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Whether you've faced up to it or not, there are gangs in your community. They're everywhere, and gang-related violence adds more than $400 million to health care costs every year. Integris Health in Oklahoma City came out of denial and found a way to get through to gangmembers in its community. It's changing--and saving lives.
Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures. Mercy's creed, based on its mission statement and core values, articulates responsibilities regarding patients and providers, business partners, society and the environment, and internal relationships. The CIP is carried out through an integrated network of committees, advocacy teams, and an expanded institutional review board. Two documents set standards for how Mercy conducts external affairs and clarify employee codes of conduct.
This study investigated the relative impact of various forms of exposure to the 1995 Oklahoma City bombing in middle and high school students seven weeks after the incident. We assessed 3210 youths with an instrument that probed for physical, television, and emotional exposure to the bombing and subsequent posttraumatic stress symptomatology and television reactivity. The majority of youths were exposed through physical proximity--hearing and/or feeling the blast--and through television viewing. These types of exposure, as well as emotional exposure, constituted important variables in the development of posttraumatic stress symptoms and television reactivity. Youths with immediate family casualties were more symptomatic than those without.
This article summarizes a study showing the major factors that affect referral rates of Oklahoma City Area Indian Health Service primary-care professionals. The article also summarizes a referral rate prediction model. The multiple linear regression statistical analysis, employed in the study, produced three factors that largely determined the referral rates of physicians practicing in tertiary-care and secondary-care facilities: hospitalized morbidities per 1,000 population, the total medical-care professionals associated with a facility, and the number of specialists associated with a facility. The referral rates of physicians practicing in primary-care facilities were associated with morbidities per 1,000 population, median age of primary-care professionals, and distance to the closest medical referral center. The findings of this article take on new meaning and importance with the advent of diagnostic related group (DRG) reimbursement legislation. If administrators understand more about physician referrals, they will better understand one significant aspect of the cost of DRGs in their facilities.
Medical education and ambulatory care are not mutually exclusive to cost effectiveness. Rather they can, and should be, concurrent goals that do not compromise the quality of either product. In order to maximize this opportunity, the mutual cooperation of faculty, administration, and support staff are mandatory. Synergistic efforts result in a superior and relevant product--well-trained, primary care physicians prepared to practice cost effective and quality medicine in the office. Experience at the Medical Center indicates that disinterest or neglect by educators will not influence cost nearly as much as the quality of care and relevance of the educational experience. To do so due to a real or imagined lack of resources is a disservice to patients, community and society, and does not recognize the longer-term fiscal consequences on us all. The institutional challenge to medical schools is to examine the potential for training physicians at sites most resembling the realistic practice of office-based medicine and to then take full advantage of the opportunity. The University of Oklahoma Tulsa Medical Center affords the faculty and students an innovative national model for cost conscious, relevant and transferable primary care medical education programs.
The Muskogee Regional Medical Center is a 360-bed, non-profit institution located in northeastern Oklahoma. Approximately 950 OR, endoscopy lab, and outpatient procedures are performed at the medical center each month. The success of these procedures often depends on the quality of the service that SPD provides. This article provides some background on the medical center's SPD department, and describes the quality attainment program we designed to measure the competence of our services.
This article reports the results of a mail survey of businesses in Tulsa, Oklahoma (population 377,900 in the city and 745,300 in the surrounding metropolitan area). The purpose of the research was to analyze differences in health care provision and perspectives between large and small businesses. The survey of 3,200 members of the city's chamber of commerce yielded 640 responses. Analysis of the data revealed distinct differences between the two segments of the health care industry. The findings suggest that market opportunities exist for the development of health care delivery system programs aimed at small businesses.
Like many other schools, the faculty of the University of Oklahoma College of Nursing (OUCN) recently revised its baccalaureate and master's curricula to prepare students better for the evolving changes in the nursing profession and the health care job market. Our personal visions of needed changes, reviews of the literature, and feedback from nursing leaders and community employers supported the need for four significant changes. First, students needed more experiences in the community and clients' homes, with the aged, the chronically ill, and the disabled in all age brackets. Second, students needed greater familiarity with Medicare, Medicaid, and managed care, and more active involvement in the wise use of limited resources. Third, they needed more experience with interdisciplinary teams and with the management of care across sites and levels of acuity. Fourth, there was a need for more consistent integration of health promotion and research content into student learning related to emerging trends in health care and nursing practice.
