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PubMed2006

Dental students' knowledge about careers in academic dentistry.

The purposes of this study were to determine the knowledge of fourth-year dental students regarding certain issues related to an academic career and to ascertain their intent to pursue such a career. Factors contributing to the students' intent to pursue academia were assessed, including the effect of dental school programs designed to educate students about a career in dental education. Surveys were sent to twelve U.S. dental schools that reported having either a mandatory or elective academic career educational program or no program at all. The surveys were completed by fourth-year dental students who were queried as to their knowledge of selected academic issues. Surveys were returned by 561 students from eleven of the twelve selected dental schools. Knowledge level of academic issues among respondents was overwhelmingly low. Factors contributing to the intent to pursue some form of faculty career were gender, plans to specialize, knowledge of academic issues, having a parent in higher education, and personal teaching experience. The results of this study suggest that dental students in general do not possess the knowledge and information necessary to make an informed decision regarding a career in dental education.

Adult↗
PubMed2006

Screening for conditions that do not meet the Wilson and Jungner criteria: the case of Duchenne muscular dystrophy.

In this manuscript, I examine four overlapping policy and ethical issues regarding screening newborns (and infants) for Duchenne muscular dystrophy (DMD). First, what are the risks and benefits of expanding newborn screening (NBS) to include DMD? Second, if NBS were to expand to include DMD, should it require informed consent? Third, should NBS for DMD be limited to boys? Why or why not? Fourth, when is the ideal timing for screening (prenatal, newborn, or later in infancy) and what factors influence this determination? I argue that decisions about when, how, and whom to test reflect a tension between maximizing uptake and diagnosis versus maximizing autonomy and choice with respect to genetic information. I conclude that screening for DMD is a valid moral option, but not as part of the mandatory NBS population program. Rather, I propose that screening for DMD should be offered only on a voluntary basis beyond the newborn period. I support offering this screening to families of young boys and girls to ensure that all children and their families can benefit from early diagnosis and its reproductive implications. A rigorous consent process will be necessary to ensure that the decision whether or not to test is a voluntary and informed choice.

Genetic Testing↗
PubMed2005

[Risk of infection in institutions for elderly people].

The infectious risk in long-term care facilities and nursing homes is significant. Patients living in those facilities are very old, with a poor health status, and a high degree of dependency. The risk for epidemic outbreaks, in particular with viruses, is very high. A simple system for surveillance and action, in relation with hospital infection control units, is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, anti-viral and pneumococcal vaccination. The program must be simple, pragmatic, allowing to maintain social links and quality of life, which are essential for these patients. A strong cooperation between these long-term care facilities and nursing homes, general practitioners, healthcare team, and relatives is necessary.

Age Factors↗
PubMed1982

Exercise training in patients with COPD.

Exercise is a useful therapeutic intervention for many COPD patients. The progressive stress test is the single most important means of clinical evaluation, although a thorough physical examination and preexercise ECG are also mandatory. The exercise program is prescribed according to duration of exercise and the maximal load reached by the patient during testing. As tolerance builds, exercise time, speed, and grade level are increased. Patients who exercise routinely should be watched carefully for problems, such as hypoxia, hypertension, abnormal right-sided cardiac function, and air tapping. Supplemental oxygen is required for those who are hypoxic.

Aged↗
PubMed2006

Procedure-specific surgical site infection rates and postdischarge surveillance in Scotland.

