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PubMed2001

The EXCEL Program: strengthening diversity.

The Boston University Henry M. Goldman School of Dental Medicine (BUSDM) initiated a program in the summer of 1993 to strengthen diversity in the entering class of first-year students. The Experiential Center for Excellence in Learning (EXCEL) Program is a voluntary, one-month-long prematriculation experience that combines didactic, laboratory, study skills, and social activities to prepare participants to transition into the rigorous first-year curriculum. From 1996 to 2000, ninety students participated in EXCEL. The two primary reasons cited for participating were to become familiar with the school, faculty, and classmates and to strengthen basic science background. Participants' ages ranged from twenty to over forty. Fifty-nine percent of participants had been out of college for more than one year; 10 percent had been out of school for three years or more. Thirty percent listed nontraditional predental school majors. Fifty-six percent listed a country other than the United States as country of birth. Of those completing an exit survey, 96 percent reported that EXCEL strengthened their decision to study dentistry, and 97 percent would recommend that future entering BUSDM students participate in EXCEL. The EXCEL Program may serve as a model for increasing diversity in U.S. dental school enrollment.

Adult↗
PubMedDate not supplied

Activity of cat parietofrontal neurons during the performance of a voluntary movement.

The impulse activity of 227 neurons of field 5 was investigated in cats trained to complete a movement of the forepaw in response to a stimulus. The discharges of each of them were collected relative to three markers: the presentation of the conditional signal, the raising of the paw from a support, and pressing on a pedal. The reactions associated with the performance of the reflex were recorded in 224 neurons. The majority of the cells reacting to the stimulus generated a pronounced excitatory response even at the beginning of the movement, but were inhibited at the moment of the touching of the pedal. Sixty-seven percent of the neurons whose discharges were collected relative to the raising of the paw reacted prior to the appearance of the EMG response. The parietofrontal neurons were identified on the basis of the presence of an antidromic response to the stimulation of the motor cortex. The changes in the discharge frequency which were associated with the movement significantly more often anticipated the EMG response in the parietofrontal neurons as compared with non-parietofrontal cells (79.0 and 63.3%, respectively). The parietofrontal neurons reacted more actively to the conditional signal, light flashes, acoustic tone, and tactile stimulation as well. Their role in the triggering and unfolding of the program of a voluntary movement is discussed.

Animals↗
PubMed2000

To buy, or not to buy: factors associated with the purchase of nongroup, private health insurance.

BACKGROUND: Employment-based health insurance coverage is declining in the United States. Many recent efforts to increase coverage have promoted the individual purchase of insurance, with or without subsidies. OBJECTIVES: To study the associations of factors including minority group membership, education, income, wealth, and health status with the voluntary purchase of nongroup, private health insurance. DESIGN: Analysis of the 1987 National Medical Expenditure Survey (NMES). SUBJECTS: Adult respondents to the NMES who were younger than 65 years of age in 2,574 health-insurance eligibility units (HIEUs) and who either were uninsured or who purchased nongroup, private health insurance for all of 1987. MEASURES: Adjusted odds ratios and marginal effects for the associations of minority group membership, educational attainment, income, and wealth with the purchase of nongroup insurance. RESULTS: Lower-income and less-wealthy HIEUs were much less likely to purchase insurance than higher-income and wealthier HIEUs, with income and wealth measures having relatively independent effects. With simultaneous adjustment for income, wealth, and other factors, members of minority groups had less than half the odds of non-Hispanic whites and persons with less than a high school education had less than half the odds of college graduates of purchasing nongroup insurance. CONCLUSIONS: Minorities and the less educated are much less likely to buy their own health insurance, even after adjustment for income and wealth. Programs encouraging the voluntary purchase of health insurance are likely to widen coverage gaps between historically disadvantaged groups and others.

Adult↗
PubMed1983

Proficiency testing in forensic toxicology: a feasibility study.

