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Biomedical subjects

Ming Lee

Publications and source records attributed to Ming Lee.

10 recordsLinked to original sources
PubMed2005

Multidimensional attitudes of medical residents and geriatrics fellows toward older people.

OBJECTIVES: To examine dimensions of a validated instrument measuring geriatric attitudes of primary care residents and performances on these dimensions between residents and fellows. DESIGN: Cross-sectional and longitudinal studies. SETTING: An academic medical center. PARTICIPANTS: Two hundred thirty-eight primary care residents (n=177) and geriatrics fellows (n=61) participated in the study from 1995 to 2000. MEASUREMENTS: A 14-item, 5-point Likert scale previously validated for measuring primary care residents' attitudes toward older people and geriatric patient care was used. RESULTS: Factor analysis showed four dimensions of the scale, labeled Social Value, Medical Care (MC), Compassion (CP), and Resource Distribution, which demonstrated acceptable reliability. Both groups of subjects showed significantly (P<.001) positive (mean>3) attitudes across the dimensions and times, except for residents, who had near-neutral (mean=3) attitudes on MC. Residents' mean attitude scores on the overall scale and the MC and CP subscales were significantly (P<.001) lower than those of fellows over time. Residents and fellows showed different change patterns in attitudes over time. Residents' attitudes generally improved during the first 2 years of training, whereas fellows' attitudes declined slightly. Personal experience was a strong predictor of residents' attitudes toward older patients. Ethnicity, academic specialty, professional experience, and career interest in geriatrics were also associated with residents' attitude scores. CONCLUSION: The multidimensional analysis of the scale contributes to better understanding of medical trainees' attitudes and sheds light on educational interventions.

Attitude of Health Personnel↗
PubMed2004

Cost savings and effectiveness of outpatient treatment with low molecular weight heparin of deep vein thrombosis in a community hospital.

UNLABELLED: This study was conducted at Centenary Health Centre of the Rouge Valley Health System, a community based hospital in Toronto. In January 1997, a new treatment was introduced for the management of patients with uncomplicated deep vein thrombosis (DVT). Eligible patients presenting at the ER were placed on LMWH (tinzaparin) and followed at home. Previously the patients had been hospitalized and treated with intravenous heparin until they reached a therapeutic international normalized ratio (INR). The intent of this study was to evaluate the patient outcomes and cost-savings of the new approach. METHODS: Data from all patients eligible for home care, treated in 1996 were assembled and compared with those from all eligible patients treated from April 1, 1997 to March 31, 1998. The data was collected by chart review and consisted of patient outcomes and costs during the period of heparin treatment. Costs for hospitalized patients were based on a per diem. For home care patients, the costs were itemized according to service and medication usage. All costs were calculated in 1999 Canadian dollars. RESULTS: In each one year period, 39 cases were treated. There was no serious adversity and the outcomes were compatible with what has been reported in the literature. The mean cost per patient for the 1996 hospitalized cohort was $3,266 compared to $584 for the subsequent home care cohort. The difference was statistically significant (p<0.00001). CONCLUSION: Home care with tinzaparin compared to hospital care with IV heparin resulted in a large mean saving per patient with no difference in outcome.

Adult↗
PubMed2004

Development and validation of a geriatric knowledge test for medical students.

OBJECTIVES: To assesses the reliability and validity of a geriatrics knowledge test designed for medical students. DESIGN: Cross-sectional studies. SETTING: An academic medical center. PARTICIPANTS: A total of 343 (86% of those sampled) medical students participated in the initial study, including 137 (76%) first-year, 163 (96%) third-year, and 43 (86% of those sampled) fourth-year students in the 2000-2001 academic year. To cross-validate the instrument, another 165 (92%) third-year and 137 (76%) first-year students participated in the study in the 2001-2002 academic year. MEASUREMENTS: An 18-item geriatrics knowledge test was developed. The items were selected from a pool of 23 items. An established instrument assessing the clinical skills of medical students was included in the validation procedure. RESULTS: The instrument demonstrated good reliability (Cronbach alpha=0.80) and known-groups and concurrent validity. Geriatrics knowledge scores increased progressively with the higher level of medical training (mean percentage correct=31.3, 65.3, and 66.5 for the first-year, third-year, and fourth-year classes, respectively, P<.001). A significant (P<.01) relationship was found between the third-year students' geriatrics knowledge and their clinical skills. Similar results, except the relationship between knowledge and clinical skills, were found in the cross-validation study, supporting the reliability and known-groups validity of the test. CONCLUSION: The 18-item geriatrics knowledge test demonstrated sound reliability and validity. The average scores of the student groups indicated substantial room for growth. The relationship between geriatrics knowledge and overall clinical skills needs further investigation.

Education, Medical, Undergraduate↗
PubMed2004

Disciplinary split: a threat to geriatrics interdisciplinary team training.

