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Historically black colleges and universities have educated significant numbers of black students preparing for careers in medicine. These institutions have the potential to make even greater contributions to the pool of black medical school applicants and ultimately to the supply of black physicians. The Division of Disadvantaged Assistance, Bureau of Health Professions, Health Resources and Services Administration within the Public Health Service, commissioned a study of the curriculums and other factors related to premedical education. The study was conducted at the historically black colleges and universities that graduate a large number of students who gain admission to medical school, and the historically black colleges and universities whose students are less successful in gaining admission to medical school. Nine historically black colleges and universities participated in a self-assessment of their undergraduate premedical curriculums. The findings from schools with higher acceptance rates were compared with those of schools with lower acceptance rates to identify factors contributing to the production of significant numbers of successful medical school applicants. Comparisons of data on these schools revealed several important factors that may be related to differences in acceptance rates: Those schools that devoted greater effort to premedical training (for example, advising students about how to prepare for medical school, curriculum development, maintaining premedical or pre-health professions offices and clubs--the staff of these offices provide students with information on medical or other health professions schools--to identify and recruit students) tended to have higher acceptance rates. * Schools with higher acceptance rates had larger proportions of biology and chemistry majors aspiring to medical and dental careers and stronger affiliations with medical schools than schools with lower acceptance rates.* Institutions with higher acceptance rates offered a broader range of externally sponsored enrichment programs; the highest medical school acceptance rates were found among those schools with continuing Health Careers Opportunity Program projects that served significant percentages of students interested in careers in medicine.* Mean Medical College Admission Test scores were somewhat lower for applicants from schools with lower acceptance rates, but the great variation in acceptance rates for these schools is not reflected in a comparable variation in the Medical College Admission Test scores.
PURPOSE: To determine whether innate visual-spatial ability influences medical student choice of a surgical career. In addition, the student's career interests on entering medical school (matriculation) predicted application and acceptance to a residency program. METHODS: Fifty-nine fourth year medical students at the University of Western Ontario completed a career choice questionnaire that identified the residency program(s) to which they showed interest at the time of matriculation, the program(s) to which they applied, and the residency program(s) to which they matched. The selections were compared with the student's score on the Vandenberg & Kuse Mental Rotations Test, a test of visual-spatial ability. RESULTS: Graduates initially interested in visual-spatially intense medical disciplines scored better (P < 0.02) on the Mental Rotations Test. The findings did not persist to the time of application and acceptance into residency training programs. There was no correlation between visual-spatial ability and selection of a visual-spatially intense specialty. Only 32% of graduates applied to their specialty of initial interest. CONCLUSION: The ability to rotate an object in three dimensions mentally does not to play an important role in surgical career selection although it was a predictor of initial career interest upon entry to medical school. Initial career interest was not an accurate predictor of career choice in general. In contrast to the overall results, 71% of individuals initially interested in family medicine ultimately applied to this medical discipline.
During the last few decades myoelectric prostheses were generally provided for adolescent or adult patients. Since 1991 the availability of smaller sized electric hands in conjunction with technical improvements enabled the introduction of myoelectric prostheses for preschool children.However, this progress remained widely unnoticed in Germany. This study presents the authors' experiences with prosthetic devices for preschool children with unilateral upper limb deficiency (congenital and traumatic). Twenty children received a myoelectric prosthesis between the ages of 2 and 5 years (3.9+/-1.1 years). The follow-up period was 1.7 years. The prosthesis was worn for an average of 5.6 h/day. Our hospital-based intensive training program positively influenced the acceptance rate. All children with a below-hand amputation rejected their prosthesis.However, the general dropout rate in preschool children is conspicuously lower compared to adults. In this study 2.4+/-2.9 repairs per year per patient were required. The susceptibility for repairs in this age group is much higher for myoelectric prostheses compare to body-powered devices. Since the correct indication and the intensive training program significantly influence the acceptance rate, the introduction of myoelectric prostheses to preschool children should take place at specialized centers with an interdisciplinary team composed of orthopedists,occupational therapists,and technicians.
