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PubMed2006

[Evaluation of specialist training in basic sciences in two university medical schools: perspectives from both specialist residents and trainers].

A questionnaire survey has been undertaken to evaluate the specialist training in basic sciences in view of both specialist residents (SpRs) and trainers of two university medical schools in Izmir, Turkey. Seventy four SpRs (39 from Dokuz Eylül and 35 from Ege Universities) and 15 basic science units (8 from Dokuz Eyül and 7 from Ege Universities) were joined in this survey. The response rate was 73% for SpRs and 86.7% for basic science units. Technical equipments, the number of trainers, education programmes and training equipments of basic science units have been found adequate both by SpRs and trainers. However, professional education has been found incapable. In basic science units, it was seen that the SpRs are permanently assessed and attended the investigation activities during educational process. The trainers expressed that the SpRs have got training knowledge, skills and attitute sufficiently, but SpRs answered that they have got them in moderate means. In conclusion, although the training programmes of SpRs in both of the university hospitals have been found competent, SpRs indicated that there is a need for development of trainers quality, assessing methods and rotational education programmes in basic science.

Education, Medical↗
PubMed1991

Is MRCP (U.K.) a redundant qualification for graduates of D.M. (Internal Medicine), University of the West Indies?

M.R.C.P.(U.K.) and D.M. (Internal Medicine), University of the West Indies, are postgraduate qualifications that did, or now do, evaluate and set the quality of specialist Internal Physician training. Since the inception of the degree, graduates of D.M. (Internal Medicine), University of the West Indies, have developed sub-specialty interests and have been recognized as being of consultant status throughout the region and the world. D.M. is of a higher standard as it is an exit examination whereas the MRCP(U.K.) diploma is an entrance examination. Acquisition of the MRCP (U.K.) is expensive; travel to the U.K. is mandatory. Possession of MRCP (U.K.) is considered by most graduates of D.M. (Internal Medicine), University of the West Indies, to be unnecessary; it has not advanced their career in any discernible way. It should no longer be encouraged in any way at the University of the West Indies.

Education, Medical, Graduate↗
PubMedDate not supplied

Nursing education and practice for the 21st century: forecasting an agenda for historically/predominantly black colleges and universities.

The social worth and contribution of the historically Black colleges and universities has been well documented. We have only to look at Blacks who are in leadership positions to understand that the majority of these leaders have received their basic undergraduate preparation in historically Black colleges and universities. Dr. Elizabeth Carnegie who has recorded the Black nurses who have been admitted to the American Academy of Nursing states that most of the Black fellows are graduates of historically Black colleges and universities. The five minority fellowship programs in nursing, psychology, psychiatry, social work and sociology funded by NIMH have identified 97.3% of the Black fellows are graduates of historically Black colleges and universities.

Education, Nursing, Baccalaureate↗
PubMed1991

Current status of organ preservation with University of Wisconsin solution.

A retrospective analysis of all organs that were preserved with University of Wisconsin solution was undertaken to assess the impact of this solution on early allograft function. From May 1987 until June 1990, 181 livers, 92 pancreata, and 92 kidneys were preserved with University of Wisconsin solution for extended periods of time. The mean (+/- SD) preservation times were as follows: liver, 12.6 +/- 4.5 hours; pancreas, 16.7 +/- 4.4 hours; and kidney, 18.3 +/- 4.3 hours. The overall rate of primary nonfunction and hepatic artery thrombosis were 6.1% and 3.9%, respectively. No differences in the rates of primary nonfunction and hepatic artery thrombosis were noted for combined liver-pancreas procurement vs isolated liver retrievals or when reduced-size liver transplants were compared with nonreduced liver transplants. Likewise, no difference in primary nonfunction or hepatic artery thrombosis was seen in livers that were preserved for less than 6, 6 to 12, and greater than 12 hours. However, serum aminotransferase levels and prothrombin times were lower on the first postoperative day in livers that were preserved for less than 6 hours when compared with 6 to 12 or greater than 12 hours. Early pancreatic allograft function was also excellent for up to 24 hours of cold-storage preservation. All patients were immediately insulin independent, and there were no cases of initial nonfunction or graft pancreatitis. There were only two cases (2.2%) of pancreatic vascular thrombosis in this series. No difference in pancreatic function was noted for organs that were preserved for less than 6, 6 to 12, or greater than 12 hours. Likewise, renal allograft function was excellent, with only two patients (2.2%) requiring postoperative hemodialysis. The actuarial 1-month patient survival for liver and pancreas-kidney transplant recipients was 91.5% and 98.9%, respectively. Actuarial 1-month allograft survival for liver, pancreas, and kidney transplants was 83.0%, 96.7%, and 97.8%, respectively. In conclusion, University of Wisconsin solution represents a significant advancement in cold-storage organ preservation and is ideally suited as a universal intra-abdominal aortic-flush and cold-storage solution.

