Faculty Bibliography

Counselling pregnant women seeking advice about travel should begin with a frank, in-depth discussion about their contemplated trip. While most travel during pregnancy is relatively safe, some women should be urged not to go on their planned trip, or to change their itineraries. But some women are not receptive to such advice. Much of today's popular culture preaches that pregnancy is a normal phase of life, not a health issue, and that restrictions placed on women during pregnancy by the medical profession are largely unnecessary. The women must truly and totally understand potential risks and realise that medical science does not have all the answers, especially as far as risks to the foetus are concerned. The women should be aware that travel may remove them from access to medical care, require immunisations and prophylactic medications, involve long hours sitting in aircraft, necessitate dietary restrictions at the destination, and expose them to extremes of climate, to mention just a few

BACKGROUND: We developed computer-based virtual patient (VP) cases to complement an interactive continuing medical education (CME) course that emphasizes skills practice using standardized patients (SP). Virtual patient simulations have the significant advantages of requiring fewer personnel and resources, being accessible at any time, and being highly standardized. Little is known about the educational effectiveness of these new resources. We conducted a randomized trial to assess the educational effectiveness of VPs and SPs in teaching clinical skills. OBJECTIVE: To determine the effectiveness of VP cases when compared with live SP cases in improving clinical skills and knowledge. DESIGN: Randomized trial. PARTICIPANTS: Fifty-five health care providers (registered nurses 45%, physicians 15%, other provider types 40%) who attended a CME program. INTERVENTIONS: Participants were randomized to receive either 4 live cases (n=32) or 2 live and 2 virtual cases (n=23). Other aspects of the course were identical for both groups. RESULTS: Participants in both groups were equivalent with respect to pre-post workshop improvement in comfort level (P=.66) and preparedness to respond (P=.61), to screen (P=.79), and to care (P=.055) for patients using the skills taught. There was no difference in subjective ratings of effectiveness of the VPs and SPs by participants who experienced both (P=.79). Improvement in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. CONCLUSIONS: Improvements in performance and diagnostic ability were equivalent between the groups and participants rated VP and SP cases equally. Including well-designed VPs has a potentially powerful and efficient place in clinical skills training for practicing health care workers

In 1947, he and Marcel Bessis developed exchange blood transfusion as a therapy for childhood leukemia. The transfusions induced what is believed to have been the first temporary remission of acute lymphoblastic leukemia in children, Professor Jacques- Louis Binet, a hematologist and secretary of the French Academy of Medicine, said last week. In 1948, Bernard and Dr. Jean-Pierre Soulier described a hereditary syndrome that does not allow platelets to stick to blood vessels and form clots. It leads to bleeding in children and is now known as the Bernard-Soulier syndrome. He did not know who the patient would be when a trainee of his, practicing in Iran, asked him to come to Tehran urgently in 1974. Bernard took another trainee, Georges Flandrin. The patient was Shah Mohammad Reza Pahlavi, who was bothered by an enlarged spleen

Since AIDS first made headlines 25 years ago, it killed 25 million people worldwide and infect 40 million more in one of the worst epidemics in history. Altman relates that in 1985 he was greeted with skepticism about AIDS in Africa, even though the disease had begun to take a devastating toll there. Here, he details the outbreak of AIDS and why many people, including doctors, did not recognize an epidemic in the making and take steps to try to contain it

David Oshinsky reviews "Kingfish: The Reign of Huey P. Long," by Richard D. White Jr

There are increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in horses and evidence that MRSA can be transmitted between horses and humans. The objective of this study was to investigate reports of skin infection in personnel working with a foal with community-associated MRSA colonization and subsequent infection. Clinical diagnostic specimens were collected from individuals reporting skin lesions following contact with the affected foal. Nasal and groin screening swabs were collected from other veterinary personnel that attended a voluntary screening clinic. MRSA skin infections were identified in three neonatal intensive care unit personnel. Nasal colonization was subsequently identified in 10/103 (9.7%) other veterinary hospital personnel. Isolates were indistinguishable by pulsed field gel electrophoresis, classified as Canadian epidemic MRSA-5, possessed SCCmecIV, were negative for the Panton-Valentine leukocidin and were multidrug resistant. Transmission to veterinary personnel despite short-term contact with standard protective barriers highlights the potential importance of MRSA as an emerging zoonotic pathogen, and indicates that further evaluation of interspecies transmission of MRSA and means to prevent zoonotic infection are required

