Faculty Bibliography

We studied 63 randomly selected third-year students who split their 10-week medicine clerkship between ambulatory and inpatient components. Compared with their inpatient experience, during the ambulatory rotation, the 63 students felt more like doctors, more responsible for patients, and more able to know and help their patients. Students reported that ambulatory attending staff appeared happier and less stressed, and did not embarrass them as frequently. Compared with their 619 "inpatient" classmates, these 63 "ambulatory" students scored as well on the medicine examination, and were as likely to receive honors (44% vs 41%), and to choose internal medicine residencies (35% vs 34%). In conclusion, students experienced better relationships with their patients and teachers during the ambulatory rotation, which was academically comparable to the inpatient experience.

An A1400G mutation of the rrs gene was identified in Mycobacterium tuberculosis (MTB) strain ATCC 35827 and in 13 MTB clinical isolates resistant to amikacin-kanamycin (MICs, >128 microg/ml). High-level cross-resistance may result from such a mutation since MTB has a single copy of the rrs gene. Another mechanism(s) may account for high-level amikacin-kanamycin resistance in two mutants and lower levels of resistance in four clinical isolates, all lacking the A1400G mutation

PURPOSE: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. METHODS: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. RESULTS: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would 'definitely' recommend them to colleagues. CONCLUSION: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians

An influential panel of the New York State Health Department is urging sweeping changes in the regulation of new fertility technologies, including more steps to reduce the incidence of multiple births. In a report issued today, the panel said doctors providing infertility treatments must think more about the babies born as a result and avoid treatments that are more likely to produce so-called high-order multiple births -- pregnancies of three, four or more babies who are far more prone to devastating problems such as retardation and blindness. Doctors should talk with patients in advance about the possible need to abort one or more fetuses in a high-order multiple pregnancy, the panel said. If an abortion is not an option for the patient, doctor and patient should consider other treatments, even if the chances of pregnancy are reduced

Two new studies reported in preliminary form Monday suggest that a second drug apparently can prevent breast cancer, at least in the short term. But this drug, raloxifene, did not appear to raise the risk of uterine cancer, a side effect of the first drug, tamoxifen, whose benefits were reported earlier this month. Raloxifene reduced the incidence of breast cancer by about half, roughly the same proportion as in the earlier study of tamoxifen, according to information made public on Monday by a national cancer organization. However, the raloxifene studies did not last as long as the tamoxifen study

Two new studies reported in preliminary form yesterday suggest that a second drug can apparently prevent breast cancer, at least in the short term. But this drug, raloxifene, did not appear to raise the risk of uterine cancer, a side effect of the first drug, tamoxifen, whose benefits were reported earlier this month. Raloxifene reduced the incidence of breast cancer by about half, roughly the same proportion as in the earlier study of tamoxifen, according to information made public yesterday by a national cancer organization. However, the raloxifene studies did not last as long as the tamoxifen study. In calling the new findings ''important and encouraging,'' the head of the National Cancer Institute, Dr. Richard D. Klausner, said they had led his institute to design a study directly comparing the benefits and risks of raloxifene and tamoxifen. The study, which is expected to begin later this year, was announced on April 6, when the cancer agency reported a 45 percent reduction in risk of breast cancer among tamoxifen users compared with those who took a dummy pill, or placebo

Two new studies reported in preliminary form Monday suggest that a second drug apparently can prevent breast cancer, at least in the short term. But this drug, raloxifene, did not appear to raise the risk of uterine cancer, a side effect of the first drug, tamoxifen, whose benefits were reported earlier this month. Raloxifene reduced the incidence of breast cancer by about half, roughly the same proportion as in the earlier study of tamoxifen, according to information made public Monday by a national cancer organization. However, the raloxifene studies did not last as long as the tamoxifen study. In calling the new findings 'important and encouraging,' the head of the National Cancer Institute, Dr. Richard Klausner, said that they have led his institute to design a study directly comparing the benefits and risks of raloxifene and tamoxifen. The study, which is expected to begin later this year, was announced April 6, when the cancer agency reported a 45 percent reduction in risk of breast cancer among tamoxifen users compared to those who took a dummy pill, or placebo