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PubMed1982

A randomized trial of continuing medical education.

To determine whether continuing medical education affects the quality of clinical care, we randomly allocated 16 Ontario family physicians to receive or not receive continuing-education packages covering clinical problems commonly confronted in general practice. Over 4500 episodes of care, provided before and after study physicians received continuing education, were compared with preset clinical criteria and classified according to quality. Although objective tests confirmed that the study physicians learned from the packages, there was little effect on the overall quality of care. When the topics were of relatively great interest to the physicians, the control group (who did not receive the packages) showed as much improvement as did the study group. When the topics were not preferred, however, the documented quality of care provided by study physicians rose (P less than 0.05) and differed from that provided by control physicians (P = 0.01). Finally, there was no spillover effect on clinical problems not directly covered by the program. In view of the trend toward mandatory continuing education and the resources expended, it is time to reconsider whether it works.

Canada↗
PubMed1977

Impact of external influences on food packaging.

Since the food supply is dependent upon an effective packaging system, threats to packaging represent implied threats to food processing and distribution. Enacted and potential legislation and regulation are retarding technological and commercial progress in food packaging and have already restricted some food packaging/processins systems. The results of these external influences is not simply the sum of the individual acts, but is a cascading self-imposed arresting of food packaging/processing advancement. The technological bases for the enacted and proposed legislation and regulation are presented in the enumeration of the external influences on food packaging. Economic and sociological arguments and facts surrounding the issues are also presented. Among the external influences on food packaging detailed are indirect additives, nutritional labeling, benefit:risk, solid waste and litter, environmental pollution, universal product code, and food industry productivity. The magnitude of the total impact of these external influences upon the food supply is so large that assertive action must be taken to channel these influences into more productive awareness. An objective and comprehensive public communications program supported by the technological community appears mandatory.

Advertising↗
PubMed2002

Teaching effectiveness of the trauma evaluation and management module for senior medical students.

BACKGROUND: The Trauma Evaluation and Management (TEAM) module was devised by the American College of Surgeons for teaching senior medical students trauma management principles. This article reports on the teaching effectiveness of this module. METHOD: Cognitive skills (by 20 item multiple-choice question examination on trauma topics) and clinical trauma management skills performance, using the Objective Structured Clinical Examination, were compared between two groups of 16 randomly selected final year medical students who had completed the standard curriculum including trauma topics. One group had the TEAM (TEAM group) and the other did not (no-TEAM group). Objective Structured Clinical Examination score (percentage), Priority score (range, 1-7), Organized Approach score (range, 1-5), and Global Pass status were assigned at each station. The students also completed a five-part questionnaire. RESULTS: Results of the questionnaire showed that on a scale of 1 to 5, with 5 being excellent, 96.8% assigned a score of 4 or greater, indicating the objectives were met, 83.8% that trauma knowledge was improved, 51.6% that clinical skills were improved, 90.3% that the module should be mandatory, and 83.9% overall satisfaction with the program. CONCLUSION: The TEAM module is very effective in teaching trauma management principles to senior medical students, by whom the program was very well received. Consideration should be given to adopting this program more widely in our medical undergraduate curriculum.

Clinical Competence↗
PubMed2005

Completing a scholarly project during residency training. Perspectives of residents who have been successful.

BACKGROUND: Resident research has potential benefits and scholarly activity is an internal medicine residency training requirement. This study sought to learn about the resources needed and the barriers to performing scholarly work during residency from residents who had been successful. METHODS: A questionnaire was delivered to 138 internal medicine residents presenting their work at the 2002 American College of Physicians-American Society of Internal Medicine annual session. Residents were asked to comment on why they had participated in a scholarly project, the skills and resources needed to complete the project, as well as the barriers. Comparisons were made between residents who presented a research abstract and those who exhibited a clinical vignette. RESULTS: Seventy-three residents (53%) completed the questionnaire. Thirty-nine residents presented a clinical vignette and 34 displayed a research abstract. Residents participated in research for a variety of reasons, including intellectual curiosity (73%), career development (60%), and to fulfill a mandatory scholarly activity requirement at their residency program (32%). The most common barriers were insufficient time (79%), inadequate research skills (45%), and lack of a research curriculum (44%). Residents who had presented research abstracts devoted more time (median, 200 vs 50 hours; P<.05) to their project than those who exhibited clinical vignettes. Sixty-nine percent of residents thought research should be a residency requirement. CONCLUSIONS: The majority of respondents reported that their scholarly project was a worthwhile experience despite considerable barriers. Teaching research skills more explicitly with a focused curriculum and providing adequate protected time may enable residents to be successful.

