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PubMed2003

Future applications of case-based teaching in population-based prevention.

The Case-Based Series in Population-Oriented Prevention (C-POP) introduced in this supplement to the American Journal of Preventive Medicine provides a set of tools to integrate clinical- and community-based prevention into interactive teaching cases. These cases, which address recommended core competencies in prevention education, have been taught to both medical students and preventive medicine residents. Initial experience with the cases indicates that this method is a promising tool to enhance prevention education in medical schools and primary care residencies. Because prevention education is essential in other fields, such as public health and nursing, extension of this approach to other professional schools is possible. Such extension is feasible because the cases are designed to be adaptable for different levels of education, flexible to be tailored to local situations, and expandable to accommodate changes in the field. In addition, the cases can be made accessible to all educators through a national library and in interactive web-based format. This article describes how the C-POP series can be used to strengthen prevention education for a wide audience of physician and nonphysician learners.

Computer-Assisted Instruction↗
PubMed2005

[The cookery book of the monastery library of Michaelbeuern (Man.of cart. 81). Edition and commentary].

We present the edition of 12 cookery recipes which are found in the manuscript Man. cart. 81 of the monastery of Michaelbeuern near Salzburg (Austria). The manuscript dates from the middle of the 15th century and contains mostly religious texts; some medical texts as well as texts belonging to the liberal arts indicate that it may have been used as a school book for the monks. The dialect of the recipes shows upper German and Bavarian peculiarities, according to the place the manuscript is preserved. The edition of the recipes is followed by a commentary and a glossary. Eight of the recipes concern lenten meals, which means that they were probably collected especially for the religious community of the monks.

Austria↗
PubMed1999

Delivering health information statewide via the Internet in a collaborative environment: impact on individual member institutions.

The Arizona Health Information Network (AZHIN) is a statewide member-driven organization committed to improving access to information for health sciences students and practitioners. Members include several hospitals and hospital systems, an academic health sciences center, and other diverse health care organizations. AZHIN offers its members unlimited Web access to ten well-known health sciences databases. This paper explores the impact that AZHIN has had on its member institutions. A survey asked members to reflect on AZHIN and its possible effects on the visibility of the librarian within the institution, relative dollars spent on AZHIN and range of resources available, Internet connectivity within their institution, access to AZHIN and other Internet resources, teaching, and benefits of collaboration. Results indicated that AZHIN members have access to a wider range of resources than they would otherwise. There are financial savings for some. Internet connectivity and AZHIN membership can provide the librarian with a broadened role and increased visibility. The availability of MEDLINE and other AZHIN resources encouraged some institutions to install Internet connectivity more quickly. Teaching library users has increased. Overall, AZHIN members recognized many benefits of their collaboration.

Arizona↗
PubMed2006

Student perspectives on pharmacy curriculum and instruction in Egyptian schools.

OBJECTIVES: To determine student attitudes and opinions towards pharmacy education in Egyptian universities to provide information for designing delivery of a revised pharmacy curriculum. METHODS: Students were recruited from the pharmacy faculties at a government-sponsored university and a privately funded university. Data were gathered using a structured questionnaire and statistically analyzed. Responses from open questions were subjected to thematic analysis. RESULTS: Students spent widely differing amounts of time on non-classroom study, little of which was self-directed. This was reflected in the low frequency of use of library facilities and the preference of students for passively acquired information. Themes that emerged on how students would improve the curriculum were to increase the use of computers and the Internet; make the course more relevant to pharmacy practice and/or clinical pharmacy; improve and expand the practical components of the course; increase their own involvement in learning; and increase their understanding of subjects as well as their knowledge. For many of the questions, there was a significant different between the responses of students at the 2 universities. CONCLUSIONS: Students relied on classroom teaching and devoted little time to self-directed study. However, students were aware of international developments in pharmacy education and practice and are receptive to change.

Attitude↗
PubMed2001

Teaching critical appraisal skills in health care settings.

BACKGROUND: Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. OBJECTIVES: To assess the effects of teaching critical appraisal skills to health professionals, on the process of care, patient outcomes and knowledge of health professionals. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 2 2000), MEDLINE (1966 to 1997), EMBASE (1980 to 1997), Eric (1966 to 1997), Cinahl (1982 to 1997), Lisa (1976 to 1997), Sigle (1980 to 1997), Science Citation Index (1981 to 1997), PsycLit (1974 to 1997), the world-wide-web, and reference lists of articles. We also contacted major medical education centres. SELECTION CRITERIA: Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of educational interventions teaching critical appraisal to health professionals. The outcomes were: process of care; patient mortality, quality of life, and satisfaction; and health professional knowledge/awareness based upon objective, standardised, validated instruments. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and three reviewers independently assessed study quality. MAIN RESULTS: One USA hospital-based randomised trial was included involving 44 doctors. The outcome assessed was critical appraisal knowledge. Process of care, patient health or attitude/awareness outcomes were not assessed. Critical appraisal teaching was reported to have resulted in a 25% improvement (adjusted figure) in critical appraisal knowledge in the intervention group compared to a 6% improvement in the control group, which was statistically significant (p=0.02). REVIEWER'S CONCLUSIONS: There is evidence that critical appraisal teaching has positive effects on participants' knowledge, but as only one study met the inclusion criteria the validity of drawing general conclusions about the effects of teaching critical appraisal is debatable. There are large gaps in the evidence as to whether teaching critical appraisal impacts on decision-making or patient outcomes. It is also unclear whether the size of benefit seen is large enough to be of practical significance, or whether this varies according to participant background or teaching method. The evidence supporting all outcomes is weakened by the generally poorly designed, executed and reported studies that we found.

