Disaster planning & fire safety.
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Burns↗
Biomedical subjects
D Irby
Publications and source records attributed to D Irby.
Measuring the costs of primary care education in the ambulatory setting.
In 1995, the authors obtained cost, operations, and educational activity data from 98 ambulatory care sites across the United States in which primary care teaching was occurring and compared those data with the corresponding data from 84 ambulatory care sites where no teaching was going on. The teaching sites in the sample were found to have 24-36% higher operating costs than the non-teaching sites. This overall difference in costs is approximately the same difference in costs earlier estimated for university teaching hospitals compared with non-teaching hospitals. These costs are shared by all involved in the ambulatory education process: sponsors, sites, and faculty. In a related finding, the authors discovered that 30-50% of all ambulatory care sites thought not to be involved in education are in fact teaching at a high level of involvement. Further research into not only the costs but the value of education in the clinical setting is encouraged. The authors also hope that the publication of this report will encourage accrediting bodies and professional organizations to improve the information available about ambulatory care training in general.
Ambulatory Care↗
Time-efficient preceptors in ambulatory care settings.
PURPOSE: With increasing amounts of medical education occurring in ambulatory care and managed care settings, time-efficient and educationally effective teaching methods are in high demand. To identify such methods, four exemplary preceptors who taught in a family medicine clerkship in the context of their managed care clinics were observed in two consecutive years. The purpose of this second observational case study was to look at the teaching and practice strategies of these four exemplary preceptors in more detail and to directly measure the use of strategies that have previously been identified. METHOD: Observation of 44 patient encounters by four exemplary preceptors in ambulatory managed-care settings. RESULTS: On average, these preceptors spent one minute per patient more when the student was involved. With students present, the preceptors saved 3.3 minutes per patient in charting time, while spending 2.2 minutes more listening to student presentations and 1.6 minutes more in pure teaching time. The preceptors spent half a minute less time in direct contact with each patient when a student was present. However, the patients received 12.4 additional minutes from the health-care team. CONCLUSION: Time savings from student charting may allow preceptors to teach and care for patients without losing valuable practice time.
Ambulatory Care↗
The interdisciplinary team's approach to lupus nephritis.
The interdisciplinary team approach in assessment and treatment of patients with chronic disease in general and lupus nephritis in particular provides a global format for identifying the multiple problem areas that retard or prevent optimal patient functioning. These areas include the physical, emotional, economic, psychosocial, and functional. Benefits to the individual patient include a thorough multifaceted assessment by professionals who have the benefit of peer collaboration and validation. This increases the likelihood that the whole patient is considered, not just the problem of nephritis. For example, how does the patient and her or his family cope with the impact of such a disease and how, in turn, do the coping abilities of the patient and family affect the disease. The interdisciplinary team also assesses how the treatment strategies for each problem area influence each other. Finally, the interdisciplinary team serves as a positive role model for effective collaboration among health professionals and for students in their respective disciplines.
Adult↗
Effects of chronic ethanol on growth hormone secretion and hepatic cytochrome P450 isozymes of the rat.
Growth hormone (GH) secretion is sexually dimorphic in the laboratory rat and the plasma GH profile is a determining factor in the regulation of the male-specific cytochrome P450 (CYP) 2C11. Acute ethanol has been reported previously to alter the secretion of GH, and in the present investigation, we have studied the effects of chronic (38 days) ethanol on plasma GH profiles, CYP 2C11 and the major ethanol-inducible cytochrome, CYP 2E1, using a total enteral nutrition system, where 35% of the total calories were ethanol. Ethanol-treated rats had elevated (P < or = .05) CYP 2E1 activities and apoprotein levels and increased steady-state mRNA levels encoding for CYP 2E1. Ethanol-treated rats also had reduced (P < or = .05) hydroxylation of testosterone at positions 2 alpha and 16 alpha, lower 2C11 apoprotein levels and lower steady-state mRNA levels encoding for 2C11. In addition, the plasma GH pulse profiles were altered in chronically treated rats by reducing (P < or = .05) the GH pulse amplitude and mean plasma GH concentrations. Our results suggest that: 1) the reduced CYP 2C11 activities, apoprotein levels and steady-state mRNA levels during chronic alcohol exposure are causally related to the alterations in GH secretion; and 2) chronic alcohol exposure elevated CYP 2E1 activities, apoprotein levels and steady-state mRNA levels, and these changes occurred primarily as the result of ethanol rather than undernutrition or as the combination of ethanol and undernutrition.
