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PubMed1998

Strategies for improving teaching practices: a comprehensive approach to faculty development.

Medical school faculty members are being asked to assume new academic duties for which they have received no formal training. These include time-efficient ambulatory care teaching, case-based tutorials, and new computer-based instructional programs. In order to succeed at these new teaching tasks, faculty development is essential. It is a tool for improving the educational vitality of academic institutions through attention to the competencies needed by individual teachers, and to the institutional policies required to promote academic excellence. Over the past three decades, strategies to improve teaching have been influenced by the prevailing theories of learning and research on instruction, which are described. Research on these strategies suggests that workshops and students' ratings of instruction, coupled with consultation and intensive fellowships, are effective strategies for changing teachers' actions. A comprehensive faculty development program should be built upon (1) professional development (new faculty members should be oriented to the university and to their various faculty roles); (2) instructional development (all faculty members should have access to teaching-improvement workshops, peer coaching, mentoring, and/or consultations); (3) leadership development (academic programs depend upon effective leaders and well-designed curricula; these leaders should develop the skills of scholarship to effectively evaluate and advance medical education); (4) organizational development (empowering faculty members to excel in their roles as educators requires organizational policies and procedures that encourage and reward teaching and continual learning). Comprehensive faculty development, which is more important today than ever before, empowers faculty members to excel as educators and to create vibrant academic communities that value teaching and learning.

Ambulatory Care↗
PubMed2001

Novel mutations identified using a comprehensive CCR5-denaturing gradient gel electrophoresis assay.

BACKGROUND: Most mutations detected for the gene for CC chemokine receptor 5 (CCR5) are either relatively specific to different population groups or rarely observed in Africans. OBJECTIVES: To develop a comprehensive mutation detection assay for the entire coding region of CCR5 and to identify novel mutations that may play a role in genetic susceptibility to HIV-1 infection, within the diverse South African population. DESIGN: The study cohort consisted of 103 HIV-seropositive patients and 146 HIV-seronegative controls of predominantly African descent. METHODS: A mutation detection assay for the entire coding region of CCR5 was designed; this included amplification of part of the coding region of CCR2. The assay was based on denaturing gradient gel electrophoresis (DGGE) and allowed the complete analysis of samples from 10 individuals per denaturing gel. RESULTS: The use of the CCR5-DGGE assay led to the identification of seven novel and six previously reported mutations. All novel mutations, including a common polymorphism at codon 35, occurred exclusively in non-Caucasians, indicating possible African origin. CONCLUSION: A comprehensive DGGE mutation detection assay has been developed for the entire coding region of CCR5. Application of this assay resulted in the identification of novel CCR5 mutations, which may have a significant effect on the normal functioning of CCR5 and thus contribute to host variability and susceptibility to HIV-1 infection and/or progression to AIDS within this population.

Codon, Nonsense↗
PubMed2002

The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999.

This is the 10th annual report describing patients discharged from comprehensive medical rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation. The analysis included 298,973 complete records of first admission cases discharged alive from 676 facilities in 1999. The data show that patients receiving care in comprehensive rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

Activities of Daily Living↗
PubMed1988

Proverb and idiom comprehension in Alzheimer disease.

Twenty-nine patients diagnosed with Probable Alzheimer Disease were administered tests of word, familiar phrases (idioms and proverbs), and novel phrase comprehension. From the early stage of the disease, patients performed worse at understanding familiar phrases than single words or novel phrases. The results uphold common observations that AD patients have difficulty interpreting abstract meanings. Cognitive variables responsible for poor idiom/proverb comprehension and the clinical implications of this new protocol are discussed.

Aged↗
PubMed1999

The therapist's role in comprehensive assessment and OASIS.

Looking for guidelines for using therapists to collect comprehensive assessment data & OASIS? This article presents issues related to the involvement and restrictions of physical therapists, speech-language pathologists, and occupational therapists in comprehensive assessment functions. The scope of practice and roles therapists can assume is outlined and provides references you can use to develop your own policies.

Clinical Competence↗
PubMed2000

Integrating OASIS data collection into a comprehensive assessment.

OASIS should not be used as a survey tool; rather, it should be integrated into a comprehensive assessment. It is almost never appropriate to simply read OASIS questions verbatim to patients and expect them to name the letter of the response. This article provides strategies for collecting OASIS data as part of a routine patient comprehensive assessment.

Data Collection↗
PubMedDate not supplied

Comprehensive radiological equipment management program.

