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At least 127 records · Page 7Linked to original sources

PubMed1998

Providing care in an infectious disease clinic. Why students volunteer.

This qualitative study explores the motivations of dental students who volunteered as care providers for patients identified as carriers of infectious diseases. The study involved 12 students, seven 4th year and five 3rd year students who worked 1-2.5 days per week in an infectious disease clinic in a dental school in the northeastern United States. 4 faculty members who also volunteered their time in the clinic supervised the students. Personal interviews were conducted with each student to determine their reasons for volunteering and to explore the perceived significance of their experiences in the clinic. Internal validity was established through group interviews wherein responses during the personal interviews were discussed with the students. All 12 students were interested in Oral Medicine and all 4th year students had completed a course on HIV-AIDS for their selective requirement. Students expressed willingness to care for patients who are medically compromised in anticipation of an increase of this type of patients in their future practice. Previous exposure to a family member or friend or patients (non-dental) who were terminally ill or to patients with HIV was another common reason. All 12 students preferred to work in the infectious disease clinic more than in other school clinics. They felt that there was more faculty-student interaction and a more stimulating learning atmosphere that the faculty created. The students felt that the patients treated in the clinic were more appreciative. Students also claim they experienced more team spirit among their fellow students and staff and that the clinic atmosphere was more relaxed and less competitive. Students got the most satisfaction from helping patients who were perceived to have had problems in accessing care prior to their visit to the clinic. Results of the study show that the students volunteered to treat patients who are known to have infectious diseases such as HIV/AIDS because they find personal and academic satisfaction from working in a clinic which provides care to individuals with specific medical needs.

Attitude of Health Personnel↗

PubMed2003

Sonographic training in rheumatology: a self teaching approach.

OBJECTIVE: To evaluate a self teaching approach to be followed by a novice without previous practical experience in musculoskeletal ultrasonography. METHODS: The novice was given short general training (two hours) by an experienced sonographer focusing on the approach to the ultrasound equipment, and asked to obtain the best sonographic images of different anatomical areas as similar as possible to the "gold standard" pictures in the online version of the guidelines for musculoskeletal ultrasonography in rheumatology (free access at http://www.sameint.it/eular/ultrasound). At the end of each scanning session, both novice and tutor scored "blindly" all the images from 0 (the lowest quality) to 10 (the highest quality), with a minimum quality score of 6 considered acceptable for standard clinical use. The tutor then explained how to improve the quality of the pictures. Fourteen consecutive inpatients (seven with rheumatoid arthritis, three with psoriatic arthritis, two with reactive arthritis, and two with osteoarthritis) and five healthy subjects were examined. Ultrasound examinations were performed with a Diasus (Dynamic Imaging Ltd, Livingston, Scotland, UK) using two broadband linear probes of 5-10 and 8-16 MHz frequency. RESULTS: Sonographic training lasted one month and included 30 scanning sessions (24 hours of active scanning). 243 images were taken of the selected anatomical areas. The mean time required to produce each image was 6 minutes (SD 4.2; range 1-30). At the end of the training, the novice scored >/=6 for each standard scan. CONCLUSION: A novice can obtain acceptable sonographic images in 24 non-consecutive hours of active scanning after an intensive self teaching programme.

Clinical Competence↗

PubMed1999

Pharmacokinetics and dose requirements of vancomycin in neonates.

AIMS: To design and evaluate dosing guidelines for vancomycin based on data collected during routine use of the drug. METHODS: Following the observation that 66% of neonatal vancomycin trough concentrations were outside the target range, new dose guidelines were developed using a population pharmacokinetic approach. NONMEM (non-linear mixed effects model) was used to analyse dose histories and 347 concentration measurements collected during routine therapeutic drug monitoring in 59 neonates. RESULTS: Postconceptual ages in the patient group ranged from 26-45 weeks, weights from 0. 57-4.23 kg, and creatinine concentrations from 18-172 micromol/l. The population estimate of vancomycin clearance (l/h/kg) was 3. 56/creatinine concentration (micromol/l) with an interpatient coefficient of variation (CV) of 22% and volume of distribution 0.67 l/kg with a CV of 18%. Residual error was 4.5 mg/l. When the new recommendations on dosing were used prospectively in a separate group of neonates the proportion of acceptable troughs increased from 33% to 72%. CONCLUSIONS: The pharmacokinetics of vancomycin in neonates and young infants depend on weight and serum creatinine. Preliminary results from the new guidelines indicate an improvement on previous practice, but also an ongoing need to monitor concentrations.

