[Two severe cases of disseminated cutaneous nontuberculous mycobacteriosis due to Mycobacterium haemophilum]

Mycobacterium haemophilum is a rare pathogen belonging to the group of slowly growing nontuberculous mycobacteria (NTM) that can cause infections, especially in immunocompromised patients. Detection by culturing is difficult because M. haemophilum only grows under special cultivation conditions. Therefore, it is believed that the pathogen is too rarely identified as a cause of disease overall. In addition to patients with severe immunodeficiency, e.g. due to acquired immunodeficiency syndrome (AIDS), chemotherapy or immunosuppression after transplantation, patients with underlying rheumatic diseases are increasingly described in the literature, who are at risk due to the immunosuppressive treatment regimen. Clinically, ulcerative skin alterations, lymphadenopathy and arthropathy are in the foreground. In immunosuppressed patients with unclear skin lesions, infections due to M. haemophilum should be considered and specific microbiological diagnostics should be initiated.

Models of asthma: density-equalizing mapping and output benchmarking

Despite the large amount of experimental studies already conducted on bronchial asthma, further insights into the molecular basics of the disease are required to establish new therapeutic approaches. As a basis for this research different animal models of asthma have been developed in the past years. However, precise bibliometric data on the use of different models do not exist so far. Therefore the present study was conducted to establish a data base of the existing experimental approaches. Density-equalizing algorithms were used and data was retrieved from a Thomson Institute for Scientific Information database. During the period from 1900 to 2006 a number of 3489 filed items were connected to animal models of asthma, the first being published in the year 1968. The studies were published by 52 countries with the US, Japan and the UK being the most productive suppliers, participating in 55.8% of all published items. Analyzing the average citation per item as an indicator for research quality Switzerland ranked first (30.54/item) and New Zealand ranked second for countries with more than 10 published studies. The 10 most productive journals included 4 with a main focus allergy and immunology and 4 with a main focus on the respiratory system. Two journals focussed on pharmacology or pharmacy. In all assigned subject categories examined for a relation to animal models of asthma, immunology ranked first. Assessing numbers of published items in relation to animal species it was found that mice were the preferred species followed by guinea pigs. In summary it can be concluded from density-equalizing calculations that the use of animal models of asthma is restricted to a relatively small number of countries. There are also differences in the use of species. These differences are based on variations in the research focus as assessed by subject category analysis.

Mobile Air Quality Studies (MAQS)-an international project

Due to an increasing awareness of the potential hazardousness of air pollutants, new laws, rules and guidelines have recently been implemented globally. In this respect, numerous studies have addressed traffic-related exposure to particulate matter using stationary technology so far. By contrast, only few studies used the advanced technology of mobile exposure analysis. The Mobile Air Quality Study (MAQS) addresses the issue of air pollutant exposure by combining advanced high-granularity spatial-temporal analysis with vehicle-mounted, person-mounted and roadside sensors. The MAQS-platform will be used by international collaborators in order 1) to assess air pollutant exposure in relation to road structure, 2) to assess air pollutant exposure in relation to traffic density, 3) to assess air pollutant exposure in relation to weather conditions, 4) to compare exposure within vehicles between front and back seat (children) positions, and 5) to evaluate "traffic zone"-exposure in relation to non-"traffic zone"-exposure.Primarily, the MAQS-platform will focus on particulate matter. With the establishment of advanced mobile analysis tools, it is planed to extend the analysis to other pollutants including NO2, SO2, nanoparticles and ozone.

Analysis of research output parameters: density equalizing mapping and citation trend analysis

BACKGROUND

Burden of disease studies indicate major socio-economic burdens since many years. They should be used for the allocation of funding. However, imbalances are present in funding policies and therefore benchmarking becomes increasingly important in health services research.

METHODS

The present study assessed benchmarking approaches. Using large data base analyses, research was analyzed for different health research output parameters. The fields of cardiovascular and respiratory medicine served as models to assess irregular patterns of health research. For visualization, density equalizing mapping procedures were used.

RESULTS

Specific areas of major research activity were identified for European countries and large differences were found. Spatial distribution of published items for cardiac and cardiovascular systems differed in comparison to the distribution for the respiratory system. In general, large countries dominated the overall number of published items. When qualitative measures such as citation analysis were assessed, differing results were achieved. In this category, mostly Scandinavian countries dominated.

