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Biomedical subjects

M T Ruffin

Publications and source records attributed to M T Ruffin.

15 recordsLinked to original sources

Characteristics of a productive research environment: literature review.

What environmental factors stimulate and maintain research productivity? To answer this question, the authors conducted an extensive review of articles and books on research productivity published from the mid-1960s through 1990. This review revealed that a consistent set of 12 characteristics was found in research-conducive environments: (1) clear goals that serve a coordinating function, (2) research emphasis, (3) distinctive culture, (4) positive group climate, (5) assertive participative governance, (6) decentralized organization, (7) frequent communication, (8) accessible resources, particularly human, (9) sufficient size, age, and diversity of the research group, (10) appropriate rewards, (11) concentration on recruitment and selection, and (12) leadership with research expertise and skill in both initiating appropriate organizational structure and using participatory management practices. Some of these characteristics are not surprising, although some findings were unexpected, such as that participative governance correlated consistently with research productivity. The differential impact of each of these 12 characteristics is unclear. It is clear, however, that the leader has a disproportionate impact through his or her influence on all of the other characteristics. Yet, an overarching feature of these characteristics is their interdependency. These factors do not operate in research groups as isolated characteristics. Rather, they are like fine threads of a whole fabric: individual, yet when interwoven, providing a strong, supportive, and stimulating backdrop for the researcher. The authors conclude that while at a distance the productive research enterprise looks like a highly robust entity, upon closer inspection it is revealed to be a delicate structure highly dependent on the existence and effective working of numerous individual, organizational, and leadership characteristics.

Attitude

Primary care research funding sources.

BACKGROUND: Numerous studies and anecdotal reports have identified lack of funding as a major obstacle to recruiting young physicians to academic medicine and to developing research in primary care. The focus of this study is the comparison of funding sources reported for published research in the primary care disciplines of family medicine, general internal medicine, pediatrics, and obstetrics and gynecology. METHODS: Articles from a representative sample of the journals of each discipline were eligible for review and inclusion in the study if the work was an original research article. The eligible articles were reviewed and classified by specialty and by funding source. The reported funding sources were categorized into federal, private foundation, local, discipline specific, corporate, and none. After all of the articles had been categorized, 40 articles from each discipline that had not reported any funding source were randomly selected. The primary author of each study was then contacted by telephone for a structured interview to verify the absence of reported funding in the published study. RESULTS: Eligible published articles used in this study numbered 319 in family medicine, 208 in general internal medicine, 522 in obstetrics and gynecology, and 888 in pediatrics. There was a statistical difference between the disciplines regarding the source of funding (chi 2 = 223.0, P less than .0001). Family medicine research was funded primarily by federal and discipline sources. Obstetrics and gynecology research was funded primarily by federal, private foundation, and corporate sources. General internal medicine research and pediatric research were funded primarily by federal and private foundation sources. The majority of the research articles in all four disciplines did not report any funding source. CONCLUSIONS: All four disciplines had diverse sources of funding with many similarities and relatively few differences. An important finding of the study was the amount of unfunded research conducted and published in these primary care disciplines.

Family Practice

Adults' knowledge about the use of child restraint devices.

BACKGROUND: Injuries are the number one cause of morbidity and mortality among children age 14 and younger in the United States, and motor vehicle crashes account for most of these injuries. Although child restraint devices (CRDs) have been shown to protect children involved in motor vehicle crashes, only minimal decreases in mortality and morbidity have occurred since their introduction. This study evaluated the accuracy and sources of adult knowledge about CRDs. METHODS: A self-administered questionnaire was completed by patients at a community-based family practice clinic to obtain demographic information, assess knowledge of recommendations for CRD use, and identify sources of this knowledge. RESULTS: Of the 368 participants, 36% were men, 52% were women, and 12% did not indicate gender. The frequencies of correct responses on positioning infants younger than nine months of age and weighing less than 20 lbs in a CRD were: upright, 47%; rear middle-seat location, 22%; and rear facing, 54%. For toddlers older than nine months who weighed more than 20 lbs, the frequencies of correct responses on positioning were: using a booster seat plus a seat belt, 71%; rear-middle location, 17%; and front facing, 66%. In addition, only 42% of the respondents correctly identified the booster seat as not crash-test certified, and 44% indicated that a CRD should not be reused after an accident. The majority of respondents indicated that the year of manufacture was important and that loose objects in the car were not safe. TV/radio (51%), newspaper/magazine (41%), and relatives (31%) were the most common sources of information about CRD use. CONCLUSION: Our findings suggest that a lack of knowledge about CRD use among adults contributes to improper use of these devices. This may explain the minimal effect CRD use has had on reducing morbidity and mortality of children from motor vehicle crashes.

