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PubMed1985

Physician characteristics and organizational factors influencing use of ambulatory tests.

A number of studies have suggested that there is considerable variation in the frequency with which physicians order particular tests. This paper reviews the relationship of variations in ambulatory testing to characteristics of physicians' training and practice; and organizational factors such as physician group size, method of reimbursement, and ease of access to technical services. Results from previous investigations suggest that specialty training, more recent physician graduation, and large group practice settings are associated with significantly higher test use. Information available about other physician characteristics and organizational factors is equivocal. The extent of variations in practice has important implications for the cost and quality of medical care. Greater effort should be made to document the effects of nonmedical factors and to clarify how those effects are mediated and how they might be modified to improve the use of medical resources.

Ambulatory Care↗
PubMed2001

Computers in surgical education and the operating room.

Medicine has gone through major changes over the last 50 years. Today it is recognized that medical knowledge doubles every 6-8 years. It is also true that with the advent of many new medical procedures, surgeons must continue to learn new techniques throughout their careers; this was not the case in the past. Significant changes have also occurred during the same period in computers. It has recently become apparent that there exists a synergy between these two industries - computers can be used to assist surgeons in both initial education and in learning new skills. The National Capital Area Medical Simulation Center is a unique resource that makes use of state-of-the-art computer resources to teach resuscitation and other skills. Both computerized mannequins and virtual reality training devices are used to teach surgical principles and technical procedures. The natural progression of this technology will be for virtual reality simulations to be used for selecting, training, certifying, and recertifying surgeons. Ultimately, surgeons will practice operative procedures using 3D data sets of the patients they plan to operate the next day and then use recordings to play back their optimal procedure robotically on their patients.

Computer Simulation↗
PubMed2002

Functional electric stimulation-assisted rowing: Increasing cardiovascular fitness through functional electric stimulation rowing training in persons with spinal cord injury.

OBJECTIVES: To assess changes in peak functional aerobic power after a 36-session, progressive functional electric stimulation (FES) rowing hybrid training program for persons with spinal cord injury (SCI) and to examine the safety and acceptability of the ROWSTIM II device as well as the integrity of technical modifications to it. DESIGN: Repeated-measures training study, quasi-experimental design, within-person data comparison. SETTING: A university-based recreational physical activity facility for persons with physical disabilities. PARTICIPANTS: Six persons with level C7-T12 SCI (American Spinal Injury Association classes A-C). INTERVENTION: Progressive rowing training program, 30 minutes per session, 3 times a week for 12 weeks at 70% to 75% of pretest peak functional aerobic power during FES rowing on an open loop control, FES-assisted rowing machine. MAIN OUTCOME MEASURES: Total rowing distance, peak functional oxygen consumption, and peak oxygen pulse. RESULTS: Subjects completed between 22 to 36 sessions. After 3 months of training, rowing distance increased by 25% (P<.02), peak oxygen consumption by 11.2% (P<.001), and peak oxygen pulse by 11.4% (P<.01). Heart rate response to hybrid training did not change at the end of training, although peak heart rate with FES lower-extremity exercise increased significantly from pre- to posttraining (P<.01). CONCLUSIONS: Pre- and posttraining peak aerobic power values for ROWSTIM II training were comparable to previously reported values for hybrid cycle and upper-extremity exercise. We conclude that FES-assisted rowing is an effective, safe, and well-tolerated training system for persons with SCI.

Adult↗
PubMed2006

Assessing urinary diversion experience in urologic residency programs-are we adequately training the next generation?

