Use of Standardized Patient Scenarios to Train Medical Assistants in an Ambulatory Rehabilitation Medicine Clinic

Objectives: To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care. To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process. To demonstrate the utility of in-situ simulation for MA training. To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention. To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and attending physician encounters, clinic and exam room accessibility).https://jdc.jefferson.edu/patientsafetyposters/1051/thumbnail.jp

Two novel evolutionary formulations of the graph coloring problem

We introduce two novel evolutionary formulations of the problem of coloring the nodes of a graph. The first formulation is based on the relationship that exists between a graph's chromatic number and its acyclic orientations. It views such orientations as individuals and evolves them with the aid of evolutionary operators that are very heavily based on the structure of the graph and its acyclic orientations. The second formulation, unlike the first one, does not tackle one graph at a time, but rather aims at evolving a `program' to color all graphs belonging to a class whose members all have the same number of nodes and other common attributes. The heuristics that result from these formulations have been tested on some of the Second DIMACS Implementation Challenge benchmark graphs, and have been found to be competitive when compared to the several other heuristics that have also been tested on those graphs.Comment: To appear in Journal of Combinatorial Optimizatio

Pattern of Patient Presentation to the General Surgery Unit of a Tertiary Health Care Centre in a Developing Country

Background: Not much has been published on the surgical burden in Africa. This study describes the pattern and distribution of surgical  conditions treated by the general surgery division in a Nigerian tertiary hospital.Method: This was a retrospective study over thirty months. All patients treated by the general surgery divisions of the hospital were included in this study.Results: A total of 5631 new patients were seen over the period. Male: Female sex ratio was 1: 1.35 with a mean age of 39.6 years. malignant conditions accounted for 22.7% while 74.6% were benign. Breast carcinoma was the commonest malignancy in females. The commonest malignancyin males was abdominal (gastrointestinal, hepatobiliary and  retroperitoneal).Conclusion: Patients are getting increasingly educated. Appropriate manpower training is required so that tertiary hospitals are not encumbered by mundane surgical conditions .Specialty clinics for hernias, breast, gastrointestinal malignancy and anorectal conditions should beconsidered.Key words: Breast, Colon, Epidemiolog

An Audit of Perforated Peptic Ulcer Disease in a Tropical Teaching Hospital

Background: Perforated peptic ulcer (PPU) is associated with high  morbidity and a mortality rate. Thus it requires urgent surgical  intervention. Recently a reduction in the rate of peptic ulcer perforation in young men with a relative increase in the elderly and in women has been documented. This study is an audit of perforated peptic ulcer surgical emergencies treated by the gastrointestinal surgery division of a teaching hospital in Nigeria. It also reviews the early complications and the average duration of admission of these set of patients.Method: This was a retrospective five-year audit of patients admitted by the gastrointestinal surgery division of a tertiary teaching hospital in Ibadan Nigeria. The data extracted from the patients’ records included the bio-demographical data, the duration of symptoms prior to admission, thepatients’ vital signs at presentation and the results of the haematological investigations. Other information includes the duration from admission to surgery, the intra-operative findings and the outcome of the treatment.Results: Forty patients consisting of thirty three male and seven female were treated. The ages ranged from 20 years to 70 years. The peak incidence was in the fifth decade. None of the patients was seen within 6 hours of the onset of symptoms however fifteen patients were seen within twenty four hours of the onset of symptoms. Twelve patients (30%) had history of significant ingestion of non-steroidal anti-inflammatory drugs, nine (22.5%) had a significant history of alcohol ingestion, while one (2.5%) had a recent history of fasting prior to the onset of symptoms. The distribution of the sites of perforation, revealed a pattern of 9(22.5%), 21(52.5%) and 10(25%) in the body of the stomach, pre-pyloric region and the first part of the duodenum respectively. There were six mortalities.Conclusion: The outcome is excellent when prompt and adequate resuscitation and surgical repair of perforation are done. Health education  may increase patient awareness which may translate to early presentation. Risk scores may be helpful in predicting the outcome but an experienced clinical opinion is still essentia

The distinctive population structure of Colletotrichum species associated with olive anthracnose in the Algarve region of Portugal reflects a host–pathogen diversity hot spot

Anthracnose (Colletotrichum spp.) is an important disease of olive fruits. Diversity and biogeographic relationships of the olive anthracnose pathogens in the Algarve (Portugal) were investigated, along with host association patterns and disease levels during 2004–2007, to test the hypothesis that this region is a host–pathogen diversity hot spot. Diverse Colletotrichum acutatum and Colletotrichum gloeosporioides populations were identified based on rRNA-internal transcribed spacer and partial β-tubulin 2 gene sequences of 95 isolates. Spatial and temporal variations in the occurrence of the eight genetic entities of the pathogens were linked to olive biogeography. Disease occurrence patterns suggest that C. acutatum populations are more stable pathogens, while C. gloeosporioides populations appear to be more influenced by favourable conditions. Three unique C. acutatum populations were identified, but none of the eight populations were dominant, with the most frequent type representing only 27%. Thus, the population structure of olive anthracnose pathogens in the Algarve is distinct from other parts of Portugal and other world locations, where only one or two genetic entities are dominant. This pattern and level of genetic diversity in a restricted area, where oleaster (wild olive tree), ancient landraces and modern cultivars of olive occur in close proximity, suggests the Algarve as a centre of diversity of the anthracnose pathogens and corroborates recent work suggesting western Mediterranean as an important centre of olive diversity and domestication