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Biomedical subjects

C A Pfeiffer

Publications and source records attributed to C A Pfeiffer.

11 recordsLinked to original sources
PubMed2001

The impact of a curriculum renewal project on students' performances on a fourth-year clinical skills assessment.

PURPOSE: To study the performances of three consecutive classes of medical students on a fourth-year clinical skills assessment that remained constant during a curriculum renewal project that involved earlier clinical work, more ambulatory training, and an emphasis on lifelong learning. METHOD: Three classes were involved: 83 baseline students (class of 1997) educated in the old curriculum, 77 transitional students (class of 1998) exposed to some curricular change, and 88 renewal students (class of 1999) in the first year of full curricular change. Each class completed a fourth-year assessment, during which students performed a focused history and physical examination on 14 standardized patients. Scores for these elements were calculated as the percentages of items obtained. Each case also includes a communication skills element rated on the Arizona Clinical Interview Rating scale (ACIR). RESULTS: Small but significant improvements in the means of scores were found in all three elements of the assessment over the study period (history taking scores increased from 74% to 80%, physical exam scores increased from 51% to 58%, and ACIR scores increased from 3.7 to 4.0). More pronounced was the decline in the percentage of students who failed the assessment (from 8% to 0%), and a marked increase in those who passed over 80% of the case elements (from 65% to 89%). CONCLUSION: Renewing the curriculum to expose students to clinical skills earlier, increase the amount of ambulatory training, and promote lifelong learning resulted in small but significant increases in students' performances on a fourth-year clinical skills assessment. The major impact of the new curriculum, however, was to improve the clinical skills assessment performances of marginal and average students.

Clinical Competence↗
PubMed2000

Teaching patient wellness to first-year medical students: the impact on future ability to perform the history of present illness.

OBJECTIVES: Curriculum innovations to improve clinical skills have been implemented at many American medical schools. A current curricular change at the University of Connecticut School of Medicine involves teaching wellness to students in the first year rather than the more traditional focus on disease processes. It is unknown, however, if focusing on wellness detracts from students' future ability to perform the history of present illness (HPI) which requires students to focus on disease processes. DESIGN: The current study examined this issue by comparing two cohorts' clinical skills (n=156), with one class participating in a traditional curriculum during their first year and the other in a revised curriculum teaching wellness during the first year. Each class was evaluated at the beginning of their second year to determine their level of clinical competence. SETTING: University of Connecticut School of Medicine SUBJECTS: Second-year medical students. RESULTS: Analyses suggested that teaching wellness did not detract from future ability to perform an HPI, and in fact students taught wellness had significantly higher history-taking scores. CONCLUSIONS: Curricular innovations which stress wellness and prevention early in medical education do not detract from and may enhance students' ability to perform the history of present illness later during medical training.

Clinical Competence↗
PubMed1999

Angiotensin induces inflammatory activation of human vascular smooth muscle cells.

Multiple data suggest that the renin-angiotensin system contributes to the pathogenesis of atherosclerosis. The atherogenic effect of the renin-angiotensin system can only in part be explained by the influence of its effector angiotensin II on blood pressure, smooth muscle cell (SMC) growth, or antifibrinolytic activity. Because chronic inflammation of the vessel wall is a hallmark of atherosclerosis, we hypothesized that angiotensin II may elicit inflammatory signals in vascular SMCs. Human vascular SMCs were stimulated with angiotensin. Inflammatory activation was assessed by determination of interleukin-6 (IL-6) release into the culture medium, detection of IL-6 mRNA by RT-PCR, and demonstration of activation of nuclear factor-kappaB in electrophoretic mobility shift assays. Angiotensin II concentration-dependently (1 nmol/L to 1 micromol/L) stimulated IL-6 production by SMCs via activation of the angiotensin II type 1 receptor (demonstrated by the inhibitory action of the receptor antagonist losartan). Angiotensin I increased IL-6 production by SMCs, too. This effect was inhibited by captopril and ramiprilat, suggesting conversion of angiotensin I to angiotensin II by angiotensin-converting enzyme in SMCs. Steady-state mRNA for IL-6 was augmented after stimulation with angiotensin II, suggesting regulation of angiotensin-induced IL-6 release at the pretranslational level. Moreover, the proinflammatory transcription factor nuclear factor-kappaB, which is necessary for transcription of most cytokine genes, was also activated by angiotensin II. Pyrrolidine dithiocarbamate suppressed angiotensin II-induced IL-6 release, a finding compatible with involvement of reactive oxygen species as second messengers in cytokine production mediated by angiotensin. The data demonstrate the ability of angiotensin to elicit an inflammatory response in human vascular SMCs by stimulation of cytokine production and activation of nuclear factor-kappaB. Inflammatory activation of the vessel wall by a dysregulated renin-angiotensin system may contribute to the pathogenesis of atherosclerosis.

Angiotensin II↗
PubMed1994

Hormonal and behavioral responses of male hamsters to females and female odors: roles of olfaction, the vomeronasal system, and sexual experience.