OBJECTIVE: To investigate the impact of postdischarge surveillance (PDS) on surgical-site infection (SSI) rates for selected surgical procedures in acute care hospitals in Scotland. DESIGN: Prospective surveillance of SSI after selected surgical procedures. SETTING: The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP), which is based on the methodology of the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance system (NNIS). Thirty-two of 46 acute care hospitals throughout Scotland contributed data to SSHAIP for this study. METHODS: Data were from 21,710 operations that took place between April 1, 2002, and June 30, 2004; nine categories of surgical procedures were analyzed. CDC NNIS system definitions and methods were used for SSI PDS. PDS is a voluntary component of the mandatory SSI surveillance program in Scotland. PDS was categorized as none, passive, active without direct observation, and active with direct observation. RESULTS: From our study information, PDS data were available for 12,885 operations (59%). A total of 2,793 procedures (13%) were associated with passive PDS and 10,092 (46%) with active PDS. The SSI rate among the 8,825 operations with no PDS was 2.61% (95% confidence interval [CI], 2.3%-3.0%), which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed (6.34% [95% CI, 5.9%-6.8%]). For breast surgery, cesarean section, hip replacement, and abdominal hysterectomy, the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed (P<.01 for each procedure). No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement. SSI rates were examined according to procedure type, performance of PDS, and NNIS risk index; rates of SSI increased with NNIS risk index within procedure group and PDS group. Logistic regression analyses confirmed that procedure type, performance of PDS, and NNIS risk index were all statistically independent predictors of report of an SSI (P<.05). CONCLUSIONS: This Scottish national data set incorporates a substantial amount of PDS data. We recommend a procedure-specific approach to PDS, with direct observation of patients after breast surgery, cesarean section, and hysterectomy, for which the length of stay is typically short. Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery, for which the length of stay is typically longer.

Cohort Studies↗
PubMed2003

Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings.

The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled "The Physician, Patient, and Society," a clerkship essay in the Medicine Clerkship, an opportunity for reflection during the medicine clerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning.

Clinical Clerkship↗
PubMed1982

A review of methods for ambulatory medical care evaluations.

Medical Care Evaluations (MCEs) are in widespread use in hospitals in the United States as a means of evaluating and improving the quality of patient care. Increasingly, MCEs are required or used in ambulatory care facilities, particularly group practices. Mandatory quality assurance programs require internal review subject to monitoring by external reviewers. For internal self-evaluation, multiple simple task-oriented evaluations prove more feasible than the complex multifaceted all-in-one evaluations often used by external reviewers. A detailed review of methods for designing such focused, internally conducted evaluations of medical care is presented, covering the following issues: identification of problems for evaluation; use of process versus outcome data; choice of data source, topics and criteria; indices for case identification; units of care to be studied; and feedback interventions.

Ambulatory Care↗
PubMed1998

HIV prevalence in pregnant women in Europe: differences in assessment methods and prevalence levels across countries.

OBJECTIVE: To describe methods used to assess HIV prevalence and to assess prevalence levels and time trends among pregnant women in various European countries. METHODS: We used the European HIV Prevalence Database to examine annual HIV prevalence data in pregnant women for the years 1990 to 1996 (20 countries). RESULTS: In Western Europe, prevalences were generally obtained through unlinked anonymous surveys, whereas in most Central, and Eastern European countries, they were based on testing programs (voluntary or mandatory). Prevalences (per 10,000) were highest (i.e., 10-30/10,000) in large western urban areas including Amsterdam, Barcelona, London, Milan, Paris, and Rome; between 1 and 2 in Scandinavian countries; and down to 0.5/10,000 in Central and Eastern European countries (except Ukraine, 1996: 5/10,000). Prevalences decreased in Rome, whereas they increased in London, the Czech Republic, and since 1995 in Russia and Ukraine; elsewhere, no time trends were detected. CONCLUSIONS: Methodologic differences and potential biases should be considered when comparing these data. HIV prevalence in pregnant women is useful for monitoring the AIDS epidemic and for assessing and improving prevention. Efforts should be made to offer voluntary counseling and testing to women at risk for HIV and provide treatment to those who are infected.

Europe↗
PubMed2002

Functional performance deficits in athletes with previous lower extremity injury.

OBJECTIVE: To evaluate the influence of previously treated, though clinically resolved, lower extremity injury on performance in a timed 20-meter shuttle run. DESIGN: Case control study. SETTING: National Collegiate Athletic Association (NCAA) Division I college during the 2000/2001 preparticipation physicals. PARTICIPANTS: NCAA Division I athletes (n = 213) participated in this research study. Athletes were excluded if they presently had an unresolved lower extremity injury or low back pain. MAIN OUTCOME MEASURES: Time to complete a 20-meter shuttle run was recorded. Previous lower extremity injury and college year were recorded via a short questionnaire. RESULTS: A significantly slower response time on the 20-meter shuttle run was observed in freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). CONCLUSION: Kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. The slower shuttle run times observed in freshmen with previous lower extremity injury may be a manifestation of insufficient treatment received at the high school level or the benefit of a mandatory core strengthening program in returning athletes. Further study is necessary to identify and validate the cause-and-effect relationship. CLINICAL RELEVANCE: This study may support residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting.