PURPOSE: Operative experience is important in developing surgical skills and technical competency. There is also emerging evidence directly linking increased surgical volume to patient outcomes. Accordingly, resident training should provide the framework for mastery of complex operations. We evaluated the current urological residency experience in performing adult urinary diversion. MATERIALS AND METHODS: The Accreditation Council for Graduate Medical Education-Residency Review for Urology Operative Log Reports were reviewed from 2000 to 2004 with an emphasis on urinary diversion experience. Resident logs were analyzed specifically for all procedures that included CPT codes for continent and incontinent diversions. The logs were compared by year of training and type of urinary diversion. RESULTS: Overall, the total number of urinary diversions performed by graduating residents from 4-year programs has increased from 2,259 (2000 to 2001) to 4,017 (2003 to 2004). In addition, the mean and median number of urinary diversion cases among residents completing training have remained relatively constant. For graduating urology residents in 2003 to 2004, the mean (median) number of continent urinary diversion and incontinent urinary diversion cases were only 6.7 (3.0) and 9.5 (4), respectively. CONCLUSIONS: Current Accreditation Council for Graduate Medical Education data suggest the average urology resident has limited exposure to urinary diversion in general, and even less experience with more complex continent urinary diversion. These results suggest that many urology residency programs may not have sufficient volume to provide residents with a broad experience in urinary diversion, and alternative strategies to ensure proper training should be explored.

Internship and Residency↗
PubMed1995

[Sports and rehabilitation in old age].

Cardiac rehabilitation of older patients aims at restoring physical aptitude as well as possible and at preserving independence. Prognostic aspects are less important than symptomatic relief. A formal rehabilitation program is indicated in adjunction to revascularization procedures and in cases, where a closer medical supervision is warranted. Exercise guidelines for persons older than 65 years should include prescriptions for endurance training of moderate intensity and an exercise program to enhance flexibility and coordination. Weight training at 40 to 60% of maximal voluntary contraction to support muscle-strength is feasible and useful even in frail persons, whereas sports with high impact of technical skills and speed are not advisable. Such training prescriptions will allow to maintain physiological and psychological function and will thus enhance the quality of life of older patients.

Aged↗
PubMed2006

A community-driven action plan to eliminate breast and cervical cancer disparity: successes and limitations.

BACKGROUND: The objective of Alabama Racial and Ethnic Approaches to Community Health 2010 is to implement and evaluate a community action plan (CAP) developed by a diverse coalition to reduce breast and cervical cancer screening disparities between African American and White women. METHODS: The CAP entailed (1) establishing a core working group (CWG) in each county, (2) training CWG members to promote screenings, and (3) providing coalition members with technical assistance to write mini-grants. RESULTS: Overall, 241 CWG members were trained. They have conducted 2800 cancer screening surveys. A total of 8 coalition members received mini-grants. CONCLUSION: Community capacity building can lead to a sense of ownership and empowerment.

Adult↗
PubMed1997

Use of Iliad to improve diagnostic performance of nurse practitioner students.

Nurse practitioners (NPs) have dual goals as primary care providers, combining the traditional goals of nursing with extended goals as diagnosticians. Diagnostic reasoning, therefore, is a critical component of NP education. Iliad, a computerized diagnostic reasoning expert system, has been used effectively to teach diagnostic skills to medical students. A pilot study was undertaken to determine the effects of Iliad training on NP students' diagnostic skill performance and to identify technical and instructional issues of implementation. The study found that the use of Iliad improved NP students' diagnostic reasoning, and that the training effects were modified by prior nursing experience. Successful use of Iliad required planning, faculty commitment, and technical support.

Clinical Competence↗
PubMed2001

Bile duct injury during laparoscopic cholecystectomy: results of a national survey.