Removal of the vomeronasal organ eliminated androgen surges in male hamsters in response to female vaginal secretions in both sexually experienced and sexually naive males; lesions of the olfactory mucosa had no effect on such responses. Both lesions led to deficits in behavioral responses to vaginal secretions. In response to interactions with estrous females, in contrast, lesions of either system alone had no influence on androgen surges in males (either sexually experienced or naive). Lesions of both systems, however, eliminated androgen surges in sexually naive males but not sexually experienced males. These dual lesions eliminated male mating behavior, while lesions of either system alone had little influence on mating. There were no significant correlations in any experiment between level of behavioral responses and degree of change in androgen levels. Thus, we conclude that the vomeronasal system mediates androgen surges in response to female odors but is not necessary for such responses to females themselves. In sexually naive males the vomeronasal and olfactory systems together are necessary for androgen responses to females. Behavioral responses were influenced by lesions and by sexual experience. Lesions of both systems increased the latency to investigate vaginal secretions, and sexual experience decreased the latency and increased the duration of investigation. Lesions and experience also influenced male sexual performance.

Androgens↗
PubMed1992

Socially stimulated androgen surges in male hamsters: the roles of vaginal secretions, behavioral interactions, and housing conditions.

The sources of cues necessary for elicitation of androgen surges and sexual behavior in male golden hamsters (Mesocricetus auratus) were investigated. Circulating androgen levels were measured in males after interactions with other males or several types of estrous females: intact females, vaginectomized females, or vaginectomized females scented with vaginal secretions. All groups of males that interacted with estrous females demonstrated significant elevations in androgens whereas those that interacted with other males did not. Thus, the presence of vaginal secretions is not necessary for the elicitation of androgen surges in sexually experienced male hamsters. Individual differences in sexual performance were not correlated with the degree of change in androgen levels, suggesting that such hormonal responses are not graded but are all-or-none. Housing males in isolation from females did not alter either baseline androgen levels or the magnitude of androgen responses caused by interactions with females.

Animals↗
PubMed1989

Methods used by urban, low-income minorities to care for their arthritis.

The purpose of this study is to describe the current treatment methods minorities use and believe are effective in relieving the pain and discomfort of arthritis. One hundred sixty subjects from two urban, low-income minority communities reported to case finders that they had some form of arthritis. Subsequently they were interviewed and examined by a rheumatologist. Sixty-six percent were black, and 34% were Hispanic. The study found that 83% had some type of rheumatic disease. Differences existed between the black and Hispanic samples in age, rheumatic disease distribution, and methods of care. The majority of black respondents were older, with a frequent diagnoses of osteoarthritis, compared to the Hispanics, who reported fibrositis as their dominant rheumatic problem. An array of conventional and nonconventional therapies were used by both groups to care for their arthritis. Prayer (92%), equipment (70%), and heat (33%) were reported as "most helpful" for the blacks. Hispanics reported prayer (50%), heat (40%), and topical ointments as "most helpful." In order to communicate and provide optimal care to patients from divergent cultural backgrounds, it is important to understand both likenesses and differences, and to be sensitive to the patient's belief system and health care practices.

Adult↗
PubMed1989

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors.

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward one's illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Connecticut↗
PubMed1989

Induction of peritoneal adhesions with small intestinal ischaemia and distention in the foal.

Twenty-two foals were divided into groups of intestinal distension and intestinal ischaemia as methods to induce peritoneal adhesions. In the first group, the lumen of a segment of distal small intestine was occluded without extramural vascular compromise and distended with lactated Ringer's solution to a constant pressure of 25 cm H2O for 2 h within the abdomen. The ischaemic group underwent 70 mins total vascular occlusion of identical segments of bowel. Serosal biopsies were obtained before and after each experimental procedure and following 60 mins of reperfusion. Similar biopsies were harvested from a control group of foals with no bowel occlusions. The foals were destroyed 10 days after surgery and tissues collected for histological and ultrastructural evaluation. Experimental and control mesothelial surfaces were denuded histologically immediately after experimental occlusions. Serosal oedema and cellular infiltration were observed following reperfusion of the ischaemic segments but were present immediately after 2 h of distension. All foals had developed bowel-to-bowel and bowel-to-mesentery adhesions of the experimental segments. Control foals under 30 days old exhibited mesenteric contraction and thickening of the isolated segment whereas those older than 30 days had little or no mesenteric thickening or contraction. Histologically, in the experimental segments, fibrous tissue had formed on the outer boundary of the original serosa, and new mesothelial-like cells were present on the surface of fibrous tissue in some areas. Some serosal fibrosis was also seen in most of the control segments.

Animals↗
PubMed1987

Computer-based patient education for older persons with osteoarthritis.

A program of 8 lessons on various aspects of osteoarthritis (OA), its treatment, and patient self-care was prepared on an Apple IIc computer. The courses were then field-tested and evaluated by 72 older (age range 52-88) OA patients in community centers for senior citizens. Statistical analysis of the findings showed significant increases in knowledge and significant self-reported, beneficial behavior changes, including increased exercise, use of heat, and rest. Our findings demonstrate that older persons can use the computer to learn to cope with OA when a thoughtfully planned program is made available in a community setting.

Aged↗
PubMedDate not supplied

Social and psychological aspects of illness--past and present.

As industrialization and automation spread in the workplace in the 19th century and economic needs shifted, one major cultural response was to redefine the nature of women as fragile physically, intellectually inferior, and too emotionally unstable to stand the rigors of the workplace. These views persist today, as women are back in the workforce in numbers higher than ever. The elements in society, home, and workplace that contribute to absenteeism, poor or inconsistent performance, and depression among women are reviewed. This chapter reviews the historical events in the saga of women in the workplace and analyzes the contemporary status of those who are striving toward better work environments and greater occupational health for women workers.

Female↗