Biomedical subjects

Anthony M Paolo

Publications and source records attributed to Anthony M Paolo.

11 recordsLinked to original sources

PubMed2006

Absence of the apolipoprotein E epsilon4 allele is associated with working memory impairment in Parkinson's disease.

The apolipoprotein E (APOE) epsilon4 allele has been associated with an increased risk of Alzheimer's disease (AD) and weaker episodic memory among elderly. Although this APOE allele has been linked to earlier onset of Parkinson's disease (PD), an association with dementia in PD has been only inconsistently demonstrated. Given the heterogeneity of cognitive impairment patterns in PD, this study sought to determine whether an association exists between APOE genotype and specific cognitive deficits in PD. The neuropsychological test performance of 42 PD patients without an epsilon4 allele (PD-Non4) and of 20 with at least one epsilon4 allele (PD-epsilon4) was compared to that of 146 elderly control subjects (NC). The PD groups were comparable in overall severity of cognitive impairment and disease duration, but the PD-epsilon4 group was younger, had an earlier disease onset, and contained a higher proportion of persons with dementia. Both PD groups showed wide-ranging cognitive impairments relative to NC. Once age differences between groups were controlled for, the PD groups generally did not differ from each other in cognitive performance. However, only the PD-Non4 group demonstrated working memory/attention impairments (digit span, visual span, Trailmaking test) relative to the NC group. Results suggest that the APOE genotype may influence the cognitive phenotype of PD, and specifically that absence of the epsilon4 allele is associated with working memory impairment. Additionally, results are consistent with prior findings showing an association between the epsilon4 allele and earlier onset of PD and presence of dementia.

Aged↗

PubMed2006

Which U.S. medical graduates plan to become specialty-board certified? Analysis of the 1997-2004 national association of American Medical Colleges Graduation Questionnaire database.

BACKGROUND: Predictors of U.S. allopathic medical-school graduates' board-certification plans have not been characterized. METHOD: Using multivariable logistic regression, graduates' responses to 11 questions on the 1997-2004 Association of American Medical Colleges Graduation Questionnaire were analyzed to identify independent predictors of plans for specialty-board certification. RESULTS: The proportion of 108,408 graduates planning specialty-board certification decreased from 97.3% in 1997 to 88.4% in 2004. Among 101,805 (93.9%) graduates with complete data, graduates who were Hispanic, rated their clinical clerkships, quality of medical education, and confidence in clinical skills more highly, had any debt, and planned "University-faculty" careers were more likely to plan becoming board certified. Females, Asians/Pacific Islanders, and graduates who planned to practice in underserved areas, planned "other" nonclinical-practice careers, and graduated with MD/other (non-PhD) degrees were less likely to plan becoming board certified. CONCLUSION: Specialty-board certification does not appear to be among the professional goals for a growing proportion of U.S. medical graduates.

Career Choice↗

PubMed2006

A comparison of students from main and alternate admission lists at one school: the potential impact on student performance of increasing enrollment.

PURPOSE: If medical schools increase enrollment to meet anticipated physician shortages, more students from alternate lists will likely be accepted. This study compared the performance of alternate- and main-list students during and one year after medical school. METHOD: The authors assessed admission and performance measures for 1,188 students matriculating from 1997-2003 at the University of Kansas School of Medicine. Measures included Medical College Admission Test scores, basic and clinical science grade point averages, United States Medical Licensing Examination Step 1 and Step 2 scores, residency match information, and residency director ratings. Chi-square analyses, proportional analyses, and independent t-tests were performed. RESULTS: The results indicated that both the admission measures and performance of alternate-list students were generally lower than main-list students, but the differences were small and probably not meaningful. CONCLUSIONS: As long as the applicant pool does not substantially change from its current makeup, increasing enrollment by accepting more students from alternate lists may not adversely affect overall student performance.

Clinical Competence↗

PubMed2006

Effects of writing about emotions versus goals on psychological and physical health among third-year medical students.

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the "best possible self" (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.

Adaptation, Psychological↗

PubMed2006

Student treatment on clerkships based on their specialty interests.

