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Biomedical subjects

R R Frank

Publications and source records attributed to R R Frank.

10 recordsLinked to original sources
PubMed1999

Effectiveness of an occupational and environmental medicine curriculum as indicated by evaluation of medical student performance on an objective structured clinical examination.

Medical students must learn to recognize occupational and environmental-related illness. An occupational and environmental medicine curriculum can achieve this goal. The curriculum must be evaluated to ensure that medical students are learning to recognize exposure-related health conditions and to evaluate if this ability correlates with medical interviewing skills. A case, formatted for an Objective Structured Clinical Examination (OSCE), was developed to evaluate student performance on an exposure-related clinical problem. The OSCE results were analyzed to identify the areas that differentiated the students who recognized an exposure-related medical condition from those who did not. We conclude that an OSCE is an effective curriculum evaluation tool to assess whether a core occupational and environmental-related curriculum is contributing to student learning in exposure history-taking and associated clinical reasoning skills.

Clinical Competence↗
PubMed1997

Assessing medical students' perceptions of mistreatment in their second and third years.

PURPOSE: To study medical students' perceptions of mistreatment in their second and third years of training. METHOD: A questionnaire was distributed at Wayne State University School of Medicine to the class of 1993 at the end of its third year and to the class of 1994 at the end of its second and third years. The students were asked if they had been subjected to various forms of mistreatment; the third-year students were asked to rate their perceptions of each clinical department's response to them on the basis of gender and race-ethnicity, as well as their overall treatment. The students also completed demographic information about age, gender, and marital status, number of children, and race-ethnicity. Results were analyzed using chi-square statistics, multivariate statistical analyses, analyses of variance, and Duncan's post-hoc comparisons. RESULTS: The response rate for the class of 1993 was 71.5%; response for the class of 1994 were 66.9% in their second year and 75.2% in their third year; 41.7% were women, and the racial-ethnic breakdown was 71.2% white/Caucasian, 11.7% black/African American and 16.8% other. There was a significant difference between the percentages of second-year and third-year students reporting any experience of mistreatment (37.2% vs 75.8%, p < .001). Canonical correlation analysis revealed bias in the third year based on gender (p < .0001) and race-ethnicity (p < .0002); both variates were related to sexual humor. The students' perceptions of mistreatment were lowest for family medicine and highest for obstetrics-gynecology and surgery. Perceptions of mistreatment in departments varied significantly by gender and race-ethnicity. The nonwhite males reported the least favorable treatment in most departments. CONCLUSION: Marked variability in the students' perceptions of mistreatment within departments suggest that a variety of approaches will be required to improve the medical training environment.

Education, Medical, Undergraduate↗
PubMed1997

Experience with an end-of-life practice at a university hospital.

OBJECTIVE: To describe a 10-yr experience with an end-of-life practice in a hospital. DESIGN: A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team. SETTING: Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital. PATIENTS: Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting. CONCLUSIONS: A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

Adolescent↗
PubMed1988

Development of a comprehensive supportive care team for the hopelessly ill on a university hospital medical service.

We developed a supportive care service for a university hospital medical service that serves a socially and medically disadvantaged urban population. The team includes a faculty physician and a clinical nurse specialist who provide primary medical care, family support, and in-service guidance to hospital staff about ethical issues. A multidisciplinary approach incorporates nursing, pastoral care, social work, and other hospital services. We report our experience from November 1985 through May 1987, during which time 222 patients were referred to the team; 212 patients were accepted. The goals and operation of the service are described. The most common (n = 62, 29%) diagnosis on referral was global central nervous system anoxia following cardiopulmonary arrest. Other severe neurological conditions accounted for an additional 79 patients (37%). Comparison of patients on the service with a similar group revealed no difference in survival rate, although hospital length of stay and charges were progressively reduced after implementation of the service. This approach to the care of hopelessly ill patients may serve as an alternative method of treatment in similar hospital settings.

Brain Diseases↗
PubMed1981

Evaluation of blood pressure during early alcohol withdrawal.

Ninety-five patients undergoing early alcohol withdrawal were observed for a five-day period in a non-hospital facility to evaluate the natural history of blood pressure change during this period. Patients under 30 years old developed a significant increase in systolic pressure on the second abstinent day, decreasing a mean of 10 mm Hg by the fourth abstinent day. With increasing age there was a progressively smaller rise in systolic pressure. Multivariate analysis showed a history of hypertension, delirium tremens, seizures, initial pulse, race, and sex not to be predictive of blood pressure change. Diastolic pressure was unaffected. Etiology of this difference requires further study. There were no hypertensive complications in this group. Patients undergoing early withdrawal need not be treated for changes in blood pressure without evidence of end organ damage or severe hypertension.

Adolescent↗
PubMed1980

Human leptospirosis in Detroit and the role of rats as chronic carriers.

Human leptospirosis was diagnosed in three patients from Detroit General Hospital. Epidemiological studies of these cases revealed heavy rat infestations in the residences of two of the patients. Leptospires serotype icterohaemorrhagiae were isolated from the rats and one of the patients. Cultural isolation was attempted from numerous blood and urine samples from each patient. Media containing different selective contaminant inhibitor substances was also utilized. Only two samples were culturally positive. It appears that very few viable cells are shed by human patients intermittently. Clinical reports and leptospirosis diagnosis are reported for each of the cases. The agglutinin-absortion test proved to be helpful in elucidating the true etiologic agent in the absence of cultural isolation. A serological survey for leptospirosis was conducted among swine slaughterhouse workers in Detroit. Significant titres to Leptospira pomona were observed.

Animals↗