Adenosine↗
PubMed1991

Comparative ultrastructural study of rat livers preserved in Euro-Collins or University of Wisconsin solution.

University of Wisconsin solution greatly lengthens the time liver storage is possible compared with all previous solutions used. To test whether this improvement is related to better preservation of the endothelial cell, which is thought to be the most vulnerable cell type in cold storage, we compared time-related ultrastructural changes in rat livers stored in this solution or in Euro-Collins solution. Rat livers were harvested after combined arterial and portal perfusion with the cold-storage solution. They were then preserved for different lengths of time in the same solution at 4 degrees C before being perfusion-fixed and processed for light and electron microscopy. The first preservation damage was noted in endothelial cells; the time course of the lesions was similar in both solutions. After 2 hr of storage, enlarged and ruptured fenestrae with many gaps were observed. Swollen at 4 hr, the endothelial cells became stringlike at 10 hr, leading to stripped sinusoidal walls. Hepatocytes appeared better preserved in University of Wisconsin solution. The amount of glycogen, maintained near the control level at 24 hr in the latter, decreased dramatically between 0 and 4 hr in Euro-Collins solution, as ultrastructurally observed and biochemically confirmed. Furthermore, sinusoidal obstruction by blebs originating from the hepatocytes and quantified by image analysis on electron micrographs was markedly delayed. It was significantly less pronounced in University of Wisconsin solution at 24 hr than in Euro-Collins solution at 2 hr (p less than or equal to 0.05). Our findings confirm that endothelial cells are highly susceptible to preservation damage and show that University of Wisconsin solution does not improve preservation during storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1991

Universal promoter for gene expression without cloning: expression-PCR.

We present a rapid and simple system called expression-PCR (E-PCR) for in vitro synthesis of functional protein from genomic or plasmid DNA. A universal promoter was developed containing an untranslated leader sequence from alfalfa mosaic virus directly downstream from the T7 bacteriophage promoter. When this universal promoter is spliced to a DNA segment, it produces a suitable template for in vitro transcription and translation. The DNA to be expressed is first amplified by the PCR using a 5'-primer that incorporates an area homologous to the 3'-end of the universal promoter. The universal promoter and this DNA fragment are mixed and re-amplified in a reaction analogous to splicing by overlap extension, generating a recombinant DNA template that can be transcribed and translated in vitro without further processing. Unlike standard methods for in vitro transcription and translation, E-PCR is not dependent upon specialized transcription vectors, cloning, plasmid isolation and purification, or restriction enzyme sites. This approach has been used to synthesize and examine the biological activity of malaria proteins that are vaccine candidates for Plasmodium falciparum. E-PCR represents a significant improvement over current in vitro expression systems, most notably in its time savings, versatility of gene expression and its compatibility with rapid PCR-based site-directed mutagenesis procedures.

Animals↗
PubMed1990

Universal precautions to prevent HIV transmission to health care workers: an economic analysis.

The universal precautions recommended by the US Centers for Disease Control (CDC), Atlanta, for the prevention of HIV (human immunodeficiency virus) transmission to health care workers are widely accepted, despite little documentation of their effectiveness and efficiency. We reviewed the evidence on the risk of HIV transmission to hospital workers and the effectiveness of the universal precautions. We also evaluated the costs of implementing the recommendations in a 450-bed acute care teaching hospital in Hamilton, Ont. On the basis of aggregated results from six prospective studies the risk of HIV seroconversion among hospital workers after a needlestick injury involving a patient known to have AIDS (acquired immune deficiency syndrome) is 0.36% (upper 95% confidence limit 0.67%); the risk after skin and mucous membrane exposure to blood or other body fluids of AIDS patients is 0% (upper 95% confidence limit 0.38%). We estimated that 0.038 cases of HIV seroconversion would be prevented annually in the study hospital if the CDC recommendations were followed. The incremental cost of implementing the universal precautions was estimated to be about $315,000 per year, or over $8 million per case of HIV seroconversion prevented. If all HIV-infected workers were assumed to have AIDS within 10 years of infection the of the program would be about $565,000 per life-year saved. When less conservative, more probable assumptions were applied the best estimate of the implementation cost was $128,862,000 per case of HIV seroconversion prevented. The universal precautions implemented in the study hospital were not found to be efficacious or cost-effective. To minimize the already small risk of HIV transmission in hospitals the sources of risk of percutaneous injury should be better defined and the design of percutaneous lines, needles and surgical equipment as well as techniques improved. Preventive measures recommended on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The direct costs of universal precautions in a teaching hospital.