This study has shown that a national proficiency testing program in forensic toxicology is feasible. Samples that resemble typical case specimens were prepared and shipped to approximately 100 laboratories. Participation varied between 61 and 73%. Tissue samples obtained from laboratory animals can be used to simulate those encountered by forensic toxicologists. This has been demonstrated using liver homogenates from animals administered pentobarbital and methaqualone and propoxyphene and acetaminophen. There was a large coefficient of variation however, for the quantitation of acetaminophen in liver. The qualitative data obtained during the course of this study showed a very low incidence of false positives. However, there was a disappointingly low percentage of positive responses for (a) low concentrations of secobarbital and (b) the opiate narcotics (morphine and codeine) in blood, despite the fact that sensitive immunoassay procedures are available for detecting these particular compounds in blood samples. The quantitative determination of drugs and metabolites, other than ethanol, shows wide interlaboratory variation. This variation is presumably not a result of the use of different analytical techniques, since gas liquid chromatography was used by the majority of participants to quantitate drugs and metabolites. Forensic toxicologists are willing to participate in a voluntary proficiency testing program conducted by an independent agency. The performance data developed in this study can serve as a baseline for current forensic toxicology laboratory functional capability in the assessment of future changes and improvements in analytical forensic toxicology.

Biotransformation↗
PubMed1997

Improving the processes of care and outcomes in obstetrics/gynecology.

BACKGROUND: The obstetrics/gynecology department of York Hospital (York Health System, York, Pennsylvania) initiated a program to improve the processes of care and control costs for common women's and newborns' health care services. Twelve clinical policies were established between June 1993 and February 1995. CONDUCTING THE QUALITY IMPROVEMENT (QI) PROJECTS: Using the plan-do-check-act (PDCA) improvement cycle method, the QI group established clinical pathways for high-volume conditions or procedures known to have low rates of complications and clinical guidelines for those conditions or procedures not requiring coordinated efforts of a group of health care professionals. EXAMPLE--PYELONEPHRITIS IN PREGNANCY: The literature had indicated that the prevalence of pyelonephritis can be decreased by identifying and treating asymptomatic bacteriuria early in prenatal care. After the validity of the clinical policy was demonstrated in the resident service, the policy was extended to all private obstetric practices. Dissemination of the finding that most of the admissions for pyelonephritis were for referred patients (for whom we had no control over prenatal care) or for patients referred by private physicians who were not yet following the guidelines quickly led to complete compliance by our obstetricians and other health care providers referring patients to the York Health System. RESULTS: The 12 clinical policies resulted in the elimination of 113 admissions and 5,595 inpatient days and in the reduction of the cost of patient care by $1,306,214 for the years 1994-1995 and 1995-1996 combined, without apparent adverse effects on patient health. CONCLUSION: A voluntary clinical policies program can change the culture of a department and lead to cost-effectiveness and better quality of patient care.

Algorithms↗
PubMedDate not supplied

The effects of a 9-week program of aerobic and upper body exercise on the maximal voluntary ventilation of chronic obstructive pulmonary disease patients.

PURPOSE: The purpose of this study was to evaluate the effects of a 9-week exercise program that emphasized aerobic and upper body strength on the maximal voluntary ventilation (MVV) of patients with chronic obstructive pulmonary disease (COPD). An experimental and control group totaling 40 patients with a diagnosis of COPD was studied. METHODS: Experimental group subjects were given a pre- and post-MVV breathing test, a Patient's Attitude Toward Health (PATH) questionnaire, a knowledge of disease questionnaire and a 6-minute walk test. Pre- and post-MVV breathing tests were performed on the control group. Dependent t-test and analysis of covariance were utilized to evaluate the results. RESULTS: Significant differences were found between the pre-test and post-test within the experimental group on MVV results, program attitudes toward health (PATH scores), knowledge level about their disease state after the rehabilitation program, and 6-minute walk distance. There were no significant differences found in the MVV results between the pre-test and post-test for the control group. There was a significant difference when comparing the control group MVV results to the MVV results of the exercise group. CONCLUSIONS: These findings indicate that pulmonary rehabilitation programs can help patients realize improved lung function, improved emotional states, increased knowledge about their disease states, and an increased cardiovascular fitness level. The results of this study suggest a regimen that can improve the quality of life for patients with chronic lung disease.

Aged↗
PubMedDate not supplied

Evaluation of a peer support program for staff nurses.

