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Biomedical subjects

M Albanese

Publications and source records attributed to M Albanese.

At least 19 recordsLinked to original sources
PubMed2000

Implant placement in the maxillary tuberosity: the Summers' technique performed with modified osteotomes.

The maxillary tuberosity region is becoming increasingly involved in preprosthetic surgery as part of a comprehensive implant treatment planning. The lower success rates in osteointegrated implant placements seen in the posterior regions of the upper maxilla as compared to the anterior regions of the jaws, most often come from bone quality types and the presence of the maxillary sinus. In order to overcome these limitations and obtain a successful result in such a demanding area, several authors suggest that long implants (15.0 to 20.0 mm long) should be placed in the maxillary tuberosity region as an alternative to sinus floor elevation. The challenges frequently associated with the surgical placement of "maxillary tuberosity implants" (MTI), can be reduced through a "Ridge Expansion Osteotomy" (REO) procedure as described by Summers (1994). This indeed improves the recipient bed bone quality and causes no bone overheating. In order to improve this technique performed for MTI, in co-operation with Ing. Albanese G, authors have developed different prototypes of modified osteotomes. A case report using these new instruments is presented. Clinical and radiographic evaluations are obtained.

Dental Implantation, Endosseous↗
PubMed2000

Problem-based learning: why curricula are likely to show little effect on knowledge and clinical skills.

OBJECTIVES: A recent review of problem-based learning's effect on knowledge and clinical skills updated findings reported in 1993. The author argues that effect sizes (ES) seen with PBL have not lived up to expectations (0.8-1.0) and the theoretical basis for PBL, contextual learning theory, is weak. The purposes of this study were to analyse what constitutes reasonable ES in terms of the impacts on individuals and published reports, and to elaborate upon various theories pertaining to PBL. DESIGN: Normal theory is used to demonstrate what various ESs would mean for individual change and a large meta-analysis of over 10 000 studies is referred to in identifying typical ESs. Additional theories bearing upon PBL are presented. RESULTS: Effect sizes of 0.8-1.0 would require some students to move from the bottom quartile to the top half of the class or more. The average ES reported in the literature was 0.50 and many commonly used and accepted medical procedures and therapies are based upon studies with ESs below 0.50. CONCLUSIONS: Effect sizes of 0.8-1.0 are an unreasonable expectation from PBL because, firstly, the degree of changes that would be required of individuals would be excessive, secondly, leading up to medical school, students are groomed and selected for success in a traditional curriculum, expecting them to do better in a PBL curriculum than a traditional curriculum is an unreasonable expectation, and, thirdly, the average study reported in the literature and many commonly used and accepted medical procedures and therapies are based upon studies having lesser ESs. Information-processing theory, Cooperative learning, Self-determination theory and Control theory are suggested as providing better theoretical support for PBL than Contextual learning theory. Even if knowledge acquisition and clinical skills are not improved by PBL, the enhanced work environment for students and faculty that has been consistently found with PBL is a worthwhile goal.

Clinical Competence↗
PubMed2000

Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report.

The authors report a case of vertical distraction osteogenesis of a free revascularized fibula flap used to reconstruct an hemimandible lost as a result of a gunshot injury. The reconstruction procedure and the distraction protocol are described; clinical and radiological results are presented. The vertical discrepancy between the fibula and the native right hemimandible was corrected.

Adult↗
PubMed2000

Collaboration and peer review in medical schools' strategic planning.

The management of medical schools has never been so difficult, but can be facilitated by using a well-developed, broadly accepted strategic plan. While the concept of strategic planning has been reasonably well accepted by both faculty and leaders at most medical schools, using the strategic plan to allocate resources has proved to be a challenge. Achieving "buy-in" by all parties involved can help meet this challenge and can be critical to the success of strategic planning and management. The authors describe the collaborative planning process that the University of Wisconsin Medical School used to develop its 1998-2000 strategic plan. This unique effort culminated in using a peer-review process--similar to that used by the National Institutes of Health (NIH)--and developing criteria to select a limited number of program priorities. This selection occurred after a school-wide process to solicit strategic program proposals had taken place. Over 130 faculty from most departments throughout the school helped develop and revise the strategic plan. There was frequent communication and engagement with faculty at all levels, which was important in gaining the faculty's acceptance and, indeed, endorsement of the process and its outcomes. Because the process was effective in achieving consensus about the school's strategic priorities, it enabled the school to reach a firmer end-point and implementation plan than had been possible with the previous strategic plan. It also identified important weaknesses in some areas of the medical school; the resulting attention to those areas will help strengthen the school. Finally, the process moved much more swiftly than the previous effort. The authors recommend that such an approach be used by other medical schools, and be carried out before a school implements mission-aligned budgeting and management of its fiscal resources.

Curriculum↗
PubMed2000

Treatment of small hepatocellular carcinoma with percutaneous ethanol injection: a validated prognostic model.