Accidents, Traffic

A criterion-based review of preventive health care in the elderly. Part 2. A geriatric health maintenance program.

Although the geriatric population is growing rapidly and using an increasing portion of health care dollars, no consensus exists about the best approach to preventive medicine in this age group. The most comprehensive review to date is the 1989 United States Preventive Services Task Force (USPSTF) recommendations. However, the USPSTF did not specifically address the unique situation of the elderly. Consequently, we have evaluated numerous screening tests and preventive interventions for the elderly by systematically applying the geriatric-specific criteria for preventive services proposed in Part 1 of this article (J Fam Pract 1992; 34: 205-224). Tests and interventions were measured against specific screening criteria and put into one of three categories: those that have been proven effective, those that may be effective but about which more research is needed, and those that are not effective. Recommendations were compared with those of the USPSTF. Proof of the efficacy of most screening tests and interventions in the current literature was found to be lacking, pointing to the need for substantial future research in this area.

Aged

A criterion-based review of preventive health care in the elderly. Part 1. Theoretical framework and development of criteria.

The magnitude of health care resources devoted to care for the elderly is increasing; however, little is known about the efficacy of the services purchased with those resources. This is especially true in the area of preventive health care. In the absence of a consistent and comprehensive definition of health for the elderly population, it has been difficult either to establish criteria for evaluating preventive services or to assess the impact of those services. This article extends criterion-based review to the assessment of preventive services for the elderly. Health in the elderly can be defined by three related factors: the absence of disease, the maintenance of optimal function, and the presence of an adequate support system. Based on this definition of health, goals for preventive care should include compression of morbidity in addition to prevention of disease, and will require that quality of life be measured to completely assess the value of services. Unfortunately, existing measures of quality of life are difficult to apply to the elderly population, and there are no consistent societal values on which to base a new definition for quality of life. Because existing sets of criteria for the evaluation of preventive services do not address the distinctive health issues affecting the elderly, we have constructed a set of six criteria designed specifically for the well elderly population. In a companion article, we will apply these criteria to candidate preventive services for the elderly population to develop a geriatric health maintenance protocol for use in clinical practice.

Aged

Improving the yield of endocervical elements in a Pap smear with the use of the cytology brush.

A clinical trial assessed the efficacy of three different combinations of instruments for capturing endocervical elements when performing a Pap smear. The instrument combinations tested were: 1) the cytology brush and extended-tip wooden spatula; 2) moistened cotton swab and extended-tip wooden spatula; and 3) extended-tip wooden spatula and Ayre blunt spatula. Ninety-six eligible women seen for Pap smears were randomized to one of these three groups. In addition, two comparison groups were included to evaluate the effects of education about collection protocols and of strict protocol adherence. The cytology brush and extended-tip wooden spatula combination captured endocervical elements in 90.3% of Pap smears, compared to 66.7% for cotton swab and extended-tip wooden spatula, and 60.0% for Ayre spatula and extended-tip wooden spatula. The strict adherence to a collection protocol or education on tools and collection methods did not significantly increase the capture of endocervical elements. Widespread use of the cytology brush was introduced into the clinical setting after the study was completed and resulted in an increase to 80.1% capture rate for endocervical elements from a preexisting rate of 49.9%.

Adult

Fibrolamellar hepatoma.

Primary hepatocellular carcinoma (HCC) has a high incidence rate worldwide with an extremely grave prognosis, but, fortunately, accounts for only 2% of all cancers in the United States. Yet, a unique subset of HCC fibrolamellar hepatocellular carcinoma (FLHC) is reported only from the United States. Five cases of FLHC from the University of Minnesota's 17 years of experience are reported and compared with the literature reports for FLHC, as well as contrasted to reports of HCC. The review of the literature is addressed for data evaluating FLHC as a distinct entity from HCC.

Adult

Papanicolaou smear.

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Family Practice