Androgens↗
Episodic excretion of ethanol during chronic intragastric ethanol infusion in the male rat: continuous vs. cyclic ethanol and nutrient infusions.
Continuous intragastric infusion of ethanol has been reported to result in episodic daily blood alcohol concentrations in male rats (Tsukamoto et al., 1985). We have used a total enteral nutrition (TEN) model to study the effects of chronic alcohol exposure on blood and urine alcohol concentrations in adult male Sprague Dawley rats (300 g). Two TEN models were studied: 1) the continuous model in which a complete diet was infused i.g. for 24 h/day; or 2) the cyclic model in which TEN was infused intragastrically for 12 h/day (i.e., only during the dark phase of the lighting cycle). In the continuous model, blood alcohol concentrations (BACs) were determined at 0900 h each morning and were found to vary from day to day in an episodic fashion, with values ranging from less than 10 mg/dl to greater than 500 mg/dl. The urine alcohol concentrations (UACs) were also episodic and closely tracked those of serum, such that the 24-h UACs were excellent predictors of the BACs taken at 0900 h. Both BACs and UACs increased from values below 10 mg/dl to greater than 500 mg/dl, and then decreased back to below 10 mg/dl with a mean peak-to-peak interval of 6 +/- 0.9 days. In the cyclic model, daily UACs were also episodic (i.e., had a daily variation) and very closely resembled those of the continuous model. We have proposed that ethanol metabolism during experimental intragastric ethanol infusion in the rat occurs via a system characterized by time-dependent pharmacokinetics.
Alcohol Dehydrogenase↗
Cytochrome P450 CYP 2E1 induction during chronic alcohol exposure occurs by a two-step mechanism associated with blood alcohol concentrations in rats.
Intragastric infusion of ethanol to male rats as part of a system of total enteral nutrition allows chronic ethanol treatment without the nutritional and feeding problems associated with traditional liquid diets. Even though ethanol was infused at a constant rate 24 h a day, blood alcohol concentrations were observed to cycle over a 5- to 7-day period from values less than 10 mg/dl to greater than 400 mg/dl. Examination of the hepatic microsomal mono-oxygenase system in animals chronically treated with ethanol using this model revealed variable induction of cytochrome P450 CYP 2E1, the principal component of the microsomal ethanol oxidizing system. Correlations were observed between urine alcohol concentrations (UACs) and 1) the level of expression of CYP 2E1 mRNA in Northern blot analysis, 2) the level of CYP 2E1 apoprotein in Western blot analysis and, 3) microsomal p-nitrophenol (PNP) hydroxylation. The data from ethanol-treated animals were expressed as low UAC group (UACs < 200 mg/dl) and a high UAC group (UACs > 300 mg/dl) and compared to total enteral nutrition controls. In the low UAC group, a 6- to 7-fold induction in microsomal PNP hydroxylase (a CYP 2E1-dependent activity) was accompanied by a 4- to 5-fold increase in CYP 2E1 apoprotein, but no increase in CYP 2E1 mRNA levels. In contrast, in the high UAC group, induction of PNP hydroxylase was 15- to 16-fold, induction of CYP 2E1 apoprotein was 12- to 13-fold and CYP 2E1 mRNA was elevated 5- to 6-fold.(ABSTRACT TRUNCATED AT 250 WORDS)
Alcohol Dehydrogenase↗
Circulating maternal immunoreactive inhibin levels during pregnancy in the rat: effects of oophorectomy, hypophysectomy, hemihysterectomy, delayed implantation and pseudopregnancy.