The increasing cost and complexity of state-of-the-art radiological equipment, and the need for more comprehensive safety and performance assurance, have increased maintenance expenditures to a level where they have become one of the largest operating expenses of radiology departments. To cope with this ever increasing expenditure, a comprehensive in-house maintenance program was implemented in our institution. This program properly balanced the capability of the radiology department's in-house technical personnel with support provided by equipment manufacturers' service organizations. Quality assurance activities are also included as an integral part of the entire program. Since the implementation of the program, an average 40% reduction in the annual maintenance expenditure has been observed.

Hospital Bed Capacity, 300 to 499↗
PubMed1988

A plea for more comprehensive blood pressure measurements when evaluating drug treatment of hypertension.

Blood pressure was studied at rest, continuously for 24 h and during dynamic and isometric exercise in previously untreated males with documented mild hypertension. The antihypertensive efficacy of atenolol was compared with that of enalapril in a randomized, double-blind, crossover study, in order to elucidate whether or not these more comprehensive measurements could better distinguish between the efficacy of the drugs than office recordings made at rest. Atenolol proved more effective than enalapril in reducing diastolic blood pressure at rest (P less than 0.05), and systolic blood pressure during dynamic exercise (P less than 0.001), but in the 24-h ambulatory study there were no differences in effectiveness between the drugs. Several patients did not attain our pre-set diastolic treatment goal at rest (less than or equal to 90 mmHg) on single-drug therapy, thus indicating a need for supplementary treatment. When blood pressure was analysed over 24 h, however, there were few recordings greater than 90 mmHg, and the need for supplementary treatment appeared less obvious. Therefore, more comprehensive blood pressure measurements should be considered in the evaluation of antihypertensive treatment.

Atenolol↗
PubMed1981

A controlled clinical trial of "family care" compared with "child-only care" in the comprehensive primary care of children.

We performed a randomized controlled clinical trial in a health center serving a poor population to attempt to find the differences, if any, between the effectiveness of primary care provided to children by two patterns of comprehensive medical care practiced by a pediatrician-internist-allied health team--one pattern offering care exclusively to children and the other offering care to both children and their parents. The study demonstrated few measurable differences between the two groups of children in either utilization or outcome. Where there were differences, most tended to favor slightly the family pattern of care: older children maintained their use of the center, immunization was somewhat more timely and children over time appeared to make fewer visits to sources of ambulatory care other than the health center. The absence of more or greater measurable differences may be due to the relatively short period of study, to the extremely disadvantaged population served, to the special model of family care used or to the comprehensive, team-based care provided to both groups of children.

Adult↗
PubMed1999

A comprehensive prognostic index to predict survival based on multiple comorbidities: a focus on breast cancer.

BACKGROUND: The presence of comorbidities often influences clinical decision-making, although many studies exclude patients with comorbid disease for the sake of analysis. OBJECTIVES: The purpose of this study was to develop a Comprehensive Prognostic Index (CPI), designed specifically for breast cancer patients. RESEARCH DESIGN: This study linked Medicare claims with the Kentucky Cancer Registry and developed two models based on 1 year survival; one focused on deaths caused by breast cancer and the other on deaths from all causes. Comorbidities were derived from inpatient and ambulatory claims for up to 2 years before the diagnosis of breast cancer. SUBJECTS: Subjects included a cohort of 848 elderly women first diagnosed with breast cancer in the state of Kentucky in 1993. MEASURES: Each model identified the comorbidities specific to breast cancer that were detrimental to survival, and generated a refined comorbidity index. The CPI integrated these measures with age and stage of cancer into a comprehensive prognostic index. RESULTS: Nearly two-thirds of the patients had evidence of at least one comorbidity. Survival rates decreased with age, more advanced stage, and increased comorbidity burden, as expected. The interaction of comorbidity burden with either age or stage was particularly strong for the older and more advanced stage of cancer. CONCLUSIONS: The CPI could be a useful tool in breast cancer intervention studies and a prognostic aid for clinicians.

Age Distribution↗
PubMed1998

A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms.