Anti-Bacterial Agents↗

PubMed1983

Selection of students for veterinary training.

The difficulties facing admissions committees and prospective students in the selection of veterinary undergraduates are described. An attempt is made to evaluate the current selection procedures which are based on the applicant's academic record and previous practical experience and on interview. A correlation is drawn between these factors and a student's subsequent performance. A number of alternative selection methods are discussed.

Education, Veterinary↗

PubMed1975

Chromosomes of cattle: present clinical status and promise.

Current information on cytogenetics in veterinary medicine is presented as a resume for the veterinarian in cattle practice; previous reviews of the subject are recorded. The literature depicting the recognised chromosome abnormalities in cattle is breifly reviewed. It is suggested that chromosome screening already has a role to play in the economics of cattle production.

Animals↗

PubMed2004

Individual trait anxiety levels characterizing the properties of zen meditation.

Meditation is a specific consciousness state in which deep relaxation and increased internalized attention coexist. There have been various neurophysiological studies on meditation. However, the personal predispositions/traits that characterize the properties of meditation have not been adequately studied. We analyzed changes in neurophysiological parameters [EEG coherence and autonomic nervous activity using heart rate variability (HRV) as an index] during Zen meditation, and evaluated the results in association with trait anxiety (assessed by Spielberger's State-Trait Anxiety Inventory) in 22 healthy adults who had not previously practiced any form of meditation. During meditation, in terms of mean values in all subjects, an increase in slow alpha interhemispheric EEG coherence in the frontal region, an increase in high-frequency (HF) power (as a parasympathetic index of HRV), and a decrease in the ratio of low-frequency to HF power (as a sympathetic index of HRV) were observed. Further evaluation of these changes in individuals showed a negative correlation between the percent change (with the control condition as the baseline) in slow alpha interhemispheric coherence reflecting internalized attention and the percent change in HF reflecting relaxation. The trait anxiety score was negatively correlated with the percent change in slow alpha interhemispheric coherence in the frontal region and was positively correlated with the percent change in HF. These results suggest that lower trait anxiety more readily induces meditation with a predominance of internalized attention, while higher trait anxiety more readily induces meditation with a predominance of relaxation.

Adult↗

PubMed2004

Nephron-sparing surgery--strategies for partial nephrectomy in renal cell carcinoma.

The use of partial nephrectomy for renal cell carcinoma has continuously changed in the clinical practice. Previously it was mostly used in imperative cases, in patients with a solitary kidney or in patients with a risk of renal failure. An increased number of incidentally detected renal cell carcinomas are diagnosed due to the advances of the radiological methods. These tumours tend to be smaller and generally with a lower stage. The reported excellent results of partial nephrectomy have promoted the use of nephron-sparing surgery also in patients with a normal contralateral kidney and tumours smaller than 4-5 cm. The technical outcome is excellent with a low operative morbidity and a good oncologic control. Therefore partial nephrectomy has become a standard technique in the treatment of properly selected patients. Laparoscopy with its reduced postoperative pain and shorter rehabilitation time, has encouraged the interest in minimally invasive nephron sparing surgical techniques. Although low, the risk of local tumour recurrence and surgical complications are higher after nephron-sparing surgery compared with radical nephrectomy. Furthermore, long-term renal function remains adequate in most patients with a normally functioning contralateral kidney also after radical nephrectomy. Albeit these facts, there is convincing evidence justifying nephron-sparing surgery to be used routinely for patients with a small renal cell carcinoma and a normal functioning contralateral kidney.

Carcinoma, Renal Cell↗

PubMed1997

Novel decision making in patients with prefrontal or posterior brain damage.

