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PubMed1994

[Evaluation of students rotational work experience in health centers of the Faculty of Medicine of the University of Extremadura].

OBJECTIVE: To evaluate the opinions of the students from the 6th year of the medical degree course, regarding their rotation in health centres, together with their knowledge, preferences and perception on various different aspects of primary medical attention. DESIGN: Cross-sectional observation. Evaluation by means of opinion questionnaire. SETTING: Primary medical attention. Four urban health centres in Badajoz and one in Mérida, with responsibilities for the teaching of pregrade medicine. PATIENTS OR OTHER PARTICIPANTS: 67 students of the sixth year of the University medical course, 1992-1993. MEASUREMENTS AND MAIN RESULTS: Out of a total of 101 university students, 67 (66.3%) took part in the voluntary rotation scheme that the Health Centres offer the University. The average age of the students was 24.3 +/- 1.1 years. 84% of the students rated the experience as "useful" or "very useful", and 63% thought it should be longer. The students correctly identified features that distinguish outpatients clinics from Health Centres. Medicine is the magazine most known and most consulted by the students. Almost all of the students (97%) will take the MIR examination, and the family and community medicine specialties hold a particular attraction for these students. CONCLUSIONS: We note that students rated the rotation work experience in the health centres highly. But there is still a lack of coordination and a degree of fragmentation of teaching aims. The universities are not making sufficient use of the learning opportunities offered by the health centres.

Academic Medical Centers↗

PubMed1993

Examining the range of health care reform. University of Pittsburgh Task Force on Health Care Financing.

On December 16, 1991, Senator Harris Wofford invited the president of the University of Pittsburgh Medical Center to convene a group of its leaders for a roundtable discussion of health care issues. At that meeting, J. Dennis O'Connor, Ph.D., chancellor of the University of Pittsburgh, offered to appoint a multidisciplinary group of people from western Pennsylvania to collect data to analyze future policy options relative to health care and make its findings available to the senator, other legislators, and health policy makers. The chancellor invited representatives from the community, the University of Pittsburgh Medical Center, the University's Faculty of Arts and Sciences, and other academic and health care institutions in the area to participate in the analytical process. The task force met frequently over a 10-month period to develop a report, a portion of which is excerpted here.

Health Policy↗

PubMed1995

[Establishing a quality assurance system in transfusion medicine exemplified by the Heidelberg University Blood Bank].

BACKGROUND: The 'Zweite Verordnung zur Anderung der Betriebsverordnung für pharmazeutische Unternehmer vom 13. Juli 1994' requires a quality assurance system for the manufacturing of blood products. METHODS: On the basis of national law and guidelines we worked out a concept for establishing a quality assurance system at a university blood bank and applied it to the university blood bank at Heidelberg. RESULTS: The quality assurance system of the university blood bank at Heidelberg is based on the components 'quality of structure', 'quality of process' and 'quality of result'. The internal standard is specified in written form for every aspect of structure, process and result by standard operating procedures (SOP). The SOP serve as a basis for the quality system manual and the laboratory reference books. The quality assurance system described here integrates a programme for carrying out internal quality audits as well as a concept for updating SOP at regular intervals. CONCLUSIONS: The concept underlying the quality assurance system of the university blood bank at Heidelberg allows continuous quality improvement in transfusion medicine; moreover, it offers the chance to integrate quality assurance in transfusion medicine in an interdisciplinary, patient-orientated, not only regional concept of quality assurance.

Blood Banks↗

PubMed1995

Delivering health information databases on World Wide Web at the National University of Singapore.

