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Biomedical subjects

M K O'Brien

Publications and source records attributed to M K O'Brien.

14 recordsLinked to original sources
PubMed2000

Integrating a domestic violence education program into a medical school curriculum: challenges and strategies.

BACKGROUND: Domestic violence affects millions of women in the United States each year. Physicians are in a unique position to screen for violence in their patients' homes and refer individuals before they are injured or killed. All U.S. medical schools are expected to incorporate partner violence into their curricula. DESCRIPTION: The MCP Hahnemann School of Medicine has developed and integrated a domestic violence educational intervention program into the existing problem-based medical school curriculum. This educational intervention includes modification of an existing teaching case to include signs and symptoms specific to domestic violence, written learning objectives on domestic violence in the health care setting, relevant resource material, and a 3-hr training program conducted by an interdisciplinary teaching team. EVALUATION: Based on quantitative and qualitative data over a 3-year period, this domestic violence education program has been successfully integrated into an existing problem-based curriculum. Overall, the high student exam scores indicate the effectiveness of the teaching program. In addition, the students' evaluation of the program reflects a high level of student satisfaction with the curriculum presented on domestic violence. CONCLUSION: This article describes both the content of a domestic violence teaching program and the process used to integrate such a program into a medical school curriculum. Although medical schools and their teaching programs are uniquely structured, with slight modifications they are able to accommodate domestic violence teaching programs.

Curriculum↗
PubMed1998

Essentials: going online.

The moment has arrived for you to go online! This article provides an overview of online access and Internet services. Resources are suggested and hints are offered to get the novice started on the information highway. Enjoy your journey!

Computer User Training↗
PubMed1997

Love, boundaries, and the patient-physician relationship.

Physicians often use their relationships with patients to promote specific therapeutic goals. Because of their personal histories, values, and biases, patients may react to physicians in ways that inhibit or enhance the relationship. The feelings that are aroused may induce physicians to become overly distant, engendering patient and physician dissatisfaction, or to become overly involved emotionally, which can have serious psychological and clinical consequences. We explore how a balance between clinical objectivity and bonding with the patient is optimal and achievable. The nature and origin of personal boundaries are described. Boundary transgressions on the part of the patient are discussed, and the means of preventing transgressions by both patients and physicians through medical education, the process of self-awareness, and an exploration of family-of-origin issues are proposed. Through attention to communication with patients, the physician can maintain an empathetic yet objective relationship with the patient.

Awareness↗
PubMed1996

An innovative CME program in cardiology for primary care practitioners.

The authors describe an innovative continuing medical education (CME) program they developed to improve the ability of community practitioners to manage common cardiology problems. The program includes an objective structured clinical examination (OSCE) with nine standardized patient (SP) stations. The SPs are trained to use checklists to assess the examinees' clinical skills, and to enter the checklist data directly into computers located within each of the examining rooms. Checklists cover the participants' knowledge of cardiology, and their interviewing, physical-examination, and counseling skills. The computer immediately generates detailed individual reports, which include a skills report, reflecting performance of core skills across all nine stations with group means for comparison, and an omissions report, listing items missed in each case for each participant and, again, comparing the results with group means. Participants review and discuss their performances and then discuss identified learning issues with a cardiologist. The cardiologist also reviews state-of-the-art diagnosis and treatment for the cases presented in the OSCE. Participants have reported having a high regard for the program and have indicated that the program has left them better prepared to deal with clinical cardiology issues.

Attitude of Health Personnel↗
PubMed1993

The effect of parents' alcohol problems on children's behaviour as reported by parents and by teachers.

Associations between parents' alcohol problems when children were aged 9 and children's behaviour at ages 9 and 13 as reported by parents and teachers were investigated. The sample consisted of participants in a multidisciplinary longitudinal study, data were collected by face-to-face interview. When compared to children with no or mild parental alcohol problems, children classified as having severe parental alcohol problems were more likely to display high levels of problem behaviour at age 9 as reported by teachers and at age 13 as reported by parents. Poorer family relationships, lower verbal and reading proficiency and being male were also associated with high levels of behaviour problems.

Achievement↗
PubMed1992

Adherence to medication regimens: updating a complex medical issue.

Clinicians face nonadherence as the norm in everyday medical practice. The literature suggests a number of techniques that are likely to increase adherence when incorporated into regular clinical practices and routines. Central to these guidelines appears to be the doctor-patient relationship. For instance, the physician who uses understandable language, encourages open doctor-patient exchange, fosters participation by patients in their own medical care, and creates a friendly and efficient environment should increase the likelihood of adherence. Clinicians can also check adherence to medication regimens by requesting patients to bring in their pill bottles (or other prescription containers) for a discussion on how the medication appears to be working for them. This should elicit information from the patient about problems related to medication adherence. Since patient variables and social support affect adherence behaviors, eliciting information from patients about their understanding and beliefs regarding their particular illness and treatment, as well as enlisting the support of family and friends, may encourage adherence. Identifying what individual patients perceive as obstacles in following treatment regimens decreases their likelihood of nonadherence; these are difficulties that can be negotiated during the medical interview. Individualizing the treatment and minimizing its complexity may provide the solution that encourages adherent behavior. Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition. Some patients may even wish to openly solicit family and friends for help in the management and monitoring of their illness and treatment, and to structure their environment to support adherence. Education programs for the patient featuring handouts and pamphlets that provide information about the illness in written and illustrated form have been used successfully. Education programs such as patient-oriented package inserts to accompany the medications and brief written summaries of complex treatment plans may also be useful. The purpose of such patient education adjuncts to illness and treatment lie in the hope that they will enhance the likelihood of following treatment recommendations. Through their use, the reason for the treatment and its potential effectiveness will, it is hoped, be better understood (Ley 1988). Overall, significant advances have been made in adherence research. Measurement systems have become more finely tuned, and the definitions and criteria for adherent behaviors are more clear and precise.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗
PubMed1990

Development and survival of thoracic motoneurons and hindlimb musculature following transplantation of the thoracic neural tube to the lumbar region in the chick embryo: anatomical aspects.