Patients with lesions of the frontal lobes experience greater difficulties in performing nonroutine tasks, but their ability to cope with novel situations has not been studied. We assessed novel and previously practiced decisions in normal subjects and patients with frontal or posterior brain damage using a unimanual two-choice response time test. Patients with frontal damage had a dramatic impairment on novel decision, whereas practiced decision was normal. Relative Judgment Theory analysis suggested that the basic disorder concerns the ability to create internal referents that are determined from instructions and are subsequently required to associate the current stimulus with the appropriate response. The results of the study suggest that the prefrontal cortex is critical for novel decision making and that it operates mainly at the stage of creation of internal referents that associate some subsequent event with the selection of appropriate processing. This basic disorder may underlie some behavioral changes such as apathy and difficulty on tests that are sensitive to frontal damage.

Adult↗

PubMed1980

Health policy and religion: conflict and accommodation in Israeli politics.

The paper focuses on the impact of religious values and organizations on two issues of health policy, abortion and autopsy, both of which have been subjects of deep controversy between religious and nonreligious groups. The comparison between the issues centers on three stages of policy making: problem formation, problem solving and decision making. Two models of influence on public policy are employed: (1) one in which political parties attempt to suppress issues, and (2) a group model which applies to a well articulated, controversial issue which is resolved by groups with direct access to decision makers. The party model is relevant to the abortion issue, which was submerged beneath the surface of the public agenda due to national-religious value orientations. The group model fits the autopsy issue, which has been a subject of controversy between the Medical Association and religious groups. Decision making on these issues was characterized by a pattern of compromise and accommodation which resulted in only slight deviations from norms of behavior previously practiced. The decisions made reflected the intricacies of the Israeli political system, and the salience of religious values in health policy making.

Abortion, Induced↗

PubMed2002

Availability of dental services for patients with blood-borne viruses.

Dental practitioners were surveyed, using a self-completed postal questionnaire, to assess their attitudes to managing patients with blood-borne viruses (BBV) and to identify dental services available for such patients in North Nottinghamshire. Questionnaires were completed by 79 (65.3%) of the 121 practitioners from 43 (82.7%) of the 52 study practices. Previous BBV experience was reported by 44 (55.7%), 31 (39.2%), 20 (25.3%) respondents for hepatitis B (HBV), hepatitis C (HCV), HIV, respectively. Over two-thirds would maintain existing patients with subsequently diagnosed BBV on their lists, approximately one-third would accept new BBV patients. Risk factors for BBV of homo/bisexuality and injecting drug use were not asked by 71 (89.9%) and 49 (62.0%) practitioners, respectively. Universal precautions were employed by 67 (84.8%) practitioners regardless of the patient's status and by seven practitioners for known BBV patients. The advice of the General Dental Council, British Dental Association, and the use of universal precautions are discussed.

Blood-Borne Pathogens↗

PubMedDate not supplied

Implementation of an enteral nutrition and medication administration system utilizing oral syringes in the NICU.

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using TV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double-check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Administration, Oral↗

PubMed1996

Role of ruminant livestock in sustainable agricultural systems.