Physician impairment due to substance use occurs in all age groups of physicians. Risk factors are similar for age-matched controls, but choice of substance may be influenced by specialty and narcotic permit. Alcohol is by far the most commonly abused drug involved. One of the last areas of performance affected is work. Other areas may provide earlier clues. Intervention and referral to appropriate treatment centers is important. Death rates are relatively high in this disease. We report a favorable outcome of 75 percent at The University of Oklahoma Health Sciences Center, Tulsa (OUHSC-T), but a death rate of 16.7 percent in our small sample. Aftercare and monitoring are essential to a successful outcome. The vast majority of physicians in training can complete their training with appropriate treatment and monitoring and go on to successful careers.
Most general surgeons involved in breast cancer care have limited experience with phyllodes tumors. We analyzed a comprehensive database incorporating 8567 breast cancer cases treated surgically in the Tulsa, Oklahoma, region between 1969 and 1993. This yielded 32 cases of phyllodes tumors (0.37%) in 31 patients. The median age was 57 years (range, 18-91). There were 9 low-grade (28%), 2 intermediate-grade (6%), and 21 high-grade (66%) lesions. Size distribution consisted of 23 (72%) lesions 5 cm or less and 9 (28%) greater than 5 cm (mean, 3; range, 1.2-17.5 cm). Of 137 resected nodes in 13 patients, none were positive for metastatic disease. Surgical management consisted of wide excision or mastectomy. No patients received adjuvant chemoradiation therapy. The disease-free, locoregional disease-free, and overall mean survival rates were 80, 81, and 97 months, respectively. Ten-year disease-free survival (DFS), locoregional disease-free survival (LRDFS), and overall survival (OS) rates were 66, 72, and 55 per cent, respectively. Although there was a tendency toward a higher rate of locoregional recurrences and metastases with high-grade lesions, this was not statistically significant and did not affect DFS, LRDFS, or OS rates. Similarly, size of lesion did not affect DFS, LRDFS, or OS rates. Three patients (9.6%) had metastatic disease at presentation, and a further two (6.4%) developed metastases during follow-up. Overall, nine (28.1%) recurrences developed in eight patients, seven locoregional and two distant. Four patients (12.9%) died with evidence of disease. These findings indicate prolonged survival in this patient population with cystosarcoma phyllodes. Wide local excision of primary and recurrent lesions remains the mainstay of therapy. Neither regional lymph node dissection nor adjuvant chemoradiation adds significant benefit.
Rose bush thorns from plants in the Oklahoma City area were cultured to determine the prevalence and species of fungi present. One hundred fifty isolates grew from thorns on 103 plants. All thorns harbored at least one species, while one thorn had five species of fungi. Of the 21 fungal species isolated, all are known human pathogens, although most rarely cause disease in immunocompetent individuals. Alternarium sp., Bipolaris sp., Aspergillus niger, Curvularia sp., and Fusarium sp. were the most common fungi, accounting for 75% of the isolates. Sporothrix schenckii, an organism often associated with rose bushes, was found on thorns of only two plants. Findings of this study suggest that since fungi are common inhabitants of roses, individuals who experience rose-thorn punctures are at increased risk of acquiring fungal infections, especially if they are immunocompromised.
The purpose of screening is to identify asymptomatic disease, or risk factors for disease, so that interventions can occur as early as possible in the disease process. The primary goal is to decrease the morbidity the patient experiences from the disease. For infectious diseases, screening can benefit not only the individual with the disease but also the community, since infectious persons can be identified and treated prior to transmitting the disease to others. Although screening can be very beneficial to the individual and to the community, it can also have adverse outcomes if not used appropriately. In this article we will discuss current recommendations for the use of screening tests and their role in addressing the leading causes of morbidity and mortality in Oklahoma. In general, physicians should consistently screen for the risk factors for cardiovascular disease and stroke (hypertension, high cholesterol, obesity and diabetes) and for early-stage cancers of the colon, breast, and cervix. They should also consider screening Native Americans for diabetes and persons at increased risk for certain infectious diseases, particularly sexually transmitted diseases.