Biomedical Research↗
PubMed2004

Should we continue performing intrauterine inseminations in the year 2004?

This review summarizes the existing evidence regarding intrauterine insemination (IUI) as a treatment for cervical hostility, male and unexplained subfertility. IUI in natural cycles has been proven effective in patients with cervical hostility and moderate male subfertility. IUI in cycles with mild ovarian hyperstimulation (MOH) should be the treatment of choice in couples with mild male subfertilty (average total motile sperm count above 10 million) and unexplained subfertilty. When MOH is applied, gonadotropins have been proven more effective compared with clomiphene citrate. Further large trials comparing clomiphene citrate with gonadotropins are mandatory. Prevention of multiple pregnancies in MOH/IUI programs is of paramount importance. A strategy with a low-dose step-up protocol and strict cancellation criteria is proposed. When multiple pregnancies are kept to a minimum, MOH/IUI is more cost-effective compared with in vitro fertilization and embryo transfer. Future research should focus on prediction models to predict the outcome of MOH/IUI treatment for individual couples before starting treatment.

Female↗
PubMed1989

Tumor volume, CT scan, lymphography, sonography, intravenous pyelography, and tumor markers in testis tumors.

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diagnostic tools (accuracy 0.79) with high sensitivity (0.88) and specificity (0.77). For patients with negative CT scans, subsequent lymphangiography is recommended for accurate staging, as seems mandatory in stage 1 patients entering surveillance programs.

Adult↗
PubMedDate not supplied

Percutaneous intraductal sampling for cyto-histologic diagnosis of biliary duct strictures.

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) allows ductal material to be collected for cyto-histologic examination. We evaluated the data from a large series of patients with a PTBD in whom endobiliary cyto-histologic sampling techniques were employed in order to define a strategy for their use in the diagnostic work-up. PATIENTS AND METHODS: Ductal samples for cyto-histologic examination were obtained from 409 consecutive patients with a PTBD for stenosing lesions of the biliary tree. Bile aspirate cytology was performed for all patients and ductal biopsy specimens were obtained, generally after negative cytology, from 49 of them (11.9%), all candidates for a therapeutic procedure. The cyto-histologic results of intraductal sampling were compared with pathologic surgical data in 210 patients and with clinical-radiologic follow-up in 199. RESULTS: Overall, 22 out of the 409 patients had a final diagnosis of benign stenosis and 177 had samples positive for neoplastic disease. The sensitivity of bile cytology was 43.8% while ductal biopsies showed a sensitivity of 60.4%. The combination of the two sampling techniques achieved a sensitivity of 65.1%. For both sampling methods the specificity was 100%. Hilar metastases from neoplastic lesions of the GI tract and primary lesions of the biliary ducts showed the highest sensitivity. CONCLUSION: Cyto-histologic assessment of stenosing lesions of the biliary ducts is mandatory when highly sophisticated interventions (e.g. wide hepatic resection or liver transplantation) or non-surgical treatments are envisaged. The collection of cyto-histologic samples from bile ducts, in patients with a percutaneous bile drainage, is an easy, safe and valuable method to obtain the diagnosis. In view of the absence of false positive results in our series and in others, intraductal biopsy serves no purpose when positive exfoliative cytology is positive for malignancy. In the presence of negative cytology it is felt that an intraductal biopsy should be mandatory when the choice of a therapeutic program depends on the result of the cyto-histologic diagnosis.

Adolescent↗
PubMed2004

Tissue ischemia time affects gene and protein expression patterns within minutes following surgical tumor excision.

