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PubMed1985

Isolation of Naegleria australiensis from an Oklahoma Lake.

Eight isolates of Naegleria australiensis were obtained from a small lake in Tulsa, Oklahoma. The eight strains were isolated during the hot summer months of July through September, when water temperatures ranged from 27 to 33 degrees C. All eight isolates were pathogenic for mice. The mean time to death for mice was 10 days (range 6-13 days). This pathogenic free-living ameba has not before been reported from the United States or the Western Hemisphere.

Amoeba↗

PubMed2000

Clinical research. Flawed cancer study leads to shake-up at University of Oklahoma.

Allegations of lax safety procedures and flawed management in a clinical cancer trial have cost four researchers and administrators their jobs at the University of Oklahoma. They have also led to a temporary shutdown of 75 clinical trials at the university's Health Science Center in Tulsa and a sweeping overhaul of the school's process for approving human experiments. University officials emphasize that none of the roughly 100 patients involved in the 3-year-old study of an experimental cancer vaccine was known to have been harmed, and that most trials will soon be restarted.

Cancer Vaccines↗

PubMed1976

Oil degradation in soil.

The environmental effects of adding certain selected petroleum products to field soils at widely separated geographical locations under optimum conditions for biodegradation were studied. The locations selected for study of soil biodegradation of six oils (used crankcase oil from cars, used crankcase oil from trucks, an Arabian Heavy crude oil, a Coastal Mix crude oil, a home heating oil no. 2, and a residual fuel oil no. 6) were Marcus Hook, Pennsylvania, Tulsa, Oklahoma, and Corpus Christi, Texas. The investigative process, covering a period of 1 year at each location, was conducted in 14 fields plots (1.7 by 3.0 m) to which the oils were added in a single application at a rate of 11.9 m3/4 X 10(3) m2. One-half of the plots at each location were fertilized, and the incorporation of the oils and fertilizers was accomplished with rototillers to a depth of 10 to 15 cm. Concentrations of all oils decreased significantly at all locations. The average reduction ranged from 48.5 to 90.0% depending upon the type of oil and location. Rates of degradation did not exceed 2.4 m3/4 X 10(3) m2 per month. Compositional changes in the oil with time were investigated using silica gel fractionation, gas chromatography, and ultraviolet absorbance. With the possible exception of the two fuel oils, the compositional changes were generally in the same direction for all of the oils. The silica gel fractionation and gravimetric data on residual oils show that all classes of compounds were degraded, but the more polar type degrade more slowly. Analysis of runoff water, leachate, and soils indicated that at the concentration applied no oil less was observed from these plots via water movement. No significant movement of lead compounds added to the soils in the used crankcase oils was observed. Significant increases in hydrocarbon-utilizing microorganisms were demonstrated in all treated plots using either the pure hydrocarbon, n-hexadecane, or the applied oils as the growth substrate. These increases were usually sustained throughout the year. Significant increases in hydrocarbon-utilizing fungi were not demonstrated by the plating technique used. The concentrations of residual oils or their oxidation products were of sufficient magnitude in the treated plots, 9 months after application, to cause significant inhibition of plant growth. From the data obtained, it was not possible to determine the type of compounds causing this inhibition or their long-term environmental effects.

Bacteria↗

PubMedDate not supplied

A pilot use of team-based learning in psychiatry resident psychodynamic psychotherapy education.

OBJECTIVE: Demonstrating psychotherapy competency in trainees will test the resources of psychiatry training programs. The authors outline the phases of team-based learning (TBL). METHODS: The University of Oklahoma College of Medicine, Tulsa (OUCM-T), Department of Psychiatry reorganized its psychodynamic psychotherapy didactic course using TBL. CONCLUSION: Team-based learning offers a promising alternative to traditional psychodynamic psychotherapy didactics, potentially increasing resident learning efficiency through a structured learning cycle emphasizing accountability to a learning team.

Cooperative Behavior↗

PubMed1978

Frequency of canine and feline tumors in a defined population.