Ruminants have served and will continue to serve a valuable role in sustainable agricultural systems. They are particularly useful in converting vast renewable resources from rangeland, pasture, and crop residues or other by-products into food edible for humans. With ruminants, land that is too poor or too erodable to cultivate becomes productive. Also, nutrients in by-products are utilized and do not become a waste-disposal problem. The need to maintain ruminants to utilize these humanly inedible foodstuffs and convert them into high-quality foods for human consumption has been a characteristic of advanced societies for several thousand years. Further, ruminant livestock production is entirely consistent with proper agronomy practices in which forages are grown on 25% of arable land to minimize water and soil erosion. Questions have been asked, however, about the use of humanly edible foodstuffs (grains, protein sources, etc.) in ruminant diets. Does their use create a net loss of nutrients for human consumption? What level of their use is necessary or desirable? Does the use of some of these improve the nutrient (e.g. protein) quality or product value? Too often the opponents of animal agriculture evaluate the desirability of animal production on gross calorie or protein intake/output values. However, in many cases the feeds used in animal production are not consumable by humans, and in order to properly evaluate animal production, humanly consumable energy and protein intake should be used for efficiency comparisons. Analysis of the costs/returns of humanly edible energy and protein for a variety of dairy and beef cattle production systems shows that food value is increased with ruminant products, and that net returns of humanly edible nutrients are dependent on the production system used. The efficiency with which ruminants convert humanly edible energy and protein into meat or milk is highly dependent on diet, and hence, on regional production practices. Previous studies suggest that in the United States, dairy production efficiency ranges from 96 to 276% on a humanly consumable protein basis. Beef production efficiency is very dependent on the time spent in the feedlot and digestible energy and protein efficiencies range from 28 to 59% and 52 to 104%, respectively. However, beef production can add to the humanly consumable protein pool depending on the feeding schedule. In addition, the protein resulting from ruminant livestock production is of higher quality with a greater biological value than protein in the substrate feeds. The evidence that ruminant livestock belong in sustainable livestock production systems is convincing.

Agriculture↗

PubMed2002

An interactive, student-centered approach to teaching large-group sessions in veterinary clinical pathology.

INTRODUCTION: The purpose of this study was to describe and evaluate an interactive, student-centered approach to teaching large-group sessions in Veterinary Clinical Pathology. The strategy was designed to operate in the place of expository lectures and to encourage a deep approach to learning though discussion and problem solving. METHODOLOGY: The teaching strategy ran over two hours and required students to answer a series of questions on the topic to be discussed before attending the session. In the first part of the session, limited information and laboratory data related to a series of cases were presented to the students for discussion and analysis. These cases were selected on the basis of their usefulness for discussion in relation to the answers to the previously set questions and to reinforce an approach to the analysis of laboratory data. After a break, students were given a series of multiple-choice questions, related to the topic previously discussed, to answer. Students were given the opportunity to discuss the reasons for their answers. Finally, the students were given information and laboratory data from an unknown case and asked to analyze them, through a mechanism previously practiced in small-group tutorials, in order to reach conclusions and to consider the need for further investigation and implications for case management. A consensus diagnosis and plan for the case was reached after reflective observation and discussion. The teaching strategy was evaluated, utilizing teacher reflection and a student questionnaire, on the basis of its success in encouraging active and simulated experiential learning. CONCLUSION: The evaluation of one session indicated that students strongly valued the strategy in relation to actively engaging them in discussion, providing feedback on how they were learning, and enhancing their understanding of how theoretical knowledge can be applied to actual clinical cases. These pedagogical principles appeared to give students greater confidence in analyzing laboratory data through a mechanism of diagnostic reasoning. More sessions of this kind, tied to specific content or skills areas, will allow better evaluation of the perceived student outcomes, which can then be correlated with actual student outcomes through formal assessment.

Education, Veterinary↗

PubMed2004

The recommended role of exposure biomarkers for the surveillance of environmental and occupational chemical exposures in military deployments: policy considerations.

A lack of individual exposure information limited the evaluation of exposure-outcome relationships after the Gulf War. Exposure concerns during Operation Enduring Freedom and Iraqi Freedom deployments have increased interest in individual environmental and occupational chemical exposure assessment. Currently, deployment assessments are conducted using intermittent ambient air monitoring, occasional focused evaluations based on these results, and postdeployment questionnaire documentation of exposure and/or health concerns. Although this strategy is an improvement over previous practice, it has limitations, including a reliance on evidence of an acute problem, to initiate in-depth health evaluation. Exposure biomarkers may have the potential to overcome some of the limitations of current environmental and occupational exposure assessment tools. This article examines current exposure assessment methods, reviews emerging technologies, and recommends a phased approach to introducing exposure biomarkers into a comprehensive occupational and environmental health surveillance program.

Biomarkers↗

PubMed1988

Control of infection in the community.