The National University of Singapore (NUS) is one of the first medical schools in Asia to exploit the use of the World Wide Web on the Internet for the delivery of health information databases. Its WWW server was established in 1993 by the NUS Biocomputing Research and User Support (BRUS) technology group in collaboration with the Computer Resource Planning committee of the Faculty of Medicine. As a result of the early recognition of the powerful platform on which health information services can be delivered worldwide, the NUS effort has been accredited with a number of Internet firsts in the area of health informatics. The following are some of the NUS achievements: NUS-NCI CancerNet on the Web. The NUS developed and implemented the first WWW version of the popular CancerNet database offered by the National Cancer Institute, NIH, USA. Health Info-Com Network Medical Newsletter. The NUS developed and implemented the first WWW version of the medical newsletter, MEDNEWS which is edited by Dr. David Dodell, USA. It is now mirrored by the University of Pennsylvania in the United States and De Montfort University, U.K. Poisons Information Database. This first WWW implementation of a database on known plant, snake and other animal toxins with directories of antivenoms, toxinologists and poisons control centers around the world is offered by the NUS Venom and Toxin Research Group. HistoNet. This is a large collection of histology specimens from the NUS Department of Anatomy. MEDISTAT. This is the first WWW implementation of a Health and Population Statistical Database which contains information for Singapore, selected Asian countries and aggregate data for world regions. The Singapore Biotechnology Database. This database features companies and organizations involved in biotechnology and related activities in Singapore. Efforts are continuing to offer more value-added health information databases on the NUS WWW server and to link the server with other top-class information centers worldwide. Our mission is to identify the National University of Singapore as a global health information hub on the Internet.

Computer Communication Networks↗

PubMedDate not supplied

University of Wisconsin solution versus Stanford cardioplegic solution and the development of cardiac allograft vasculopathy.

BACKGROUND: University of Wisconsin (intracellular) solution has been shown to offer some distinct benefits of myocardial preservation over Stanford (extracellular) solution, including a more rapid functional recovery, improved adenosine triphosphate preservation, and a tendency for less postoperative inotropic agents. However intracellular solutions with high potassium content have been reported to cause a functional if not structural endothelial injury in laboratory experiments. METHODS: Because of this information we retrospectively viewed our follow-up angiographic data for the development of the cardiac allograft vasculopathy in a consecutive series of 195 heart transplant recipients. These patients were treated in identical fashion, with the same immunosuppression regimen, except for the type of cardioplegia used--Stanford solution (group I n = 95) and University of Wisconsin solution (group II n = 100). RESULTS: With a mean follow-up of 24 months after transplantation, a significant difference was seen in the development of cardiac allograft vasculopathy in group II (22%) versus group I (14%, p < 0.03). Although significant differences were observed with univariate analysis with respect to donor age and ischemic time favoring group I and with multivariate statistical analysis with respect to overall rejections favoring group II, the only significant variable for the difference in the development of allograft vasculopathy was University of Wisconsin cardioplegic solution (p < 0.003). A subgroup of 30 patients previously randomized for a functional study comparing the two cardioplegic agents showed a tendency for statistical significance with a freedom from allograft vasculopathy of 93% in group I, as compared with 83% in group II, after 13 months follow-up (p = 0.09). The overall probability of being free of vasculopathy at 24 months was 86% for group I and 70% for group II. CONCLUSIONS: The data support the conclusion that University of Wisconsin intracellular solution is associated with an increased incidence of vasculopathy versus Stanford solution and warrants investigation for modification of this preservation agent in heart transplantation.

Adenosine↗

PubMed1997

Binding of malaria T cell epitopes to DR and DQ molecules in vitro correlates with immunogenicity in vivo: identification of a universal T cell epitope in the Plasmodium falciparum circumsporozoite protein.

The efficacy of a malaria peptide vaccine would be enhanced by the inclusion of a parasite-derived universal T cell epitope to ensure that all vaccinees develop parasite-specific cellular and humoral immunity. Two circumsporozoite (CS) protein T cell epitopes, previously identified by CD4+ T cell clones derived from Plasmodium falciparum sporozoite-immunized volunteers, were studied to determine their HLA class II binding potential. One epitope, located in amino acid (aa) 326-345 of the P. falciparum (NF54 strain) CS protein, was "universal" in that it could bind to multiple DR and DQ molecules in vitro. In contrast, the second epitope, T1, which is located in the CS repeat region, was recognized by T cells in the context of DQ6 (DQB1*0603) and did not bind with high affinity to any of the class II molecules tested in the peptide binding assays. The in vitro patterns of peptide/HLA interactions correlated with immunogenicity in vivo. A multiple antigen peptide (MAP) containing the aa 326-345 epitope elicited responses in eight inbred strains (H-2(a,b,d,k,p,q,r,s)), while the T1 MAP was recognized by only a single haplotype, H-2b. The combination of the universal aa 326-345 T cell epitope and the T1 repeat in a di-epitope MAP overcame the genetic restriction to the P. falciparum CS repeat region and elicited antisporozoite Ab responses in all of the MAP-immunized mice. Synthetic peptide malaria vaccines containing the aa 326-345 universal T cell epitope would be expected to elicit parasite-specific immune responses in both sporozoite-primed and naive individuals of diverse genetic backgrounds.

