3.5; and cardiac output, 82.6 +/- 3.5. In contrast, the mean recoveries after St. Thomas' Hospital solution No. 1 were as follows: peak aortic pressure, 82.8 +/- 1.3; dP/dt, 49.7 +/- 3.0; aortic flow, 58.4 +/- 5.3; coronary flow, 79.6 +/- 5.9; and cardiac output, 63.0 +/- 4.9. In contrast still, mean recoveries after St. Thomas' Hospital solution No. 2 were as follows: peak aortic pressure, 83.1 +/- 1.2; dP/dt, 40.7 +/- 6.1; aortic flow, 37.0 +/- 5.1; coronary flow, 65.8 +/- 3.6; and cardiac output, 43.1 +/- 5.6. The recovery of all indexes were significantly superior (p less than 0.005) after preservation with University of Wisconsin solution compared with either of the St. Thomas' Hospital solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMed1990

The universal orbital implant: indications and methods.

Major criticisms of quasi-integrated implants, such as the Iowa Implant, have been the time-consuming surgical technique needed to implant the prosthesis, and the high rate of extrusion. The Universal Implant (Oculo-Plastik, Montreal) is designed with these concerns in mind. In addition, those qualities that produce the motility advantages of a quasi-integrated implant and the ease of placement of a sphere have been incorporated into the design of the Universal Implant. The Universal Implant also (1) uses a faster implantation technique at surgery, (2) avoids cleaning the muscles, (3) has smaller mounds that are lower and more rounded, and should decrease the late extrusion rate, (4) can be used as an evisceration implant, enucleation implant, or secondary implant, and (5) has a larger girth and radius on the posterior surface that, in turn, helps support orbital fat and tissues and results in a more natural superior sulcus. It is recommended that the Universal Implant be used by surgeons who were pleased with the Iowa Implant, as the Universal implant represents an excellent alternative with major advantages over most other enucleation implants.

Humans↗

PubMed1990

The Pew National Dental Education Program at the University of Florida College of Dentistry.

The University of Florida College of Dentistry is located in a dynamic environment. Socially, economically, and demographically, the state of Florida manifests changes reflective of the entire nation, i.e., increasing numbers of elderly and minorities, a fluctuating, diversified economy, and altered cultural values. The explosive growth unique to this state has both positive and negative implications for all aspects of its culture and economy. The college resides in a maturing, research-oriented university facing vigorous competition from other major universities in the state. Within the Health Science Center, the college was occupied during the first decade of its existence with development of an innovative curriculum, and now it must turn its attention to a new emphasis on research and service. A process of strategic planning was conducted at the University of Florida College of Dentistry from January 1986 through June 1987. Four consultant groups representing the college, the university, organized dentistry in Florida, and outside consultants, were guided by a steering committee in a thorough evaluation of the external and internal environment of the institution.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Dental↗

PubMed1990

Effectiveness of modified University of Wisconsin solution for heart preservation as assessed in heterotopic rat heart transplant model.

A solution developed at the University of Wisconsin is an excellent preservation solution for the kidney, pancreas, and liver. We studied the effectiveness of a modified University of Wisconsin solution, which was made by reversing the sodium and potassium concentrations, in heart preservation. We first examined the relationship between total ischemic time and 1-week graft survival rates using a saline solution as a control preservation solution by transplanting a heart to the neck of test animals. To determine preserved heart viability, we palpated the heart 1 week postoperatively. The 1-week graft survival rates for the various total ischemic times were as follows: less than 1 hour, six of six; 4 hours, five of six; 8 hours, two of six, 12 hours, one of six; and 16 hours, one of six. These results demonstrate a correlation between total ischemic time and survival rate. Then we compared three preservation solutions--glucose-insulin-potassium, Bretschneider's solution, and the modified University of Wisconsin solution--for 16 hours of simple preservation. The 1-week graft survival rates were one of six for glucose-insulin-potassium, two of six for Bretschneider's solution, and five of six for the modified University of Wisconsin solution. The high survival rate for the modified University of Wisconsin solution under adverse conditions indicates its effectiveness in heart preservation.