Adolescent↗
PubMed2007

Jordan: communities and community genetics.

The population in Jordan mounted from half a million in 1952 to 5.3 millions in 2004 and is composed of a variety of ethnic groups, the majority being Arabs. Couples nowadays tend to have fewer children, with the total fertility rate falling from 7.4 in 1976 to 3.7 in 2004. Consanguineous marriages are traditionally favored, with the preferred marriage partner being the offspring of the father's brother. First-cousin marriages declined from 28.5% for marriages contracted between 1950 and 1979 to 19.5% for marriages contracted after 1980. In the overall population, carrier rates for beta-thalassemia, alpha-thalassemia and sickle cell anemia are in the range of 2-4%, 3.2-12% of males have glucose-6-phosphate dehydrogenase deficiency, and the prevalences for familial Mediterranean fever and cystic fibrosis were estimated at around 0.04% each. A mandatory premarital screening program for beta-thalassemia carriers commenced in June 2004. The high consanguinity rate and the large family size in Jordan have contributed to the description of a number of rare and new autosomal recessive conditions. Genetic services in Jordan are still scarce and do not cover all the country due to the major impediments of a paucity of resources and trained health professionals in the area of medical genetics. The demographic data suggest that the health system in Jordan is capable of introducing some basic community genetic services into the primary health care program through comprehensive and cost-effective programs.

Community Health Services↗
PubMed1990

Sudden death during exercise.

Although death during exercise is rare, vigorous physical activity is associated with increased risk for fatality, particularly in individuals with overt cardiac disease or a high coronary risk profile. The mechanism of death is usually a lethal ventricular arrhythmia, but this may vary depending on the underlying cardiac condition. Cardiac disease is present in the great majority of individuals who die during exercise. In young persons, hypertrophic cardiomyopathy and congenital coronary anomalies are most frequent, whereas older victims usually have coronary artery atherosclerosis. Cardiac disease is typically unrecognized before the fatal event in young individuals; in the older group, most have overt coronary disease or identifiable risk factors. Screening asymptomatic subjects to identify increased cardiac risk during exercise is problematical in terms of logistics, expense and accuracy. However, careful evaluation, including exercise testing, is mandatory before a program of increased physical activity is initiated in cardiac patients. For other individuals, firm guidelines are lacking, and the extent of the evaluation must be determined on an individual basis.

Death, Sudden↗
PubMed1997

Physicians' perceptions of commercial and Medicaid managed care plans: a comparison.

Physician participation in fee-for-service Medicaid programs has been declining nationally since the mid-1970s. Numerous studies have documented the reasons for this decline, including poor reimbursement, payment delays, and administrative burdens. Most are now incorporating managed care into their Medicaid programs as an approach to reduce costs. Arizona has the only statewide, mandatory managed care Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS). This study examines Arizona physicians' perceptions of both AHCCCS and commercial managed care plans. If physicians' perceptions of commercial and Medicaid managed care plans are similar, as suggested by this study, then recruitment of physicians into Medicaid programs should improve during the coming years in geographic areas that have some managed care penetration.

Adult↗
PubMed1991

Aquaculture product quality issues: market position opportunities under mandatory seafood inspection regulations.

Impending legislation for a mandatory seafood inspection program will be important in shaping the consumer's perception and expectation of quality in seafood products. Because aquacultured species are produced in controlled environments, fed special diets, and processed under optimum conditions, they possess unique product characteristics. The perception by the consumer that these products could be safer, fresher, more wholesome, and better tasting may lead to a competitive marketing position relative to captured products.

Animals↗
PubMedDate not supplied

Gaming: a teaching strategy to enhance adult learning.