A district nurse encounters a wide variety of environments in which to provide care. Changing the home environment requires considerable skill as the nurse really is the guest in the home. A sound body of knowledge is required in the areas of microbiology and immunology to enable infection and contamination risks to be assessed in the community. This knowledge may not be there in the mature nurse, trained many years ago. Resources are frequently limited and may be abused. Practice may primarily be based on ritual and tradition. Perhaps to some extent those working in the community are enjoying a false sense of security regarding the incidence of infection. The more recent concern relating to infection risk from HIV and Hepatitis B has made nurses question their actions, this can only be of benefit. The increasing quantity of clinical waste and toxic substances and incidence of infection hazard must surely cause those with concern for health in the community to examine practices previously unquestioned. Some priority should be given to equipping staff with both the knowledge and resources they need.

Community Health Nursing↗

PubMed1999

Health care consolidation and the changing health care marketplace. A review of the literature and issues.

This Issue Brief examines the academic literature and issues in consolidation of the hospital sector in the context of responses to changes in the competitive environment. It analyzes the motivations for consolidation as well as its effects. Hospital merger activity has increased dramatically in recent years. The current wave of mergers is primarily a reaction to a competitive environment that is placing a greater emphasis on controlling costs and forcing high-cost providers out of the market. The growth of managed care has placed considerable pressure on providers of health care and, in particular, on hospitals. The evolution of insurance companies' behavior helps explain the recent hospital consolidation movement. As managed care has become the dominant type of coverage in the last decade, insurance companies have become more active in trying to control costs--a reversion to their previous practices before the advent of managed care. Insurance companies have placed cost constraints on providers, both in the early years of health insurance and currently, when there are strong competitive forces. Hospitals claim that their primary merger motives are improving efficiency and the quality of care. The empirical evidence on this claim is mixed. Vertical integration (between suppliers and buyers of health care services, such as between hospitals and physicians) has appealed to hospitals because of their need to obtain more patients. More research is needed to explore the effects of vertical integration in the health care sector. In one of the more significant recent legal rulings, the U.S. Justice Department lost a 1997 case challenging the merger of two hospitals in the New York City metropolitan area. This, along with other recent losses by the antitrust authorities, does not bode well for the government's ability to prevent hospital mergers in metropolitan areas. It is difficult to generalize on an appropriate antitrust policy for hospital mergers. Hospital consolidation is likely to continue at a rapid pace. Since some developments may reduce the cost of employee benefits while others may increase the cost of these benefits, the final effect on the provision of health care benefits by employers is uncertain. Employers must pay close attention to the hospital consolidation movement because it will lead to important changes in the provision of health care benefits.

Antitrust Laws↗

PubMed2002

Update on prosthetic joints, dental treatment, and antibiotic prophylaxis.

At this time, all dentists and physicians should be very familiar with the 1997 ADA/AAOS antibiotic prophylaxis recommendations for joint prosthesis patients who are undergoing dental treatment. The guidelines identify physical conditions that place joint replacement patients at the highest risk for joint sepsis. They also stratify dental procedures into higher-risk and lower-risk categories. Combining these two groupings clarifies the dentist's strategy for antibiotic prophylaxis protocols, which are greatly simplified over previous practices. Of notable importance is the elimination of posttreatment antibiotic dosing, the reduction of the loading dose of antibiotic, and the identification of a large group of joint replacement patients who do not require antibiotic prophylaxis prior to dental treatment. Every dentist must use clinical judgment, knowledge of the patient, and consultation with the attending physician to determine the appropriate treatment plan.

Amoxicillin↗

PubMed1976

Causes of physician migration: responses of Iranian physicians in the United States.

Each of the 2,270 Iranian physicians listed by the American Medical Association as residing in the United States in 1973 was sent a questionnaire in which he was asked whether or not he intended to return to Iran, his reasons for not returning if he did not intend to return and other questions concerning his history and present status. A total 760 questionnaires were returned. The results indicated that age, level of training, martial status, and previous practice in Iran were all related to intention to return, although whether or not the physician had returned to Iran on a visit was not an important factor. The most frequently cited reasons for not returning were professional reasons, particularly lack of medical facilities and equipment in Iran.

Age Factors↗