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Enabling a developing country to become self-sufficient in health care is a major feat. This two-part article outlines how a general practice training project was established in Uganda to prepare postgraduate students to work in rural hospitals. The first part looked at the setting, personnel, and facilities. Part 2 outlines the curricula and clinical practice.
Psychiatric education in the United States has undergone vast changes during the past 40 years, from a classical psychoanalytic model to an evidence-based neurobiological paradigm. Training standards, set by the Accreditation Council for Graduate Medial Education, have brought more scientific rigor to the training of young psychiatrists, but the danger of losing the psychotherapeutic skills provided in the past by long-term psychodynamic supervision is of concern to many psychiatric educators. A model for evaluating competence in psychodynamic psychiatry is discussed and postgraduate psychoanalytic training is encouraged.
Diagnostic coronary angiography is an important tool in the assessment of heart disease. No objective data are available regarding the best method of training or testing a cardiology trainee's skill in the performance of this procedure. Training guidelines are based on the consensus opinions of experts in the field, and the assessment of proficiency is relegated to a generalized in-training evaluation report (ITER). However, is an ITER sufficient? The current modes of assessment are examined, with the question of whether a more comprehensive and valid assessment process is needed.
One hundred consecutive patients with chronic lateral functional instability of the ankle were treated non-operatively with physiotherapy (active range-of-motion training, strengthening exercises and co-ordination training with a tilt-board). All patients were evaluated functionally with a special rating scale, and radiologically with standardised stress radiographs measuring anterior talar translation (ATT) and talar tilt (TT). Excellent or good functional results were obtained in 49 of the patients, fair or poor in the remainder. The outcome was better in those with painful functional instability or mild mechanical instability, while those with more pronounced mechanical instability required further treatment (i e, reconstructive surgery). Of 10 patients with generalised joint laxity, only fair or poor results were obtained in seven, all of whom had mechanical instability.
Twenty-two patients, 18 years old, with the predominant somatic type of NCA, and a control group of 22 healthy subjects participated in a short term training course lasting three weeks. Following the training the NCA subjects showed a significant change in the systolic and diastolic blood pressure after 5 minutes of recumbency as well as in the systolic blood pressure after 5 minutes of standing, diastolic pressures during 50 W load and submaximal effort (100-150 W) - all the values being significantly lower following the training, except the diastolic pressure during 50 W load which was higher following the course. The prominent training effect was on the heart rate during light work loads (50 W) in which a decrease from a mean of 151.2 +/- 13.9 to 118.3 +/- 16.3 beats/min was recorded. This decrease indicates the better adaptation of the NCA patients to physical effort. Similarly, a significant increase in the mean VO2max from 31.5 +/- 6.1 to 37.7 +/- 5.9 ml O2/kg B.W./min was observed. No changes were recorded in the ECG after the short training course. Following the training all the symptoms typical of the NCA syndrome vanished. A short physical training of 3 weeks can start the procedure of rehabilitation of a well selected group of NCA patients with predominant somatic complaints. The rehabilitation must be continued throughout life by continued physical training.
PURPOSE: The purpose of this study was to evaluate the impact of a tobacco cessation intervention using motivational interviewing on smoking cessation rates during diabetes self-management training (DSMT). METHODS: A randomized controlled trial was conducted with subjects recruited from an ongoing type 2 diabetes adult education program at a large diabetes center. A total of 114 subjects were randomized to intervention (n = 57; face-to-face motivational interviewing plus telephone counseling and offering of medication) or standard care (n = 57). Outcome measures included tobacco cessation rates, mean number of cigarettes smoked, A1C, weight, blood pressure, and lipids. RESULTS: Intensive intervention using motivational interviewing integrated into a standard DSMT program resulted in a trend toward greater abstinence at 3 months of follow-up in those receiving the intervention. However, this same trend was not observed at 6 months. The addition of this structured smoking cessation intervention did not negatively affect either diabetes education or other measures of diabetes management, including A1C values. CONCLUSIONS: Structured tobacco cessation efforts can be readily integrated into established diabetes education programs without a negative impact on diabetes care or delivery of diabetes education. However, an intervention of moderate intensity for smoking cessation was no more effective than usual care in assisting patients with tobacco cessation after 6-month follow-up. Whether a more intensive intervention, targeting patients expressing a readiness to discontinue tobacco use, and/or a longer duration or a more cumulative effect of treatment will be more effective must be evaluated.
