Feasibility study on the MammoSite in early-stage breast cancer: initial experience.

The aims of this study were to evaluate the feasibility, practicality, efficacy and safety of the delivery of accelerated partial breast irradiation using the MammoSite for the boost phase. Six patients aged 53-69 years with stage T1N0, T2N0, Grade I-II invasive ductal carcinoma received 9-10 Gy prescribed at 1 cm from the MammoSite balloon surface in two fractions of 4.5-5 Gy 6 h apart. The MammoSite was inserted 20-37 days postoperatively. External beam radiation therapy to the whole breast commenced 1-5 days after accelerated partial breast irradiation. The maximum skin dose ranged from 3 to 9 Gy. The skin-cavity distance ranged from 7 to 19 mm. Local discomfort resolved as the scar healed spontaneously within 3-5 days. No Grade III or higher acute toxicity or local infection was recorded. The ease of insertion and accuracy of dosimetry makes the MammoSite suitable for use in properly selected women with early-stage breast cancer in a trial setting.

A comparison of patient satisfaction among current and former dental school patients.

Patient satisfaction is becoming an increasingly important indicator of quality dental care. However, most patient satisfaction surveys target only the current patients of the dental practice or institution, which may give an inflated estimate of satisfaction with care, since dissatisfied patients are likely to have left the practice or institution. The purpose of this study was to compare the satisfaction of three categories of dental school patients with several aspects of care received at the school. Data were collected using a telephone survey of 291 patients, systematically selected from the dental school's computer listings of all current, recall, and former patients. The survey instrument sought information about why respondents came to the school for dental treatment, why respondents who were no longer in treatment had dropped out of care, and respondents' opinions on eleven aspects of quality of care provided at the dental school. Dental students who had completed a training session served as interviewers. Results indicate that, overall, patient satisfaction with the care received was high, with none of the means for any category of patient falling into the dissatisfied range. Respondents who had dropped out of care were less satisfied than active or recall patients in five areas: quality of care, length and number of appointments, treatment explanation, and fees. Results have implications for dental school administrators and educators in their efforts to provide high quality patient care and to retain an adequate patient pool to ensure optimal clinical experiences for students.

The effects of gender and race on practice pattern preferences of dental students.

Type of practice arrangement is an important decision for student dentists, and one that has implications for the future delivery of dental care. This study examined the effects of two student-related characteristics, gender and race, on dental student preferences for three practice arrangements: solo ownership, group ownership, and employee practice. Dental students read content-validated practice descriptions and rated each practice in terms of long-range practice preferences. The descriptions differed according to three practice-related factors: (a) decision-making autonomy, (b) income opportunity, and (c) financial risk. The independent variables were student gender and student race. The dependent variable was student rating of a dental practice. Results indicated that student preferences for different practice arrangements differ by gender and by race. Males rated the solo owner arrangement more favorably than did females and Whites rated the solo owner arrangement more favorably than did African Americans. Also, females demonstrated a stronger preference for group practice than did males, while African Americans rated the employee practice arrangement more favorably than did Whites.

The effect of an extramural education program on the perceived clinical competence of dental hygiene students.

The purpose of this study is to evaluate the effect of an extramural rotation on dental hygiene student self-perceptions of competence in specific clinical areas. Dental hygiene students attending one midwestern university from 1992 through 1998 rated their perceived level of competence on nineteen dimensions of dental hygiene practice prior to beginning a four-week extramural rotation and again at the completion of the rotation. Results indicated that student perceptions of competence improved significantly on six of the nineteen dimensions in each of the study years. Study results suggest that an extramural rotation is a valuable component of a dental hygiene curriculum to enhance student self-perceptions of clinical competence.

An investigation of dental student values.

The development of a dental student's professional values system is an important issue in dental education. The purpose of this study was to assess the relative importance of different values of dental student and instructor populations at a single dental school. Data was collected from surveys disseminated to dental students and faculty. Statistical analysis of the data indicated faculty showed a different set of values than students. Faculty placed greater value on patient care and clinical education. Students were more focused on passing licensure examinations, completing course requirements, and personal satisfaction. Junior and senior dental students placed greater value on the requirements of becoming a licensed dentist than did their younger student colleagues. Freshman and sophomore dental students placed higher values on additional academic pursuits and personal growth. This study also revealed no statistically significant difference between males and females in any of the values ranked.

