Faculty Bibliography

Scientists at Stanford University say they have developed a novel way to generate a powerful immune response targeted specifically against non-Hodgkins lymphoma, a cancer of the lymph system. The Stanford researchers start the multistep process by removing two kinds of tissue from a lymphoma patient. One tissue is a dendritic cell, which is important in stimulating immune reactions in humans. The cells are obtained from the blood. The second tissue is the lymphoma, which is removed by a biopsy and from which researchers isolate a protein from the surface of the cancerous cells. The protein is specific for each patient's cancer. Because the therapy must be tailored to each patient, widespread testing to evaluate the effectiveness of the new therapy is impractical, said Dr. Ronald Levy, the head of the Stanford team

Taking medical photographs of nude patients was common in the nineteenth century and was related to the diagnostic promises of photography. Nude photography today, while just as diagnostically important, is a carefully thought out practice fraught with serious legal ramifications especially when dealing with children and adolescents. As members of the human race, we are diverse in our practices and not only on a country wide but a regional level. What is acceptable in New York is not necessarily acceptable in central Kansas. Unfortunately, in many circumstances, it is difficult to measure intent. Vintage medical photographs have become valued as art, as well as historic and cultural documents. Nude vintage medical photographs fully expose the human condition and have become among the most valued of historic medical photographs. The implications for the future treatment of nude medical photography is well established. The passage of time, nostalgia, and, most importantly, the attempt to learn the secrets of life and means of death in past epochs will result in preserving and valuing these most important clinical photographs

We analyzed the clinical and laboratory findings and outcome of 173 patients hospitalized at our institution from 1983 to 1994 with multidrug-resistant tuberculosis (MDR-TB) and evaluated outcome. The 173 patients (mean age 40 +/- 1 yr) were predominantly male (92%), African American or Hispanic (80%), and mostly undomiciled. Over half (52%) were known to be HIV-infected. HIV-positive MDR-TB patients had significantly more pulmonary and constitutional symptoms, more extrapulmonary disease, and fewer cavitary lesions on chest radiographs. Fifty-five percent of the patients in the cohort have died; mortality was significantly greater for HIV-positive than HIV-negative (72% versus 20%, p < 0.01). The median duration of survival of MDR-TB patients was 22 +/- 1 mo. Overall, extrapulmonary involvement was a risk factor for shorter survival, while a cavitary lesion on initial chest film and institution of appropriate treatment were positive predictors of survival. In HIV+ patients, only appropriate therapy was associated with prolonged survival (median of 14.1 mo). Interestingly, there was a trend toward better outcome in the first half of the decade reviewed. We conclude that although mortality from MDR-TB is high in both HIV-positive and HIV-negative patients, institution of appropriate therapy is the factor most strongly associated with a favorable outcome. Development of new diagnostic and therapeutic strategies for MDR-TB are urgently needed

This paper reports the development, implementation and evaluation of a training program for all levels of staff of Maternity Infant Care Family Planning Centers in New York City. The learner-centered training is designed to enhance cross-cultural sensitivity and communication skills. It provides epidemiological and patient management skills for serving ethnically diverse populations and focuses on skills training, such as the cross-linguistic, cross-cultural interview, and using epidemiological principles in diagnosis and treatment. In addition to the core curriculum, each module is tailored to the site-specific information needs of the participants, as determined during individualized needs assessments. There are five sessions: the cross-cultural medical interview and working with interpreters; epidemiologic issues; attitudes and practices in maternal child health; family dynamics and interactions; and a session devoted to follow-up and evaluation. This training has been very successful in enhancing health care providers' sensitivity toward immigrant health issues. Pre- and post-test measurements found statistically significant improvements in the knowledge and attitudes of participants. Patient care has been greatly improved

Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting

The catalase-peroxidase gene (katG) and a two-gene locus (inhA) containing mutations associated with resistance to isoniazid in Mycobacterium tuberculosis were sequenced in 34 resistant and 12 susceptible strains. Virtually all resistant organisms had amino acid changes in KatG or nucleotide substitutions upstream of inhA. A region of katG encoding two amino acids frequently altered in resistant strains (residues Ser315 and Arg463) and the inhA locus were sequenced in 10 susceptible and 51 isoniazid-resistant isolates from the Netherlands. Most (84%) of the resistant isolates had mutations in katG or the inhA locus or lacked katG. Together, approximately 75% of isoniazid-resistant isolates had replacements at amino acids 315 or 463 in KatG or nucleotide substitutions upstream of inhA. All 16 strains of Mycobacterium bovis and Mycobacterium microti studied had Leu463 rather than Arg463 in KatG, an observation consistent with the hypothesis that Leu463 is the ancestral condition in M. tuberculosis

The modern understanding of patient education derives from a robust literature from public health and clinical medicine that started to become empirical and rigorous in the mid-1960s. Patient education is one of three functions of the medical interview, each of which must each be accomplished skillfully if the others are to be maximally effective. This article discusses the new conceptualization of patient education and provides examples of how it works. The rule of patient activation is discussed and implications for future research are presented.

Avoiding macrostructural or individualistic explanations as to why homeless individuals cannot get off the streets, this paper examines the social structure of street life as it impinges on a sample of homeless persons' chances of obtaining nonshelter housing. Specifically, by interviewing 42 homeless individuals about a housing grant offered by New York State and the possibility of obtaining shaved housing arrangements with such a grant, this study documents possible ways in which the social relations homeless people have with institutions and each other may dash potential efforts to obtain nonshelter housing. The research finds that distrust of the homeless among landlords and a high level of contingency with respect to welfare cases interact with distrustful personal relations among the sample of homeless themselves to reduce the likelihood of successful utilization of the housing grant. Due to sample limitations, findings from this study cannot be generalized to all homeless; nonetheless they offer insight into a dynamic which may be similar to those at work among other homeless sub-populations as well.