BACKGROUND: Medical diagnoses such as headaches, diplopia, nausea, and asthenopia are conditions that are often treated with optometric vision therapy. Improvement of such subjective conditions after a regimen of therapy is often difficult to objectively quantify. The goal of this study was to verify the test-re-test reliability of a new clinical survey instrument, the College of Optometrists in Vision Development (COVD) Quality of Life Outcomes Assessment, which allows the analysis of symptoms data. METHODS: The first-year class of optometry students at the Oklahoma College of Optometry at Northeastern State University were administered the instrument in a group setting on two different occasions, two weeks apart. Nineteen students completed both test and re-test. Statistical analysis by the Wilcoxon Signed Rank Test and paired t test were performed. RESULTS: Each subject reported some of the 30 symptoms on both test and re-test. The instrument was found to be reliable. Wilcoxon Signed Rank Analysis showed no significant differences in test-retest scores, either pooled or item-by-item. A paired t-test group and item analysis were insignificantly different between scores. Spearman's rho correlation for test-retest of each subject was 0.878. Eighty-nine percent (17 of 19) scored insignificantly different between administrations. Ninety percent of the items (27 of 30) were found to vary insignificantly between the two administrations. CONCLUSIONS: The COVD Quality of Life Outcomes Assessment is a reliable tool to measure changes in symptoms on the basis of optometric intervention--specifically, vision therapy.
A study examining patient arrival at local EDs after the bombing of the federal building in Oklahoma has shown there are two "waves" of patients after a terrorist attack. Contrary to popular belief, after a mass casualty incident, most patients arrive by means other than ambulance transport. Because the first group of patients arriving at EDs are transporting themselves, they tend to be of less severity than the second wave of patients. While triaging patients from the first wave, you need to prepare for more serious injuries in the second.
Throughout its 100-year existence, the College of Medicine has faced numerous crises, mostly due to inadequate funding. Furthermore, at various times there has been significant political interference, the worst of which was the Executive Order issued by Governor William H. Murray. However, these four Deans exhibited great leadership during especially difficult times. In several instances, they were aided by sympathetic and effective Governors including Robert L. Williams, Roy S. Turner, and Henry Bellmon. The College of Medicine was fortunate that they were willing to proceed through adverse conditions, because without them, many of us would not have had the opportunity to attend medical school in Oklahoma.
By the early 1950s, medical schools across the United States were in a state of major transition. Significant growth in full-time faculty and full-time clinical department chairs heralded dramatic changes in medical education and clinical research that would change American medicine. This article is a brief summary of the appointment of the first full-time chairs of clinical departments in the University of Oklahoma College of Medicine, focusing on the critical period from 1952 to 1961.
This past decade the medical community saw an increase of national interest in the training and educating of physicians to provide quality end-of-life care for patients. This article describes the efforts of the University of Oklahoma College of Medicine to respond to the demand for educating medical professionals in end-of-life care. A Palliative Care Program was created to develop and implement new courses, seminars, and lectures for medical students, residents, and practicing physicians. Palliative medicine is in the process of being integrated into the OU academic medical environment so that all trainees, regardless of their educational level, have the opportunity for didactic and clinical exposure to end-of-life care.
Advances in technology provide new challenges to public health to implement screening programs that are effective, cost-efficient, and available to all infants regardless of ability to pay. The Newborn Metabolic Disorder Screening Program (NMDSP) of the Oklahoma State Department of Health is evaluating the expansion of newborn screening for the disorders of cystic fibrosis, congenital adrenal hyperplasia, and medium-chain acyl coenzyme A dehydrogenase deficiency (MCAD) to the current screening battery of disorders (phenylketonuria, congenital hypothyroidism, galactosemia, and sickle cell disease). The challenge is to offer these new screening tests in a cost-efficient manner that ensures all newborns have access to screening and that an infrastructure exists to diagnose and provide the specialized comprehensive care affected infants will require to reduce the morbidity, mortality, and disability associated with these disorders. Essential components of an effective newborn screening system include the smooth integration of sample collection, laboratory testing, follow-up, diagnosis, timely treatment, and tracking components. The NMDSP has recommended that screening should be expanded, but issues of cost and the establishment of a sustainable infrastructure of comprehensive medical services must be addressed.