Animals↗

PubMed1998

[Institutional reorganization associated to curricular changes in the School of Medicine of the University of Chile].

The model of medical education of the Faculty of Medicine of the University of Chile is being subjected to important changes. These changes are required to introduce new teaching methodologies and new curricular contents to prepare professionals suited to the needs of the XXI Century. Complex universities need to modify their academic behavior and administrative management, to become competitive with the new universities that proliferate, with drastic changes in play rules and expectancies to accomplish their aims. Universities must reorganize and modify their structures to avoid becoming obsolete in the exercise of teaching and other academic options. The transformations of the Faculty of Medicine are good examples of the resources that have to be mobilized and the organisms that must be adapted to obtain changes that will improve academic efficiency. The continuous assessment of its functioning will establish the usefulness of adopted changes and the need for rectification.

Chile↗

PubMed1998

A study of substance abuse on two campuses of University of Papua New Guinea.

BACKGROUND: Recent research reports indicate that there is a substantial amount of substance abuse on the campuses of the University of Papua New Guinea. OBJECTIVE: To compare the frequency and quantity of alcohol and drug abuse on the two campuses of the University of Papua New Guinea in the National Capital District. METHODS: A purposely designed questionnaire was used to collect data randomly on a total of 90 subjects (45 from each campus). The data was subjected to computer analysis. RESULTS: The results show that abuse of alcohol, tobacco and other drugs is prevalent on the two campuses of the University of Papua New Guinea. CONCLUSION: The results will form the basis of recommendations for substance abuse prevention, through information and education of the University students and staff members.

Alcohol Drinking↗

PubMed1998

[The virtual university in medicine. Context, concepts, specifications, users' manual].

The widespread use of Web servers, with the emergence of interactive functions and the possibility of credit card payment via Internet, together with the requirement for continuing education and the subsequent need for a computer to link into the health care network have incited the development of a virtual university scheme on Internet. The Virtual University of Radiology is not only a computer-assisted teaching tool with a set of attractive features, but also a powerful engine allowing the organization, distribution and control of medical knowledge available in the www.server. The scheme provides patient access to general information, a secretary's office for enrollment and the Virtual University itself, with its library, image database, a forum for subspecialties and clinical case reports, an evaluation module and various guides and help tools for diagnosis, prescription and indexing. Currently the Virtual University of Radiology offers diagnostic imaging, but can also be used by other specialties and for general practice.

Computer-Assisted Instruction↗

PubMed1998

[History of student medical journals at the Medical School of the University of Zagreb].

The aim of the present study was to describe students' medical journals that have been edited by students of the Medical School of the University of Zagreb through history. Data were collected from the archives of the National and university library in Zagreb and from the Central library of the Medical School of the University of Zagreb. In 1925 in Zagreb was published the only number of "Medicinarski Vesnik--Glasilo Saveza medicinarskih drustava u Kraljevini SHS". In 1937-1938 in Zagreb were published eleven numbers of "Savremeni hrvatski medicinar--Casopis Kluba Medicinara Zagreb", then it ws forbidden. "Medicinar" has been published from 1946 till today. From 1958 to 1963 "Medicinar na Autoput" was published, and 1959 two numbers of "Ekscitator"--humoristic medical journal. From 1984 to 1987 the journal "Limfa" was published. During eighty years of the existence of the Medical School of the University of Zagreb, students have dignified work of the school by editing and publishing journals. Through "Medicinar"--the journal with the longest tradition and with major importance they do the same nowadays, contributing to the reputation and specialty of the school and the state as a whole.

Croatia↗

PubMed1998

Trophoblastic disease: twenty years' experience at Niigata University.