The Tulsa Registry of Canine and Feline Neoplasms was the second animal tumor registry in the United States concerned with a defined population in a delimited geographic area. Only tumors histologically confirmed by registry pathologists were included in frequency statistics based on the annual dog and cat population presented to veterinarians. During the first registry year, about 1% of the 63,504 dogs and 0.5% of the 11,909 cats had one or more primary tumors. While the incidence rate for malignant tumors in dogs was similar to that in cats, the incidence of benign tumors of dogs was over 10 times that of cats. The most common tumors were sebaceous adenoma in dogs and lymphosarcoma in cats. Mammary cancer was the most common malignant tumor in dogs. Mammary tumors of female dogs were significantly more frequent in Pointers, Poodles and Boston Terriers, in that order, than in other breeds. A greater incidence of mammary tumors among intact compared to spayed female dogs was seen for virtually every age group except in the Pointer breed.

Age Factors↗

PubMed2005

Women and postfertilization effects of birth control: consistency of beliefs, intentions and reported use.

BACKGROUND: This study assesses the consistency of responses among women regarding their beliefs about the mechanisms of actions of birth control methods, beliefs about when human life begins, the intention to use or not use birth control methods that they believe may act after fertilization or implantation, and their reported use of specific methods. METHODS: A questionnaire was administered in family practice and obstetrics and gynecology clinics in Salt Lake City, Utah, and Tulsa, Oklahoma. Participants included women ages 18-50 presenting for any reason and women under age 18 presenting for family planning or pregnancy care. Analyses were based on key questions addressing beliefs about whether specific birth control methods may act after fertilization, beliefs about when human life begins, intention to use a method that may act after fertilization, and reported use of specific methods. The questionnaire contained no information about the mechanism of action of any method of birth control. Responses were considered inconsistent if actual use contradicted intentions, if one intention contradicted another, or if intentions contradicted beliefs. RESULTS: Of all respondents, 38% gave consistent responses about intention to not use or to stop use of any birth control method that acted after fertilization, while 4% gave inconsistent responses. The corresponding percentages for birth control methods that work after implantation were 64% consistent and 2% inconsistent. Of all respondents, 34% reported they believed that life begins at fertilization and would not use any birth control method that acts after fertilization (a consistent response), while 3% reported they believed that life begins at fertilization but would use a birth control method that acts after fertilization (inconsistent). For specific methods of birth control, less than 1% of women gave inconsistent responses. A majority of women (68% or greater) responded accurately about the mechanism of action of condoms, abstinence, sterilization, and abortion, but a substantial percentage of women (between 19% and 57%) were uncertain about the mechanisms of action of oral contraceptives, intrauterine devices (IUDs), Depo-Provera, or natural family planning. CONCLUSION: Women who believe that life begins at fertilization may not intend to use a birth control method that could have postfertilization effects. More research is needed to understand the relative importance of postfertilization effects for women in other populations, and in relation to other properties of and priorities for birth control methods. However, many women were uncertain about the mechanisms of action of specific methods. To respect the principles of informed consent, some women may need more education about what is known and not known about the mechanisms of action of birth control methods.

Journal Article↗

PubMed2000

Aeration management for stored hard red winter wheat: simulated impact on rusty grain beetle (Coleoptera: Cucujidae) populations.

Simulation studies were conducted to determine temperature accumulations below defined thresholds and to show the impact of controlled aeration on populations of the rusty grain beetle, Cryptolestes ferrigineus (Stephens), a major secondary pest of stored wheat, Triticum aestivum (L.). Recorded data from weather stations in Texas, Oklahoma, Kansas, eastern New Mexico, and eastern Colorado (356 total) were used to determine hours of temperature accumulation below 23.9 degrees C in June and July, 15.6 degrees C in September and October, and 7.2 degrees C in December. At an airflow rate of 0.0013 m3/s/m3 (0.1 cubic ft3/min/bu), which requires 120 h of temperatures below the specified threshold to complete an aeration cycle, summer cooling at 23.9 degrees C in bulk-stored wheat could be completed throughout the hard red winter wheat zone except for extreme southern Texas. An early-autumn cooling cycle at 15.6 degrees C could not be completed throughout most of Texas and Oklahoma before the end of September. The late-autumn cooling cycle could be completed in all states except Texas by the end of November. Five geographic regions were delineated and the times required for completion of the summer, early-autumn, and late-autumn cooling cycles within each region were estimated. Population growth of the rusty grain beetle was modeled for San Antonio, TX; Abilene, TX; Tulsa, OK; Topeka KS; and Goodland, KS, by predicting the numbers of adults in the top, outer middle, outer periphery, and the center of the bin during a 1-yr storage season. Populations of C. ferrugineus in San Antonio and Austin were predicted to exceed the Federal Grain Inspection Service (FGIS) threshold of two beetles per kilogram of wheat in all four levels of the bin during late autumn, decline during the winter, and increase the following spring. In Midland, TX, and Oklahoma City, OK, populations were predicted to exceed the threshold only in the top and outer middle of the bin, whereas populations in the Kansas locations were not predicted to exceed the threshold at any time.

