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PubMed2003

Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers.

OBJECTIVE: Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals. METHODS: Outcomes and charges were analyzed for all adult patients undergoing craniotomy for tumor in 33 nonfederal acute care hospitals in Maryland using the Maryland Health Service Cost Review Commission database for the years 1990 to 1996. A total of 4723 patients who underwent craniotomy for tumor were selected on the basis of Diagnostic Related Group 1 (craniotomy except for trauma, age 18 or older) and International Classification of Diseases-9th Revision diagnosis code for benign tumor, primary malignant neoplasm, or secondary malignant neoplasm (codes 191, 192, 194, 200, 225, 227, 228, 237, and 239). Hospitals were categorized as high-volume hospitals (>50 craniotomies/yr) or low-volume hospitals (<or=50 craniotomies/yr). In-hospital mortality, length of stay, and charges were evaluated. RESULTS: The mortality rate was 2.5% at high-volume centers and 4.9% at low-volume hospitals with an adjusted relative risk of 1.4 (P < 0.05), assuming equivalence of disease severity. Adjusted average length of stay in high-volume centers was 6.8, as compared with 8.8 days in low-volume hospitals (P < 0.001). Adjusted average total charges were $15,867 at high-volume centers and $14,045 at low-volume centers (P < 0.001). If all patients in the state had been treated at centers with survival rates equal to those achieved by the high-volume centers, then 46 patients would not have died of operation; that is, 48.6% fewer patients would have died, at an additional adjusted cost of $76,395 dollars per patient saved. CONCLUSION: High-volume regional medical centers are capable of providing services with improved mortality rates and fewer hospital days, although with adjusted costs slightly higher than those at low-volume hospitals.

Academic Medical Centers↗
PubMed1998

Grade predictions for school-leaving examinations: do they predict anything?

The attributes of 721 medical students admitted to the United Medical and Dental Schools (UMDS) of Guy's and St. Thomas' Hospitals, London, UK between the years 1991 and 1994 were examined to determine the relationship between A-level grade predictions (as completed on each student's UCAS form by their school/college at the time of their application to the school) and subsequent assessments of their academic ability and performance. Predicted A-level grades were found to be significantly, if weakly, correlated with the rating of academic ability made at interview by the UMDS interviewing panel. They were not however, related to the grades obtained by students in the A-level examination itself. Further, while success at pre-clinical examinations was predicted by obtained A-level grades, it showed no relationship with the predicted grades. In contrast, the interview-based rating of the applicant's academic potential was significantly predictive of subsequent A level and, to a lesser extent, pre-clinical examination performance. It is concluded that predicted A-level grades may not offer a valid method of assessing the academic potential of applicants for medical school.

Education, Medical, Undergraduate↗
PubMed2004

Rapid improvement in academic grades following methylphenidate treatment in attention-deficit hyperactivity disorder.

In the present study a 16 week comparison study was conducted of behavioral, cognitive and educational measures in school-age Taiwanese children with attention-deficit hyperactivity disorder (ADHD) receiving open-label methylphenidate (MPH). Subjects include 14 male and five female ADHD children. They received MPH twice per day continuously for 16 weeks. Measures of behavior, cognitive function (Wisconsin Card Sorting Test, Tower of London and Continuous Performance Test), Chinese and arithmetic learning achievement were compared with those of their baseline condition. After MPH, 68-78% of children showed improving behavior in classroom and at home. Among the neuropsychological tests, only the percentage of preservative error was improved (P = 0.022). Approximately 61-66% of children had improvement in academic learning (P = 0.013 for Chinese, 0.004 for arithmetic). The MPH treatment demonstrated improvement in domains of classroom/home behaviors and academic performance, but showed minimal change on neuropsychological functioning in Taiwanese ADHD children. The finding of academic gain was unexpected, which might be due to the greater interest in achievement and better compliance to cultural expectations by Taiwanese versus Western students, which translated into more rapid improvement in academic performance.

Administration, Oral↗
PubMed1983

Evaluation of common predictors for selection of postdoctoral dental students.