The author engaged in the registration work and the clinical studies of trophoblastic disease over 20 years at Niigata University in Niigata prefecture, before transferring to University of the Ryukyus in Okinawa prefecture in 1992. In this paper, the following four topics are reviewed and discussed. 1) the registration data of trophoblastic disease in Niigata prefecture, 2) the treatment results of gestational chorio-carcinoma at the Niigata University Hospital, 3) a trial administration of Gn-RH analogue in patients with gestational choriocarcinoma to suppress secretion of hCG-like substance (hLS) which might cross-react anti-hCG antibodies in hCG immunoassay system, 4) the two rare cases of extrauterine gestational choriocarcinoma who were presented to the Ryukyus University Hospital.

Adult↗

PubMed1998

[Universal dyschromatosis: a familial case].

INTRODUCTION: Universal dyschromatosis is a generalized leucomelanodermia recognised in Japan in 1933. We report a family with universal dyschromatosis, demonstrating the mode of transmission. The ultrastructural aspects are compatible with a functional melanogenesis anomaly. CASE REPORT: A 9-year-old girl was hospitalized for recently diagnosed insulin-dependent diabetes mellitus. She was born to non-consanguinous parents and her past medical history was uneventful. Her father was of mixed ethnic origin. The physical examination revealed generalized leukomelanoderma identified since the first year of life. Zones of small achromatic maculae alternated with zones of pigmented maculae of variable size and color. Lesions were diffuse but predominated on the trunk and did not involve the face, the hands or the feet. Neither the child nor her father who also has leukomelanoderma were photosensitive. A skin biopsy from the gluteal region revealed alternating zones of hyper- and hypopigmentation. The ultrastructural analysis showed that the number of melanocytes was not significantly different in the different pigmented zones and the pigment transfer to adjacent keratinocytes was intact. There were three other girls in the kinhood and two, as well as a few other individuals in the family, had a localized form of the disease. DISCUSSION: Universal dyschromatosis is a rare genodermatosis. The familial cases reported here illustrate the variable clinical presentations of this pigmentary abnormality. The pedigree in this family demonstrated incomplete penetrance of hereditary leukomelanoderma with autosomal dominant inheritance. The localized forms reported to date under different names would actually appear to correspond to incomplete expression of the dermatosis. The skin manifestations in universal dyschromatosis would appear to be similar to those in a few other skin diseases, mainly xeroderma pigmentosum, especially the localized forms; for generalized forms however, there is little room for confusion as photosensitivity is absent and lesions predominate in unexposed zones. The ultrastructure investigations showed different levels of melanocyte activity without abnormal pigment production or transfer. This abnormality has variable expression, explaining the multitude of clinical presentations.

Adult↗

PubMed1992

Exposure to blood during various procedures: results of two surveys before and after the implementation of universal precautions.

In an attempt to define better situations involving exposure to blood, we surveyed nurses (N = 565) in a 1000-bed university hospital to determine the following for the last working shift: the rate of cutaneous exposure to blood for different procedures, the rate of needlestick injury, and the prevalence of hand lesions. Among nurses who had performed at least one of the specified procedures, 42% had been exposed to blood with unprotected skin. Direct examination of 100 pairs of hands revealed that 57% of the nurses had either acute or chronic skin lesions. Universal precautions were introduced, and a similar survey (N = 541) was carried out 1 year later to assess compliance. Exposure of unprotected skin to blood had been reduced to 27%, although 46% of nurses had not used gloves for any of the procedures they had performed. The main reason given by nurses for not wearing gloves was that they did not consider the patient to be at risk for carrying a blood-borne infection. The rate of needlestick injuries was high and had remained stable at approximately 2.8 needlesticks/nurse per year, as determined by information from the last working shifts. We conclude that compliance of nursing personnel with universal precautions was insufficient, despite an informational campaign throughout the hospital. Repeated instruction on barrier precautions and the prevention of needlestick injury (including the correct use of disposable containers) is necessary to ensure optimal protection.

Blood↗

PubMed2026

Efficacy of a self-guided online resilience intervention for improving mental health among university students: A randomized controlled trial.