CONCLUSION

The present approach of comparative output benchmarking can be used to assess institutional operating figures at the national and international level and to analyze imbalances in health and research funding.

Interfield dysbalances in research input and output benchmarking: visualisation by density equalizing procedures

Background

Historical, social and economic reasons can lead to major differences in the allocation of health system resources and research funding. These differences might endanger the progress in diagnostic and therapeutic approaches of socio-economic important diseases. The present study aimed to assess different benchmarking approaches that might be used to analyse these disproportions. Research in two categories was analysed for various output parameters and compared to input parameters. Germany was used as a high income model country. For the areas of cardiovascular and respiratory medicine density equalizing mapping procedures visualized major geographical differences in both input and output markers.

Results

An imbalance in the state financial input was present with 36 cardiovascular versus 8 respiratory medicine state-financed full clinical university departments at the C4/W3 salary level. The imbalance in financial input is paralleled by an imbalance in overall quantitative output figures: The 36 cardiology chairs published 2708 articles in comparison to 453 articles published by the 8 respiratory medicine chairs in the period between 2002 and 2006. This is a ratio of 75.2 articles per cardiology chair and 56.63 articles per respiratory medicine chair. A similar trend is also present in the qualitative measures. Here, the 2708 cardiology publications were cited 48337 times (7290 times for respiratory medicine) which is an average citation of 17.85 per publication vs. 16.09 for respiratory medicine. The average number of citations per cardiology chair was 1342.69 in contrast to 911.25 citations per respiratory medicine chair. Further comparison of the contribution of the 16 different German states revealed major geographical differences concerning numbers of chairs, published items, total number of citations and average citations.

Conclusion

Despite similar significances of cardiovascular and respiratory diseases for the global burden of disease, large input and output imbalances have been revealed in the present study which point to a need for changes in funding policies. The present study supplies data that could be used for decision making in the field of health systems funding.

Die Bedeutung der aviären Influenza für das Gesundheitssystem

Die aviäre Influenza ist eine Viruskrankheit, die insbesondere Vögel befällt. Die auslösenden Erreger der Erkrankung sind Influenza-Viren. Die Erkrankung ist weltweit bekannt und wurde erstmals 1878 in Italien beschrieben. Influenza-Viren gehören zur Gruppe der Orthomyxoviridae. Das Influenza-A-Virus H5N1 gilt seit seiner sprunghaften Ausbreitung unter Geflügel im Jahre 2003 als möglicher Auslöser einer neuen Pandemie.

H5N1 ist humanpathogen, es besteht keine Immunität beim Menschen und es ist hochpathogen mit einer Mortalitätsrate von über 60%. Die wesentliche, bisher fehlende Eigenschaft des Virus um eine Pandemie auszulösen, ist die mangelnde effektive Übertragung von Mensch zu Mensch. Der vorliegende Übersichtsartikel befasst sich mit der Bedeutung der aviären Influenza für das Gesundheitssystem.

Institutional operating figures in basic and applied sciences: scientometric analysis of quantitative output benchmarking

Background

Institutional operating figures and benchmarking systems are important features for the implementation of efficacy in basic and applied sciences. They are needed for research evaluation and funding policy. However, the current policy settings for research evaluation urgently need review since there may be imbalances present in many areas.

Methods

The present study assessed benchmarking of research output. By the use of large data bases research output was categorized and analyzed. Specific areas of major research activity were identified by comparing publication density on different organ systems and inter- and intrafield comparison was performed for selected countries.

Results

Novel density-equalizing mappings were constructed that illustrate trends of publication activity and identify subsets of major interest in a total of 5,527,558 published items. A dichotomy was present between Western countries such as the US, UK or Germany and Asian countries such as Japan, China or South Korea concerning research focuses.

Conclusion

The present study is the first large scale analysis of global research activity and output over the last 50 years. The presently described assessment of operating figures at the national and international level can be used to identify single areas of research that are heavily focused. Further research on qualitative output benchmarking is needed to improve current policy settings for research evaluation.

The effects of testing in shifts on a clinical in-course computerized exam

PROBLEM

Testing a large medical class over two days with a single-form computer-based test has generated questions related to test security and the influence of unequal test preparation times afforded by the testing method.