Certain predictors are traditionally presumed to be reliable measures for selection of candidates for general dentistry training programs. The purpose of this study was to assess the relative value of academic standing, letters of recommendation, and personal interview impressions by comparing them with performance during training. Predictor data were collected from the application files of all postdoctoral trainees in the advanced general dentistry training program at the Eastern Dental Center of the past ten years (N = 154). However, only 102 postdoctoral students had information available for all three predictor criteria. Performance was rated subjectively on completion of training by two faculty members on a six-point rating scale. The highest correlations between predictors and performance were to academic achievement (r = 0.347). Weaker, though statistically significant, correlations were found for the personal interview (r = 0.206) and letters of recommendation (r = 0.192). Although these predictor criteria will continue to be used in the selection of candidates, administrators and selection committees must be aware of the limitations of such criteria in predicting performance.

Education, Dental, Graduate↗
PubMed2001

Academic task persistence of normally achieving ADHD and control boys: performance, self-evaluations, and attributions.

The authors examined academic task persistence, pretask expectancies, self-evaluations, and attributions of boys with attention-deficit/hyperactivity disorder (ADHD) as compared with control boys. Participants were 83 ADHD boys and 66 control boys, all normally achieving. Prior to the task, performance expectancies were assessed. After a success-failure manipulation with find-a-word puzzles, performance on subsequent trials, self-evaluations, and attributions were evaluated. Compared with controls, ADHD boys solved fewer test puzzles, quit working more often, and found fewer words on a generalization task. Consistent with these behavioral findings, research assistants rated ADHD boys as less effortful and less cooperative than control boys. Although ADHD boys did not differ significantly from controls in their posttask self-evaluations, they did differ significantly from controls in some aspects of their attributions. Attributional data indicated that ADHD boys endorsed luck as a reason for success more strongly and lack of effort as a reason for failure less strongly than controls.

Attention↗
PubMed1998

The evolution and maturation of laparoscopic cholecystectomy in an academic practice.

BACKGROUND: The technique of laparoscopic cholecystectomy (LC) has evolved since its adoption in the late 1980s. We sought to document these changes and assess whether patient outcomes were influenced during this maturational process. STUDY DESIGN: A prospective data base was used to record the outcomes of all LCs performed in an academic surgeon's practice. Trends over time among 1,165 consecutive patients were assessed by comparing the first 100 LCs (group I), the middle 100 LCs (group II), and the most recent 100 LCs (group III). RESULTS: During a 93-month period with 1,165 patients undergoing LC, 25 procedures (2.1%) were converted to open cholecystectomy. Perioperative complications occurred in 31 patients (3%): grade I in 9 (0.8%), grade II in 16 (1.4%), grade III in 5 (0.4%), and grade IV (death) in 1 (0.1%). Length of hospital stay and convalescence were 1.1 +/- 0.1 and 9.5 +/- 0.5 days, respectively. Nineteen patients (2%) were readmitted early after operation and 10 (1%) developed long-term complications (port-site hernia or retained stone). In group III, cholangiography was largely replaced by intraoperative ultrasonography for ductal evaluation. Operating room time decreased, while the rates of conversion, morbidity, and readmission remained the same. Patients had higher ASA classifications in the latter two groups, whereas operative charges were greater in Group III than in Groups I and II. These trends occurred even though most procedures are currently performed by residents, and fewer LCs are being done. CONCLUSIONS: Laparoscopic cholecystectomy has matured into a more efficient operation, yet remains safe with low morbidity when performed by residents at an academic institution.

APACHE↗
PubMed2000

Does studying for an objective structured clinical examination make a difference?

PURPOSE: This study examines the extent to which second-year medical students studied for an objective structured clinical examination (OSCE), how they studied, and the impact of self-reported studying on OSCE performance. METHOD: One class of 113 medical students completed an end-of-second-year OSCE, held on two consecutive evenings. The OSCE was comprised of eight stations, each of which was of 20 minutes' duration. The OSCE was formative: students received performance feedback but were not graded. Prior to the OSCE, students completed a brief survey regarding their preparation for the OSCE and their perceptions of confidence, anxiety and preparedness. Only 78 students returned surveys with names, comprising the data for these analyses. RESULTS: Mean studying time was 3.3 h, ranging from 0 to 19 h. Studying time was positively associated with age and negatively associated with basic science examination scores. The most study time was dedicated to reviewing the physical examination textbook, class notes and supplemental course readings. The breadth of study strategies increased as more time was spent in OSCE preparation. OSCE performance was related to study time and to achievement on pre-clinical basic science examinations. DISCUSSION: The students whose performance was above average seemed to be the talented students whose records indicated a history of academic success. The amount of time they reported for OSCE preparation was comparable to that reported by students with below average performance. It appears that prior academic performance rather than preparatory studying time is a better predictor of OSCE outcomes.