Animals↗

PubMed1986

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research.

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.

Adult↗

PubMedDate not supplied

The Health-Grant University: a comprehensive national health education plan.

Although the need for universal and better health education has been recognized, no nationwide comprehensive program has been established. Consequently, we are proposing founding a national program of statewide health education networks, comparable in some ways to the Cooperative Extension Services of Land-Grant and Sea-Grant Universities. One institution in each state would qualify for designation as the State Health-Grant University, and all other public and private colleges located throughout the state would be encouraged to appoint one faculty member to serve as the health educator for the corresponding service area. Each health educator would receive an adjunct appointment at the health-grant university and would be required to participate in special training sessions and to master progressive health education strategies. The health educator would link the academic world and the community, educating the community about health and disease prevention and the significance of lifestyle. By catalyzing and coordinating efforts with teachers, ministers, nurses, physicians, business leaders, and others, the health educator would make an important contribution to the community. By addressing disease prevention and health maintenance, the Health-Grant University Program would strive to motivate the community to achieve greater individual health initiatives, while helping develop skills for personal health management and providing access to needed health services. Federal legislation would be required to create a national commission to coordinate the program, but community volunteers would make the program cost-effective and self-sustaining.

Health Education↗

PubMedDate not supplied

Use of the University of Wisconsin solution for the preservation of cell organelle activities in rat heart and lungs.

BACKGROUND: The University of Wisconsin storage solution has been successful in some model systems in extending the storage period of heart-lung grafts for transplantation. METHODS: In this study an aerated preparation of rat heart and lung was stored for 24 hours at 4 degrees C in either University of Wisconsin or St. Thomas' Hospital solution. Cell organelles (reticular, mitochondrial, and cell membrane fractions) were isolated from the stored hearts and lungs. Protein yield and enzyme activities were assayed for each cell organelle (reticular fractions: Ca(2+)-ATPase, NADPH-cytochrome C reductase; mitochondria: Ca(2+)-ATPase, cytochrome C oxidase; cell membrane fraction: Na+,K(+)-ATPase, p-nitrophenylphosphatase) as a measure of the recovery of function. RESULTS: Only the cell membrane fraction of heart and lung was not affected by storage in either St. Thomas' Hospital or University of Wisconsin solution with respect to protein yield (milligrams per gram of homogenate) or enzyme activities (nanomole per milligram per minute). The reticular fraction was the most sensitive to storage, with both protein yield and enzyme activities being significantly reduced in both the heart and the lung stored in University of Wisconsin of St. Thomas' Hospital solution (p < 0.05). CONCLUSION: The mitochondrial fraction was not preserved in lung in either St. Thomas' Hospital or University of Wisconsin solution but was preserved in the heart stored in St. Thomas' Hospital solution. These criteria provide preliminary screening for a superior solution that may then be used in more complicated transplantation models to more fully assess cardiac and pulmonary function.

4-Nitrophenylphosphatase↗

PubMed1993

Cardioplegic effect of University of Wisconsin solution on hypothermic ischemia of rat myocardium assessed by mitochondrial oxidative phosphorylation.

The effectiveness of the University of Wisconsin solution and the Collins' M solution for preservation of rat hearts was compared by examining histologic appearance, tissue water content, and mitochondrial respiratory functions after prolonged hypothermic storage and subsequent heterotopic transplantation. Survival of transplanted hearts after 5 days of reperfusion was markedly lowered by storage in Collins' M solution for 15 hours. Hearts stored in University of Wisconsin solution for 10 hours showed no increase in myocardial necrosis after 5 days of reperfusion, whereas hearts stored in University of Wisconsin solution for 15 hours and Collins' M solution for 10 and 15 hours showed a significant increase in tissue necrosis. University of Wisconsin solution reduced tissue swelling during hypothermic storage, whereas Collins' M solution did not cause such reduction. The yield of mitochondrial protein after reperfusion was significantly decreased by storage in either solution, especially after 15 hours in Collins' M solution. Mitochondrial oxidative phosphorylation was significantly inhibited by storage, especially by storage in Collins' M solution and subsequent reperfusion. These results indicate that myocardial injury, after prolonged ischemia and reperfusion, results in a decrease in functionally and structurally intact mitochondria that is dependent on preservation conditions. University of Wisconsin solution protects isolated hearts against ischemia and reperfusion injury possibly by preventing cellular and mitochondrial deterioration.

