[Analysis of the economic situation of the University of Chile and its means of solution. The University Council of the University of Chile].
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Chile↗
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Effect of education on the use of universal precautions in a university hospital emergency department.
STUDY OBJECTIVES: To determine if an educational program would improve both knowledge and practice of universal precautions by nursing personnel. DESIGN: Participants were given a 14-question test and observed for their, practice of universal precautions during routine IV catheter placement or phlebotomy and trauma care before and six months after an education in-service. SETTING: University hospital emergency department. TYPE OF PARTICIPANTS: Nursing personnel. INTERVENTIONS: One-hour lecture addressing the occupational risk of human immunodeficiency virus (HIV) infection and the recommended use of universal precautions. MEASUREMENTS AND MAIN RESULTS: The mean overall correct response rates to the questionnaire before and after the in-service were 70% and 73%, respectively (P = NS). The pattern of incorrect responses suggested that the perceived risks of HIV transmission are underestimated, particularly among healthy-appearing patients. For care of critical trauma patients, there were significant increases between the frequency rates before and after the in-service of glove and protective eyewear use (66.7% vs 87.7%, P less than .025; 0.0% vs 17.3%, P less than .05, respectively). The frequency rates of glove use for IV placement or phlebotomy in noncritical patients and of gown use for trauma patient care also increased (52.6% vs 65.2% and 25% vs 39.5%, respectively); however, these changes were not statistically significant. CONCLUSION: An intensive educational program was associated with a modest increase in the compliance of ED nursing personnel with universal precautions and had no long-term effect on their general knowledge of HIV risk. The practice of universal precautions is still far from universal in this ED.
Acquired Immunodeficiency Syndrome↗
Comparing postgraduate medical education at university and non-university hospitals in Japan.
In 1988 the authors surveyed all the teaching hospitals in Japan to evaluate the present status of postgraduate medical education (PGME); they received responses from 67 (84%) of the university and 172 (89%) of the non-university teaching hospitals. It was found that a large proportion of residents had spent two years in a residency without having had a single experience of some of the basic clinical skills. Consequently the residents' confidence in their abilities to perform these skills was low. The residents at the university hospitals, in particular, had had fewer experiences and were less confident about their clinical skills than were the residents at the non-university hospitals. The lack of standard and minimum requirements for PGME in Japan may be the cause of the poor level of acquisition of clinical skills of residents during PGME. Other possible causes are the tendency in Japanese medical society to attach greater importance to academic attainment than to clinical competence and the excessive gravitation of residents toward university hospitals. The authors suggest their results show the necessity to improve the training in basic clinical skills in PGME in Japan, especially in university hospitals.
Clinical Competence↗
[Exchanges between American nursing universities and the Kitasato University--toward establishment of a postgraduate nursing course in Japan (1). Visits to 4 nursing universities in the United States, the first visit to the U.S. as a preliminary study].
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Education, Nursing, Graduate↗
University-industry research relationships in biotechnology: implications for the university.
The growth of university-industry research relationships in biotechnology has raised questions concerning their effects, both positive and negative, on universities. A survey of over 1200 faculty members at 40 major universities in the United States reveals that biotechnology researchers with industrial support publish at higher rates, patent more frequently, participate in more administrative and professional activities and earn more than colleagues without such support. At the same time, faculty with industry funds are much more likely than other biotechnology faculty to report that their research has resulted in trade secrets and that commercial considerations have influenced their choice of research projects. Although the data do not establish a causal connection between industrial support and these faculty behaviors, our findings strongly suggest that university-industry research relationships have both benefits and risks for academic institutions. The challenge for universities is to find ways to manage these relationships that will preserve the benefits while minimizing the risks.
Antibodies, Monoclonal↗
[The university pharmacy and the university pharmacist in history].
The major purpose of the research is to show the influence of university pharmacy and university pharmacist on the development of pharmaceutical science. The lectures in materia medica were frequent realized in university pharmacy since middle age. In the 18th century the university pharmacy was in some cases the precursor to the institute of pharmaceutical chemistry. In the paper also a summary is given of the importance of extensive activity of the university pharmacists J.D. Leers, G.L.C. Rousseau, J.R. Spielmann, F.C. Lieblein, A.F. Duflos, E.F. Jahns, W. Mettenheimer, C. Brunnengräber, C.A. Laubinger, J. Stamm, O.H. Gerke and E. Weber.