Air↗

PubMed1982

A nutritional analysis of the Food Stamp Program.

Conflicting claims made both for and against the Food Stamp program have never been based on empirical evidence of its effects on the adequacy and the quality of diets of poor people. In this study, individual diets are measured against dietary standards appropriate for individuals and models of nutritional adequacy are constructed which make possible a determination of the program's impact on many different components of human nutrition. Two types of multiple regression models of nutrient sufficiency--ratios of dietary intake to standard as well as nutrient densities--were developed with dietary recall data from 181 and 195 subjects, respectively. These subjects were selected in a random, probability sample of a low-income area of Tulsa. Oklahoma in 1978 and all had annual household incomes which placed them at or below the poverty level. Separate models were developed for each of six nutrients, calories, protein, calcium, iron, vitamin A and vitamin C, and a large number of covariates were included in these models to isolate the effects due to program participation. The results suggest that the effects of food stamps are not uniformly positive nor are they similar to the effects which could be expected under a less expensive system of direct cash payments.

Diet↗

PubMed1999

Epizootic podoknemidokoptiasis in American robins.

Epizootics of scaly leg disease caused by infection with the submacroscopic mite Knemidokoptes jamaicensis (Acari: Knemidokoptidae) in migratory American robins (Turdus migratorius) from a residential area of Tulsa (Oklahoma, USA) are documented during the winters (December through February) of 1993-94 and 1994-95. Estimates of 60 to > 80% of the birds in several different flights arriving in the area had lesions consistent with knemidokoptic mange. Epizootic occurrence of K. jamaicensis also is confirmed incidentally in American robins from Georgia (USA) in 1995 and 1998 and in Florida (USA) in 1991. These are the first confirmed epizootics of scaly leg attributed to infections with mites specifically identified as K. jamaicensis in North America. Severity of observed lesions in American robins ranged from scaly hyperkeratosis of the feet and legs to extensive proliferative lesions with loss of digits or the entire foot in some birds. Histologically, there was severe diffuse hyperkeratosis of the epidermis which contained numerous mites and multifocal aggregates of degranulating to degenerating eosinophilic heterophils; there was mild to severe superficial dermatitis with aggregates of eosinophilic heterophils and some mononuclear cells. Based on limited data from affected captive birds in Florida, we questioned the efficacy of ivermectin as an effective acaricide for knemidokoptiasis and propose that conditions associated with captivity may exacerbate transmission of this mite among caged birds. While knemidokoptic mange apparently can result in substantial host morbidity and possibly mortality, the ultimate impact of these epizootics on American robin populations presently is unknown.

Animals↗

PubMed1999

Training psychiatric residents for Part II of the American Board of Psychiatry and Neurology Examination.

Of the physicians who took the American Board of Psychiatry and Neurology (ABPN) Examination, Part II, in 1995, 41% failed. The Accreditation Council for Graduate Medical Education (ACGME) requires that residency psychiatry programs conduct an organized evaluation of residents' clinical skills at least twice during the 4 years of training. At the University of Oklahoma Health Science Center-Tulsa, the residents attend formal didactic instruction on conducting a psychiatric interview. Having gained this didactic foundation, they then participate in actual patient interviews. First- and 3rd-year residents are mock examiners, paired with an experienced board-certified psychiatrist. Second- and 4th-year residents examine an actual patient. A survey evaluating this curriculum was rated as very good to excellent by the participants.

Curriculum↗

PubMedDate not supplied

Teaching students 'realistic medicine'.