Adenosine↗

PubMed1996

Universal newborn hearing screening: feasibility in a community hospital.

BACKGROUND: The National Institutes of Health and the Joint Committee on Infant Hearing have recommended universal newborn hearing screening. The feasibility of universal newborn hearing screening in a community hospital, however, has not been demonstrated. We initiated a universal newborn hearing screening program using transient evoked otoacoustic emissions (TEOAE) at a community hospital to assess the feasibility of universal hearing screening in this setting. METHODS: A screening team composed of a family practice physician, family medicine resident, audiologist, and four technicians was developed. The study compared testing time between the technicians and the audiologist and assessed whether the technicians were able to perform hearing testing accurately and reliably. RESULTS: A total of 627 infants were screened. Of those, 11 (1.8%) failed TEOAE screening and were referred to a tertiary care center for further evaluation. Six of the 11 referrals were found to have a hearing impairment. Trained technicians were found to be capable of performing the screening accurately and reliably. CONCLUSIONS: Universal newborn hearing screening using transient evoked otoacoustic emissions is feasible in a community hospital.

Audiometry, Evoked Response↗

PubMed1996

Comparison of burst pacing, autodecremental (ramp) pacing, and universal pacing for termination of ventricular tachycardia.

This study was designed to test the comparative efficacy of burst pacing, autodecremental (ramp) pacing, and universal (steep ramp) pacing for termination of ventricular tachycardia. A prospective, randomized sequence cross-over design was used to achieve comparisons of the pacing modalities that were matched for patient, day, and ventricular tachycardia characteristics. Thirty eight patients were enrolled, whose ventricular tachycardia was well-enough tolerated to be reinduced, and tested with 3 pacing modalities. There were 27 series 1 patients in which the pacing modalities were nonsynchronized burst pacing, synchronized burst pacing, and ramp pacing. The 11 patients in series 2 were tested with synchronized burst pacing, ramp pacing, and universal pacing. All pacing methods proved to be comparable in their ability to terminate ventricular tachycardia (p = NS). The 2 burst methods required the fewest number of attempts (significant vs ramp pacing). Universal pacing required the fewest number of stimuli. The mean paced cycle length was similar will all methods. The shortest paced cycle lengths were found with the autodecremental and universal methods because of their ramp patterns. It is concluded that burst, ramp, and universal pacing are of similar efficacy, although ramps were least efficient. Choice of a modality depends on operator preference, and individual patient response.

Cardiac Pacing, Artificial↗

PubMed1996

The beginnings and 50-year history of the Charles University Faculty of Medicine in Hradec Králové.

The Faculty of Medicine in Hradec Králové has some unique features that make it stand out from other similar faculties in this country: The school developed from regional traditions at the appropriate historic times, when due to closure of the universities during World War II. there was a serious death of physicians. The school was supported by the local governing organs, as well as by the generous financial assistance of citizens who identified with the idea of creating a university in Hradec Králové. An entirely new organizational form was utilized in the creation of the medical school: it was founded as a branch of the Faculty of Medicine at the Charles University in Prague. It was the first time that this form of organization in the history of our universities was used to prevent any legal delays during the postwar times when parliamentary legislation was not yet functional. It constitutes a synthesis of existing medical schools in Prague and Brno (Brünn): the first teachers were primarily equally recruited from both these universities. It had been connected almost from its beginning with the coexisting military medical school; at one time it represented this military medical training institution by itself. The school underwent so many transformations accompanied by the departure of a number of important professors that it was surprising that it was able to maintain its professional integrity. The answer to the question of why the first medical school in the postwar period was founded in Hradec Králové is not too difficult. The town was a metropolis of eastern Bohemia with an important cultural and political tradition; this eventually culminated in a targeted readiness of such institution.

