The short-term stability of student ratings of instruction in medical school

The purpose of this study was to assess the degree of consistency in student ratings of teacher effectiveness during the first year of medical school. Student ratings of teaching effectiveness represent a commonly used source of information that enters into the academic decision-making process. In medical school, student evaluations often represent a major source of information that is used in promotion and tenure decisions. It is essential that the precision of such ratings be ascertained so that decision-makers will know how much confidence to place in this source of information on teaching effectiveness. In this study, each member of a first-year medical school class was randomly assigned a two-digit identification number at the beginning of the spring semester, 1986. As the semester progressed students were asked to evaluate each full-time teacher in three major courses. Multiple instructors were utilized in each course (n = 10). Each teacher was evaluated immediately after lectures during the first (T1) and second (T2) halves of the course. Students evaluated the teacher a third time (T3) as part of the end-of-semester overall course evaluation. The teachers were evaluated on a short eight-item Likert-type scale that identified several key indicators of effective teaching. Students attached their anonymous identification numbers to individual ratings so that their responses could be matched in the analysis. The results indicate that medical students are only moderately consistent in the extent to which they evaluate teachers. This inconsistency varied by course and by instructors within courses.(ABSTRACT TRUNCATED AT 250 WORDS)     

五所医院特需医疗服务状况调查

通过对上海医科大学附属华山医院、协和医院、北京同仁医院、中山医科大学附属第一医院、浙江医科大学附属第二医院开展的特需医疗服务情况的调查，论述了五所医院的具体做法，在对调查结果进行分析的基础上，就特需医疗服务的管理提出了建议。     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

适应社会主义市场经济 发展妇幼保健机构

本文在分析黑龙江省妇幼保健机构设置现状的基础上,论述了在社会主义市场经济新形势下,妇幼保健机构发展的指导思想、模式与对策。     

Survey of the oral health needs of institutionalised elderly patients in Western Australia

An epidemiological survey of the oral health needs of 1144 elderly patients was conducted in hospitals and nursing homes in Western Australia. Patients were categorised as being either totally dependent (requiring intensive nursing care) or partially dependent (requiring nursing supervision). Of all patients the mean age was 80.2 yr, 70% were women, 74% were edentulous, and 70% needed some form of prosthetic care. Of all dentate patients 56% needed dental scaling (and 17% needed complex periodontal treatment), 47% needed some restorative treatment (with a mean need per patient of 1.1 coronal restorations and 0.4 radicular restoration), and 29% needed one or more dental extractions (with a mean need of 1.4 extractions per patient). Partially dependent patients had statistically significant higher needs for prosthetic work than did totally dependent patients, while the converse applied to extraction needs, but in all other aspects the needs of the two categories of patient did not differ significantly.     

Performance measures for evaluating services for people with a first episode of psychosis

Aim: The purpose of this project was to operationalize and apply a previously identified set of performance measures designed to evaluate services for those experiencing a first episode of a schizophrenia spectrum disorder. Methods: Operational definitions were developed for previously identified measures through an iterative process of discussions between clinical experts and health‐care evaluators. Data were collected from existing sources including corporate databases, clinical databases and chart review. Results: Definitions were developed for 44 measures covering seven of eight domains recommended for service level evaluation by the Canadian Institute for Health Information domains. Forty measures could be calculated. Conclusions: The measures represent a comprehensive set of performance measures suitable for the evaluation of services for people with a first‐episode psychosis. The measures could be used by other services in order to establish standards and norms for routine clinical practice.     

A programme for treating chemically dependent medical students

Summary. The first American programme for chemically dependent medical students at the University of Tennessee, Memphis is described. The goals of the Aid for the Impaired Medical Student (AIMS) Program are to provide confidential treatment for chemically dependent medical students, to assure that recovering students are able to resume their education, and to protect patients and others from the harm that may be caused by impaired students. The Program is administered by the AIMS Council, consisting of medical professionals and elected student representatives. The Council oversees the management of cases, including investigation of students who may be impaired, intervention when chemical dependency is suspected, diagnostic evaluation, treatment and aftercare, and post-recovery advocacy for students. The Program's experience includes 18 cases of suspected chemical dependency, with four self-referrals and 14 students referred by third parties. Eleven students have been diagnosed as chemically dependent and have completed treatment programmes. Nine have maintained recovery and eight have graduated. One student subsequently relapsed and committed suicide. Obstacles in programme implementation have involved absence of perceived need, the view that chemically dependent students should be dismissed from school, and reluctance of students to report classmates. Resources have included highly respected student representatives, a supportive administration, assistance of the impaired physicians programme, and medical insurance and professional courtesy to defray costs. Although the number treated has been modest, the AIMS Program is an important vehicle for training students regarding chemical dependency and their professional obligations toward impaired colleagues.     

Retention: An unresolved workforce issue affecting rural occupational therapy services

Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has been focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. This was the focus of this study. Ethnographic interviews were used to explore the experiences of 10 occupational therapists who had left rural practice. Six themes emerged from the participants' experiences, from when they first considered rural practice to reflections following their departure from it. These themes were initial appeal, facing the challenge, rural practice issues, the social sphere, reasons for leaving and the value of rural experience. These factors gave rise to a proposed Model of Retention Equilibrium, which suggests that retention can be improved by addressing the imbalance between incentives to leave and incentives to stay. The model provides a useful framework for occupational therapists contemplating rural practice, as well as for health services managers responsible for service delivery in rural areas.     

The epidemiology and surveillance of blood lead in Taiwan (R.O.C.): A report on the PRESS-BLL project

 To monitor the lead hazards in industries and to investigate the prevalence of elevated blood lead levels (BLLs) in lead-exposed workers, a lead surveillance system (PRESS-BLLs) has been established and operated in Taiwan, Republic of China, since July 1993. A cohort of lead-exposed workers who received a periodic annual health examination at 55 accredited hospital laboratories was constructed. A total of 9807 separate BLL measurements were reported to the system in 1994. The mean BLL was 15.8 μg/dl in male workers and 11.6 μg/dl in female workers. The mean BLL of lead-exposed workers was significantly (P<0.05, z-test) higher than that of the general Taiwanese population (8.6 μg/dl for males and 6.7 μg/dl for females). In addition, the BLLs of 983 (10.0%) workers exceeded the regulatory action level (40 μg/dl for males; 30 μg/dl for females). The workplaces and homes of 57% of the workers with elevated BLLs were thoroughly investigated to determine the sources of lead contamination. These actions identified the causes of elevated BLLs and set up strategies to reduce workers’ lead exposure. The establishment of this occupational lead surveillance system represents a method for monitoring of lead hazards from occupational and environmental settings to prevent lead poisoning. The information acquired from the system can help in the setting up of a priority of prevention and the development of control measures. It is also useful for further monitoring of changes in the BLLs of the lead-exposed-worker cohort. The Health Department of Taiwan can use this information to evaluate the effectiveness of current industrial hygiene practice. Subjects with elevated BLLs have been medically treated and placed on long-term follow-up for sequelae. Received: 2 September 1996/Accepted: 29 November 1996