BACKGROUND: Student clerkship experiences may suffer if teachers are not sympathetic to students' clinical interests. PURPOSE: In this study, we quantified these experiences, compared reports of primary care and focused specialty students, and identified clerkships and teachers that posed special problems. METHODS: Students starting their 4th year at 6 schools completed a survey. RESULTS: The response rate was 75%. Students reported that these experiences, which were provoked by their clinical interests, were common: hearing deprecating comments about their interests, being denied learning opportunities, receiving lower evaluations, being discouraged from pursing their interests, and needing to be evasive for self-protection. Primary care students reported less mistreatment than focused specialty students. Students identified some clerkships and types of teachers as special problem sources. Students reported mistreatment triggered by clinical interests at twice the national rates for mistreatment triggered by race or sex. CONCLUSIONS: Such mistreatment is common and challenges medical schools to ensure that students are treated well regardless of their career aspirations.

Adult↗

PubMed2005

Discrimination of healthy and brain-damaged elderly using the WAIS-R.

The authors evaluated the ability of WAIS-R variables to discriminate normal from brain-damaged persons 75 years of age and older. Fifty-four brain-damaged patients and 54 healthy elderly were matched on the variables of age, education, sex, and race. Significant level of performance differences emerged between the groups on all subtests and the three IQs. No group differences were found on the VIQ-PIQ discrepancy score or range of subtest scatter. Step-wise discriminant analysis revealed that Digit Symbol was the most potent WAIS-R variable, accounting for 34% of the variance and correctly classifying 79.6% of the subjects.

Aged↗

PubMed2004

Action verbal fluency normative data for the elderly.

An emerging body of literature points to the prominent role of the frontal lobes in the retrieval of verbs, whereas production of common and proper nouns arguably is mediated primarily by posterior and anterior temporal regions, respectively. Although the majority of studies examining the neuroanatomic distinctions between verb and noun retrieval have relied on action naming tasks (naming depicted activities, e.g., running) as indicators of verb retrieval abilities, recent studies have utilized an action (verb) verbal fluency measure, the Action Fluency Test (AFT), to assess verb retrieval. Findings from these studies suggest that action fluency is sensitive to the integrity of fronto-subcortical neural circuitry and that it is a valid measure of executive and language functions. The AFT is an easily administered executive function measure, but no normative data for the AFT or other action fluency tasks has been published. This study was undertaken to provide initial AFT normative data for a sample of 145 healthy elderly subjects. As education is significantly correlated with AFT scores, the normative data are stratified by educational level.

Aged↗

PubMed2004

Keys to career satisfaction: insights from a survey of women pediatric surgeons.

BACKGROUND/PURPOSE: Declining interest in the field of surgery is attributed to lifestyle issues, more women per class, high debt, and long residency. To maintain surgery as a premier career choice, female students must find surgery to be professionally and personally rewarding. METHODS: A 35-item questionnaire was mailed to 95 women pediatric surgeons (WPS), assessing multiple professional and personal factors. Responses were entered into a confidential database and analyzed by chi2 or t tests. RESULTS: Seventy-nine percent of surveys were returned; practice was identified as academic (60%) and private (40%). Respondents were grouped by age: A, less than 44 years (41%); B, 45 to 54 years (37%); and C, greater than 55 years (22%). For academic WPS, 81% are on timeline for promotion. Insufficient protected time was a significant obstacle for a successful academic career in groups A and B (P =.001). Clinical load, on-call responsibilities, lack of mentorship, and departmental support were major obstacles in all groups (P =.05). Seventy-three percent of WPS in private practice were satisfied with their role in practice management; poor practice conditions were cited as the most frequent reason for job relocation. Sixty-one percent of WPS are married, and 46% are raising children. WPS had statistically significant more responsibilities for child care and household tasks in comparison with their partners. Eighty-three percent report career satisfaction but desire more time with family and for personal interests. Part-time and flexible work schedules were identified as attractive ways to achieve career-family balance. Eighty-four percent believe that quality-of-life issues are the dominant reason that fewer medical students choose surgical fields. CONCLUSIONS: WPS express career satisfaction but share the concerns of their female colleagues in other surgical disciplines. Quality of life is viewed as central to career choice for the current generation of medical students; female role models are key to recruiting women into pediatric surgery.