BACKGROUND: As a nurse educator, I encountered many complaints from staff nurses about mandatory inservice education programs, stating that they are repetitious, time-consuming, often too basic, and at times, downright boring. One exception was an Infection Control Week education session that was done in the form of a game. This session set attendance records and had very positive feedback from staff nurses. As a result of this feedback, the use of gaming as a teaching strategy in nursing education was explored. METHOD: A review of the literature on gaming as a teaching strategy was conducted with special attention to its history, current use, and successes in nursing education. RESULTS: Introduced as a formal teaching strategy more than 75 years ago, gaming offers many advantages over more traditional teaching methods. Games connect theory more closely to real life situation and add innovation, diversity, and the opportunity for immediate feedback. Although gaining in popularity, gaming is not extensively used in nursing education as it is not considered a serious educational tool. However, recent literature suggests much success with its use. CONCLUSION: Gaming as a teaching strategy has proven to be an effective way of conveying information in a stimulating, appealing manner. Games facilitate both beginning and experienced nurses' learning by providing an opportunity for experience without the danger or fear of jeopardizing patient safety.

Adult↗
PubMed2005

History of U.S. military contributions to the study of diarrheal diseases.

Diarrhea, a scourge upon humanity since preliterate times, has been the particular nemesis of military forces. The Armed Forces of the United States have been in the forefront in the diagnosis, treatment, and prevention of diarrheal illness. U.S. military scientists and physicians implemented the first mandatory typhoid inoculation program, contributed to advances in water chlorination, and pioneered the use of antibiotics for typhoid fever. U.S. Navy physicians refined the intravenous treatment of cholera, reducing the death rate from 20% to less than 1%. Their studies of electrolyte and fluid balance in cholera, and the subsequent development of oral rehydration therapy for cholera and other diarrheal illness, have saved millions of lives worldwide. U.S. Army researchers refuted the desquamation theory of cholera pathogenesis, isolated the cholera exotoxin, and developed improved cholera vaccines. U.S. Army and Navy researchers pioneered the use of antibiotics for the treatment of typhoid fever, made major contributions to the treatment of dysentery, developed algorithms for the treatment of traveler's diarrhea, and continue active development of traveler's diarrhea and dysentery vaccines. U.S. military diarrheal research has directly contributed to the welfare of hundreds of millions of people.

Biomedical Research↗
PubMedDate not supplied

Mandatory continuing education for hospital managers.

Because hospital managers and supervisors are more aware of the necessity to regularly upgrade their knowledge and skills, a health care center has created a mandatory management development program that not only fills employee and hospital needs but also provides empirical data for merit reviews. How this highly structured program was developed and organized is presented in this article.

Administrative Personnel↗
PubMed1982

Prescription drug products; revocation of patient package insert requirements--Food and Drug Administration. Final rule.

The Food and Drug Administration (FDA) is revoking its final rule establishing requirements for the preparation and distribution of patient package inserts (PPI's) for prescription drug products for human use. This action is taken because the agency has determined that a mandatory pilot PPI program is unjustifiable, and that it is now preferable to encourage alternative patient information efforts. The agency believes that cooperation with health professionals and others in both the public and private sectors and reliance upon expanding privately sponsored initiatives in patient education should serve to provide patients with needed information about prescription drugs.

Drug Labeling↗
PubMed2000

Opportunities and challenges in Medicaid managed care: the experience in Maryland.

OBJECTIVE: The effects of the Maryland Medicaid mandatory managed care programs on Medicaid beneficiaries are examined with the main objective of gaining insight into the initial experience and beneficiary satisfaction with Maryland's Medicaid program. The background of the Maryland Medicaid system, initial implementation, results of beneficiary satisfaction surveys, and future concerns are discussed. STUDY DESIGN: An observational study based on survey data. DATA AND METHODS: Beneficiary surveys mailed to adult and child participants in HealthChoice and the Rare and Expensive Case Management (REM) Medicaid programs in Maryland are analyzed. Descriptive univariate and bivariate data statistics are used. RESULTS: The 4 questions rating satisfaction with primary care provider (PCP), relevant specialists, all providers, and the overall health plan indicate high levels of satisfaction in both adult and child populations. CONCLUSIONS: The Maryland Medicaid programs appear to have met the goal of providing a comprehensive, coordinated healthcare system of quality care during their first year of operation. The satisfaction of these beneficiaries suggests that with an appropriate risk-adjusted capitation approach, managed care organizations (MCOs) can successfully provide for even the most complex needs of Medicaid members.

Community Health Services↗