OBJECTIVE: Percutaneous ethanol injection may prolong the survival of patients with small hepatocellular carcinoma associated with cirrhosis. The aim was to identify prognostic factors of survival and of local recurrence, as well as separate new lesions. METHODS: We performed Cox regression analysis in 115 consecutive patients with hepatocellular carcinoma (81 Child-Pugh class A, 34 Child-Pugh class B) treated by percutaneous ethanol injection. The validity of the model was tested by comparing predicted and observed survival in 105 independent patients from an external series. RESULTS: Overall survival rates were 89%, 63%, and 43% at 1, 2, and 3 yr, respectively. The 1-, 2-, and 3-yr survival rates were 96%, 78%, and 63%, respectively, for Child-Pugh class A patients and were 73%, 35%, 12%, respectively, for Child-Pugh class B. The albumin level was the only independent variable significantly associated with survival (p < 0.0001). The 3-yr rate of appearance of separate new lesions and local recurrence were 41% and 23%, respectively. The survival predicted by the model agreed with that observed in the independent patients. CONCLUSIONS: Survival of patients with hepatocellular carcinoma treated by percutaneous ethanol injection is related to baseline albumin level. The high rate of recurrence (both local and distant) points out the palliative role of this therapy.

Aged↗
PubMed1999

Rating educational quality: factors in the erosion of professional standards.

Changes in the health care environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgments, analyzes how changes in the health care environment are influencing such judgments, and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination, and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings, and factors affecting rater judgment. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate, and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Academic Medical Centers↗
PubMed1999

Students are not customers: a better model for medical education.

The author argues that the student-as-customer model of medical education has many failings that result in interactions that are educationally dysfunctional. Ten "pathologies" resulting from the adoption of this model are presented (e.g., "The student-customer model seduces students into believing that they know what is best for them"). Part of the reason for the unprofessional conduct often demonstrated by students and faculty alike may be a result of the influence of this model on medical education and the consequent inappropriate empowerment of students in the role of customers, the diminishment of faculty in the role of workers who provide instruction, and the view that instruction is the service or product of medical education. The author proposes a new model of medical education in which faculty are managers of instruction, students are learning workers, the product is successful learning, and the customers are faculty, residency supervisors, patients, managed care organizations, and society. The implications of this new model are profound and are described in terms of Deming's 14 principles for achieving quality in business. The author maintains that the proposed model is the critical first step in clarifying and identifying the proper roles of all those involved in the medical education process, which in turn will diminish or eliminate the pathologies that currently plague medical education and lead to the achievement of real quality.

Community Participation↗
PubMed1999

Gross pathologic types of hepatocellular carcinoma in Italy.

The prevalence and independent predictors of the different macroscopic types of hepatocellular carcinoma (HCC) were assessed in 1,073 unselected patients of 14 hospitals in Italy from May 1996 to May 1997. Solitary HCC was the most common cancer type (44.6%), followed by multinodular (44.2%), diffuse (8.4%) and massive (2.8%) types. After adjustment for the influence of confounders by multiple logistic regression analysis, Child-Pugh grades B and C were found to be independent predictors of multinodular (odds ratio, OR, 2.0; 95% confidence interval (CI) = 1.5-2.6) and diffuse (OR 2.6; 95% CI = 1.6-4.4) HCC types. These findings indicate that the majority of HCC cases are not detected at a potentially treatable stage. Delayed detection of HCC is associated with a higher likelihood of the multinodular or diffuse gross pathologic type.

Carcinoma, Hepatocellular↗
PubMed1998

Evaluation of Internet-based oncologic teaching for medical students.

BACKGROUND: Electronic tools with substantial educational applications are now widely available. METHODS: In a prospective, randomized study, the value of Web-based educational tools for teaching second-year medical students was evaluated. The 35-hour, image-intensive multifaculty neoplasia course was selected for the experiment, with 103 students assigned to the control group (C) and 61 to the experimental group (E). Representative password-controlled multimedia course modules, accessible via the Internet, were developed. The E cohort was exposed to both classroom and Web-aided materials, whereas the C group had access to the Web modules only after the experiment was concluded (but before the final examination). Pre- and post-exposure questionnaires assessed computer knowledge, familiarity with the Internet, availability of computer access, and the value of Web-based education for both cohorts. Additionally, pre-and post-exposure tests were administered to both cohorts based on educational materials presented in the Web modules. RESULTS: The overall participation rate was 64% (E = 69%; C = 60%). The post-test showed no major performance difference between the two groups. The questionnaires revealed that: less than 1% of the students had not accessed the Internet previously; less than 5% had not used the Internet for medical education before; 34% felt that computer resources on campus were inadequate; and over 75% found Web-based education to be an important additional educational resource. The major negative aspect was the slow pace of data transfer for modem-based home access. Only 1% of students felt that Web-based education could completely replace traditional teaching. CONCLUSION: The potential for incorporating Web-based education in the medical curriculum is considerable.