METHODS

An analysis of variance (anova) design was used to compare the scores for the two days for each of the three tests. In addition, a within-student match-paired t-test of standard score differences was used to examine the relative standing of students across tests administered on different days.

RESULTS

Both the anova and the match-paired t-test failed to detect a difference between first and second day testing.

CONCLUSION

This research suggests that using a single test form with shift-based computerised assessments, spread over as many as two days, does not seriously compromise the integrity of the results. Since creating multiple unique-item forms is often not possible, shift-based testing with a single test form appears to be a fair method of accommodating a large number of students.

Comparison of a virtual microscope laboratory to a regular microscope laboratory for teaching histology

Emerging technology now exists to digitize a gigabyte of information from a glass slide, save it in a highly compressed file format, and deliver it over the web. By accessing these images with a standard web browser and viewer plug-in, a computer can emulate a real microscope and glass slide. Using this new technology, the immediate aims of our project were to digitize the glass slides from urinary tract, male genital, and endocrine units and implement them in the Spring 2000 Histology course at the University of Iowa, and to carry out a formative evaluation of the virtual slides of these three units in a side-by-side comparison with the regular microscope laboratory. The methods and results of this paper will describe the technology employed to create the virtual slides, and the formative evaluation carried out in the course. Anat Rec (New Anat) 265:10-14, 2001.

Team-based versus preceptor-based assignment of junior surgery students

BACKGROUND

Clinical evaluations of junior surgery students frequently lack sufficient detail for effective formative or summative feedback. We hypothesized that this was in part due to a lack of personal accountability associated with large general surgery teams, and that altering the format to assign students to specific surgical faculty preceptors rather than to teams would affect the clinical evaluation products.

METHODS

Over a 1-year period, 154 junior medical students grouped into 8 successive clerkships were assigned alternately in the usual Team (3-5 junior students, with 2-4 general surgery faculty, 2-4 residents, and 0-2 senior students) or a new Preceptor format (1-2 students to each faculty preceptor). In order to keep the ratio of students to faculty low, approximately one-third of the Preceptor format students were assigned to subspecialists.

RESULTS

The preceptor format resulted in the use of more adjectives to describe students in the open-ended portions of the faculties' clinical evaluations (mean of 3.2 as compared with 2.5, P = 0.003), and a greater proportion of students recommended for overall clinical Honors (47% as compared with 25%, P = 0.004). The clerkship format had no impact on exam performance, students' perceptions of the faculty, or the amount of students' self-reported clinical activity. Nevertheless, twice as many Team format students felt they had too few patients, whereas twice as many Preceptor students felt their informal instruction had been less than "good."

CONCLUSIONS

Preceptor assignment increased the number of students recommended for Honors, but this did not correlate with students' exam performance. From the students' standpoint, each format had advantages and disadvantages. Limiting the number of students on the general surgery teams and adding structured formative feedback from faculty before the end of the clerkship might give students the instructional advantages of the Preceptor format without sacrificing those of the Team format.

Preclinical science course "preludes" taken by premedical students: do they provide a competitive advantage?

BACKGROUND

Premedical students often elect advanced science courses whose content will reappear during preclinical courses. Are such "preludes" useful?

METHOD

The study participants were the 176 first-year students entering the University of Iowa College of Medicine in 1992. Their grades in medical school courses in biochemistry, gross anatomy, histology, physiology, and microbiology were compared with their grades in similar premedical courses.

RESULTS

The students who had taken a premedical prelude in advanced science performed no better than their classmates except in biochemistry, where the 118 students (67%) with prior biochemistry exposure had a significantly higher mean score (96.3 vs 87.6, p < .0001 using Student's t-test). A biochemistry prelude appeared to benefit all students, especially those from minorities underrepresented in medicine. In addition, among the 13 students who failed biochemistry in medical school, a number of them had low grades in organic chemistry and had not taken a premedical course in biochemistry. To test the replicability of the findings, an analysis was undertaken of the biochemistry performances of the 162 students who had entered in 1991, and again a significant difference was found between the students who had and those who had not taken a biochemistry prelude.

CONCLUSION

A premedical biochemistry course, required by only two schools in 1995-96, appears advantageous, especially for students with weak academic preparation. Lack of such benefit from other preludes suggests that premedical students might better choose electives in arts and humanities to enhance their educational breadth.

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.