An analysis of the increase in expenditures for barrier isolation materials before and after the institution of universal precautions at our 900-bed university hospital was used to generate a national estimate of the cost of implementation of the new Centers for Disease Control guidelines. Following the institution of universal precautions, use of rubber gloves at our hospital increased from 1.64 million pairs of 2.81 million pairs annually. A 5-year review of hospital purchasing and supply records in both inpatient and outpatient areas indicated that the total annual costs for isolation materials increased by $350,900. This represented an increase from $13.70 to $22.89 per admission (60%) after adjustment for inflation. The cost of isolation materials increased from $98 to $215 per 1000 outpatient visits, an adjusted increase of 92%. Two thirds of the increase (64%) was due to rubber gloves and an additional 25% was due to disposable isolation gowns. Universal precautions are estimated to have cost at least $336 million in the United States in fiscal year 1989 after adjustment for inflation. If expenditures for isolation materials at our medical center are representative, previous estimates may have significantly underestimated costs nationwide.

Centers for Disease Control and Prevention, U.S.↗
PubMed1989

[A new general orthopedic universal intramedullary nail for the tibia. Clinical development and experiences].

The new AO-Universal-Nail was developed through intensive cooperation between fundamental research, technicians and clinical application. We are now able to transfer the concept of a Universal-Nail (initially for the femur) to the tibia as well. The existing technique of the medullary nail was maintained as far as possible. Special features to be highlighted: The new AO-bend obtains better impact behavior and a more anatomical stabilization of the bone cavity. The tapered tip eases the gliding of the tip of the nail along the inner wall of the dorsal corticalis and past the fracture. Proximal locking is obtained through three transverse extending holes. They offer many choices for optimal placement of the locking bolts. Interlocking from anterior to posterior has been logically abandoned, due to danger for nerves and vessels. Distal looking offers a large selection for stabilization through one a.p.-hole and two transverse holes for the locking bolts. The design from anterior to posterior entables the protection of the soft tissue. The Universal-nail can either be inserted with or without interlocking. A free decision is possible during the operation. The new AO-Universal-Nail for the tibia (as for the femur) maintained reliable aspects and was consequently converted to meet new demands and findings. The basic fundamentals of the AO, namely the observance and application of biomechanical principles and safe operation procedure were attained through simple instrumentation and have been proved successful for clinical application.

Fracture Fixation, Intramedullary↗
PubMed1989

Enrollment factors and preexisting medical conditions in a prepaid capitated plan. A comparison of university and nonuniversity clinic enrollees.

Traditional wisdom suggests that academic medical centers attract sicker patients than nonacademic facilities, thereby incurring greater risk when caring for patients enrolled in prepaid health care plans. This study examines the affiliation of an academic medical center with a prepaid capitation-based medical plan in western Washington state and focuses on demographic characteristics, prior existing medical conditions, recent utilization, and factors affecting enrollee choice of health care plan, clinic, and physician. It was hypothesized that university clinic enrollees would differ from nonuniversity clinic enrollees with regard to many of these factors. A questionnaire was sent to a random sample of 400 university clinic enrollees and 759 enrollees in nonuniversity, private practice settings. The response rate was 56.1%. Results showed that, when compared with nonuniversity clinic enrollees in the same plan, university clinic enrollees were significantly younger and had more formal education. University clinic enrollees reported less health care utilization and expressed fewer strong preferences than nonuniversity clinic enrollees in choosing a health care plan, clinic, and physician. Based on this survey, there was no evidence that the academic medical center attracted sicker HMO enrollees than did nonuniversity clinics.

Academic Medical Centers↗
PubMed1988

The responsibilities and role of universities in dental manpower.

Although other educational facilities are needed for developing the oral health manpower team, universities have the primary role in educating the dentist. The need for a curriculum based on fundamental research which is responsive to the needs of society is essential for the future development of the profession. Oral health manpower plans should be dependent upon the type of service designed for a country and an appropriate mix of manpower should be developed. By the collection, monitoring and interpretation of epidemiological data, universities have a major role to play in the forecasting of trends. Relevance of programmes within universities in health matters must be made more apparent to the community, especially when financial restriction in both health services and higher education are being felt. A national planning programme, centrally managed to include national associations, government, universities and interested parties, is essential if the relevance of oral health manpower is to be maintained.

