Clinical anatomy: a review course for emergency medicine residents.

An understanding of anatomy is essential to the practice of Emergency Medicine. A significant amount of anatomy knowledge is lost in the transition from student to clinician. This article describes the content and structure of a clinically oriented anatomy review course for senior emergency medicine residents.

Health promotion mini-grants: grassroots implementation in New Mexico.

The populations of New Mexico are ethnically diverse, with large Hispanic and Native American components, and live in communities that are geographically dispersed and economically challenged. The University of New Mexico is located in Albuquerque, the state's only major urban area, and houses the state's only academic health sciences center. In 1986, the University received a grant from the W.K. Kellogg Foundation to establish health promotion/disease prevention curricula for health science students and create two Wellness Centers on campus. The Wellness Centers train students to be providers of health information and learn how to counsel and assist people with changing health-related behaviors. A campus-wide employee health promotion program was also implemented. Most of the instructional and service programs initiated by the grant have continued with stable institutional support. A later phase of the project was to encourage other agencies and organizations throughout New Mexico to adopt or expand their own health promotion initiatives. An operating premise of this phase was that local initiatives should respond to locally perceived priorities. To accomplish this, a program of mini-grants was designed to assist in creating health promotion programs within a variety of topic areas. Thirteen mini-grants were awarded to agencies representing diverse groups and cultures throughout New Mexico. Our experience with the mini-grants and the ability of organizations to sustain the activities past the period of grant support are described. The successful use of mini-grants has been reported elsewhere in the literature.

Organizational development of a university-based interdisciplinary health promotion project.

PURPOSE: To analyze the organizational development and implementation of an interdisciplinary health promotion project at the University of New Mexico. The effort involved three academic units in a 3-year externally funded project to institutionalize health promotion curricula in the respective schools and to develop a wellness-oriented service for students, faculty, and staff. METHODS: The open systems theory was used as a framework to analyze the organizational and role issues that emerged from the data collected through interviews, staff surveys, and document review. The analysis is summarized by five thematic questions: (1) How did the project's vision affect its development? (2) How was leadership enacted, and with what effect? (3) What were the organizational issues for the staff? (4) What were the interdisciplinary dilemmas? (5) What was instituted or changed as a result of the project? RESULTS: The analysis uncovered a series of interpersonal and organizational dilemmas involving the nature of the organizational environment, the character of interdisciplinary work, leadership, boundaries of group membership, and the structuring of a unified vision. CONCLUSIONS: Future projects should consider the strength and stability of the boundary spanners, the resource context, and the role of a unified vision for new and organizationally linked units as key issues in facilitating and sustaining change.

Objectives to direct the training of emergency medicine residents on off-service rotations: psychiatry.

Objectives for Emergency Medicine residents on a Psychiatry rotation is the 33rd article in this continuing series of off-service objectives. Psychiatric presentations, including substance abuse and violent behavior, are ubiquitous in the emergency department. In addition, psychological issues influence every aspect of clinical care. A psychiatry rotation can be valuable in emergency medicine training. This experience can be enhanced by clearly defined learning objectives in clinical psychiatry.

Effect of lordosis on the position of the nucleus pulposus in supine subjects. A study using magnetic resonance imaging.

STUDY DESIGN: Healthy young women (N = 20) underwent magnetic resonance imaging while supine with their hips and knees flexed (flexed position) and supine with a lumbar roll under the low back (extended position). The posterior and anterior margins of the nucleus pulposus (NP) relative to posterior and anterior margins of the adjacent vertebral bodies were calculated from mid-sagittal T2-weighted images to determine the position change of the NP as a function of two supine postures. OBJECTIVES: This study describes the effect of two commonly used supine postures on the position of the NP. SUMMARY OF BACKGROUND DATA: Management of patients with low back pain is often based on theorized positional changes of the NP during spinal extension and flexion. Data describing NP positional changes have not been reported for noninvasive measurements. RESULTS: The distance of the posterior margin of the NP to the posterior margins of the adjacent vertebral bodies was greater in the extended compared with the flexed position. There was no difference in the anterior distance. Eight of the 20 subjects had at least one degenerative disc in the lower lumbar spine. The NPs of the degenerative discs did not move the same as normal discs. CONCLUSIONS: The use of a lumbar roll under the low back when supine causes an increase in the distance from the posterior margin of the NP to the posterior portions of the vertebral bodies in normal discs of healthy young females. Degenerative discs deform differently from nondegenerative discs.

Improving the quality of emergency medicine rotation/clerkship evaluations.

The process of evaluating the performance of medical students and/or residents during emergency medicine clinical rotations is constrained by several potential shortcomings. These constraints can limit the quality of the information provided to the student/resident, as well as that provided to the sponsoring institution. During the course of an academic year at United States Air Force Medical Center, Wright-Patterson, a number of medical students, interns, and residents rotate through the emergency department. The limitations identified in the process of evaluating these trainees include the (1) retrospective nature of the data provided in evaluations; (2) the lack of clear pre-established performance criteria; (3) the time constraints placed on preceptors; and (4) the incremental nature of the observations of performance during emergency medicine rotations. The evaluation tool developed to address these limitations is presented as a mechanism to help improve the ability of educators to evaluate and record performance during emergency medicine rotations.

Influence of psychosocial development and life events on the health practices of adults.

The purpose of this study was to examine variables believed to contribute to healthy life-styles of adults. Psychosocial development and the presence of stressors (i.e., life changes) were selected for the potential contribution they make to the practice of health behaviors of adults. Psychosocial theory of development and theory of human adaptation provided the conceptual framework that guided the investigation. Using a survey design, three self-report instruments were mailed to 216 potential subjects. The study participants (N = 156) were employees (current or retired) of a large midwestern university ranging in age from 24 to 80. The results revealed that the means for each stage of psychosocial development were at the upper end of the scale. Positive resolution of intimacy, the stage of early adulthood, was more strongly correlated with the health practices than the remaining seven stages, and four of the stages were significantly associated with the practice of healthy behaviors. Exposure to stressors as measured by life changes increased the predictive values of two of the subscales of the total health behaviors score, nutrition and safety. Stressors and their impact did not, in general, lend strength to the predictive value of healthy life-styles.

The evolution of a baccalaureate program for registered nurses.

Many collegiate schools of nursing are attempting to meet the needs of ever increasing numbers of RNs who are returning to school for the purpose of earning the baccalaureate degree. As non-traditional learners their professional and personal needs vary. Mechanisms have been developed and evaluated to assist the assessment of prior knowledge and skills. Support systems and program changes have been put in place to facilitate accomplishment of the goals of the RN student. The authors discuss ten years' experience with one RN-BSN program, and describe procedures for advance placement credit and special RN courses. Descriptive data and success measures of the 198 graduates of the original curriculum are presented as well as support systems and program changes that proved helpful. More than half of the graduates assumed positions with managerial responsibility. They were more active in professional organizations and nearly half had completed or were enrolled in graduate study. Nearly two-thirds responded positively about their derived benefits of the program listing specific courses, self-confidence, and improvement in critical thinking as some of the gains. Many noted an increased awareness of the need for nurses to work collectively in the pursuit of professional issues. This potential for development of strong leadership from this group in nursing is seen as an asset to our profession.