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters-level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case-study and cross-case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs. This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team-training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline-specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training. Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.

Aged↗
PubMed2004

Building academic geriatric capacity: an evaluation of the John A. Hartford Foundation Centers of Excellence initiative.

Almost 15 years ago, the John A. Hartford Foundation began its Centers of Excellence (CoE) program. In summer 2002, a quantitative and qualitative evaluation of the CoE program was conducted. The evaluation used previously collected quantitative data from surveys of program directors and graduates of fellowship programs, as well as interviews and surveys of currently funded CoEs. Since its inception, the CoE program has supported 163 geriatrics fellows, of whom 63% entered academic geriatrics. Almost half of these graduating fellows have gone to new academic institutions. CoEs have also supported 222 faculty, including some who were in disciplines other than geriatrics. The vast majority (82%) have remained in academics, and nearly two-thirds are currently in geriatrics. As the priorities and needs of the institutions and geriatrics programs changed, most centers shifted their CoE priorities. These changes predominantly took two forms: a refocus from one activity to another or an expansion of outreach or levels of support. Based upon this formal evaluation, the Hartford-supported CoE program has been successful in strengthening academic geriatrics, particularly in attracting, developing, and retaining geriatrics faculty.

California↗
PubMed2003

Assessing physical examination skills of senior medical students: knowing how versus knowing when.

PURPOSE: Literature has documented a lack of physical examination proficiency among medical students. To investigate UCLA medical students' physical examination proficiency, this study compared their performance on a multiple-station Clinical Performance Examination (CPX) focused on clinical cases with that on a thorough physical examination objective structured clinical examination (OSCE) of the same organ systems. METHOD: One hundred sixty-three beginning fourth-year students participated in the study. Four organ systems were included in both the CPX and OSCE. Pearson's correlation coefficients and paired-sample t-tests were conducted to determine the correlations between and differences in the two tests. RESULTS: The physical examination scores on the CPX were significantly (p <.001) lower both by organ subscale and in total than those on the OSCE. Correlation coefficients between the two tests were negligible. CONCLUSIONS: The study suggests that fourth-year medical students may demonstrate competency in directed examination of organ systems while being unable to correctly apply those examination skills to the work-up of clinical cases.

California↗
PubMed2003

Successful use of 6 antigen HLA mismatched kidneys for cadaveric renal transplantation.

PURPOSE: We retrospectively evaluated the outcome of transplantation with kidneys with 6 antigen HLA mismatches. MATERIALS AND METHODS: From October 1990 to September 2001, 1,270 cadaveric renal transplants were performed at our center, including 33 (2.59%) involving recipients of kidneys with 6 antigen HLA mismatches. Mean recipient age +/- SD was 40.2 +/- 14.4 years. Of the 33 recipients 19 were male, 14 were female, 31 received an initial transplant, 4 had diabetes and 6 had panel-reactive antibodies of greater than 10%. Mean donor age was 30.3 +/- 13.7 years and mean cold ischemia time was 22.9 +/- 7.8 hours. All recipients had negative current and previous B and T-cell lymphocytotoxicity cross-matching and all received a triple immunosuppression regimen consisting of the calcineurin inhibitor cyclosporine or tacrolimus combined with steroids and azathioprine. RESULTS: One-year patient and graft survival was 93.3% and 93.7%, respectively. Of the 33 grafts 31 (94%) functioned immediately. During the mean followup of 3.31 years 10 grafts (30%) were lost, including 6 (60%) due to death with a functioning graft and 4 due to chronic rejection. Acute rejection in 8 patients (24%) was reversed in 7 by steroid pulses. No graft was lost to acute rejection. Technical complications included wound infection in 2 patients (6%), transplant-ureteral obstruction in 1 (3%) and a urinary fistula in 1 (3%). CONCLUSIONS: Kidneys with 6 antigen HLA mismatches can be used effectively.

Adult↗
PubMed2002

Predictors of self-perceived competency in cancer screening examinations.

BACKGROUND: Factors contributing to medical students' self-perceived competency in cancer screening examinations have not been well studied. METHODS: Ending third-year students of UCLA Medical School were surveyed to assess their self-perceived competency and training in performing clinical breast, Pap smear, digital rectal, and skin cancer examinations. Analysis of variance was conducted to compare the differences in competency ratings. Multiple regression analysis was applied to identify predictors of competency. RESULTS: Fifty-two (67%) of the 78 third-year medical students sampled participated in the study. They reported being least (p < 0.001) competent in performing skin cancer examinations. The number of times practicing screening examinations was the most significant (p < 0.001) educational predictor for self-reported competency in every area except skin cancer. More practice is needed in each screening exam before students feel somewhat or extremely competent. CONCLUSION: Student hands-on experience is crucial in the development of cancer screening competency.

Analysis of Variance↗