Decision Making↗
PubMed1996

Oxidative stress induces the levels of a MafG homolog in hamster HA-1 cells.

The Maf family encodes nuclear proteins that recognize AP-1-like response elements. MafB, MafK, MafF, and MafG, are all able to heterodimerize with each other, c-fos, and erythroid cell-specific transcription factor NF-E2, to affect the transcription of target genes. Using the technique of differential display, we recently identified a new oxidant-inducible mRNA, designated adapt66, in HA-1 hamster fibroblasts. Cloning, partial sequencing, and GenBank analysis of adapt66 revealed strong homology to chicken mafG, a newly identified member of the maf oncogene family. The mafG homolog/adapt66 mRNA induction appeared to be dependent upon calcium; occurred as early as 90 minutes following exposure of HA-1 cells to hydrogen peroxide; and peaked between 5 and 10 hours after peroxide treatment. It has previously been demonstrated that several cellular transcription factors, including Fos, can be induced by oxidative stress. The induction of the DNA binding sequence mafG homolog/adapt66 by hydrogen peroxide, and it's known interaction with c-fos, may represent important mechanisms by which oxidative stress can modulate gene expression.

Animals↗
PubMed1996

Developing a virtual reality-multimedia system for anatomy training.

The University of California, San Diego, School of Medicine's Learning Resources Center is developing a prototype next-generation application for anatomy education which combines virtual reality and multimedia curricular resources. The anatomy lesson utilizes polygon-based 3-D models of the hepatobiliary system created by BioGraphics Inc. of Fort Collins, Colorado which were derived from the National Library of Medicine's Visible Human Project Dataset. This article describes the needs assessment, learning objectives, and preliminary design of the current prototype. The multivariate design, the development strategy for implementing functionalities, and the engineering of critical software interface components are also outlined.

Anatomy↗
PubMed2005

Revitalization of academic medicine in Albania.

The Faculty of Medicine in Tirana, the only institution providing medical training in Albania, has currently developed three separate branches of study, General Medicine, Dentistry, and Pharmacy. Since the early 1990s, following the collapse of the communist regime, many faculty members have been trained abroad in different areas of medical sciences. Yet, little emphasis is placed on research work and teaching of evidence-based medicine in both, undergraduate and postgraduate studies. Medical students are not exposed to sources of evidence, searching techniques, and important medical databases, such as PubMed and Cochrane Library. Exposing medical students and young physicians to probabilistic thinking, the importance of communication, and levels of evidence in medical practice is what the academic medicine in Albania should strive for. To address this challenge, the Faculty of Medicine in Tirana needs to strengthen the mobility of its students and their training in Western schools. These young and well-trained faculty members will provide the critical mass of future academicians required to develop a modern medical school in Tirana.

Academic Medical Centers↗
PubMed1991

A collaborative institutional model for integrating computer applications in the medical curriculum.

The introduction and promotion of information technology in an established medical curriculum with existing academic and technical support structures poses a number of challenges. The UNC School of Medicine has developed the Taskforce on Educational Applications in Medicine (TEAM), to coordinate this effort. TEAM works as a confederation of existing research and support units with interests in computers and education, along with a core of interested faculty with curricular responsibilities. Constituent units of the TEAM confederation include the medical center library, medical television studios, basic science teaching laboratories, educational development office, microcomputer and network support groups, academic affairs administration, and a subset of course directors and teaching faculty. Among our efforts have been the establishment of (1) a mini-grant program to support faculty initiated development and implementation of computer applications in the curriculum, (2) a symposium series with visiting speakers to acquaint faculty with current developments in medical informatics and related curricular efforts at other institution, (3) 20 computer workstations located in the multipurpose teaching labs where first and second year students do much of their academic work, (4) a demonstration center for evaluation of courseware and technologically advanced delivery systems. The student workstations provide convenient access to electronic mail, University schedules and calendars, the CoSy computer conferencing system, and several software applications integral to their courses in pathology, histology, microbiology, biochemistry, and neurobiology. The progress achieved toward the primary goal has modestly exceeded our initial expectations, while the collegiality and interest expressed toward TEAM activities in the local environment stand as empirical measures of the success of the concept.