OBJECTIVE: To determine whether surgical residency training has influenced the occurrence of common bile duct injuries during laparoscopic cholecystectomy, and to asses the anatomic and technical details of bile duct injuries from the practices of surgeons trained in laparoscopic cholecystectomy after residency versus surgeons trained in laparoscopic cholecystectomy during residency. SUMMARY BACKGROUND DATA: Shortly after the introduction of laparoscopic cholecystectomy, the rate of injury to the common bile duct increased to 0.5%, and injuries were more commonly reported early in each surgeon's experience. It is not known whether learning laparoscopic cholecystectomy during surgery residency influences this pattern. METHODS: An anonymous questionnaire was mailed to 3,657 surgeons across the United States who completed an Accreditation Council for Graduate Medical Education (ACGME)-approved residency between 1980 and 1990 (group A) or 1992 and 1998 (group B). All surgeons in group A learned laparoscopic cholecystectomy after residency, and all those in group B learned laparoscopic cholecystectomy during residency. Information obtained included practice description, number of laparoscopic cholecystectomies completed since residency, postgraduate training in laparoscopy, and annual volume of laparoscopic cholecystectomy in the surgeon's hospital. In addition, technical details queried included the completion of a cholangiogram, the interval between injury and identification, the method of repair, and the site of definitive treatment. The primary endpoint was the occurrence of a major bile duct injury during laparoscopic cholecystectomy (bile leaks without a major bile duct injury were not tabulated). RESULTS: Forty-five percent (n = 1,661) of the questionnaires were completed and returned. Mean practice experience was 13.6 years for group A and 5.4 years for group B. At least one injury occurrence was reported by 422 surgeons (37.6%) in group A and 143 surgeons (26.5%) in group B. Forty percent of the injuries in group A occurred during the first 50 cases compared with 22% in group B. Thirty percent of bile duct injuries in group A and 32.9% of all injuries in group B occurred after a surgeon had performed more than 200 laparoscopic cholecystectomies. Independent of the number of laparoscopic cholecystectomies completed since residency, group A surgeons were 39% more likely to report one or more biliary injuries and 58% more likely to report two or more injuries than their counterparts in group B. Bile duct injuries were more likely to be discovered during surgery if a cholangiogram was completed than if cholangiography was omitted (80.9% vs. 45.1%). Sixty-four percent of all major bile duct injuries required biliary reconstruction, and most injuries were definitively treated at the hospital where the injury occurred. Only 14.7% of injuries were referred to another center for repair. CONCLUSIONS: Accepting that the survey bias underestimates the true frequency of bile duct injuries, residency training decreases the likelihood of injuring a bile duct, but only by decreasing the frequency of early "learning curve" injuries. If one accepts a liberal definition of the learning curve (200 cases), it appears that at least one third of injuries are not related to inexperience but may reflect fundamental errors in the technique of laparoscopic cholecystectomy as practiced by a broad population of surgeons in the United States. Intraoperative cholangiography is helpful for intraoperative discovery of injuries when they occur. Most injuries are repaired in the hospital where they occur and are not universally referred to tertiary care centers.

Adult↗
PubMed1992

In-line skating: physiological responses and comparison with roller skiing.

The use of in-line skates has become popular in recent years for recreational and conditioning purposes. This investigation evaluated the physiological responses of ten subjects during in-line skating on a flat track with three different in-line skating techniques. The double pole technique demonstrated the greatest economy with oxygen uptake requirements that were approximately 12% lower (p less than 0.05) than conventional skating (without poles) or the V1 skate technique. Across the investigated velocity spectrum of 14.6 to 18.0 km.h-1, individuals with an average fitness level of 40 ml.kg-1.min-1 will achieve exercise intensities of 68-90% of maximum oxygen uptake using the conventional skating and V1 skate techniques on flat terrain. These exercise intensities are appropriate for cardiorespiratory training. However, high fit individuals who are attempting to elicit a cardiorespiratory training effect using in-line skates with rolling resistances similar to those tested may need to perform uphill interval work or skate at higher velocities which may be technically difficult and may be unsafe in some training environments. Comparison of the present data with previously published data on roller skiing demonstrates that differences in physiological responses for the two modes of exercise are the result of differences in rolling resistances between the devices. Measurements of rolling resistance and comparison of the oxygen uptake requirements for double polling on both devices allow for the mechanical efficiency to be estimated at approximately 18% for this mode of locomotion.

Analysis of Variance↗
PubMed2004

Therapeutic apheresis in low weight patients: technical feasibility, tolerance, compliance, and risks.