Perceived competence and social acceptance scores of 17 maltreated children enrolled in therapeutic day treatment were compared to those of 17 maltreated children who had not received the program services. Multivariate and follow-up univariate analyses indicated developmental gains and enhancement of self-concept among the treatment group when compared to controls and to their own pretreatment levels.
In 1996, as an overseas school nurse/health educator, the author designed a health and personal development curriculum for an international school in Bandung, Indonesia, where 220 children from 26 different countries were enrolled. Part of the health curriculum included a drug awareness program for students from kindergarten through high school. Many parents, students, administrators, and faculty had never been involved in such a program before; therefore, obtaining acceptance from these groups was a first step in designing the drug awareness program. Because there have been no school or government anti-drug groups to promote drug prevention, this program was the first of its kind in the international community of Bandung. A review of the literature guided the choice of intervention strategies built into the program. Information also was collected about the major risk and protective factors that are known to be associated with an increased risk of drug use in the international community. Existing models of drug use prevention were used in designing the program. As in most prevention programs, drug use was viewed as a deficit in coping or self-regulation skills. The drug awareness program was developed with emphasis on peer, school, and community factors potentially influencing the tobacco, alcohol, and other drug use of the adolescent students.
The main objective of this study was to identify the number and type of alcoholism programs in the province of Ontario, Canada, which endorse treatment goals other than complete abstinence. A survey of all alcoholism programs in the province revealed that 36.7% of the programs found nonabstinence goals appropriate for at least some clients. Endorsement of nonabstinence goals was lowest for detoxication centers and residential treatment services, and highest for nonresidential programs and assessment-referral services. Endorsement of nonabstinence goals was higher among programs aimed at young people and those associated with the criminal justice system. Within a treatment program, the use of various kinds of assessment methods and treatment modalities did not appear to be closely associated with the endorsement of abstinence vs nonabstinence treatment goals.
In 1972 the Society for Vascular Surgery and the North American Chapter of the International Cardiovascular Society recommended that the American Board of Surgery establish a method for the certification of special competence in vascular surgery. The American Board of Surgery in 1974 judged that, for the present, vascular surgery training best could be upgraded by certifying training programs and not individuals. The Residency Review Committee for Surgery now has approved guidelines which define acceptable vascular surgery training programs. These guidelines require approval of the American Medical Association and the governing bodies of the Liaison Committee for Graduate Medical Education before accreditation procedures can be implemented. It is proposed that vascular surgery is different enough from general surgery and cardiothoracic surgery so that special training programs are needed. Vascular surgeons require a fund of knowledge and surgical skills beyond that learned in most surgical programs as well as a special experience with vascular operations if they are to provide optimal patient care. Acceptance of the principle of the accreditation of surgeons caring for vascular surgical problems is an important step in the upgrading of vascular surgery.
The measurement of several performance parameters of a scintillation camera at the time of installation and thereafter at regular intervals is necessary to ensure that the camera is operating within specifications and to detect changes over time that can initiate a request for service. There are varied opinions on what constitutes a satisfactory acceptance test and quality control program. Few individuals would disagree that either an acceptance test or routine quality control measurements are necessary, yet agreement on the contents and frequencies of these tests is lacking. This paper discusses the performance parameters of scintillation cameras that are usually measured for planar imaging and also for SPECT with rotating cameras.
Kidney tissue of acceptable quality was available from autopsies of 55 patients who had been followed prospectively for 3 to 15 years as participants in the University Group Diabetes Program, a study of vascular disease in Type 2 (non-insulin-dependent) diabetic patients. Slides were prepared for light microscopic reading by uniform histologic techniques, and then were randomly intermixed and coded with tissues identically prepared from matched non-diabetic subjects (morphologic controls). After independent review by three morphologists, the results were tabulated and assigned to one of four diagnostic groups: 1) typical diabetic nodular glomerulosclerosis; 2) mesangial changes suggestive of diabetes (diffuse lesion); 3) non-diabetic renal disease; 4) normal for age. Of the diabetic cases 31% (17 of 55) were found to show nodular glomerulosclerosis, and another 47% (26 of 55) showed suggestive changes; none of the morphologic control slides was read as showing nodular glomerulosclerosis, but some were judged to show suggestive mesangial (diffuse) changes. Although only 4 of the 17 diabetic patients with nodules had died of uraemia, many had hypertension, which may have contributed to their deaths from vascular disease. The patients with nodular glomerular changes also showed, on the average, the highest blood glucose levels during life. Type 2 diabetes in later life appears to be associated with a high risk for typical tissue changes of diabetic kidney damage, which may contribute significantly to morbidity and mortality and may be present before azotaemia and qualitative proteinuria have been recognized.