OBJECTIVE: By conducting a review of clinical outcomes for patients with aneurysms treated using current microneurosurgical techniques and intensive care unit management, we determined that grading systems based only on the clinical condition of the patient failed to produce a significant stratification of outcome between individual grades of patients. We hypothesized that outcome prediction for patients surgically treated for intracranial aneurysms could be improved by including factors other than clinical condition that were also strongly associated with outcome. METHODS: To identify potential factors for inclusion in a risk prediction tool, we conducted a multivariate logistic regression analysis of patient- and lesion-specific factors suspected to be associated with outcome in a series of 434 aneurysm operations. Factors that were strongly associated with outcome were used to develop a comprehensive grading system. In the system, 1 point is assigned for Hunt and Hess Grade IV or V, Fisher Scale score of 3 or 4, aneurysm size greater than 10 mm, patient age older than 50 years, and if the lesion is a giant (> or =25 mm) posterior circulation lesion. By adding the total points, a 5-point grading system (Grades 0-5) is obtained. RESULTS: Age of patient, size of aneurysm, severity of subarachnoid hemorrhage (Fisher Scale evaluation of density of blood present as revealed by computed tomography), and clinical condition (Hunt and Hess grade) were each independently and strongly (relative risk, >4) associated with long-term outcome. In addition, there was a trend for increased risk with larger (>25 mm) posterior circulation lesions. When applied to the study population, individual grades on the new grading scale correlated well with actual outcome. In a prospective assessment of the system as applied to an additional 72 operations with at least 1 year of follow-up, the correlation of individual grades and outcome was strong and validated the retrospective findings. CONCLUSION: This new grading system is easy to apply, separates patients into groups with markedly different outcomes, and is comprehensive, allowing for more accurate prediction of surgical outcome for both unruptured and ruptured cerebral aneurysms.

Adult↗
PubMedDate not supplied

An evaluation of the nursing success program: reading comprehension, graduation rates, and diversity.

The Nursing Success Program was developed to enhance retention of baccalaureate nursing students. Reading comprehension scores are used to identify students who are at risk for failure and direct them into the retention program that addresses their skill deficits. To evaluate the program, the authors assessed reading comprehension, graduation rates, and ethnic diversity.

Cohort Studies↗
PubMed1990

Extensive wounds of the spine: a comprehensive approach to debridement and reconstruction.

Extensive wounds involving the spine (greater than three vertebral segments exposed) may threaten its indispensable roles of biomechanical support and vital neurologic function. Although there have been select reports of specific flap applications in this body region in the reconstructive surgical literature, there has been a paucity of comprehensive descriptions of pertinent anatomy, pathophysiology, and the perioperative care of such patients--including the degree to which the spine is suited to aggressive debridement. Four patients with complex spine wounds involving greater than three vertebral segments were treated by the authors from 1986 through 1988. These patients ranged from 28 to 80 years of age. They were all found to have multiple risk factors, including neoplasm (4), severe nutritional depletion (3), advanced age (2), wound sepsis (2), and multiple other general medical problems (4). All patients underwent wide bony and soft-tissue debridement. A new clinically essential four-pillar concept of spinal support predicted spinal instability in two of the four patients. These patients could thus be protected from neurologic compromise with internal stabilization (1) or external orthotic support (1). Wound closure was achieved with skin graft (1) or traditional or extended musculocutaneous flap coverage (3). With 7 to 20 months of follow-up, wound healing has been complete in all patients despite a 100 percent complication rate and one late postoperative death. Multisegment spine wounds tend to arise in the setting of multiple medical problems or risk factors. Despite these risk factors and a high postoperative complication rate, gratifying results may be achieved in these patients with a comprehensive understanding of regional surgical anatomy and a multidisciplinary approach to their care.

Adult↗
PubMed2001

A comprehensive review of epinephrine in the finger: to do or not to do.

The prohibition against the use of local anesthetics with epinephrine for digital blocks or infiltration is an established surgical tradition. The present article provides a comprehensive review of all reported digital necrotic and ischemic complications with epinephrine in the digits in an effort to understand whether the current prohibition is based on documented reports. A comprehensive review of articles showing the successful use of local anesthetic with epinephrine in the digits is presented.A review of Index Medicus from 1880 to 1966 and a computer review of the National Library of Medicine database from 1966 to 2000 were performed using multiple keywords. Selected major textbooks from 1900 to 2000 were also reviewed.A total of 48 cases of digital gangrene after anesthetic blocks (mostly using cocaine or procaine) have been reported in the world literature. Only 21 cases involved the use of epinephrine; 17 involved an unknown concentration based on manual dilution. Multiple other concurrent conditions (hot soaks, tight tourniquets, and infection) existed in these case reports, making it difficult to determine the exact cause of the tissue insult. There have been no case reports of digital gangrene using commercial lidocaine with epinephrine (introduced in 1948). Multiple studies involving thousands of patients support the premise that the use of lidocaine with epinephrine is safe in the digits. An extensive literature review failed to provide consistent evidence that our current preparations of local anesthesia with epinephrine cause digital necrosis, although not all complications are necessarily reported. However, as with all techniques, caution is necessary to balance the risks of this technique with the dangers of mechanical tourniquets and upper extremity block anesthesia.