The use of therapeutic apheresis in very low weight patients is generally thought to have limitations, because of possible severe adverse reactions, potential risk related to the extracorporeal procedure, due to the low weight of the young patients. A careful therapeutic approach using appropriate precautions, and also introducing modifications to the standard procedure, can minimise the risk without compromising the efficacy of the plasmapheresis. The aim of the study was to evaluate apheresis tolerance and acceptability in children [Artif. Organs. 21 (1997) 1126] and infants [J. Clin. Apheresis 5 (1989) 21] with inherited lipid metabolism disorder, familial hypercholesterolemia (FH), primary hyperlipoproteinemia (lipoprotein phenotype I), and acute leukemia, weighing on average 20.55 kg. One thousand one hundred twenty three aphereses were completed. Three types of apheresis were performed: leukapheresis, plasma exchange, dextran sulphate cellulose (DSC) low density lipoprotein (LDL)-apheresis. Three different types of continuous flow systems were used. Technical adaptation depending on patients blood volume, body mass index, hematocrit, type of system used, permitted us to perform complete aphereses, obtaining a high degree of tolerance and acceptability of the treatment. The use of plasmapheresis is regarded to be an extreme therapeutic measure in children. However, when the need for such treatment is undebatable, plasmapheresis must be done. A well-trained and experienced team can overcome the technical difficulties in order to complete the procedures without complications. The most frequently observed adverse effects are vascular relative access insufficiency (2.0%), and mild hypotension (2.0%).

Adolescent↗
PubMedDate not supplied

Educational and experiential effects on radiographers' radiation safety behavior.

Forty-four radiographers from 11 hospitals in Northern California were observed for radiation safety behaviors in six categories. A multiple regression analysis was performed to determine if there was a significant relationship between the six radiation safety behaviors and the radiographer's age, sex, type of professional training, years since completion of professional training, years of professional practice, time of day, and exposure frequency. The multiple regression analysis showed that there was a significant relationship between use of gonadal shielding and years since completion of professional training, years of professional practice, type of training, and age. The multiple regression analysis also showed that the number of repeated films due to technical error was significantly related to the type of professional training a radiographer received.

Adolescent↗
PubMed2003

[The history of dental technology instruction and its leading scholars at the Budapest university].

The preconditions for university level education on odontotechnology was first set in 1900 with the establishment of the first Odontotechnological Laboratory in the Dental Institute of the Medical Faculty. The first head of the laboratory and the lecturer of the subject was Dr. Lajos Hattyassy who obtained a senior lecturer (private docent) position in the faculty. Both the technical and personal preconditions substantially improved with the opening of the new clinic of Stomatology in 1909. The dental residents could provide comprehensive prothodontic treatment in the dental lab with its 18 working place and also in the auxiliary practical units. They were supervised by dental specialist and assisted by laboratory technicians. The senior lecturer of the subject was Dr. Henrik Salamon the internationally well know dental researcher. During the mid 20's Dr. Dénes Máthé succeeded him, who also became the director of the whole dental clinic. It was him, who introduced the systematic curriculum in odontotechnology. After World War II according to the requirements of the new health insurance system the independent dental training program started in 1952 besides the traditional stomatologist training. The old dental laboratory could not meet the requirements imposed by the large number of dental students. The new teaching laboratory was organized by Dr. Imre Földvári. This new teaching laboratory made room for the teaching of dental materials and metallurgy, odontotechnology and the phantom head training on operative dentistry and prosthodontics. The technical level of the lab was continuously improved. Dr. Imre Földvári was succeeded by Dr. György Huszár. The previously independent dental subject were first merged and later incorporated into the subject of prosthodontics. In the practical training several modern devices, mimicries and articulators were used. Lately Dr. György Götz succeeded Dr. Huszár, and the subjects of dental materials, odontotechnology and phantom head prosthodontics became again independent dental subjects. With the total refurbishment of the teaching laboratory it became one of the most up to date dental teaching laboratories of Europe. The structure and the curriculum of these newly established dental subjects have also changed and upgraded. The international connections has recently improved and many dental students came from all over the world to study dentistry. Recently for a very short period of time Dr. Pál Tóth jr. was the head of this teaching unit of the Dental Faculty.

Education, Dental↗
PubMed2006

Core training in surgery: what does it need to include?