Academic Medical Centers↗
PubMed2002

The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review.

Professional and parental uncertainty regarding the natural history of cough and respiratory tract infection (R77) in pre-school children may in part be responsible for the high consultation, reconsultation, and antibiotic prescribing rates in this age group. The aim of the study was to review the evidence about the natural history of acute cough in children aged between 0 and 4 years presenting to primary care in terms of illness duration and complications. The study was a systematic review, with qualitative and quantitative data synthesis, of control and placebo arms of systematic reviews, randomised controlled trials (RCTs), and cohort studies set in primary care. Searches were done of MEDLINE (between 1966 and June 1998), EMBASE (between 1988 and September 1998), and the Cochrane Library databases, using the MeSH terms 'respiratory tract infection, 'cough, and 'bronchitis, and the textwords 'cough' 'bronchitis, and 'chest infection, limited to children aged between 0 and 4years, and English language articles. Eight RCTs and two cohort studies met the review criteria. At one week, 75% of children may have improved but 50% may be still coughing and/or have a nasal discharge. At two weeks up to 24% of children may be no better. Within two weeks of presentation, 12% of children may experience one or more complication, such as rash, painful ears, diarrhoea, vomiting, or progression to bronchitis/pneumonia. This review offers parents and clinicians more prognostic information about acute cough in pre-school children. Illness duration may be longer and complications higher than many parents and clinicians expect. This may help to set more realistic expectations of the illness and help parents to decide when and if to reconsult. This information may be useful to those designing patient information and self-help resources.

Acute Disease↗
PubMedDate not supplied

Early language development and kindergarten phonological awareness as predictors of reading problems: from 3 to 11 years of age.

At the end of Grade 4, 481 children on the Danish island of Bornholm were screened using group tests for sentence reading. For 205 of these children, language and speech data from the speech therapist's screening at age 3 were available, as well as language comprehension and linguistic awareness data from the kindergarten year (age 6) and word decoding measures in Grades 2 and 3. A path analysis revealed significant paths from early language abilities at age 3 through expressive and receptive language in kindergarten via language awareness in kindergarten and word decoding in Grade 2 to sentence reading in Grades 3 and 4. The subgroup of children with parents who had reported a history of reading problems at school entry scored significantly below average on sentence reading in Grade 4. The subgroup of children that were reported to show a very low interest in books and story reading before age 5 also scored low on sentence reading in Grade 4. Statistically significant but weak relationships were also found between parents' educational background, parents' library visits, and number of books at home and the child's reading ability in Grade 4.

Awareness↗
PubMed2005

Fluoridated milk for preventing dental caries.

BACKGROUND: Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of school children and the vast majority of adults. Milk provides a relatively cost-effective vehicle for fluoride in the prevention of dental caries. OBJECTIVES: To determine the effectiveness of fluoridated milk, as a means of delivering fluoride on a community basis, for preventing dental caries. SEARCH STRATEGY: We searched Cochrane Oral Health Group Trials Register (28 April 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to 17 May 2005), OLDMEDLINE (1950 to 1965), EMBASE (1980 to 2005 week 20), LILACS (1982 to 17 May 2005), BBO (1986 to 17 May 2005), SIGLE (1980 to 17 May2005), Digital Dissertations (1861 to 17 May 2005) and reference lists of relevant articles. Attempts were made to identify both unpublished and ongoing studies. There were no language restrictions. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs), with an intervention or follow-up period of at least 3 years, comparing fluoridated milk with non-fluoridated milk. Primary outcome was change in caries experience, as measured by changes in decayed, missing and filled figures on tooth (dmft/DMFT) and surface (dmfs/DMFS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, data extraction and quality assessment were carried out independently and in duplicate. Study authors were contacted for additional information where necessary. MAIN RESULTS: Two RCTs involving 353 children were included. For permanent teeth, after 3 years there was a significant reduction in the DMFT (78.4%, P < 0.05) between the test and control groups in one trial, but not in the other. The latter study only showed a significant reduction in the DMFT until the fourth (35.5%, P < 0.02) and fifth (31.2%,P < 0.05) years. For primary teeth, again there was a significant reduction in the dmft (31.3%, P< 0.05) between the test and control groups after 3 years in one study, but not in the other. The results could not be pooled because of the difference in concentration of fluoride in the milk. AUTHORS' CONCLUSIONS: There are insufficient studies with good quality evidence examining the effects of fluoridated milk in preventing dental caries. However, the included studies suggested that fluoridated milk was beneficial to school children, especially their permanent dentition. The data need to be supplemented by further RCTs to provide the highest level of evidence for practice.