This study examines the source of inhibin in the maternal circulation of pregnant rats by measuring serum immunoactive inhibin levels following a range of experimental procedures. Ovariectomy at days 7, 13 or 19 of gestation, with maintenance of pregnancy by supplementation with progesterone and oestradiol dipropionate, led to a profound fall of serum inhibin levels in comparison with controls, demonstrating that the ovary is a major source of circulating inhibin. This conclusion was supported by the inhibition of the late rise (days 16-22) in serum inhibin in pregnant rats which were hypophysectomized on day 15 and maintained with oestrogen and progesterone supplementation. These data support the view that the rise in serum inhibin from days 16 to 22 is due to re-activation of follicular development in preparation for the post-partum oestrus. Reduction of fetal numbers by hemihysterectomy on days 7, 13 or 19 did not alter serum inhibin levels. Induction of delayed implantation by ovariectomy on day 3 and progesterone supplementation together with initiation of reimplantation by the addition of oestradiol dipropionate on day 7 or 11 did not significantly alter inhibin levels. The induction of pseudopregnancy by mating to vasectomized rats did not result in the maintenance of stable serum inhibin levels until oestrous cycles recommenced. Taken together, the studies have identified the ovary as the predominant source of circulating maternal inhibin levels throughout pregnancy in the rat.
Animals↗
Effect of hypophysectomy on schedule-induced wheelrunning.
Previous research has shown that adrenalectomy suppresses schedule-induced wheelrunning, and that the suppressant effect of adrenalectomy can be totally reversed by the replacement of corticosterone. The present study confirms the role of the hormones of the pituitary adrenocortical axis in the control of schedule-induced wheelrunning by means of hypophysectomy. As anticipated, hypophysectomy also suppressed schedule-induced wheelrunning. The suppressant effect of hypophysectomy on schedule-induced wheelrunning was partially, but significantly restored by the implantation of corticosterone. Present findings, in conjunction with the previous work, show that schedule-induced wheelrunning is markedly dependent on the function of the pituitary-adrenal axis, and the nature of pituitary-adrenal involvement is mainly through circulating corticosterone levels.
Animals↗
Radioimmunoassay of rat serum inhibin: changes after PMSG stimulation and gonadectomy.
A heterologous inhibin radioimmunoassay (RIA) method has been developed which is highly specific and of sufficient sensitivity to detect inhibin in female and male rat serum. Purified bovine 31 kDa inhibin was used in the generation of the antiserum and following iodination as tracer in the assay. Parallel logit-log dose-response lines were observed between a rat ovarian extract used as standard and serial dilutions of female and male serum and testicular interstitial fluid. The within-assay variation based on index of precision was 0.049 (n = 5) and the between-assay variation (n = 4) was 9.8%. The specificity of the assay was assessed from: (a) the failure of a number of structurally related proteins (activin-A, transforming growth factor-beta (TGF-beta), Müllerian inhibitory substance) as well as inhibin subunits to crossreact (less than 0.5%) in the assay relative to bovine 31 kDa inhibin; (b) nondetectable levels of immunoactivity in the serum of gonadectomised rats; and (c) a close correlation (r = 0.96) between serum levels of in vitro biological and immunological activities from rats following pregnant mare serum gonadotropin (PMSG) stimulation. Similar initial t 1/2 values (14-15 min) of serum inhibin following gonadectomy were obtained in both sexes. This RIA method will be useful in the study of the physiology of inhibin in the female and male rat.
Animals↗
Behavioural effect of adrenalectomy: reversal by glucocorticoids or [D-Ala2,Met5]enkephalinamide.
Rats adrenalectomized 4-6 d before a 15-min swimming test showed levels of immobility indistinguishable from controls. Retested 24 h later, adrenalectomized rats showed significantly reduced (28%) immobility compared with controls (70%) or hypophysectomized rats (60%), but not hypophysectomized-adrenalectomized rats (41%). The effect of adrenalectomy was reversed by the administration (within 1 h of initial test, but not subsequently) of dexamethasone (6-20 micrograms; 65% immobility) and corticosterone (6 mg; 74%), but not by the mineralocorticoid deoxycorticosterone (6 mg; 33%). [D-Ala2,Met5]enkephalinamide (5-50 micrograms) also restored immobility (66%). We postulate that hormones from both adrenal medulla and cortex are involved in the retention of information post-stress, and that these hormones act directly on the CNS rather than via the pituitary, since the response to adrenalectomy is not dependent on the presence of the pituitary gland.
Adrenalectomy↗
Evaluating clinical teaching in medicine.