A hospital-based quasi-experimental (pretest and post-test) study was conducted in Kaohsiung Veteran General Hospital, Taiwan. This study was to evaluate a continuing education program (CEP) on nurses' practices of cancer pain assessment and their acceptance of patients' pain reports with respect to four types of misconceptions. A questionnaire was sent to on-duty nurses or head nurses with patient care responsibilities before the implementation of CEP (n=645) and six months after the program (n=630). The response rates were 92.6% and 91.3% for pretest and post-test surveys, respectively. The CEP was implemented in 8 weeks with four-repeated sessions of 4-hour lectures. A one-day workshop focused on cancer pain assessment and treatment was held 3 months after the four-repeated sessions. Several educational strategies and teaching materials were used in the CEP. The results showed that CEP made statistically significant yet moderate improvement in nurses' practices of pain assessment using pain rating scales (pretest 3.29+/-0.76 vs. post-test 3.48+/-0.75, P<0.001) and acceptance of patient's pain reports without misconceptions on addiction (3.12+/-0.80 vs. 3.39+/-0.90, P<0.001), phantom pain (3.91+/-0.96 vs. 4.07+/-0.92, P=0.005), and placebo testing (3.63+/-0.72 vs. 3.81+/-0.73, P<0.001), except on patient gender-age-related doubts (3.60+/-0.72 vs. 3.67+/-0.77, P=0.109). In order to achieve further improvement, additional follow-up CEP combined with a hospital-wide institutionalization of pain assessment should be promoted and implemented in the future.
In reviewing the Joint Commission on Accreditation of Hospitals' acceptance of the CAP Inspection and Accreditation program, this article examines, for example, the effect of this acceptance on the cost of laboratory inspections, on the handling of so-called splinter laboratories, and on the I&A program. The author also reviews briefly current efforts to obtain state equivalency.
OBJECTIVE: This study was designed to investigate the efficacy and feasibility of a web-based depression stigma education tool for healthcare professionals. METHODS: A web-based depression stigma program utilizing adult learning theories was developed. Forty-two consecutive subjects were enrolled from University of Maryland staff and graduate students. Primary outcomes were Bogardus Social Distance Scale with a vignette on major depression disorder (BSDS-MDD) and the Depression Stigma Scale (DSS) administered before and after the intervention. RESULTS: Internet-based education significantly decreased the level of depression stigma (BSDS-MDD 10.6+/-4.4 versus 7.2+/-4.4, p<0.001; DSS-personal 12.7+/-7.2 versus 7.8+/-5.3, p<0.001; DSS-perceived 21.7+/-5.5 versus 12.4+/-5.5, p<0.001). After the educational intervention the subjects' knowledge about depression significantly improved (pre-test DKS=18.2+/-8.2 versus post-test DKS=20.6+/-4.1, p<0.001). The program was very well accepted by participants. For 100% of participants, it was not difficult to operate the program. CONCLUSIONS: Computer-assisted education was effective in reducing the stigma of depression and increasing knowledge about depressive disorder. A web-based intervention has the potential to be used for educating graduate students and university staff about depression and for reducing depression stigmata. Healthcare professionals interacting with people with stigmatizing conditions can benefit from web-based computer education.