Czech Republic↗

PubMed2007

The current status of palliative care teams in Japanese university hospitals: a nationwide questionnaire survey.

GOAL: Although the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals. MATERIALS AND METHODS: In 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals. RESULTS: Of 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 +/- 64, mean/median +/- SD), daily number of patients treated by PCTs (12/11 +/- 14), and days of PCT care per patient (30/30 +/- 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p < 0.001) compared to noncertified PCTs. Over the 3-year period, the number of hospitals utilizing PCTs only slightly increased (2003: 27%, 2004: 29%, 2005: 33%), as did those using certified PCTs (2003: 3%, 2004: 9%, 2005: 11%). In 2005, the reasons for noncertification of PCTs included "lack of physicians who specialize in palliative care (82%)" and "lack of nurses who specialize in palliative care (56%)." CONCLUSIONS: The entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue.

Cross-Sectional Studies↗

PubMed1992

Entering first-year residents' experiences and knowledge of infection control of hepatitis B and HIV, at five university-affiliated hospitals.

In 1990, the authors surveyed 149 entering first-year residents at five university-affiliated hospitals concerning the residents' experiences and knowledge of infection control. Sixty residents (40%) had experienced a needlestick injury during medical school, but only 35 of these residents (58%) had reported the mishap. One hundred thirty-nine residents (93%) had received the hepatitis B vaccine. Of those 60 who had experienced a needlestick injury, 57 (95%) had received the vaccine. Of the 149 residents, 111 (74%) reported having received instructions in universal precautions, as advocated by the Centers for Disease Control. There was a trend for residents who had received the vaccine also to have been instructed in universal precautions. Regarding the residents' knowledge of infection control, there was no statistically significant difference between the responses of those who had been instructed in universal precautions and those who had not. The authors conclude that students are at risk for needlestick injuries; however, underreporting is frequent.

Educational Measurement↗

PubMed2005

Health care workers' knowledge on HIV and AIDS: universal precautions and attitude towards PLWHA in Benin-City, Nigeria.

OBJECTIVE: Health care workers are at risk of becoming infected with blood-borne pathogens, including HIV. The study was designed to test health care workers knowledge about HIV transmission, universal precautions and their attitude towards people living with HIV and AIDS. DESIGN: A cross-sectional study. SETTING: University of Benin Teaching Hospital, Benin-City, Nigeria. PARTICIPANTS: 120 Health Care Workers (HCWs) who were occupationally exposed to patient's blood and body fluids completed a self administered structured questionnaire between March and May 2004. The HCWs consisted of 50 doctors drawn from obstetrics and gynaecology (25) and surgery departments (25). 70 nurses from accident and emergency unit (23), labour ward (18), labour ward theatre (4), main surgical theatre (22) and family planning clinic (3). RESULTS: The mean age of the health care workers and duration of practice were 39.8 +/- 8.0 years and 14.0 +/- 8.2 years respectively. Though many of the respondents demonstrated good knowledge about HIV transmission, more than 25% of them thought that HIV could be transmitted through saliva, vomit, faeces and urine. They over estimated their risk of acquiring HIV infection following needle stick injury, exposure of mucocutaneous membrane and intact skin to infected blood and body fluids. There was poor adherence to universal precautions which was attributed to lack of knowledge and availability of materials in 48% and 60% of the workers respectively. Over 40% of the health care workers exhibited discriminatory attitude towards people living with HIV and AIDS. There was no statistical significant difference (p > 0.05) in the knowledge of HIV and AIDS transmission and infection prevention practices amongst the doctors and nurses. Similarly there was no significant difference in their discriminatory attitude towards PLWHA. CONCLUSION: We recommend that seminars, workshops should be organized on a continuous basis for health care workers on universal precautions, stigma and discrimination reduction. Those trained should train others on the job. The institution should also make available materials needed to protect workers against the risk of acquiring pathogenic infection in the course of providing health services to their patients.