Adult↗
PubMed1990

Academic, social and cultural factors influencing medical school grade performance.

Studies of medical student performance have focused on various factors, including premedical academics, maturity, familial background and support, and personal experiences with illness. Most studies have been conducted in countries with highly developed educational systems and similar cultural and social systems. It is not clear that these findings can be applied to developing countries, where the educational and cultural experiences may be very different, and where medical instruction is carried out in a non-native language. Information was obtained from a survey of 153 fifth- and sixth-year medical students at King Abdulaziz University in Saudi Arabia. The survey measured premedical educational, social and cultural experiences that might affect medical school performance. Men performed as well as women in the medical school despite heavy familial and social commitments. Women's performance seems to be more influenced by changes in living environment. Achievement in premedical years was correlated positively with grade performance in medical school. Competence in the high-school English courses was related to medical school performance. Interest in the study of medicine prior to medical school was not related to performance. Other motivations, such as social gains, financial benefits or family wish, were related to lower performance. Current interest in clinical medicine correlated negatively with performance. Students motivated by the presence of chronic ill health in their families performed significantly lower. Factors influencing medical school performance in developed countries had similar impact on medical students in a developing country. Social factors, unique to the country, also play a role in medical student performance.

Achievement↗
PubMed2003

Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial.

OBJECTIVES: Our goal was to determine which of the two major methods of vital organ support used in infant cardiac surgery, total circulatory arrest and low-flow cardiopulmonary bypass, results in better neurodevelopmental outcomes at school age. METHODS: In a single-center trial, infants with dextrotransposition of the great arteries underwent the arterial switch operation after random assignment to either total circulatory arrest or low-flow cardiopulmonary bypass. Developmental, neurologic, and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children (97%). RESULTS: Treatment groups did not differ in terms of most outcomes, including neurologic status, Full-Scale or Performance IQ score, academic achievement, memory, problem solving, and visual-motor integration. Children assigned to total circulatory arrest performed worse on tests of motor function including manual dexterity with the nondominant hand (P =.003), apraxia of speech (P =.01), visual-motor tracking (P =.01), and phonologic awareness (P =.003). Assignment to low-flow cardiopulmonary bypass was associated with a more impulsive response style on a continuous performance test of vigilance (P <.01) and worse behavior as rated by teachers (P =.05). Although mean scores on most outcomes were within normal limits, neurodevelopmental status in the cohort as a whole was below expectation in many respects, including academic achievement, fine motor function, visual-spatial skills, working memory, hypothesis generating and testing, sustained attention, and higher-order language skills. CONCLUSIONS: Use of total circulatory arrest to support vital organs during heart surgery in infancy is generally associated with greater functional deficits than is use of low-flow cardiopulmonary bypass, although both strategies are associated with increased risk of neurodevelopmental vulnerabilities.

Boston↗
PubMed1996

The effects of neglect on academic achievement and disciplinary problems: a developmental perspective.

The present study examines the effect of child neglect, alone and in combination with abuse, on academic achievement and school disciplinary problems for elementary, junior high, and senior high students. The sample included 324 neglected children and adolescents, and a matched nonmaltreated sample of 420 children and adolescents. All subjects were in grades K through 12 in a small city in New York state. The results revealed that neglected children did perform more poorly than their nonmaltreated counterparts, having lower grades, more suspensions, more disciplinary referrals, and more grade repetitions, even when controlling for gender of child and SES. Neglect alone and neglect in combination with physical or sexual abuse was related to lower grades and more suspensions. The combination of abuse and neglect had a particularly strong effect on the number of disciplinary referrals and grade repetitions. Abused/neglected students in junior high had the highest number of grade repetitions. The number of disciplinary referrals continued to increase through senior high for both neglected and abused/neglected students. Interestingly, the academic performance of all subjects dropped during junior high. Neglect and neglect in combination with abuse appeared to exacerbate a decline in academic performance that occurs as children enter junior high school.