Canada↗
PubMed1987

Dietary intake and symptoms of anorexia nervosa in female university dancers.

This study was designed to measure and evaluate the dietary intake and symptoms of anorexia nervosa in female university dancers (no. = 21) and a control group of female university non-dancers (no. = 29). Three-day food records were analyzed for calories, protein, vitamin A, vitamin C, thiamin, riboflavin, niacin, calcium, phosphorus, and iron. Symptoms of anorexia nervosa were determined through the use of an objective questionnaire, the Eating Attitudes Test (EAT). The percent of subjects who consumed less than two-thirds of the Recommended Dietary Allowance (RDA) for energy was significantly higher in the dance group (28.6% vs. 10.3%, p less than .005). Seventy percent of the total study population consumed less than two-thirds of the RDA for at least one nutrient, and 24% consumed less than two-thirds of the RDA for three or more nutrients. Thirty-three percent of the dancers and 13.8% of the controls scored in the range symptomatic of anorexia nervosa on the EAT, a difference that was statistically significant (p less than .005). The results indicate that both female university dancers and female university students may be at risk for nutrient deficiency and anorexia nervosa.

Anorexia Nervosa↗
PubMed1984

[Compulsory internship in diagnostic radiology in the 5th year of medicine at the University of Montreal].

Problems of methodology, organization, and evaluation confronting the radiology departments of the university hospitals affiliated with the University of Montreal, the medical students, and the University itself in connection with an elective internship in radiology offered in the fifth year of medicine, resulted in the formation of a committee to reorganize the course of study. In this concise article the authors describe this and other measures taken by the University to solve these problems. The committees' main purpose was to restructure the internship which was made compulsory so that future physicians would be prepared to draw on the resources of diagnostic radiology and nuclear medicine. To this end, the committee formulated the objectives, content, evaluation system, and pedagogical methods to be used in those courses. The 25 self-teaching modules, together with the observation and practical interpretation of radiology sessions, proved highly useful in solving the initial problems, and were of particular interest to the students.

Curriculum↗
PubMed1982

Development of a universal control unit for functional electrical stimulation (FES).

In collaboration with the College of Engineering the author has developed a laboratory, or clinic, based, battery operated "universal" control system, designed to improve disabled gait in upper motor neuron disabilities, especially stroke, hemiplegia, and cerebral palsy, by applying several channels of FES (Functional Electrical Stimulation) to the lower limb muscles while the patient is walking. The timing of the FES pulses, which can be applied to as many as six of the patient's muscles, is determined by potentiometer controlled one-shot timers, which are triggered by any of three switches in the sole of either shoe. Combinations of inverters, flip flops, AND gates and OR gates in the externally connected logic circuits determine the sequence of delays and pulses applied to the patient's muscles. This paper describes and diagrams some of the logic circuits and as an example of the possible application of the concept of a "universal" control unit reports the modifications of gait induced in a hemiplegic, four year post-stroke, patient. The characteristics of this patient's gait with FES in comparison to its characteristics without FES are demonstrated with motion picture frames, EMG recordings and graphic tracings of her right knee and ankle joint positions. They include more symmetrical timing of her right and left stance and swing phases, increased dorsiflexion of her right ankle in the swing phase, followed by a more distinct heel strike, and improved flexion--extension sequences of the knee and ankle joints and an increased heel rise in the stance phase. The author concludes that the gait characteristics of some hemiplegic patients will improve as they become adapted over a period of weeks or months to a control logic, which lessens their functional limitations by the use of a properly timed and amplified sequence of FES pulses. He suggests that the FES control requirements for individual patients should be determined experimentally with a control system "universally" adaptable to a wide range of disabilities, and that these control parameters could then determine the design of portable units, which may be used on a long term basis. These units would include only the operational options needed to duplicate the gait corrections found to be practicable for each individual patient, by the testing procedure, through a universal logic unit as described in this paper.

Cerebrovascular Disorders↗
PubMed1995

Universal health care and high-tech medicine.