Adult↗

PubMed2004

Comparison and cross-validation of simple and multiple logistic regression models to predict USMLE step 1 performance.

BACKGROUND: Early identification of students who may have difficulty with the United States Medical Licensing Examination-Step 1 examination is important for medical schools and students. Numerous models that predict Step 1 performance have been identified, but few of these models have been cross-validated. PURPOSE: To cross-validate different prediction models of Step 1 performance. METHODS: The development sample was 686 students from a Midwestern medical school. The cross-validation sample was 147 different students. Logistic regression was used to develop the multiple model and Year 1 grade point average (GPA) and Year 2 Fall GPA were used as the simple models. Receiver Operating Characteristic graphs were used to select optimal cutoffs for each model. Kappa coefficients were used to determine level of agreement, and sensitivity and specificity were used to assess classification accuracy. RESULTS: The Year 1 GPA model had relatively poor agreement with actual Step 1 performance, but the other models evidenced fair agreement. The multiple and Year 1 GPA models demonstrated statistically significant loss of classification accuracy on cross-validation, whereas the Year 2 Fall GPA model did not. CONCLUSIONS: Cross-validation is necessary to determine the generalizability and overall utility of prediction models.

Education, Medical↗

PubMed2003

Measuring outcomes of undergraduate medical education: residency directors' ratings of first-year residents.

PURPOSE: There is a growing recognition of the need to show the relationship between undergraduate medical education (UME) and achievements during residency. This study provides reliability and validity evidence for a residency rating scale as well as a method for gathering comparison information about first-year residents. METHOD: A 25-item rating scale measuring important areas of physician functioning was mailed to residency directors of 485 graduates of the 1998-2000 classes of the University of Kansas School of Medicine. The same rating scale was sent to residency directors for a comparison sample of 251 graduates of other U.S. medical schools who were residents at the University of Kansas Medical Center. Each item on the rating scale was rated on a five-point Likert scale. Principal-components analysis, correlational analyses, internal consistency reliability analysis, and mean comparisons were used to provide evidence of reliability and validity. RESULTS: A total of 382 (82%) usable rating scales were returned. A principal-components analysis extracted five factors that accounted for 86% of the variance. The final factors were (1) interpersonal communication, (2) clinical skills, (3) population-based health care, (4) record-keeping skills, and (5) critical appraisal skills. The internal consistency of the entire scale was.98, with coefficients for the five factors ranging from.92 to.97. The correlations between the five factors and measures of undergraduate performance ranged from.21 to.49. Group analyses revealed that residents with high GPAs and USMLE Step 1 and Step 2 scores tended to be rated higher than those with lower scores. CONCLUSIONS: The rating scale demonstrated adequate reliability and validity and showed that residency directors' ratings are a useful outcome measure for UME performance.

Academic Medical Centers↗

PubMed2003

Treatment of medical students during clerkships based on their stated career interests.

BACKGROUND: Clerkship students often face questions from teachers about their career interests and may perceive that their responses change their clerkship experiences significantly. PURPOSE: To explore student experiences with "career interest" inquiries and how responses may influence clerkship experiences. METHODS: A qualitative study of 4th-year medical students by use of focus groups, whose experienced facilitators used a structured interview protocol. Purposeful sampling identified a representative group of participants. Transcribed focus group proceedings were analyzed with a predetermined theme matrix. RESULTS: Participants reported frequently facing career interest inquiries, feeling comfortable with some, and feeling threatened by others. The tone of inquiries ranged from casual to confrontational. Participants perceived that their responses could significantly influence the quality of teaching relationships, access to clinical opportunities, and grades. Students often responded vaguely or deceptively for self-protection. CONCLUSIONS: For clerkship students, career interest inquiries and how students respond can be high-stakes issues, potentially compromising teaching quality, equitable treatment, and fair evaluations. Further quantitative study is essential

Attitude of Health Personnel↗