Achievement↗
PubMed1998

Results of selective use of operative laparoscopy in gynecologic oncology.

OBJECTIVE: To evaluate the impact of integration of operative laparoscopy on length of stay (LOS) and complication rates on an academic gynecologic oncology service. METHODS: Retrospective analysis of all admissions to our gynecologic oncology service was performed for the academic years 1990/1991 and 1993/1994. Primary endpoints were frequency of complications and LOS. RESULTS: In 1990/1991, there were 785 total admissions, of which 287 were surgical and 3% were approached laparoscopically. In 1993/1994, there were 973 admissions of which 436 were surgical and 23% were approached laparoscopically. Operative laparoscopy was applied equally regardless of age and reproductive status; the utilization of laparoscopy was increased by 14-fold for patients with cancer, 4. 5-fold for patients with benign disease, and 12-fold for patients with adnexal masses. No change in the mean LOS of nonsurgical admissions was noted, yet overall LOS for all patients decreased from 6.3 to 4.8 days (P < 0.0001). Mean LOS in surgical patients decreased from 9.4 to 6.0 days (P < 0.0001). After correction for complications, decreases in LOS only occurred in procedures for which laparoscopy was significantly integrated. No reductions in LOS were noted with like surgical approaches; i.e., there was no change in the LOS of patients undergoing laparotomy in both years. Surgical complications were not increased by laparoscopy. CONCLUSIONS: Aggressive utilization of operative laparoscopy, even only for selected patients, into the surgical practice of a gynecologic oncology service demonstrates significant improvements in LOS without adversely affecting surgical complication rates.

Adult↗
PubMedDate not supplied

Attrition in a clinical laboratory technician associate degree program.

OBJECTIVE: To determine the reasons for attrition in a clinical laboratory technician-associate degree program, a retrospective study was done on classes entering from 1987 to 1992. Suggestions are made to increase retention. SETTING: The medical laboratory department at the Community College of Philadelphia in Pennsylvania. PRACTICE DESCRIPTION: There were 43,987 students enrolled for the 1993 to 1994 academic year; 17,846 full time equivalents at the college. Clinical laboratory technician students averaged 26.2 years and were 26% male and 74% female, which closely paralleled the college. The ethnic make-up of the clinical laboratory technician classes was 54% White, 32% African American, 11% Asian, and 3% Latin American, compared to 48% African American, 36% White, 10% Asian, and 6% Latin American students in the college. PRACTICE INNOVATION: A retrospective study was performed to evaluate attrition rates for the classes entering the clinical laboratory technician program at the Community College of Philadelphia from 1987 to 1992. Reasons for this attrition were tabulated and evaluated. RESULTS: One hundred twenty-nine students entered the program and 75 graduated, producing an attrition rate of 42%. There were 6 categories of reasons given for not completing the program: academic difficulties, dislike of the laboratory science field, family problems, financial problems, substance abuse, and other problems not specified. CONCLUSION: Because 80% of the attrition was due to poor academic performance and a dislike of the field, several changes are being made in the Community College of Philadelphia's retention program. An enhanced orientation will be given to all students, and students will be required to visit a hospital laboratory. Early faculty intervention and peer counseling for students with poor academic performance will be instituted.

Adult↗
PubMed1986

Relationship of left-right reversals to academic achievement.

The study was designed to investigate the relationship of reversal of letters and numbers to academic achievement to decide if the tendency to reversal might be used to predict achievement. Two groups of 45 predominantly white third-grade students whose chronological ages were 9.0 yr. or above were administered the California Achievement Tests and the Jordan Left-Right Reversal Test. A statistical comparison was made using scaled scores on the California Achievement Tests and raw errors on the Jordan Left-Right Reversal Test. Reversal was significantly correlated with academic achievement. Children who exhibit reversals at 9 yr. of age or older may be expected to perform less well academically than children who do not reverse letters.