IMPACT (Interactional Meetings--Peers Working And Caring Together) is a task-oriented, voluntary, peer-support program for staff nurses. Evaluation data suggest the program is a cost-effective method for developing and retaining nurses in the hospital.

Cost-Benefit Analysis↗
PubMed2001

The development of young children with retinoblastoma.

OBJECTIVES: To assess the health and development of children with retinoblastoma (RB), or cancer of the retina, and to determine if they are at greater risk for developmental delays than normal children. Specific aims were to determine if type of RB (unilateral vs bilateral), family history, and number of treatment types affected mental and motor development. DESIGN: Descriptive study based on medical record review and pediatric, psychological, and visual evaluations. SETTING: Major referral center for patients with RB and early intervention program in a voluntary urban hospital. SUBJECTS AND METHODS: Fifty-four children younger than 41 months with RB who attend an ophthalmology oncology clinic were recruited for study. Measures included demographic variables such as social class and race/ethnicity, and medical factors such as age at diagnosis (<18 months vs >18 months), type of RB (unilateral or bilateral), family history of RB, and number and types of treatments. All children received a pediatric examination that assessed physical growth and health; a behavioral test of visual acuity using Teller acuity cards; and the Bayley Scales of Infant Development II, a standardized test of mental and motor development. Children found to have delays were referred to intervention services to treat their specific areas of weakness. RESULTS: Three quarters of the children had had 1 eye enucleated; 51 of 54 had normal vision in at least 1 eye, and the other 3 had partial vision in 1 eye. Except for the RB, 46 children were largely normal in growth and health, and 8 had medical diagnoses that were unrelated to RB or its treatment. The average mental and motor development scores were in the normal range (91.4 +/- 16.3, and 91.1 +/- 13.4) and not significantly lower than the normal population. Twenty-six children were referred for early intervention services, and 21 of 26 were referred for services to improve their visuomotor coordination. Demographic variables were not associated with medical variables or outcome. Children with bilateral RB, in which both eyes are affected, performed significantly less well in motor development, received many more types of treatments, and were more likely to be referred for visuomotor therapy than children with unilateral RB. CONCLUSIONS: Children with RB generally function normally in terms of physical health and mental and motor development. However, they are more likely to show delays in visuomotor integration. Early developmental evaluations may improve the visuomotor development of children with visual impairment due to RB.

Analysis of Variance↗
PubMed1995

Planning and execution of pointing movements in cerebellar patients.

Twelve patients with cerebellar dysfunction including a limb ataxia and 12 age-matched controls performed pointing movements with an arm. In one condition, the task was a simple reaction time (RT) movement directed toward a spatially defined target. The other two conditions involved choice tasks in which the amplitude and direction of movement were varied. The variables recorded were: movement latency determined by measuring the RT, duration of movement and the terminal accuracy of pointing as reflected in the movement time (MT), pointing surfaces (PS), and systematic errors. RTs and MTs were found to be significantly longer in cerebellar patients than in controls. In both groups the choice RT increased significantly as compared to simple RT, but no significant difference between patients and controls was found for the mean increase of the choice RT as compared with the mean increase for simple RT. A strong correlation between MTs and PSs was found in the controls. The cerebellar patients showed no correlation between MTs and PSs. The results are discussed in relation to the ability in cerebellar patients to program and execute voluntary movements.

Adult↗
PubMed2004

[The present state of vacuum sealing].

In cases of extended post-traumatic soft-tissue and bone loss as well as with mutilating infection or radical tumor resection, multidisciplinary options are required to salvage extremities and functional rehabilitation. A surgical team approach allows for reduction of amputation rates, wound healing complications, and secondary procedures in limb oncology and trauma. The goals and limitations of cooperative surgical concepts are described. In the future, continuing medical education will focus not only on indications and techniques but also on complication management, medicolegal problems, and economic deficits due to maladapted legal structures. Provided clear clinical pathways are introduced to guide indications, surgical procedures, and postoperative treatment, marked financial deficits may be avoided. While, in the past, responsibility for the patient and ethical considerations resulted in the development of voluntary interdisciplinary treatment programs, economic strategies and an increasing number of malpractice suits in the future will inevitably produce new imperatives for interdisciplinary cooperation.