Medical education and ambulatory care are not mutually exclusive to cost effectiveness. Rather they can, and should be, concurrent goals that do not compromise the quality of either product. In order to maximize this opportunity, the mutual cooperation of faculty, administration, and support staff are mandatory. Synergistic efforts result in a superior and relevant product--well-trained, primary care physicians prepared to practice cost effective and quality medicine in the office. Experience at the Medical Center indicates that disinterest or neglect by educators will not influence cost nearly as much as the quality of care and relevance of the educational experience. To do so due to a real or imagined lack of resources is a disservice to patients, community and society, and does not recognize the longer-term fiscal consequences on us all. The institutional challenge to medical schools is to examine the potential for training physicians at sites most resembling the realistic practice of office-based medicine and to then take full advantage of the opportunity. The University of Oklahoma Tulsa Medical Center affords the faculty and students an innovative national model for cost conscious, relevant and transferable primary care medical education programs.

Academic Medical Centers↗

PubMed1988

Dissecting health care markets: large versus small businesses.

This article reports the results of a mail survey of businesses in Tulsa, Oklahoma (population 377,900 in the city and 745,300 in the surrounding metropolitan area). The purpose of the research was to analyze differences in health care provision and perspectives between large and small businesses. The survey of 3,200 members of the city's chamber of commerce yielded 640 responses. Analysis of the data revealed distinct differences between the two segments of the health care industry. The findings suggest that market opportunities exist for the development of health care delivery system programs aimed at small businesses.

Cost Control↗

PubMed1999

Substance use disorders in physician training programs.

Physician impairment due to substance use occurs in all age groups of physicians. Risk factors are similar for age-matched controls, but choice of substance may be influenced by specialty and narcotic permit. Alcohol is by far the most commonly abused drug involved. One of the last areas of performance affected is work. Other areas may provide earlier clues. Intervention and referral to appropriate treatment centers is important. Death rates are relatively high in this disease. We report a favorable outcome of 75 percent at The University of Oklahoma Health Sciences Center, Tulsa (OUHSC-T), but a death rate of 16.7 percent in our small sample. Aftercare and monitoring are essential to a successful outcome. The vast majority of physicians in training can complete their training with appropriate treatment and monitoring and go on to successful careers.

Alcoholism↗

PubMed1999

Isolation of avian influenza viruses in central Oklahoma.

Aquatic birds are the natural hosts for influenza virus. It is established that avian influenza viruses provide the gene pool for the generation of new strains of human influenza virus, which can cause pandemic infections. The recent outbreak of an avian influenza virus (H5N1) in Hong Kong not only produced high mortality in chickens, but also resulted in six human fatalities. This outbreak indicates that avian influenza virus can be pathogenic for humans. We surveyed local waterfowl habitats by taking water and fecal samples for virus isolation and identification. We isolated avian influenza viruses from ponds and small lakes in Bartlesville, Lawton, Stillwater, and Tulsa. The density of birds in these sites is small. However, our virus isolation rate is comparable to that found in higher density habitats. The risk of human infection remains to be determined. We encourage primary care physicians to submit samples for virus surveillance.

Animals↗

PubMed2000

Phyllodes tumors of the breast: a review of 32 cases.

Most general surgeons involved in breast cancer care have limited experience with phyllodes tumors. We analyzed a comprehensive database incorporating 8567 breast cancer cases treated surgically in the Tulsa, Oklahoma, region between 1969 and 1993. This yielded 32 cases of phyllodes tumors (0.37%) in 31 patients. The median age was 57 years (range, 18-91). There were 9 low-grade (28%), 2 intermediate-grade (6%), and 21 high-grade (66%) lesions. Size distribution consisted of 23 (72%) lesions 5 cm or less and 9 (28%) greater than 5 cm (mean, 3; range, 1.2-17.5 cm). Of 137 resected nodes in 13 patients, none were positive for metastatic disease. Surgical management consisted of wide excision or mastectomy. No patients received adjuvant chemoradiation therapy. The disease-free, locoregional disease-free, and overall mean survival rates were 80, 81, and 97 months, respectively. Ten-year disease-free survival (DFS), locoregional disease-free survival (LRDFS), and overall survival (OS) rates were 66, 72, and 55 per cent, respectively. Although there was a tendency toward a higher rate of locoregional recurrences and metastases with high-grade lesions, this was not statistically significant and did not affect DFS, LRDFS, or OS rates. Similarly, size of lesion did not affect DFS, LRDFS, or OS rates. Three patients (9.6%) had metastatic disease at presentation, and a further two (6.4%) developed metastases during follow-up. Overall, nine (28.1%) recurrences developed in eight patients, seven locoregional and two distant. Four patients (12.9%) died with evidence of disease. These findings indicate prolonged survival in this patient population with cystosarcoma phyllodes. Wide local excision of primary and recurrent lesions remains the mainstay of therapy. Neither regional lymph node dissection nor adjuvant chemoradiation adds significant benefit.