Medical student ratings of clinical teaching in an obstetrics and gynecology clerkship are examined. Analyses were made on 1,567 ratings of 230 faculty members and residents by 320 students. Results revealed high interrater reliability. Overall teaching effectiveness correlated strongly with enthusiasm and active involvement of students. Four underlying factors of clinical teaching were identified through factor analysis. The utility of these data is discussed in relation to faculty development, administrative decision-making, and academic promotions.
Decision Making↗
An appraisal of methods of evaluating training in psychiatry.
A survey of American chief residents in psychiatric training centres was carried out to assess how these training programmes gathered feedback on teacher effectiveness and programme content. The chief resident in each programme was asked to report how his or her department elicited information from their residents about course and teacher quality. Responses from 184 training centres in the United States were obtained and accounted for 75% of the existing centres. Fifty questionnaires were returned with the survey results and were analysed. The seven factors of clinical teacher effectiveness previously described in the literature were used to evaluate these questionnaires. The majority lacked consistent coverage of the teaching factors with the percentages of questionnaires covering a specific behaviour as follows: teacher organization, 58%; instructor knowledge, 42%; group interactional skills, 42%; instructor enthusiasm, 30%; clinical supervision skills, 25%; display of professional characteristics, 19%; and clinical competence, 17%.
Behavior↗
The effects of two methods of pelvic examination instruction on student performance and anxiety.
The impact of two methods of pelvic examination instruction on student performance and anxiety was examined. Forty second-year medical students were randomly assigned either to an experimental group which received initial pelvic examination instruction from professional patients or to a control group which received this instruction from a gynecologist with a clinic patient. Results revealed no significant difference between experimental and control subjects in subsequent performance of the pelvic examination, on heart rate, or on perceived anxiety using one anxiety inventory. However, significant differences were found using a second anxiety instrument. The cost per student examination was twice as much for the clinic-patient group as for the professional-patient group. These findings are discussed in relation to prior research and instructional practices.
Anxiety↗
Evaluating student performance in an obstetrics and gynecology clerkship.
The development of a comprehensive evaluation system for an obstetrics and gynecology clerkship at the Unviersity of Utah is described and the results of two years experience using it are presented. Seven different measurement procedures were developed and used with 111 junior medical students including pre- and post-tests, oral examination, clinical performance ratings by residents, and ratings by faculty on oral and written presentations and participation in tutorial sessions. Learning gains as measured by pre-post test scores were significant at the 0.001 level. Only six of 37 correlations among the evaluation measures were significantly related at the 0.01 level; furthermore, little relationship could be found between measures of student achievement in cognitive as compared to clinical skill areas. The need for multiple sources of information on student performance in clerkships is discussed.
Clinical Competence↗
A national survey of undergraduate teaching in obstetrics and gynecology.
Representatives of 114 academic departments of obstetrics and gynecology in North America completed a written questionnaire in 1977 designed to assess undergraduate educational programs. Respondents reported increases in numbers of departments and faculty per department and decreases in the length and number of students per clerkship in comparison with a 1968 survey. Small-group discussion, lecture, and professional patients were preferred instructional modalities of faculty and students. Evaluation procedures and faculty development activities are reported and discussed in relation to prior surveys of departments of obstetrics and gynecology.
Curriculum↗
Testicular maturation in the rabbit: secretion of testosterone, dihydrotestosterone, 5alpha-androstan-3alpha, 17beta-diol and 5alpha-androstan-3beta, 17beta-diol by perfused rabbit testes-epididymides and spermatogenesis.
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Androgens↗
A model for the improvement of medical faculty lecturing.
The development of a program designed to improve the teaching effectiveness of faculty members of a new Introductory Psychopathology course at the University of Washington School of Medicine is described. Two consultants from the Office of Research in Medical Education worked closely with the faculty in designing the evaluation program during the preparation of the course. The literature on lecture effectiveness is reviewed, as are existing instructional evaluation instruments. The integration of this information and the needs of the involved faculty produced a lecture observation schedule designed to facilitate the observation of a lecture and the immediate feedback which followed each of the 15 lectures evaluated. The process of using this instrument to assist the faculty in self-improvement is discussed. While the specific evaluation method described may not be appropriate for all situations, it may serve as a model for the development of similar programs in other settings.
Evaluation Studies as Topic↗