Acquired Immunodeficiency Syndrome↗

PubMed2007

Seroprevalence of Hepatitis-B infection amongst Taiwanese university students 18 years following the commencement of a national Hepatitis-B vaccination program.

In Taiwan, the nation-wide Hepatitis-B virus (HB) vaccination program was first launched in July 1984 and was directed to those infants born to hepatitis B surface antigen (HBsAg) carrier mothers in Taiwan. From July 1986 onwards, all infants born in Taiwan were immunized against HB. This study examined the HB-infection status amongst students at a Taiwanese university 18 years subsequent to the implementation of universal HB vaccination. A total of 1,969 new university entrants in 2005 were grouped into 1 of 3 distinct birth cohorts according to their HB-vaccination schedule (cohort-1 students born prior to July 1, 1984; cohort-3 students born subsequent to June 30, 1986) and were examined for their serum HBsAg, antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) status. Immunity arising from vaccination was defined as an anti-HBs level 10 mIU/ml. We observed a trend toward a decreasing anti-HBc-positive rate and a decreasing HBsAg carrier rate from, respectively, 26.5 and 8.7% for cohort-1 to 4.7 and 1.7% for cohort-3 students. The prevalence of students featuring seronegativity for all three HB markers increased from 12.3% for cohort-1 to 48.8% for cohort-3 individuals. Amongst the 1,695 subjects revealing seronegativity for HBsAg and anti-HBc, their anti-HBs level was analyzed according to their birth year. The prevalence of students featuring a non-protective anti-HBs level increased from 11.9% for birth-year 1984 individuals to 48.2% for birth-year 1987 students. The introduction of HB vaccine has effectively reduced the transmission of HBV infection in Taiwan, 18 years subsequent to the commencement of the universal HB-vaccination program. A "waning-off" effect of anti-HBs seropositivity acquired from the HB vaccination program has also been observed.

Adolescent↗

PubMed1982

Mortality study of patients with subarachnoid haemorrhage at University hospitals and their affiliated hospitals in Japan.

This study was undertaken to examine the differences in aneurysm statistics between University hospitals where subacute or chronic patients are primarily treated and University-affiliated hospitals where both acute and chronic cases are also admitted. In each hospital group, the transition of the statistics in the last decade was studied. The purpose of this study was also to see if any conclusion could be drawn regarding the surgical treatment of acute cases. The death rate for all aneurysm cases admitted is 8% at University hospitals, whilst that at affiliated hospitals is roughly 30% during the 1970s. The operative death rate at the University hospitals is 3%, whilst that at affiliated hospitals is 16% which improved at one affiliated hospital to 8% in the 1980-1981 period. Morbidity also improved in the latest series in the affiliated hospital. These improvements are considered to be de to the change of operative and postoperative policies for acute cases to: limited surgical indications for grade IV patients, extensive cisternal clot removal at the time of surgery, and oral administration of Ticlopidine, a new antiplatelet agent.

Hospitals, Special↗

PubMed1996

Blood and body fluid exposures during clinical training: relation to knowledge of universal precautions.

To investigate the relation between knowledge of universal precautions and rates of exposure to blood and body fluid during clinical training, a cohort of 155 students was surveyed following training in universal precautions and 18 months later. A total of 127 students (82%) participated; 58 (46%) experienced at least one exposure during the first clinical training year. Knowledge of universal precautions was inversely associated with the frequency of mucous membrane exposures (p .001); an apparent "dose-response" effect was evident (one-way analysis of variance; F = 5.2, p - 0.007). Students are frequently exposed to blood and body fluid during clinical training. Higher levels of retained knowledge about universal precautions are associated with a decreased risk of mucous membrane exposure.

Health Knowledge, Attitudes, Practice↗