Student and faculty collaboration in a clinic for the medically underserved.

BACKGROUND AND OBJECTIVES: Growing numbers of uninsured and underinsured individuals in the United States have resulted in increased needs for health care for medically underserved populations. Educational strategies are needed that provide opportunities for students to develop the attitudes, knowledge, and skills necessary for providing quality health care for underserved patients. METHODS: Medical students, residents, and faculty of the University of Wisconsin-Madison Medical School worked together to establish extracurricular opportunities for first- and second-year students to participate in medical clinics serving the poor and homeless. The process for the development and operation of a volunteer clinic is described. RESULTS: In the last 2 years, 163 medical students, 27 residents, and 21 faculty have provided care to more than 1,000 patients. Patients, students, residents, and faculty reported high satisfaction with the experience. CONCLUSIONS: Medical students, residents, and faculty working in collaboration can provide increased access to care for the medically underserved. Engaging in community-oriented primary health care early in their medical education provided positive learning opportunities for medical students, especially those interested in generalist careers.

Lubrication use in condom promotion among commercial sex workers and their clients in Ratchaburi, Thailand.

Condom promotion has been intensified in Thailand to prevent the spread of HIV. A water soluble lubricant (WSL) could be used to alleviate many unpleasant side effects of frequent condom use experienced by sex workers and their clients. This study was conducted to determine the efficacy of WSL use in preventing the side effects of condom use including condom breakage, and to assess the acceptance of WSLs within the sex-worker population. The results of this study showed that 83 (111) of the 134 sex workers reported use of the WSL provided during the study period and more than 95 per cent (106) expressed interest in employing the WSL regularly, saying that WSLs reduce unpleasant side-effects relating to frequent condom use. Also 70 per cent of them reported that the majority of their clients found using the WSL made condom use more enjoyable. A follow-up study showed that 57 per cent of the respondents were still using a WSL on a regular basis and all of them felt it reduced condom breakage. Therefore, WSL use should be an acceptable and useful method for alleviating problems associated with regular use of condoms within the sex-worker population. In addition, there is evidence that WSLs can reduce the incidence of condom breakage. Thus, WSLs could be valuable tools in condom promotion for AIDS control within this high risk population and their clients.

PIP: A study was conducted in Ratchaburi, Thailand, to determine if water soluble lubricants (WSLs) could reduce the problems associated with frequent condom use among female commercial sex workers (CSWs). 134 CSWs were recruited during March 1990 for participation from 10 different sex entertainment establishments in the city. All establishments were promoting 100% condom use and had high numbers of male clients. The participants were of mean age 22 years in the range of 14-34, had been working as prostitutes for a mean period of 2.2 years, and had an average of 3.4 clients per day. All reported using condoms at least sometimes, but only 55% reported 100% condom use. Disease prevention, cleanliness, and birth control were cited as reasons for condom use. 83% expressed their discontent with regular condom use due to the longer time required for any given client to ejaculate, discomfort or pain, and condom breakage. 50% had never used WSLs before the study. The women were given K-Y Jelly packets each containing 2.7 g of lubricant gel. One week later, 111 of the original 134 participants completed a second round of interviews. They reported an average of two clients per day during the study period and used WSLs with 68% of them. Approximately 95% expressed interest in using WSLs on a regular basis, explaining that WSLs reduced the time clients took to ejaculate, reduced vaginal pain and discomfort, and reduced condom breakage. More than 70% of the women reported that the majority of their clients found using WSLs made condom use more enjoyable. 58 of the 111 CSWs from the second round of interviews were followed two months later. At that time, almost 57% reported using WSLs on a regular basis, with 94% obtaining their WSLs from local venereal disease clinics. WSLs were used in 46% of sexual episodes. Of the 33 participants who reported using WSLs regularly, all agreed that WSLs reduced the incidence of condom breakage.

Integrating external clinical information with the ten-step monitoring and evaluation process: from theory to practice.

Traditionally, Sisters of Mercy Health System (SMHS)-St Louis hospitals have had difficulty integrating quality information from external sources into their own monitoring and evaluation activities. This difficulty became apparent at the 14 hospitals of the SMHS when the system headquarters began providing its hospitals with comparative clinical outcome information. Although the hospitals found value in the comparative studies, the information was not fully used in individual hospitals' quality improvement efforts. As a result, SMHS developed a model for integrating external quality information into the local hospitals' ten-step monitoring and evaluation process. This article explains the integration model and shows how it has worked in several clinical scenarios.

Sonography of intracranial air in a newborn with meningomyelocele.

A newborn with an open meningomyelocele and intracranial air is described. Transfontanellar sonography allows initial detection of the unusual and previously undocumented finding of intracranial air associated with spinal dysraphism.