Isolation and characterization of alpha-tubulin genes from Septoria tritici and Rhynchosporium secalis, and comparative analysis of fungal alpha-tubulin sequences.

The alpha-tubulin genes from Septoria tritici and Rhynchosporium secalis have been cloned and sequenced. The predicted amino acid sequence and intron structure showed strong homology with other known filamentous fungal alpha-tubulins. Comparison of sixteen fungal alpha-tubulin sequences based on amino acid sequence homology and intron structure identified five groups of proteins. Group 1 consists of filamentous fungi, including S. tritici and R. secalis, the dimorphic fungus Histoplasma capsulatum, and Pneumocystis carinii. Group 2 includes two divergent isoforms from Neurospora crassa and Aspergillus nidulans. Group 3 includes the yeast Saccharomyces cerevisiae and the dimorphic fungus Candida albicans. Group 4 contains the single yeast Schizosaccharomyces pombe. Group 5 includes the only Basidiomycete, Schizophyllum commune. This analysis supports the classification of P carinii as a primitive Ascomycete. The presence of an additional glycine residue between the second and third amino acid found only in Group 2 proteins may indicate a functionally distinct fungal isotype. Implications in terms of structure-function relationships for alpha-tubulin molecules are discussed.

Fungal beta-tubulin, expressed as a fusion protein, binds benzimidazole and phenylcarbamate fungicides.

Benzimidazoles are important antitubulin agents used in veterinary medicine and plant disease control. Resistance is a practical problem correlated with single amino acid changes in beta-tubulin and is often linked to greater sensitivity to phenylcarbamates. This negative cross-resistance creates opportunities for durable antiresistance strategies. Attempts to understand the molecular basis of benzimidazole resistance have been hampered by the inability to purify tubulin from filamentous fungi. We have overcome some of these problems by expressing beta-tubulin as a fusion with a maltose binding protein. This fusion protein is soluble, and we confirm for the first time using a gel filtration assay that benzimidazoles indeed bind to beta-tubulin. This binding is reduced by the mutation Glu198-->Gly198, which also confers resistance. Binding of phenylcarbamates is the complete opposite, reflecting their biological activity and the negative cross-resistance. This suggests that the fungicide binding sites fold correctly in the fusion protein.

An investigation of dental student practice preferences.

This study explored characteristics hypothesized to influence dental student long-range practice preferences. Dental students (N = 264) for this study were selected at random from all dental students in one state who rated practice arrangements they most prefer to be in five years after graduation. The rating instrument was composed of two items measured on 5-point Likert-type scales. The independent variables were student gender, year of dental study, and practice arrangement. The research design was a 2 x 4 x 3 completely randomized, fixed-factor, factorial analysis of variance (ANOVA). The ANOVA model explained 48 percent of the variance in student practice arrangement ratings. Both males and females rated solo ownership as the most favorable practice arrangement. Males rated the solo owner arrangement more favorably than did females, while females had a stronger preference for the employee practice arrangement than did males. Study results have implications for dental educators in their efforts to structure curricula to meet diverse student needs, to assess personnel needs and enhance the accuracy of projections, and to evaluate the effect of practice preferences on the health care system.

Evaluation of oral cancer screening.

BACKGROUND: Oral cancer screening procedures are designed to collectively allow early detection of cancers in a body area accessible to visual and physical examination, as well as to facilitate timely treatment, awareness, and the ongoing education of the public. METHODS: A state fair was selected for this activity because of the availability of a random population compatible with meeting these goals. A total of 1,151 individuals participated in this free elective activity. RESULTS: Of this number 4.17% were deemed to have oral pathologic states necessitating professional intervention, and 1.82% were clinically diagnosed as having potential dysplastic or precancerous lesions. No clinical oral cancer was detected in this population. Nevertheless, by virtue of screening and detecting clinically premalignant lesions, the screening test advanced the diagnosis of potential oral cancers. CONCLUSIONS: The outcome adds support to oral cancer screening as a procedure applicable in reducing morbidity and mortality from oral cancers.

Interdisciplinary student health teams: combining medical education and service in a rural community-based experience.