Epidemiological data indicates that university students are an at-risk population for the development of mental disorders. Online interventions have been proposed as promising tools for reducing barriers to treatment and establishing easily accessible health-care services promoting mental health and resilience. This study investigated the efficacy of a Learning Management System (LMS)-based self-guided online resilience intervention. 216 university students took part in a randomized controlled trial with an intervention and a waitlist control group and three measurement points (pre, post and follow-up). We conducted per-protocol (PP) and intention-to-treat (ITT) analyses with mental distress as primary outcome, and self-reported resilience and resilience factors as secondary outcomes. Further, attitudes towards online interventions, adherence, satisfaction and possible negative effects were explored. Satisfaction with the intervention was high and PP analyses (n = 150) revealed significant improvements in mental distress and self-compassion at post-test and acceptance at follow-up. No favourable effects were found for self-reported resilience and resilience factors. Adherence was low and ITT analyses revealed no significant effects. Overall, the study provides preliminary evidence for the LMS-based self-guided online intervention as a potentially valuable tool for university mental health services under optimal adherence conditions. Further research into determinants of adherence is needed to improve intervention reach.

Humans↗

PubMed1991

Monitoring universal precautions: a new assessment tool.

OBJECTIVES: Two pilot studies were conducted to produce efficacy data on an observational tool designed to assess the use of Universal Precautions (UP) in patient care settings. The instrument addresses barrier precautions, hand-washing, handling of sharps, and avoidance of unprotected mouth to mouth resuscitation. DESIGN: The Universal Precautions Assessment Tool was submitted to a panel of 3 experts to establish consensual validity. It was pilot tested by 2 simultaneous observers to establish interrater reliability. SETTING: Pilot Study I was conducted in 3 different units within a 100-bed U.S. Army hospital. Pilot Study II was conducted in the emergency department of a large university-based hospital. PARTICIPANTS: Subjects observed were registered nurses providing acute patient care. RESULTS: Two simultaneous raters calculated UP compliance rates of 76.4% and 78.6%, respectively, for 9 nurses in Pilot Study I, and 62% and 65%, respectively, for 5 nurses in Pilot Study II. The intraclass correlation coefficient for the raters' scores in Pilot Study I was 0.992 with a 95% confidence interval (0.979, 0.997). Consensual validity was established. CONCLUSIONS: The instrument has acceptable interrater reliability under the conditions used. Limitations to use include the possibility of a Hawthorne effect and the fact that assessing proper implementation of UP occasionally relies on a "judgment call" by the observer. With test conditions adjusted to minimize these limitations and with proper consideration of sample size, the tool can be used by researchers and by monitors of hospital quality control to measure UP compliance of caregivers individually or collectively.

Cooperative Behavior↗

PubMed1992

Process of forgoing life-sustaining treatment in a university hospital: an empirical study.

OBJECTIVES: The difficult decision to forgo (withhold or withdraw) life-sustaining treatment has received extensive commentary. Little attention has been paid to how physicians do, and should, care for dying patients once this decision is made. This study describes the characteristics of patients who forgo treatment, determines the range and sequential process of forgoing treatment, and suggests ethical and public policy implications. DESIGN: The charts of all patients who died at the University of Minnesota Hospital during a 2-month period were reviewed. The patient information that was collected included age and sex, diagnoses, mental status, location in the hospital length of hospital stay, method of payment, the timing of the first decision to forgo treatment, and the range and sequence of interventions forgone. SETTING: All ICUs and general wards in a 586-bed tertiary care university hospital. PATIENTS: All patients who died at the University of Minnesota Hospital during May and June 1989. MAIN RESULTS: A total of 52 (74%) of 70 patients who died had some intervention withheld or withdrawn before death. Those patients in whom treatment was forgone were more likely to have an underlying malignancy or impaired mental status and longer hospital stays. Thirty-two (62%) of 52 patients who declined some treatment were in an ICU; 26 (50%) of 52 patients required mechanical ventilation. On average, 5.4 separate interventions were forgone per patient. Resuscitation and/or endotracheal intubation were generally the first measures withheld; once a patient required a ventilator, withdrawing the ventilator was a late decision. Precise methods of ventilatory and vasopressor withdrawal varied considerably among patients. CONCLUSIONS: Forgoing life-sustaining treatment is not a single decision but it often occurs in a sequential manner over several days. A strict analysis of the benefits and burdens of various interventions may be inadequate in deciding what interventions are appropriate in the care of the dying patient.