The aim of this study was to determine the impact of ischemia on gene and protein expression profiles of healthy and malignant colon tissue and, thus, on screening studies for identification of molecular targets and diagnostic molecular patterns. Healthy and malignant colon tissue were snap-frozen at various time points (3-30 min) after colon resection. Gene and protein expression were determined by microarray (HG-U133A chips) and surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) technology (CM10 chips, SAX2 chips, and IMAC3Ni chips), respectively. Real-time reverse transcription PCR (RT-PCR) was used for comparative measurement of expression of particular genes. Initial changes of gene and protein expression profiles were already observed 5-8 min after colon resection. Fifteen minutes after surgery, 10%-15% of molecules, and after 30 min, 20% of all detectable genes and proteins, respectively, differed significantly from the baseline values. Significant changes of expression were found in most functional groups. As confirmed by real-time RT-PCR, this included not only known hypoxia-related molecules (HIF-1 alpha, c-fos, HO-1) but also cytoskeletal genes (e.g., CK20) and tumor-associated antigens (e.g., CEA). In conclusion, preanalytical factors, such as tissue ischemia time, dramatically affect molecular data. Control of these variables is mandatory to obtain reliable data in screening programs for molecular targets and diagnostic molecular patterns.

Artifacts↗
PubMed1990

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--HHS. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11986). A similar notice listing all currently certified laboratories will be published monthly, and updated to include laboratories which subsequently apply and complete the certification process. If any listed laboratory fails to maintain its certification, it will be omitted from updated lists until such time as it is restored to full certification under the Guidelines.

Certification↗
PubMed1990

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11979, 11986). A similar notice listing all currently certified laboratories will be published during the first week of each month, and updated to include laboratories which subsequently apply and complete the certification process. If any listed laboratory's certification is totally suspended or revoked, the laboratory will be omitted from updated lists until such time as it is restored to full certification under the Guidelines.

Certification↗
PubMed1991

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11979, 11986). A similar notice listing all currently certified laboratories will be published during the first week of each month, and updated to include laboratories which subsequently apply for and complete the certification process. If any listed laboratory's certification is totally suspended or revoked, the laboratory will be omitted from updated lists until such time as it is restored to full certification under the Guidelines.

Certification↗
PubMedDate not supplied

The national health insurance conundrum: shifting paradigms and potential solutions.

For nearly a century, federal lawmakers have debated the pros and cons of national health insurance. Despite surges of interest, a consensus for such action does not exist. With political camps divided a "hybrid" solution is needed. Such a plan would involve both the government and the private sector, featuring a single payer system, creation of a basic benefit package, voluntary incentives to purchase insurance that gradually move to a mandatory system, and a progressively financed public program to cover those who fall through the cracks. Presidential leadership will be necessary to gain action.

Community Participation↗
PubMed1990

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11986). Starting this month, a similar notice listing all currently certified laboratories will be published monthly, and updated to include laboratories which subsequently apply and complete the certification process. If any listed laboratory fails to maintain its certification, it will be omitted from updated lists until such time as it is restored to full certification under the Guidelines.

Government Agencies↗
PubMedDate not supplied

[Impact of health services, sanitation and literacy in the mortality of children under 5 years of age]].

OBJECTIVE: To analyze differences of the impact of health care services, sanitation and literacy on the mortality rates of children under five years of age, in two Mexican states with marked socioeconomic differences: Chiapas and Nuevo Leon. MATERIAL AND METHODS: The study design was ecologic, based on a retrospective analysis of data published by the Health Ministry (Secretaría de Salud), National Institute of Statistics, Geography and Informatics (Instituto Nacional de Estadística, Geografía e Informática) and the National Population Council (Consejo Nacional de Población), on the tendencies of mortality among children under five years and on the changes of selected indicators corresponding to the period 1990-1997. STUDY DESIGN: ecologic study. This was based on a retrospective analysis of data published by Secretaría de Salud, Instituto Nacional de Estadística e Informática and Consejo Nacional de Población, about the tendencies of mortality among children under five years, and about the changes of selected indicators. The analysis was carried out in the period comprised between 1990-1997. For both states the registered variations were calculated and the trends were determined through analysis of simple linear regression; the independent variable corresponded to the study years. Partial correlation analysis between the various mortality trends studies and between and the selected indicators, were calculated. RESULTS: During the studied period there was a steady decline of children mortality, which was more marked in Chiapas. In both entities, this decrease was closely related to the decline in mortality due to acute diarrhea, and also correlated with a descent in measles and acute respiratory infections. In Chiapas, the indicators which correlated more significantly with this decline in mortality were vaccination coverage and literacy. In Nuevo Leon, the indicators with greater correlation were the increase in the number of nurses, of lodgings with piped water and vaccination coverage. CONCLUSIONS: During the analyzed period, the mortality rate of children under five years of age decreased in the states of Chiapas and Nuevo Leon. To sustain or accelerate the decline in childhood mortality it is mandatory to continue with the currently implemented programs, and in Chiapas, and similar states, to increase the available infrastructure to provide health care.