Animals↗
PubMed1990

Medical informatics. An emerging academic discipline and institutional priority.

Information management constitutes a major activity of the health care professional. Currently, a number of forces are focusing attention on this function. After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring--to support education, decision making, communication, and many other aspects of professional activity. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. An intrinsically interdisciplinary field, medical informatics has a highly applied focus, but also addresses a number of fundamental research problems as well as planning and policy issues. Medical informatics is now emerging as a distinct academic entity. Health care institutions are considering, and a few are making, large-scale commitments to information systems and services that will affect every aspect of their organizations' function. While academic units of medical informatics are presently established at only a few medical institutions in the United States, increasing numbers of schools are considering this activity and many traditional departments are seeking and attracting individuals with medical informatics skills.

Career Choice↗
PubMed1997

Computers in dental education.

The advent of electronic support for dental education offers many possible improvements in the manner in which information is conveyed to students. Although dental schools are only beginning to implement these concepts and devices, there is indication that they will become increasingly common. Concepts can be more lucidly conveyed when images and mulitmedia are used effectively. Distances can be transcended, and information gathered from and conveyed to others without regard to physical limitations. The dental school curricula must accommodate the changing milieu in which dentistry is practiced and prepare students for the future, electronically assisted dental practice.

Computer Communication Networks↗
PubMed1990

Variables influencing career choices of graduates of informatics programs funded by the National Library of Medicine.

Graduates of the National Library of Medicine-supported Medical Informatics (MI) training programs were studied to determine the variables influencing their choices of an academic or nonacademic career. More than 60% of the available population of trainees (171 of 272) were studied in 1986 and four of the nine variables measured by means of a questionnaire were significant in differentiating the choices the students made. The training programs located in a private institution, with the majority of the faculty from the medical school and with a small number of trainees who already had the M.D. or Ph.D. degree, generated the highest proportion of graduates seeking academic careers. Discriminant analysis was done to determine whether a combination of variables would discriminate between those who chose academic careers and those who did not. It indicated that the status of the institution (public or private); the entry degree of the trainee; and the productivity of the training program faculty were sufficient to correctly classify 75.3% (67 of 89) of the students who chose academics and 71.9% (59 of 82) of those who did not. There is now a baseline of data that can be used in future studies.

Career Choice↗
PubMed1969

Trends in nursing education and the school of nursing librarian.

The history of nursing education in America is briefly told, with the growth of education in institutions of higher learning emphasized. Two trends in nursing education are paralleled by similar developments in nursing literature. The growth of scholarship in nursing is also noted. It is pointed out that nursing is a discipline in its own right, and that training for leadership is required. Continuing education programs are mentioned, together with the increase in nursing literature. Integrated libraries for the health sciences are recommended.

Education, Nursing↗
PubMed2003

[The University of Chile School of medicine : 170 years serving the country].

The first course on Medical Sciences in Chile was inaugurated in 1833, being its director William C Blest, MD, an Irish physician graduated in Edinburgh University. Therefore, Dr. Blest can be considered the founder of Chilean formal medical education. When the University of Chile was established (in 1842), among its five initial Faculties was included Medicine, on the basis of the Medical Sciences course created ten years before. By then, the medical profession was not yet socially reputed and the initial years of the Faculty were difficult. During the 19th Century and until the second decade of the 20th century, this was the only medical school in the country. Its development was slow but sustained, reaching its apogee in the middle of the 20th Century, when it had outstanding clinical and basic sciences teachers and investigators. Clinical research, postgraduate teaching and medical specialization had a great development during that period. Nowadays, it is a complex Faculty that teaches eight health sciences courses leading to different professional titles, gives higher academic degrees in biomedicine and public health and certifies different medical specialties. It has a modern, well equipped library and a unique Museum of Medicine. Besides the traditional Departments in Medical Faculties, it has Departments of Medical Teaching, Bioethics and Medical Humanities. It provides continuing medical education programs and distance teaching has recently experienced a great development. The community is also favored with specific teaching programs. The academic promotion of its faculty members is based in a strict evaluation. During its existence, the Faculty has graduated a large number of physicians and other health care professionals. Our country should be grateful to the University of Chile Faculty of Medicine, in its 170th birthday, for its outstanding contribution to the development, welfare and happiness of Chilean society.

Chile↗
PubMed2003

Fluoride mouthrinses for preventing dental caries in children and adolescents.

BACKGROUND: Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home. OBJECTIVES: To determine the effectiveness and safety of fluoride mouthrinses in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: Thirty-six studies were included. For the 34 that contributed data for meta-analysis (involving 14,600 children) the D(M)FS pooled PF was 26% (95% confidence interval (CI), 23% to 30%; p < 0.0001). Heterogeneity was not substantial, but confirmed statistically (p = 0.008). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses. A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials. REVIEWER'S CONCLUSIONS: This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.

Adolescent↗