Adult↗

PubMed2005

Prevalence of blood-borne pathogens in an urban, university-based general surgical practice.

OBJECTIVE: To measure the current prevalence of blood-borne pathogens in an urban, university-based, general surgical practice. SUMMARY BACKGROUND DATA: Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C represent significant occupational hazards to the surgeon. While the incidence of these blood-borne pathogens is increasing in the general population, little is known about the current prevalence of these exposures among patients presenting for surgery. METHODS: We studied 709 consecutive operative cases (July 2003 to June 2004) in a university practice that provides all inpatient, emergency department, and outpatient consultative general surgical services. Trauma cases and bedside procedures were excluded. Data collected included HIV, hepatitis B and C test results, type of operation, age, sex, and history of intravenous drug use. RESULTS: Testing for blood-borne pathogens was performed in 53% (N = 373) of 709 patients based on abnormal liver function tests, neutropenia, history of IV drug use, or patient request. Thirty-eight percent of all operations (142/373) were found to involve a blood-borne pathogen when tested: HIV (26%), hepatitis B (4%), hepatitis C (35%), and coinfection with HIV and hepatitis C (17%). Forty-seven percent of men tested positive for at least 1 blood-borne pathogen. Seventy-three different types of operations were performed, ranging from Whipple procedures to amputations. Soft-tissue abscess procedures 48% (34/71) and lymph node biopsies 67% (10/15) (P < 0.01) were most often associated with blood-borne pathogens. Infections were more common among men (P < 0.01), patients 41 to 50 years of age (P < 0.01), and patients with a history of intravenous drug use (P < 0.01). CONCLUSIONS: HIV and hepatitis C infections are common in an urban university general surgical practice, while hepatitis B is less common. In addition, certain operations are associated with significantly increased exposure rates. Given the high incidence of these infections, strategies such as sharpless surgical techniques should be evaluated and implemented to protect surgeons from blood-borne pathogens.

Adult↗

PubMed2026

Effects of a situational interest-based rotational fitness training program on positive affect in university students: A randomized controlled trial.

BACKGROUND: To evaluate whether a 12-week situational interest-based rotational fitness program improved positive emotional states in university students, to compare module-specific effects, and to examine whether the intervention moderated the heart rate-emotion association. METHODS: In this 2-arm randomized controlled trial, 560 freshmen from 10 Chinese universities were assigned to an experimental (n = 280) or control group (n = 280). The experimental group completed weekly 90-minute sessions covering strength, endurance, speed, and agility modules; controls received regular physical education. Positive emotional states were assessed using the positive well-being subscale of the Subjective Exercise Experiences Scale through ecological momentary assessment at 3 points per session, yielding over 14,000 observations. Linear mixed-effects models tested group, time, group × time, heart rate, and heart rate × group effects. Assessors and analysts were blinded. Ethical approval for the trial was granted by the Institutional Review Board of Capital University of Physical Education and Sports (2025A055). RESULTS: Improvement was greater in the experimental group than in controls (EMM change: 1.843 vs 0.505; difference = 1.338, 95% confidence interval [CI]: 1.275-1.400, P < .001). At week 12, the raw between-group difference was 1.85 (d = 2.23), and all group × week interactions from weeks 2 to 12 were significant. Heart rate positively predicted emotional states in controls (B = 0.005, 95% CI: 0.003-0.007), but this association was attenuated in the experimental group (interaction B = -0.008, 95% CI: -0.011 to -0.005). Strength and agility showed significant improvements, while endurance produced consistently higher emotional states across assessment points. Heart rate moderation was significant for strength and endurance, but not speed or agility. CONCLUSION: The rotational program improved positive emotional states more than regular physical education, although effects varied by module. Strength showed the most robust benefit. The program also weakened, but did not eliminate, the heart rate-emotion association during more demanding activities.

Humans↗