Thoracic spinal cord transplanted to the lumbar region at the time of neural tube closure in the chick embryo survives and initially differentiates normally similar to in situ thoracic cord. Normal numbers of motoneurons are produced that innervate the host hindlimb musculature. In control thoracic cord approximately 70% of the motoneurons are lost by normal cell death between embryonic day (E) 6 and E11-E12. By contrast, the transplanted thoracic cord loses only about 30% of the motoneurons during this period. Transplantation of one hindlimb to the thoracic region also reduces the normal loss of in situ thoracic motoneurons. We conclude that some factor(s) associated with the increased target size provided by the hindlimbs promotes the survival of thoracic motoneurons. In contrast, by E16-E18 motoneuron numbers in the thoracic transplants decrease to below control levels. Dorsal root ganglion cells in the transplant were also initially increased (on E8) but later decreased to below control values. Hindlimb muscles innervated by thoracic motoneurons in the transplant also differentiated normally up to E10 to E12. Myotube size and numbers, muscle size and myotube types (fast versus slow) all developed normally in several thoracically-innervated hindlimb muscles. However, beginning on E14 myotube numbers and muscle size were markedly decreased resulting in muscle atrophy. Injections of horseradish peroxidase (HRP) into the thoracic transplants labelled neurons in the host spinal cord and brainstem rostral to the transplant thereby indicating an anatomical continuity between host and transplant neural tube. Injections of HRP into specific thoracically innervated hindlimb muscles on E8 labelled distinct pools of motoneurons in the transplants.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Development and survival of thoracic motoneurons and hindlimb musculature following transplantation of the thoracic neural tube to the lumbar region in the chick embryo: functional aspects.

Following heterotopic transplantation of the thoracic neural tube to the lumbar region on embryonic day (E) 2, the transplanted cord differentiates normally and establishes neuroanatomical connections with the host central nervous system and hindlimb muscles. Beginning on about E12, however, the neuromuscular system begins to undergo regressive changes resulting in motoneuron degeneration and muscle atrophy (O'Brien and Oppenheim, 1990). In the present paper, we have examined the development of neuromuscular function in thoracic transplant embryos from E6 to the time of hatching on E20-21. The onset of hindlimb movements and reflexes occurred at the same time (E6-E8) in both control and thoracic transplant embryos. Further, both the nature (pattern) and frequency of these movements appeared normal in the thoracic transplants up to E10-E12, after which there was a gradual and marked reduction in the frequency, and an alteration in the pattern, of both spontaneous and reflex-evoked hindlimb movements. After E16 normal movements were virtually absent in many of the thoracic transplant cases. By contrast, movements of the head, trunk and wings were normal in these embryos throughout the observation period. Hindlimbs innervated partly by the thoracic transplant and partly by remaining host lumbar cord did not exhibit the regressive changes in function after E10 that occurred in hindlimbs innervated exclusively by the thoracic transplant. EMG recordings from specific hindlimb muscles innervated solely by thoracic motoneurons demonstrated that the activation pattern of both flexors and extensors was similar to the repetitive pattern observed in normal thoracically innervated intercostal muscles (i.e., extensor-like). Muscles did not show distinguishable EMG burst patterns with inhibitory periods as do control lumbar innervated muscles. We conclude that the development of the pattern generating circuitry in the transplanted thoracic cord was similar to normal thoracic cord and thus appeared to be uninfluenced by having contacted the foreign hindlimb muscle targets early in development. Activity blockade with curare from E6 to E14 suppressed the loss of motoneurons that occurs in the thoracic transplant after E10. Thus, the abnormal thoracic-like activation pattern of thoracically innervated hindlimbs may be a critical signal in the initiation of the neuromuscular regression that occurs after E10 in these preparations. Finally, although the innervation and formation of neuromuscular endplates in thoracic transplants appeared normal up to E12, by E14 both the intramuscular nerves and the endplates exhibited signs of degeneration and regression. Thoracic motoneurons are initially able to innervate and functionally activate hindlimb muscles in a manner similar to that of thoracically innervated intercostal muscles.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1987

Standards of performance: a model for development in health care.

Effective performance appraisal is an ongoing and dynamic process. The experiences discussed here describe one approach to this complex and important issue. By examining the department's performance appraisal practices, the manager may be better able to define and measure specific expectations that reflect the reality of the work area.

Education Department, Hospital↗
PubMedDate not supplied

Prenatal sonographic detection of congenital hepatic cyst in third trimester after normal second-trimester sonographic examination.

A solitary unilocular hepatic cyst (SUHC) is a rare prenatal or neonatal finding. There are few reports of the prenatal detection of SUHC, and the progression of SUHC in utero is unknown. We present a proven case of SUHC in a fetus detected on a 34-week ultrasound examination following a normal 19-week examination. The cyst was inseparable from the liver and caused some flattening of the liver edge. Prenatal detection of an SUHC inseparable from the liver and appearing in the late second or third trimester should suggest a congenital hepatic cyst.

Adult↗