The purpose of this study was to evaluate how clinical practice by Swedish dental hygienists was related to type of dental delivery system, period of training, educational institution attended and patient category. Dental hygienists from 14 different dental hygiene schools were represented. Of these schools, 11 are still in operation. A specially designed questionnaire was posted to all dental hygienists in Sweden (n = 1857). A total of 1399 questionnaire (75.3%) were completed and returned, providing data on 15,546 dental appointments. 37.2% of the Swedish dental hygienists are presently working in private practices, 45.8% in the public dental health service and 6.2% in both. Of the patients treated by hygienists, 88.7% were adults: 99.5% in private practice and 78.4% in the public dental health service. 42.0% of all dental hygienists were trained in 1980-84. The mean treatment time per appointment in private practice was 49.7 min and 45 min in the public dental health service. Scaling, root-planning and removal of overhangs took 27 min per visit in private practice and 22 min in the public dental health service. However, there were no significant differences in methods in the two delivery systems with respect to examinations, self-care training, professional mechanical toothcleaning (PMTC), topical fluoride application, or salivary and oral microbiology tests. The adult patient categories were periodontal risk (45.1%), caries risk (9.1%) and hygiene (34.6%). In periodontal risk patients, scaling, root-planning and removal of overhangs took 28 min per appointment and 14 min in caries risk patients.
BACKGROUND: One goal of program directors is to attract and retain high-quality residents. It is therefore important to study attrition of residents to determine specific cohorts that may be less likely to complete residency training. PURPOSE: The purpose of this study was to investigate attrition rates in targeted programs. METHOD: Surveys were sent to 540 program directors whose programs contained at least 25% international medical graduates. The program directors reported both voluntary attrition and termination rates. RESULTS: Overall attrition rates for international medical graduates and U.S. medical graduates were similar, although U.S. medical graduates were terminated at a slightly lower rate than international medical graduates (2.5% vs. 3.6%) and were somewhat more likely to transfer to other programs (9.9% and 8.9%). CONCLUSIONS: Attrition from these programs remains a small but persistent issue. In addition, the differences in termination and transfer rates for the 2 years of the study were greater than the differences in rates between U.S. and international medical graduates.
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We evaluated past medical records and conducted a hypertension screening program in the outpatient clinic of a university hospital, a community hospital, and a city hospital, with the aid of specially trained high school students under the direction of a cardiovascular nurse. Fifty-one percent of the adult black outpatients had elevations of arterial blood pressure; one half of these patients were aware of a history of hypertension. Analysis of the clinic records showed that many patients who had made multiple visits to the clinic had never had a blood pressure recorded in their charts. If progress is to be made in the detection of hypertension, blood pressures must be routinely determined. This should be incorporated into all clinic routines, particularly in clinics staffed by physicians-in-training.
Attitudes towards physical activity, perceived health, body image, anxiety and life satisfaction have been studied in men and women 60 years of age and older, volunteering for progressive endurance training. Relative to other studies of younger volunteers, the senior citizens placed more value upon activity as "an esthetic experience" and as "a means to health and fitness" showing less interest in "the pursuit of vertigo." Many non-participants and "drop-outs" perceived their current fitness as satisfactory. Subjects who selected a low frequency and low intensity of training were obese, with high Cornell Medical Index (CMI) scores on both organic and psychological scales. After 14 weeks of conditioning, 83% of subjects reported improvements in well-being. However, CMI scores were reduced on only one of twelve organic scales and none of the behavior, mood and feeling scales. Neugarten's Life Satisfaction Index, Kenyon's Body Image scales, and McPherson's the Real Me scores remained unchanged, but there was a decrease of Manifest Anxiety (Taylor scale) and a greater regard of physical activity as "the relief of tension." When subjects were classed according to changes in aerobic power, between group differences were found for "Real Me" scores and for three of Kenyon's attitude scales. Persons who trained frequently and intensively showed improvements for body image and for five of Kenyon's attitude scales.
Attitudes towards physical activity, perceived health, body image, anxiety and life satisfaction have been studied in men and women 60 years of age and older, volunteering for progressive endurance training. Relative to other studies of younger volunteers, the senior citizens placed more value upon activity as "an esthetic experience" and as "a means to health and fitness" showing less interest in "the pursuit of vertigo." Many non-participants and "drop-outs" perceived their current fitness as satisfactory. Subjects who selected a low frequency and low intensity of training were obese, with high Cornell Medical Index (CMI) scores on both organic and psychological scales. After 14 weeks of conditioning, 83% of subjects reported improvements in well-being. However, CMI scores were reduced on only one of twelve organic scales and none of the behavior, mood and feeling scales. Neugarten's Life Satisfaction Index, Kenyon's Body Image scales, and McPherson's the Real Me scores remained unchanged, but there was a decrease of Manifest Anxiety (Taylor scale) and a greater regard for physical activity as "the relief of tension." When subjects were classed according to changes in aerobic power, between group differences were found for "Real Me" scores and for three of Kenyon's attitude scales. Persons who trained frequently and intensively showed improvements for body image and for five of Kenyon's attitude scales.