Adolescent↗

PubMed2000

Adjuvant radiation after modified radical mastectomy for breast cancer fails to prolong survival.

Recent literature has reported improved local disease control and overall survival in premenopausal node-positive (stage II, and III) breast cancer patients undergoing modified radical mastectomy (MRM) using radiation therapy (RT) combined with chemotherapy. To assess the efficacy of postoperative RT in our own community, we analyzed all patients undergoing MRM for carcinoma utilizing an extensive database from the three major teaching hospitals in Tulsa, OK, between 1965 and 1993. A total of 5257 patients underwent MRM during this time period. One hundred thirty-seven patients were excluded for insufficient data or because they were found to be at stage IV, leaving a total study population of 5125. Overall survival (OS), overall mean survival (MS), disease-free survival (DFS), and locoregional DFS (LRDFS) were analyzed for all patients and were further analyzed according to stage, lymph node involvement, and menopausal status. Median follow-up was 103 months. Statistical analysis was performed using Kaplan-Meier and t-tests. The DFS at 10 years was 65 per cent in the RT group and 80 per cent in the patients who did not receive RT (P = 0.00). No improved DFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. Similarly, the LRDFS at 10 years was 91 per cent in the RT group and 96 per cent in the patients who did not receive RT (P = 0.00). No improved LRDFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. The overall MS was 97 months in the RT group and 104 months in the patients who did not receive RT (P = 0.00). Comparisons of overall MS rates revealed apparent survival benefits from RT in the premenopausal node-negative group, postmenopausal one to four-positive-node group, and all stage I patients. This apparent survival advantage was not confirmed by Kaplan-Meier curves of OS. No other overall MS differences were detected according to stage, lymph node, or menopausal status. Using Kaplan-Meier survival curves, the OS in the RT group at 10 years was 46 per cent, and 63 per cent in the patients who did not receive RT (P = 0.00). No improved OS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. These findings from a large breast cancer database failed to demonstrate any meaningful benefit from RT after MRM and serve to further question the efficacy of this treatment modality in postmastectomy breast cancer patients.

Breast Neoplasms↗

PubMed1999

Inflating LOS for transfer rule DRGs could lead to federal fraud charges.

A year after the Health Care Financing Administration implemented its controversial transfer payment policy, some hospitals are keeping patients in the hospital longer than necessary in order to receive full DRG payments. That's a risky strategy, say some experts, who warn that inflating length of stay (LOS) solely for financial reasons could provoke a federal fraud investigation. At St. John's Medical Center in Tulsa, OK, case managers haven't attempted to increase LOS in response to the new transfer rule, but they have put the brakes on any additional cuts in LOS for patients in the 10 affected DRGs. Meanwhile, at Elkhart (IN) General Hospital, case managers have made no adjustments, despite losing as much as $200,000 as a result of the transfer rule. Deborah Hale, president of Administrative Consultant Services in Shawnee, OK, suggests that the best approach for case managers eager to offset losses in reimbursement due to the transfer payment policy is to save money by focusing on patients with complicated conditions who traditionally have had longer-than-average lengths of stay.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied

Case study: improving efficiency in a large hospital laboratory.

Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third-party design expertise and quarterly metric reporting through Argent Consulting. Abbott incorporated lessons learned from the SFH OEC project with organizational changes to improve the way they work with customers. Following is a step-by-step description of the OEC project to allow others to benefit from the experience (Figure 1).

Efficiency, Organizational↗