BACKGROUND: The aim of the present study was to estimate the cost-effectiveness of populationwide approaches to reduce serum cholesterol levels in the US adult population. METHODS AND RESULTS: This cost-effectiveness analysis was made from data from the literature and the Coronary Heart Disease Policy Model and was based on the US population age 35 to 84 years. Study interventions were populationwide programs to reduce serum cholesterol levels with costs and cholesterol-lowering effects similar to those reported from the Stanford Three-Community Study, the Stanford Five-City Project, and in North Karelia, Finland. The main outcome measures were cost-effectiveness ratios, defined as the change in projected cost divided by the change in projected life-years when the population receives the intervention compared with the population without the intervention. A populationwide program with the costs ($4.95 per person per year) and cholesterol-lowering effects (an average 2% reduction in serum cholesterol levels) of the Stanford Five-City Project would prolong life at an estimated cost of only $3200 per year of life saved. Under a wide variety of assumptions, a populationwide program would achieve health benefits at a cost equivalent to that of many currently accepted medical interventions. Such programs would also lengthen life and save resources under many scenarios, especially if the program affected persons with preexisting heart disease or altered other coronary risk factors. CONCLUSIONS: Populationwide programs should be part of any national health strategy to reduce coronary heart disease.
In recent years, the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability. However, little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy. In 1977 we undertook to study this problem in a randomized prospective study designed to evaluate the effects of long-term (12 months) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a standard cytotoxic chemotherapy treatment program, in an adjuvant or therapeutic setting. The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight, either a gain or a loss, is associated with an increased risk of recurrent disease. Data are presented which show little or no correlation between standard parameters of nutritional assessment and risk of disease recurrence and/or response to chemotherapy. These data also suggest that until we better understand the relationship between tumor and host in breast cancer patients, we offer nutritional support programs only in situations where there are specific clinical indications for such interventions.
This study is based on an evaluation of the Maternal and Child Health and Nutrition Program (PROMIN) targeting pregnant women and their children under five years of age. The objective was to identify the conditioning factors for the Program's implementation in Rosario, Argentina. There were three levels of analysis: the organizational environment as perceived by the Executive Directors of the Health and Child Development Centers; management of interventions by the health teams; and the community's perception of the program's accessibility and acceptability. Two centers were chosen for the year 1998. Empirical evidence was obtained through quantitative and qualitative procedures. The results suggest that the two centers' respective organizational environments influenced the intervention strategies. The goal for coverage had been set at 80%. Documentation of the interventions by the two teams shows a partial and heterogeneous implementation. In terms of accessibility, mothers recognize the institutions by their reputation, quality of services, and extra services beyond the PROMIN basics. Acceptability is expressed as the provision of supplementary nutrition.
Although screening for cervical cancer has been shown to be effective in reducing the morbidity and mortality associated with this disease, and despite many attempts to encourage the development of provincial programs, as of 1995 no province had a comprehensive screening program for cervical cancer. Participants at the Interchange '95 workshop, held in Ottawa in November 1995, reviewed the recommendations of the 1989 National Workshop on Screening for Cancer of the Cervix and identified factors that have impeded their implementation. Participants discussed the need for comprehensive information systems, quality control and strategies to increase recruitment of unscreened and underscreened women. They concluded that the formation of a Cervical Cancer Prevention Network involving key stakeholders will facilitate the development and implementation of provincial programs to ensure optimal screening. They agreed that, in the interim, recommendations for practising physicians should remain as they were following the 1989 workshop.
This report attempts to present a comprehensive analysis of the acceptability, side effects, and efficacy of Norplant as used in rural areas, based on a field experiment conducted in four counties in Hebei and Shandong Provinces, China. The initial acceptance of Norplant was relatively high but waned after the first year in three of the four counties. Compared with clinical trials, the current study shows a lower prevalence but similar patterns of side effects. The pregnancy rate during the first two years of use is similar to that found in large-scale clinical trials conducted in China, but discontinuation due to other reasons is lower. A three-level logistic regression analysis shows significant variation in the probability of discontinuation due to side effects across counties. It also indicates an increase in the conditional probability of discontinuation with the duration of use. Whereas introducing Norplant and achieving a very low failure rate and high continuation rate in rural areas is feasible under diverse socioeconomic conditions, the results vary significantly across different areas. Particular attention should be paid to the local factors that may affect results.