Germany↗
Universal precautions are not universally followed.
Adherence to universal blood and body fluid precautions was studied in surgical patient care areas of a university hospital in an effort to identify potentially hazardous health care personnel practices. Surgical teams of an 18-unit operating room, three surgical ward patient care teams, and patient care personnel in a 16-bed surgical intensive care unit were observed during routine patient care activities before (study 1) and after (study 2) specific educational programs were held to improve universal precaution compliance. Overall, infractions occurred in 57% of 549 observed procedures in study 1 and in 58% of 616 observed procedures in study 2. In study 1, infractions occurred in 75% of operating room procedures, 30% of surgical ward procedures, and 75% of surgical intensive care unit procedures. Study 2 procedure infraction rates were 81%, 32%, and 40%, respectively. Only surgical intensive care unit compliance significantly improved. Noncompliance with universal precautions occurs frequently during the care of patients who have undergone surgery, with the type of infraction and specific offender varying according to patient locale. These violations appear unamenable to one-time educational efforts. Substantial overall improvement may arise from ongoing educational programs directed at specific personnel who care for patients who have undergone surgery.
Blood↗
[Integration of a university clinic for women into a complex university hospital].
Commonly with all special surgical branches of sciences from a medical university-sphere the hospital for gynäcology and obstetrics from the university will be placed in a "surgical orientated centre". The process--structure is underlieing the project for such a centre (summary from equal activities with equal claims to buildings, fitting and out hygiene). The singular spheres from the hospital of gynäcology and obstetrics will be coordinated to the equivalent central functional spheres of the "surgical orientated centre". The obstetrical--ward with an acute--praepartal--sphere will be commonly with the neonatological-sphere collected to a functional group on the inside of the central surgical-ward. The perceptions by the projection of a "surgical orientated centre" shall be a stimulation for the planning and the construction for medical university complexes and universal hospitals.
Berlin↗
Universal New York Health Care. A single-payer strategy linking cost control and universal access.
Now that universal access to health care is back on the governmental agenda, elected officials are faced with the dilemma of expanding our present pluralistic system of numerous private and public payers, with its built-in administrative inefficiencies and inflationary pressures, or scrapping the present system of financing and moving to a tax-based scheme like the Canadian Medicare program, an option fraught with political difficulties. There is, however, a third option. The New York State Department of Health has developed a proposal for universal access--Universal New York Health Care, or UNY-Care--that would retain the existing payers, including employer-based insurance coverage, but combine them in a one-payer framework. Providers would no longer have to interact with the many public and private payers, each with its own rules, criteria, and levels of payment. The single payer would serve as the only payer for most health care services and would also negotiate reimbursement rates. The single-payer framework should bring savings in administrative and billing costs and should move government closer to the goal of buying health care services--getting good value for payment rendered--rather than simply paying bills as they are submitted. Although the single-payer strategy could be implemented at either the state or the federal level, it seems ideal as the principal responsibility of the states in a national plan for universal coverage.
Cost Control↗
The variation of a Midwest Catholic University's drug use pattern from other Catholic University findings: why?
For over a decade, survey studies concerning drug use and college students have portrayed a significantly lower pattern of drug use by students attending Catholic controlled universities than other university types. In the spring of 1972 the author conducted a study of the undergraduates of a large Midwest Catholic University to assess various aspects of its drug scene. The involvement with drugs, especially marijuana, on this campus departed substantially from the usual Catholic control-low drug use nexus. The discussion presents a description of this departure and suggest that certain demographic and social characteristics of this Midwest Catholic University, when interacting, suffice to offset the religious control and religiosity influences that usually effect the low drug use--religious control nexus.
Cross-Sectional Studies↗
HIV, trauma, and infection control: universal precautions are universally ignored.