Core training for surgeons in any surgical specialty should include education in the relevant basic science knowledge, training in fundamental diagnostic skills, the development of surgical technical skills and considerable experience in patient care. However, for a number of reasons it is no longer acceptable to guide such training based only on such broad goals, not the least of which is the advent of resident duty-hour limitations that make it unrealistic to expect residents to simply acquire, by random observation and participation, all of the important elements of their future practices. Rather, it is necessary to provide a curriculum of learning opportunities specifically structured to allow them to gain the requisite knowledge and skills. Thus, the curriculum for the core surgical training of future vascular surgeons should be based on a very specific learning objectives, stating what information is to be learned or what action is to be done, under what conditions they are to be performed, and what criteria will be used to ascertain the acquisition of the necessary knowledge or skill. Next, the best methods of instruction, including reading materials, lectures, and exposure to specific surgical procedures must be defined and the appropriate instructional materials identified, selecting the best of existing materials or, if necessary, creating them. Finally, the residents' acquisition of knowledge and skills must be assessed. Previously this occurred through a loose combination of performance evaluations from clinical rotations, faculty group discussions, and annual in-training exams culminated in the American Board of Surgery certification process. Now evaluation must relate to specific educational objectives. This is all a daunting task currently being undertaken by vascular surgery program directors, albeit with input from the Residency Review Committee and the Vascular Surgery Board of the American Board of Surgery. Eventually, overall surgical curriculum will evolve to satisfy these educational ground rules, but currently it is very much a work in progress in most programs.

Certification↗
PubMed1983

The use of videotape programs to teach interpersonal skills.

Interpersonal skills training evolved rapidly in recent years as teachers began to exploit the distinct advantages of "live" and simulated presentations in videotapes and films as teaching aids. At the same time, psychologists and psychiatrists started to define the basic aspects of interpersonal relations. Many used prepared scripts to produce videotape programs that modeled human interactions. While clinical experience and formal studies clarified some characteristics of effective visual training programs, the impact of dramatic and technical elements in these productions was not fully explored. In the present paper, the authors review the nature of interpersonal skills and the current status of visual aids for teaching human relations and show how videotape productions with characters, a story line, and action sequences can enhance learning. The experience of producing a series of videotapes about prehospital emergency care is used as a paradigm for discussing how theatrical techniques, applied through discrete production steps, can reinforce training goals and appeal to a wide range of students with diverse learning styles.

Clinical Competence↗
PubMed2004

Managerial implications of medical sales representative perceptions of job duties, job qualifications, and other performance-related issues.

This study examined the perceptions of medical sales representatives of job related duties, job qualifications needed, and motivating factors and tested for differences based on gender, age, years of experience and education using prior research as a base. This study also explored issues that may arise between sales people and physicians. The authors surveyed 132 medical sales representatives from pharmaceutical firms located in Ankara, Turkey. The authors' findings highlight the need in Turkey for developing in-service training programs for medical sales representatives, especially in the areas related to technical aspects of the product, effective marketing and personal selling strategies, and consumer relations. Training in these areas will help salespeople to better manage the problems typically encountered in physician-sales representative relations. While the study was conducted in Turkey, the results are similar to findings in prior research conducted in other countries and therefore may be of interest to all sales managers.

Administrative Personnel↗
PubMed2006

The pretrained novice: using simulation-based training to improve learning in the operating room.

Enabling trainees to acquire advanced technical skills before they begin the operating room experience benefits both trainee and patient. Whether medical students who had received exclusively simulation-based training could perform laparoscopic suturing and knot-tying as well as senior surgery residents was determined. Simulators were used to train 11 fourth-year medical students with no previous suturing experience to perform intracorporeal suturing and to successfully tie a free-hand intracorporeal knot. Students' skills were assessed by the performance of the fundal suturing portion of a Nissen fundoplication in a porcine model. Their operative performance was evaluated for time, needle manipulations, and total errors. Results were compared to those of 11 senior-level surgery residents performing the same task. The study concluded that trainees could learn advanced technical skills such as laparoscopic suturing and knot tying by using simulation exclusively. The trainees and senior level surgery residents had a similar number of needle manipulations.

Clinical Competence↗