Extremities↗
PubMed2004

[The interdisciplinary approach in reconstructive surgery of the extremities].

In cases of extended post-traumatic soft-tissue and bone loss as well as with mutilating infection or radical tumor resection, multidisciplinary options are required to salvage extremities and functional rehabilitation. A surgical team approach allows for reduction of amputation rates, wound healing complications, and secondary procedures in limb oncology and trauma. The goals and limitations of cooperative surgical concepts are described. In the future, continuing medical education will focus not only on indications and techniques but also on complication management, medicolegal problems, and economic deficits due to maladapted legal structures. Provided clear clinical pathways are introduced to guide indications, surgical procedures, and postoperative treatment, marked financial deficits may be avoided. While, in the past, responsibility for the patient and ethical considerations resulted in the development of voluntary interdisciplinary treatment programs, economic strategies and an increasing number of malpractice suits will inevitably produce new imperatives for interdisciplinary cooperation in the future.

Adult↗
PubMed2006

Implementation of the laparoscopic simulator in a gynecological residency curriculum.

BACKGROUND: In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery, there is a growing need to improve laparoscopic training. This study was conducted to investigate if and when residents reached performance standards for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators in a gynecological residency curriculum. METHODS: Residents across all 6 years of residency (postgraduate year [PGY] 1-6) were tested once on our boxtrainer by performing five inanimate tasks (pipe cleaner, rubber band, beads, cutting circle, intracorporeal knot tying). A sumscore for the five tasks was calculated for each participant (sum of all scores). Scores were calculated by adding completion time and penalty points, thus rewarding both speed and precision. These data were compared with scores of laparoscopic experts, which were set as performance standards. RESULTS: Of the participants, 111 were residents (7 PGY1, 27 PGY2, 29 PGY3, 28 PGY4, 14 PGY5, 6 PGY6) and 8 were experts. At the end of residency, PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying. It was not until PGY5 that residents reached the performance standard for the pipe cleaner task; PGY1, for rubber band; PGY5, for beads; PGY4, for circle cutting; and PGY6, for sumscore. Throughout residency PGY6 had a mean total of only 3.6 h of simulator training experience. No correlation was found between this previous voluntary simulator training experience and performance on our boxtrainer during this study (sumscore), and between previous voluntary simulator training and total laparoscopic procedures performed. In a combined multivariate analysis, sumscore performance remained significantly associated with the number of laparoscopic procedures performed by residents when they were working as as a primary surgeon (p = 0.002), and not with the cumulative hours of simulator training during residency prior to participating in this study (p = 0.15). CONCLUSIONS: In a current Dutch gynecological residency curriculum, residents do not reach all performance standards for basic laparoscopic skills on the boxtrainer. We conclude that the voluntary simulator training program has a substantial risk to fail and that the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy.

Female↗
PubMed1986

Multiphasic Health Checkup Evaluation: a 16-year follow-up.

The Multiphasic Health Checkup Evaluation Study, a long-term clinical trial, has been completed. A study group of 5156 men and women age 35-54 at entry was urged to have annual multiphasic health checkups (MHCs) for 16 years. A control group of 5557 comparable subjects was not so urged but was followed up in a comparable fashion. The mean and median number of MHCs per person were 6.8 and 6, respectively, in the study group and 2.8 and 1, respectively, in the control group. During 16 years the study group experienced a 30% reduction (p less than 0.05) in deaths from pre-specified "potentially postponable" causes, largely associated with lower death rates from colorectal cancer and hypertension. This reduction was most pronounced in the early years of the study. The two groups did not differ to a statistically significant degree in mortality from all other causes (84% of total mortality) or in total mortality. There was no difference in self-reported disability in the overall groups. In the setting of our prepaid health care plan where MHCs were already available on a voluntary basis, a program of urging middle-aged persons to undergo regular MHCs brought about a substantial reduction in mortality from preselected diseases.

Adult↗
PubMed1990

Effects of unexpected perturbations on trajectories and EMG patterns of rapid wrist flexion movements in humans.