The medical, legal, and ethical problems associated with routine HIV screening have led to the recommendation that all patients should be presumed to be seropositive and thus protective measures should be taken by all health care workers. This philosophy, termed "universal precautions," has been difficult to adhere to or enforce, however. Nevertheless, in some trauma population subsets, the prevalence of HIV seropositivity runs as high as 19%, and thus presents an occupational hazard to the trauma health care worker. The mainstays of universal precautions (UP) are barrier techniques against body fluid contact and protection from inadvertent needlestick. To judge compliance with a strict UP protocol, surgical residents engaged in trauma room resuscitations were observed on a random basis by trauma nurse coordinators. Previously, UP had been discussed in conferences and by memo. Over 2 months, 81 trauma rooms were observed, involving 18 house officers. Overall, there was only 16% compliance with strict UP. The most common protocol variations involved sharps technique. While glove use was nearly universal, protective eye wear, ankle and foot protection, and body protection such as gowns or aprons were commonly ignored. Even in the presence of invasive procedures such as endotracheal intubation or insertion of chest tubes, compliance was less than 40%. The reasons most commonly given by house officers for the lapse in UP were not knowing the protocol, forgetting the protocol, or not having time to implement the protocol. Even for the nine patients residents identified as suspected of being in a high-risk category, UP was strictly adhered to only once. Compliance with universal precautions is difficult to achieve under the best of circumstances. It cannot be assumed that passive informational measures can achieve this goal. Active infection control surveillance and ongoing housestaff inservice are required to minimize the risk of inadvertent injury or contamination.
Acquired Immunodeficiency Syndrome↗
A University of California State-supported AIDS research award program--a unique state and university partnership in AIDS research.
This article describes the State-supported University of California AIDS research award program and its major accomplishments. It shows how a partnership between a University and a State resulted in the formation of a successful, efficient, and cost-effective AIDS research award program. This program provides funds for rapid testing of investigator-initiated meritorious research ideas, new drugs, and treatment modalities. Funds were also utilized to establish three AIDS Clinical Research Centers, which evolved into regional consortia that coordinate trials of new drugs and other modalities. This program succeeded in involving investigators whose efforts have led to excellent medical care, advanced technologies, and new drugs for treating AIDS and AIDS-related diseases. The University remains committed to continuing support of all areas of AIDS research, emphasizing drug and vaccine development, pediatric AIDS, and AIDS prevention studies in groups at high risk for HIV infection.
Acquired Immunodeficiency Syndrome↗
History of the renal section, New York University School of Medicine 1926-1986, New York University Medical Center.
This history of the Renal Section at New York University School of Medicine ascribes its birth to a policy introduced by John Henry Wyckoff in 1924 that divided the Department of Medicine into sections devoted to the various subspecialties. Physicians selected to head each section sought further training. William Goldring, asked to organize the kidney section, spent a sabbatical year working with Homer William Smith, chairman and professor of the department of physiology at New York University School of Medicine. The second event was the development of a postdoctoral fellowship program in which medical school graduates, following completion of their intern and residency program, returned to basic science departments for exposure to and training in research in preparation for their return to clinical medicine. The aim of this fellowship program was to introduce the experimental method, which had been productive in the physical sciences, to the study and treatment of disease in man. The third event was the continuous collaboration between members of the Department of Medicine and the Department of Physiology under the chairmanship of Homer Smith. Experimental protocols in cardiovascular and renal physiology developed in the laboratory were carried over to Bellevue Hospital for studies and treatment of patients with hypertensive and renal diseases under the direction of members of the Renal Section. The final step conceived by Saul J. Farber, Chairman and Professor of the Department of Medicine was unification into a single group of all faculty members working in the field of hypertensive and renal diseases in Bellevue, University, and Manhattan Veterans Administration Hospitals. The Renal Section then can attribute its origin and development to the establishment of divisions within the Department of Medicine, the postdoctoral fellowship program, and the collaboration between the Departments of Medicine and Physiology. The establishment of the Renal Section served as a prototype for organizing medical school faculties into teams responsible for teaching, investigation, and treating hypertensive and renal diseases and spawned nephrology as a subspecialty of Internal Medicine.