Anesthesia, Local↗
PubMedDate not supplied

Signs, symptoms, and ill-defined conditions in Persian Gulf War veterans: findings from the Comprehensive Clinical Evaluation Program.

OBJECTIVE: The purpose of this study was to analyze the type and frequency of signs, symptoms, and ill-defined conditions (SSID; International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes 780-799) identified by physicians evaluating Persian Gulf War veterans; to determine the influence of the extent of evaluation on the type and frequency of SSID diagnoses; and to search for evidence for a new illness, or illness related to wartime exposures, in veterans with ill-defined conditions. METHOD: Comprehensive examinations were provided for 21,579 consecutive Persian Gulf War veterans with symptoms or health concerns after the war. Data recorded on all individuals includes demographics, self-reported exposures, symptoms, and physician-assigned ICD-9-CM primary and secondary diagnoses. A detailed psychosocial history, including a multidisciplinary discussion, was incorporated for a subset of participants. RESULTS: SSID conditions were primary diagnoses for 17.2% of veterans, and either primary or secondary diagnoses for 41.8%. Although some SSIDs were objective conditions (eg, sleep apnea), most were simply symptoms. More comprehensive evaluation, especially the multidisciplinary discussion of findings, decreased the frequency of symptoms as diagnoses and increased the number of DSM-IV psychiatric diagnoses. Ill-defined conditions were not associated with particular self-reported exposures or demographic variables. CONCLUSIONS: Ill-defined conditions identified by physicians in Gulf War veterans are most often symptoms. More definitive, often psychological, diagnoses can be made by increasing the intensity of the evaluation and by multidisciplinary input. Evidence for a new or unique illness related to wartime exposures did not emerge from this analysis.

Adult↗
PubMed1991

Computer-assisted comprehensive geriatric assessment in a family physician's office.

Family physicians and other medical care providers are beginning to realize the importance of a comprehensive assessment examination for elderly patients. The components of such an examination are well documented, and include not only the standard history and physical examination, but also evaluation of mental health, functional status, and socioeconomic status of the person. A major impediment to a family physician doing such an extensive evaluation is that most offices lack the team approach commonly used in tertiary care medical facilities. In this paper I report the implementation of a computer-assisted program that was developed for use in a private physician's office. The first 22 patients examined using this protocol are discussed. A new diagnosis was uncovered in all but three of the subjects. This finding suggests that performing comprehensive geriatric assessments in a family practice setting might create an immediate benefit in terms of patient management.

Aged↗
PubMed2002

Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?

STUDY DESIGN: One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined. OBJECTIVE: To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status. SUMMARY OF BACKGROUND DATA: A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables. METHODS: Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling. RESULTS: Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants. CONCLUSIONS: Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.

Back Injuries↗
PubMed1999

Comprehensive TP53-denaturing gradient gel electrophoresis mutation detection assay also applicable to archival paraffin-embedded tissue.

A comprehensive mutation detection assay is described for the entire coding region and all splice site junctions of TP53. The assay is based on denaturing gradient gel electrophoresis, which follows either multiplex polymerase chain reaction (PCR) applied to DNA extracted from fresh or frozen tissue samples or nested PCR applied to DNA extracted from paraffin-embedded tissue samples. In both instances, the analysis can be performed under a single set of conditions. When testing the assay on DNA from cultured lung cancer cell lines and from paraffin-embedded Dukes C colorectal carcinomas, significant TP53 mutations were observed at high frequencies in 15 of 16 lung cancer cell lines (94%) and in 21 of 30 paraffin-embedded tissue samples of Dukes C colorectal carcinomas (70%). A substantial proportion of these significant mutations occurred outside the evolutionary conserved region of TP53 in 4 of 16 lung cancer cell lines (25%) and in 11 of 30 paraffin-embedded colorectal carcinomas (37%). This underscores the importance of a comprehensive TP53 mutation analysis in those instances that TP53 mutation is taken into account for diagnostic and prognostic purposes.

Colorectal Neoplasms↗