The show stopped. In a test of the crew's agility and ingenuity, [Gary Razon] supervised the eight stewards it took to dislodge the woman and carry her to the infirmary. Razon said he 'was so scared because the ship was bouncing and feared she might be bleeding from the hip fracture.' Razon could not reach the nephews. From other calls, he learned that the passenger's mother also was also demented. Her nurse provided the name of the woman's psychiatrist, who was skiing. Razon could not reach the covering physician and sent the woman to a hospital after the ship docked in Nassau. A colleague who was a ship's doctor whetted Razon's appetite for a chance to see the world while practising medicine. Razon said he has travelled to many areas but has had less time ashore than he had expected. Still, he said, 'Being a ship's doctor is an offer I cannot refuse.'

As a cruise ship physician, Dr. Gary Razon's most harrowing moments are when passengers and crew become injured or seriously ill hundreds of kilometers from shore. Sudden life-threatening emergencies like internal bleeding, heart attacks, strokes and broken bones can leave little, if any, time to divert a ship to the nearest port. The challenge for a ship's doctor is to stabilize a patient until the ship reaches land. Razon could not reach the nephews. From other calls, he learned that the passenger's mother also was also demented. Her nurse provided the name of the woman's psychiatrist, who was skiing. Razon could not reach the covering physician and sent the woman to a hospital after the ship docked in Nassau. He became a ship's doctor after a colleague, who was one, whetted his appetite about the chance to see the world while practicing medicine. Razon said he had traveled to many areas but with less time ashore than he had expected. Still, Razon said, 'Being a ship's doctor is an offer I cannot refuse.'

Last year, a woman broke her hip in a storm between Hawaii and the mainland. ''A really wide lady came down the steps trying to find a seat in the darkened show lounge when the ship lurched and she fell, landing between a railing and a wall,'' Dr. [Gary Razon] said. Summoned to the scene, Dr. Razon found that ''she was literally wedged in, screaming in pain.'' The show stopped. In a test of the crew's agility and ingenuity, Dr. Razon supervised the eight stewards it took to dislodge the woman and carry her to the infirmary. Dr. Razon said he ''was so scared because the ship was bouncing and feared she might be bleeding from the hip fracture.'' Dr. Razon could not reach the nephews. From other calls, he learned that the passenger's mother also was also demented. Her nurse provided the name of the woman's psychiatrist, who was skiing. Dr. Razon could not reach the covering physician and sent the woman to a hospital after the ship docked in Nassau

Many questions remain about the process of DNA double strand break (DSB) repair by homologous recombination (HR), particularly concerning the exact function played by individual proteins and the details of specific steps in this process. Some recent studies have shown that RecQ DNA helicases have a function in HR. We studied the role of the RecQ helicase Rqh1 with HR proteins in the repair of a DSB created at a unique site within the Schizosaccharomyces pombe genome. We found that DSBs in rqh1(+) cells, are predominantly repaired by interchromosomal gene conversion, with HR between sister chromatids [sister-chromatid conversion (SCC)], occurring less frequently. In Deltarqh1 cells, repair by SCC is favored, and gene conversion rates slow significantly. When we limited the potential for SCC in Deltarqh1 cells by reducing the length of the G2 phase of the cell cycle, DSB repair continued to be predominated by SCC, whereas it was essentially eliminated in wild-type cells. These data indicate that Rqh1 acts to regulate DSB repair by blocking SCC. Interestingly, we found that this role for Rqh1 is independent of its helicase activity. In the course of these studies, we also found nonhomologous end joining to be largely faithful in S. pombe, contrary to current belief. These findings provide insight into the regulation of DSB repair by RecQ helicases.