History, 20th Century↗
Poor compliance with universal precautions: a universal phenomenon?
An anonymous survey was conducted in order to examine compliance with universal precautions in the Department of Pediatrics at Loyola University Medical Center in Maywood, Illinois. Completed questionnaires were returned by 23 faculty members, 29 residents, and 22 medical students. Gloves were worn consistently during venipuncture or intravenous catheterization by 13, 7, and 18% of attending physicians, residents, and students, respectively. Most physicians wear gloves only occasionally and cite presence of high-risk factors as their selection criterion. Interference with the performance of procedures is the most common cause of noncompliance. In view of poor compliance with universal precautions, further efforts are needed in order to decrease the incidence of preventable exposure to blood-borne infections.
Academic Medical Centers↗
Medical ethics teaching programs at the University of California, San Francisco, and the University of Washington.
The author describes the comparative dearth of scholarship and literature on medical ethics in 1972 when he began designing an elective lecture-discussion course at the School of Medicine, University of California, San Francisco (UCSF). He traces the development of ethics teaching at that school and of his conviction that medical cases must be the focus of ethics education, not merely as illustrations but as the matrix of the ethical problems encountered and their resolution. Eventually, a required fourth-year course was developed that focused upon four essential aspects of medical cases: medical indications, patient preferences, quality of life, and external socioeconomic factors. This course and its evaluation--including inherent quandaries of evaluating ethics teaching--are described; he attributes the success of the course to the appropriateness of the four-part format for analysis and the support and participation of leading members of the medical faculty. Throughout this description of the UCSF program are short descriptions of the additions to the bioethics literature that were made during the mid- and late 1970s. The author then describes the present ethics teaching program at the University of Washington School of Medicine, where he has taught since 1987, and the intriguing and perhaps innovative possibilities for expanding and redefining that program.
Bioethical Issues↗
[Comparative study of brain tumors treated at China Medical University, China and Kyushu University, Japan].
We have re-examined histopathological specimens of brain tumors extirpated at China Medical University from May, 1990 to June, 1992. During the last 2 years, about 400 cases of brain tumors were operated and 349 cases were histopathologically diagnosed and classified by one of the authors (T. I). The most common tumor was meningioma, 97 cases, followed by gliomas, 87 case and neurinoma, 71 cases. The sex and age distributions of these three tumor types were compared to those of Kyushu University Hospital, Japan. The most striking difference was age of meningioma and neurinoma patients, and Chinese patients were 10 years younger than Japanese patients. The incidence of 30th age group of meningioma was 25% in China and 10% in Japan. Thirty percent of neurinoma patients were operated at 30th and 40th age in China and Japan, respectively. The sex and ages of astrocytoma patients were almost the same frequencies in China and Japan. Among 22 cases of congenital tumors, 11 cases of epidermoid tumor in cerebello-pontine cistern was included. Cerebral tuberculoma, although rarely encountered in Japan, was 2 cases in China.
Adolescent↗
Maternity care financing: universal access or universal care?
In an era of fiscal constraint, growing poverty, increased uninsuredness, medical liability problems, and increasing costs of maternity care, public and private financing mechanisms are changing rapidly and the service delivery system is increasingly fragmented. Despite the almost mercurial changes in the system, data from national studies show that access to care is a major problem affecting all childbearing women. This paper describes the three groups of women who require comprehensive maternity care, their insurance coverage, and the gaps for each group. It describes proposals which are currently under development to reduce uninsuredness and produce universal access and, in addition, presents an alternative plan for universal maternity care.
Costs and Cost Analysis↗
[University by radio and television in Great Britain. The Open University].
There are some 20 years since Great Britain was given a new and important University (established by a Royal Charter in 1969), especially intended for students wanting to achieve their education at home. The whole teaching, guided by tutors, is supported by various materials: booklets, audio- and videotapes which are completed by television and radio broadcasts for many courses and informations. After successful examinations are obtained the usual degrees and certificates delivered by the British Universities. Furthermore, this kind of education begins to be available in a few other countries (Belgium, Luxembourg, The Netherlands, Cyprus, Hong Kong).
Audiovisual Aids↗