The purpose of this article is to review the Canadian universal health care system, focusing on the benefits and consequences of high-tech medicine. Such knowledge could be valuable in guiding the evolving universal health care system in Taiwan. The Canadian Health Care System was developed under the ideals of universality, accessibility and portability. It has successfully provided health care to all citizens regardless of their financial resources and is supported by the great majority of Canadians. However, in spite of various efforts to control health care costs, the governmental financial burden continues to escalate, seriously affecting the development and availability of high-tech medicine for patients who require such services. Delay in the acquisition of high-tech equipment, scarcity of high-tech resources relative to the population size and long waiting periods for certain services have been experienced in Canada. An aging population and advances in medical technology will force the continued escalation of health care costs in spite of optimization of the health care delivery system, and the most serious impact will be felt in high-tech medicine. A number of possible solutions such as user fees or rationing of health care services in high-tech medicine are so far unacceptable in Canada, both for ideologic and ethical reasons. However, rationing and user fees, which the author considers to be inevitable, can be designed to diminish undesirable effects and address the problem of deteriorating high-tech medical care in a universal health care system. Approaches such as a graded user fee based on income, and technologic rationing based on a cost/utility ratio may have to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed1995

[Development of internal medicine as a discipline at the Medical School of Masaryk University].

The lecture presented in extenso at the Conference held to commemorate the 75th anniversary of the Medical Faculty, Masaryk University in the assembly hall of the New Townhall in Brno on November 11, 1994 deals with the development of medical disciplines at the Medical Faculty, Masaryk University since the opening of the first general hospital in 1786, where after the foundation of Masaryk University in 1919 the clinics of the Medical Faculty were established. The author mentions the difficult beginnings when the discipline was gradually established, the destruction of equipment during the Second World War after the universities were closed down, the difficult postwar restoration, changes after 1948 and in particular during the "normalization period" in the seventies and subsequent changes after 1989. The author mentions the foundation of different disciplines which are part of internal medicine and the foundation of clinics, as well as the profiles of their leading personalities. Not all the names are given, the main reason being, as Goncourt said, there were too many.

Czech Republic↗
PubMed1995

The changing medical student population at the University of Cape Town.

OBJECTIVE: Since 1981, the composition of applicants and students admitted to the medical school of the University of Cape Town has changed gradually. The objective of this paper is to quantify these changes and explore possible reasons for them. DESIGN: A retrospective analysis of the actual data accumulated at each annual intake was performed and the trends determined. SETTING: Only data for the University of Cape Town medical school were evaluated. Data published by similar institutions were used for comparative purposes. RESULTS: The number of applicants has risen steadily from 1,229 in 1981 to 2,330 in 1994, so that the applicant/admission ratio now stands at 12,1:1. During this same period, the percentage of women in the class has increased, with women outnumbering men in both 1992 and 1993. In 1994, black African students comprised 24% of those admitted to the M.B. Ch.B. programme, and of these 30.4% were women. By comparison, their white colleagues constituted 45.3% of the class, 57.5% of this cohort being women. CONCLUSIONS: The composition of the 1st-year M.B. Ch.B. class at the University of Cape Town has become multiracial in character, a factor achieved partly through academic support and affirmative action. The heterogeneity of the class, particularly in respect of gender, language and socio-economic factors, while appropriate and necessary, will have an impact on the university and the profession.

Black or African American↗
PubMedDate not supplied

A clinical trial comparing University of Wisconsin solution and cold cardioplegic solution with load-independent mechanical parameters.

To evaluate the efficacy of University of Wisconsin solution for clinical heart transplantation, load-independent parameters were used to assess left ventricular function after transplantation. Donor hearts were arrested with and stored in buffered cold cardioplegic solution for control (n = 5) and University of Wisconsin solution for the experimental group (n = 5). Orthotopic transplantations were performed in a routine manner. Mean donor age (cardioplegic solution, 28 +/- 5.2 years; University of Wisconsin solution, 28 +/- 5.1 years) and ischemic times (cardioplegic solution, 181 +/- 27 minutes; University of Wisconsin solution, 224 +/- 23 minutes) were similar. Two hours after reperfusion of the heart, transesophageal echocardiography was used to image the left ventricle at the mid-papillary muscle level, and a high-fidelity catheter-tipped manometer was placed in the left ventricle to record left ventricular pressure simultaneously. These images were digitized during apneic baseline conditions and during an acute reduction in preload from inferior vena caval occlusion. The left ventricular cross-sectional areas were measured and matched with left ventricular pressure from the catheter-tipped manometer to reveal pressure-area relationships. The baseline parameters fractional area change and stroke force were calculated. End-systolic elastance, the slope of end-systolic pressure-area relationship and preload recruitable stroke force, the slope of stroke force versus end-diastolic area were calculated from the inferior vena cava occlusion measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