Cause of Death↗
PubMed2001

[Therapeutic indications in symptoms of bladder and sphincter disorders in multiple sclerosis].

Bladder and bowel dysfunction is common in multiple sclerosis. After accurate diagnosis of dysfunction, a management program with anticholinergic or alphabloquers drugs is mandatory. Intermittent catheterization, surgical treatment, or electrostimulation are proposed in most severe cases. Therapies for intestinal disorders are more limited. Management of symptoms and different therapies are reviewed.

Combined Modality Therapy↗
PubMed2002

New strategies and advances in the management of cervical carcinoma.

BACKGROUND: Carcinoma of the cervix is still common female cancer in Taiwan. A large portion of patients die of the disease in spite of various kinds of therapies and even the combination of multi-modality treatment. METHODS: The current review includes a comprehensive review of the literature. Many new strategies and advanced in the management of cervical carcinoma have been the subject of this intense study and include assisted systems to improve sensitivity and specificity of Pap smear, human papillomavirus (HPV), and its vaccination, operation, radiation, chemotherapy, and combination of these strategies. Because of the constant failure rate, a systemic and critical review of the disease and management should be considered. RESULTS: With improvement of detection rate of pre-invasive cancer and popularity of screening protocol, the prevalence rate of cervical carcinoma decreases progressively. However, although new strategies in managing cervical carcinoma focus on combination therapy, the life quality and survival rate of these patients with cervical carcinoma only show beneficial in certain group patients. CONCLUSION: As to the complexity of both disease nature and various combinations in the diagnosis and treatment of cervical cancer, comprehensive quality control programs and large prospective multicenter trials are mandatory for establishing the "standard of care" adhered to the principles of evidence-based medicine.

Combined Modality Therapy↗
PubMed2002

The dental curriculum in Gies' time, now, and in the future.

Writing in the 1920s, William J. Gies was a champion for the importance of dentistry to general health, the scientific foundation for dentistry, and the need to develop and integrate an efficient curriculum. He argued that admissions standards should be made uniform and raised. He also proposed that the predoctoral dental curriculum should be reduced to three year's length by eliminating unnecessary material and improving efficiency. Gies called for available postgraduate experiences on an optional basis. Perhaps it is time to consider a three-plus-one model combining a three-year program focused on general dentistry with a mandatory fourth year along the lines of a postdoctoral general education experience.

Curriculum↗
PubMed2004

[How I treat...oropharyngeal mucositis associated with radiotherapy for head and neck cancer].

Oral mucositis the major acute effect of head and neck radiotherapy. According to the degree, irradiation may be compromised in dose and overall time with consequences on outcome. Up to now there is no standard accepted protocol. A strict program of local and general hygiene is mandatory. Analgesics are often required. Amifostine acts as a protector of salivary glands GM-CSF and G-CSF stimulate proliferation of mucosal basal cells. Sucralfate plays a barrier role. Camomile plant extract is anti-inflammatory, well tolerated and cheap. Povidone-iodine is better than chlorhexidine as an antiseptic agent. PTA lozenges with polymixin E, tobramycin and amphotericin B showed a marked power of selective microbial decontamination.

Head and Neck Neoplasms↗