Achievement↗
PubMed1982

The effect of academic preparation on medical technologists' registry examination performance.

This study investigated the effects of the college attended and the length of the educational program on ASCP Board of Registry Examination Scores. Registry scores were statistically analyzed for all graduates of Butterworth Hospital's (Grand Rapids, Michigan) Medical Technology program for the years 1970-80. Results indicated college differences in student academic preparation, as measured by the certification examination given by the ASCP Board of Registry. There were no statistical differences in average Registry examination scores for students who complete three versus four year educational programs. Other analyses considered sex differences in college grades and Registry exam performance, and the "grade inflation" phenomenon during the period of this study.

Educational Measurement↗
PubMed1994

Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms.

BACKGROUND AND PURPOSE: Randomized clinical trials have shown that carotid endarterectomy decreases the risk of subsequent stroke in patients with high-grade carotid stenosis and ipsilateral transient ischemic attack or minor stroke. The benefit of surgery is highly dependent on surgical risk. We previously found that patients with ipsilateral hemispheric symptoms were at greater risk of carotid endarterectomy complications compared with those who were asymptomatic or had nonipsilateral symptoms. The goals of the present study were (1) to identify preoperative clinical factors that may increase the risk of complications after carotid endarterectomy in patients with ipsilateral hemispheric symptoms and (2) to develop a risk index based on this patient-level data. METHODS: Records from 1160 carotid endarterectomies performed at 12 academic medical centers composed the primary data set. Hospital charts for the admission during which carotid endarterectomy was performed were systematically reviewed by abstractors using a defined protocol. The present analysis was carried out on data from the subset of patients who had carotid endarterectomy for ipsilateral hemispheric symptoms. Candidate variables were identified based on univariate Fisher's exact tests or chi 2 tests. A risk index was then developed using those variables with a greater than 90% probability of being associated with adverse outcomes. RESULTS: Of the 697 patients with ipsilateral symptoms, 8.5% had either stroke, myocardial infarction, or died during the postoperative period of hospitalization. Those over the age of 75 had a greater risk of myocardial infarction (6.6% versus 2.3%, P = .024) but not of stroke or death (P > .10). The overall frequencies of adverse outcomes were also higher in the 5 patients with complete ipsilateral carotid occlusions (40% versus 8.2%, P < .01), the 28 patients with ipsilateral intraluminal thrombus (17.9% versus 8.1%, P = .07), and the 65 patients with ipsilateral carotid siphon stenosis (13.9% versus 7.9%, P = .10). There were no differences in adverse outcomes among those with different degrees of ipsilateral stenosis (30% to 49%, 50% to 69%, and 70% to 99%). Adverse outcome rates were similar regardless of the type of symptom (transient ischemic attack, recent ipsilateral minor stroke, remote ipsilateral minor stroke). There were no significant differences in adverse outcome rates based on sex, race, history of angina, recent myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, hypertension, degree of stenosis of the contralateral carotid artery, or presence of ulceration in the ipsilateral artery (Fisher's exact tests, P > .10). A count of variables with greater than 90% probability of being associated with adverse outcomes (age > or = 75 years or angiographic evidence of ipsilateral carotid occlusion, stenosis in the region of the carotid siphon, or intraluminal thrombus) was used to form a simple risk index. "High-risk" patients (one or more risk factors) had more than two times the risk of complications compared with "low-risk" patients who had no risk factors (odds ratio, 2.18; 95% confidence interval, 1.25 to 3.81). CONCLUSIONS: Certain preoperative clinical variables may place patients with ipsilateral symptoms at greater risk of perioperative complications after carotid endarterectomy. Prospective validation of a simple risk index would provide an additional method for assessing preoperative risk in endarterectomy candidates.

Age Factors↗
PubMed1994

Test anxiety and academic achievement among South African university students.

Although studies in Western and a few developing countries have indicated students with low scores on test anxiety tend to perform better on academic tasks than those who score higher on test anxiety, at this South African university no statistically significant mean difference on a test in educational psychology was noted for 121 students who scored high on the Anxiety Achievement Test and those 117 who scored low.

Cross-Cultural Comparison↗