Computer Literacy↗
PubMed1998

Successful peer review of courses: a case study.

The authors describe their school's system of peer review for courses, established in 1988 to facilitate faculty evaluation and continual course and curriculum improvement. (The system has been temporarily suspended while the school's new curriculum becomes established.) They explain how the system was created and then report how faculty reviews of courses over the five-year operation of the system compared with students' reviews of the same courses. The faculty and students' ratings were in agreement 75% of the time. When not in agreement, the students' ratings tended to upgrade courses that were not very demanding, had easy grading, and emphasized clinical details, often at the expense of basic concepts and the big picture. The authors then document how the work of the peer review system favorably influenced the transformation of the school's curriculum. They also provide guidelines for the creation and operation of a course review process that uses faculty peers. The authors maintain that the peer review system worked because it was run by a committee of experienced and respected teachers who had been selected by their peers, the other faculty. Additional reasons for its success were that the school's faculty supported and respected the committee and its work, that course directors helped evaluate their courses, and that peer reviewers took their work seriously despite having no remuneration, and the clearly positive impact of the review system on faculty interaction, faculty-student interaction, and the reform of the curriculum.

Curriculum↗
PubMed1998

An institutionally funded program for educational research and development grants: it makes dollars and sense.

Lack of funding for educational research and a paucity of researchers with academic credibility have been identified as the key issues facing the medical education research enterprise. The authors argue that institutionally supported programs for educational research and development grants can help to address these issues. This report (1) describes the general rationale for having such programs, (2) describes the development of such a program at the University of Wisconsin School of Medicine, and (3) reports the outcome of the first three cycles of awards. The program outcomes include 28 intramurally funded projects, a 200% increase in funds for educational research from local sources other than the medical school, two new grants funded from extramural sources, one peer-reviewed publication, three presentations at national meetings, and six presentations at local meetings. Such a program is an excellent mechanism for demonstrating the administration's support for educational efforts and also provides a way to factor peer review of educational efforts into the faculty promotion process. The authors argue that these two reasons alone are sufficient to justify the development of such programs, although the outcomes at the University of Wisconsin also show compelling added value.

Education, Medical↗
PubMed1997

The effect of right or left placement of the positive response on Likert-type scales used by medical students for rating instruction.

PURPOSE: To determine whether students' ratings of instruction demonstrate a primary effect, to determine whether the primacy effect relates to the number of response options, and to assess whether the primacy effect relates to how favorably the instructional activity is rated. METHOD: Inf 1995-96 six different forms of a 13-item course-evaluation questionnaire (with Likert-type items) were used to evaluate two second-year courses, Respiratory and Hepatic, at the University of Wisconsin Medical School; the first was one of the most highly rated courses at Wisconsin, and the second was less highly rated. The forms differed by whether they contained five, six, or seven response options, and whether the "strongly agree" rating was on the left side or the right side of the page. The second-year class that participated in the study comprised 140 students. The six different forms of the course-evaluation questionnaires were randomly distributed to the students in equal numbers. Results were analyzed with a number of statistical methods. RESULTS: Completed questionnaires were obtained from 132 students (94%) in Respiratory and from 119 students (85%) in Hepatic. Overall, the forms with the positive rating on the left side had more positive ratings and less variance. For Respiratory, primacy affected the response variance. For Hepatic, primacy affected the response means. CONCLUSION: Faculty-evaluation systems are increasingly using students' ratings for making important decisions regarding salaries, teaching assignments, tenure, etc. The evidence that the primacy effect influences such ratings highlights the need to standardize as much as possible how such ratings are obtained.

Education, Medical↗
PubMed1996

Three-dimensional structure of the LDL receptor-binding domain of the human apolipoprotein E2 (Arg136-->Cys) variant.

The familial lipoprotein disorder type III hyperlipoproteinemia (HLP) is usually inherited as a recessive trait. Indeed, more than 90% of affected individuals are homozygous for a receptor binding-defective isoform of apolipoprotein (apo) E, apo E2. However, some rare apo E variants have been described that dominantly (thus in a single dose) predispose to the disease. Amino acid substitutions, which are accompanied with the loss of positive charges within the proposed apo E binding-region to lipoprotein receptors, seem to be responsible in most of these cases for the dominance with respect to the expression of type III HLP. So far available data in the literature on the naturally occurring human apo E2 (Arg136-->Cys) variant are not conclusive about its recessive or dominant character. We recently identified a subject heterozygous for this mutation, presenting the typical clinical and biochemical characteristics of type III HLP. In the present study we performed further analysis of the mutation on apo E structure and function based on computer modeling. Our combined data point to a dominant influence of the apo E2 (Arg136-->Cys) variant with respect to the transmission of the disease.

Apolipoprotein E2↗