Several initiatives have been introduced over the years to address the maldistribution of health care professionals and to improve access to care for underserved rural populations. One of these is the sponsorship of community-based, service-oriented teams comprised of students from various health disciplines. This study investigated extramural training as a complement to traditional hospital-based experiences. The specific objective of the study was to determine the extent to which the nation's medical schools combine training with a rural community-based experience in the form of an interdisciplinary student health team program. In the fall of 1994, a 32-item questionnaire was mailed to the chief academic or clinical affairs administrators of the nation's 126 allopathic medical schools. A total of 104 (82.5%) medical schools responded to the survey. Eighty-six of the respondents (82.7%) reported some type of rural training or public service activity; 22 (21.2%) acknowledged the sponsorship of an interdisciplinary student health team program. Small rural communities, those with populations of 5,000 or fewer, were the focus of 76 percent of the reporting programs. Nearly two-thirds of the reporting programs were located in the South, the region with the nation's lowest physician-to-population ratio. The nursing and medical professions were most frequently represented, although a wide range of disciplines were identified as participating on the student health teams. Activities of the teams included both ambulatory care and community outreach services. The majority of the programs used team-building exercises to enhance team effectiveness. Extramural training programs offer students a realistic examination of the social, cultural, economic, and political forces that influence both individual and community health. Rural community-based programs, such as interdisciplinary student health teams, should be valued because they can strengthen the link between the sponsoring institution's educational mission and its public service obligation.

Legal standards of conduct for students and residents: implications for health professions educators.

Students and residents are responsible for providing much of the patient care in academic medical centers. Though experiential learning has been central to equipping students with the professional knowledge and skills needed in their careers, it raises significant medicolegal questions. One such question addresses the standard of care being provided by health care practitioners in training. Referred to as "standard of conduct" in a legal setting, the applicable standard for students and residents has been addressed by the courts on several occasions. Some early cases supported the notion that there is a special standard of conduct for students and interns, one that is lesser than that expected of fully licensed, certified practitioners. Cases since the late 1970s, however, indicate a trend away from that view, generally finding that any persons holding themselves to be practitioners, including students and residents, should be held to the standard of conduct of a practicing professional. Further, providers are being held to a national rather than a community-based standard of care, heightening the extent of the duty that all providers, including those still in training, have to their patients. A significant reason that students and residents are being held by the courts to the same standard of conduct as practicing professionals is that they are providing care under the supervision of licensed, experienced faculty. Case law indicates that while personnel in training have a duty to their patients to render care of a nationally recognized standard, supervising faculty have a parallel duty to those patients to provide adequate levels of supervision to ensure that such a standard be met, as well as to ensure that the care be in compliance with relevant policies and statutes. The findings discussed in this paper hold several implications for educators and administrators. First, faculty have a duty to maintain their knowledge bases and skill levels in accordance with nationally recognized standards in their professions in order to adequately fulfill their teaching and patient care responsibilities. Second, faculty have a duty to maintain an appropriate level of supervision during the provision of patient care. Administrators and educators also have supervisory responsibilities regarding the monitoring of pertinent policies and statutes to ensure the continued appropriateness of those documents and to foster compliance of all involved. Finally, alternative modes of education that would provide opportunities for students to develop competence in technical skills before using them on real patients (such as patient simulators) should be explored.

Sociodemographics of homebound people in Kentucky.

In this report, selected results are presented from the 1987 Kentucky Oral Health Survey, which acquired statewide data on the oral health status and practices of the noninstitutionalized population of Kentucky. In the 1987 epidemiological survey, information about persons who were homebound was also gathered through telephone and in-person interviews. The results of that survey provided a relatively accurate estimate of the number of persons homebound in the state of Kentucky. Although the majority of this population was older than age 60, almost 21% were between the ages of 35 and 59. Household income for persons who are homebound and the amount of money spent on dental care is significantly less than in households not reporting the presence of a person who is homebound. These findings provide baseline data for dentists and health planners interested in serving this population. Also, this data is pertinent to the formation of health policies to create accessible, affordable care for this growing segment of the population.

Quality assessment/assurance activities in U.S. dental schools.

Quality of health care services has become a major social issue. Accordingly, activities directed toward the assessment and assurance of quality are receiving increased attention in dentistry and dental education. The purpose of this study was to determine the status of quality assessment/assurance (QA) programs in U.S. dental schools. Responses from 48 U.S. schools identify a range of institutional QA activities currently being conducted in dental education. The evaluation and remedial action elements of the QA process are being addressed in a majority of schools; however, the establishment of criteria delineating those elements of a given QA activity area that should be measured is lacking.