To investigate how motor programs can be modified by sensory inputs we recorded kinematic and EMG patterns from normal human subjects performing well-practised wrist flexion movements in response to an auditory tone. On random trials unexpected wrist perturbations were introduced at varying times after the signal to move had been given. Extension perturbations delivered before agonist EMG onset resulted in an increased maximum velocity (MV) during the wrist flexion movement and in an increased target overshoot even though the wrist was further from the target than expected by the subject at the onset of the movement. The first agonist EMG burst and the antagonist burst were both increased in magnitude in these perturbed trials. Flexion perturbations delivered before the agonist EMG onset moved the hand nearer to the target just prior to movement onset. These resulted in a reduced MV, but the expected increased target overshoot did not occur. The first agonist burst was reduced in magnitude, and the antagonist burst was increased in magnitude. Perturbations delivered after agonist EMG onset produced less change in the first agonist and antagonist EMG burst, and less compensation for the perturbation was evident in wrist position and velocity recordings. These results indicate that, at least in some situations, motor programs for rapid voluntary movements can be modified by afferent inputs. This interaction between central motor commands and sensory feedback might occur at the cortical or spinal level, depending on when perturbations occur relative to onset of EMG and movement. The timing of the EMG changes suggest that both reflex mechanisms and longer latency 'voluntary' adjustments contribute to the compensatory changes in movement trajectory.

Adult↗
PubMed1982

Smoking cessation with adolescents: a comparison of recruitment strategies.

This study compared two methods for recruiting high school students into a voluntary smoking cessation program. A person-to-person approach was compared to an approach that resembled normal school publicity procedure. Active personal recruitment produced 31 volunteers, while the normal procedures produced only one. Subsequent application of the active approach at sites where only static procedures had been used produced an additional 21 volunteers. Results suggest that active person-to-person recruitment may be an important component of a smoking cessation effort with high school students.

Adolescent↗
PubMed2005

Requiring influenza vaccination for health care workers: seven truths we must accept.

In this paper we outline the seven primary truths supporting the call for requiring influenza immunization of all health care workers. We view this as a serious patient safety issue, given the clear and compelling data regarding the frequency and severity of influenza infection. In addition, clear-cut safety, efficacy, economic, legal, and ethical platforms support the use of influenza vaccine. Unfortunately health care workers have demonstrated, over almost 25 years that they are unwilling to comply with voluntary influenza immunization programs utilizing a variety of education and incentive programs, at rates sufficient to protect the patients in their care. We suggest that an annual influenza immunization should be required for every health care worker with direct patient contact, unless a medical contraindication or religious objection exists, or an informed declination is signed by the health care worker. High rates of health care worker immunization will benefit patients, health care workers, their families and employers, and the communities within which they work and live.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Final regulations for the nutrition labeling of raw fruits, vegetables, and fish.

In August 1996, the US Food and Drug Administration published regulations that revised the guidelines for voluntary nutrition labeling of raw fruits, vegetables, and fish; revised the criteria for retailers' compliance with the guidelines; and updated the nutrition labeling values for the 20 most frequently consumed raw fruits, vegetables, and fish. These actions were in response to the requirements of the Nutrition Labeling and Education Act of 1990 and make the voluntary nutrition labeling program more consistent with mandatory nutrition labeling of other foods. The provisions of the final rule are important for dietitians who develop nutrition education materials for retail stores and for dietitians who instruct patients and clients in selecting foods according to nutrition labeling information.

Animals↗
PubMed1997

Newborn screening for 21-hydroxylase deficiency: results of CYP21 molecular genetic analysis.

Blood samples for plasma steroid hormone determinations and molecular genotype analysis of the 21-hydroxylase gene (CYP21) were obtained from 15 infants identified through a voluntary newborn screening program. Mutations were identified on both CYP21 alleles in 12 (80%) of 15 infants; all had confirmatory plasma 17-hydroxyprogesterone concentrations > 3500 ng/dl. No patient was found to carry mutations associated with late-onset 21-hydroxylase deficiency. Newborn screening hastened diagnosis in eight infants.

17-alpha-Hydroxyprogesterone↗