Faculty Bibliography

Evidence-based medicine (EBM) educators are often confronted with learners who use their new critical appraisal skills to dismiss much of the medical literature. Does this cynical attitude of "clever nihilism" affect educational outcomes, such that educators need to tailor their curricula to these learners? The authors proposed that this critical skepticism may be an intermediate developmental stage for EBM learners as they progress from "naive empiricism" to "mature pragmatism" and sought to observe its effect on educational outcomes from an intensive, 6 week EBM course. In this course, fifty-four medical residents reported significantly improved skills in critical appraisal and electronic searching. However there was no association between a measure of clever nihilism and the self-reported educational outcomes. The role of clever nihilism in the EBM classroom remains a potentially important issue, and its lack of effect here may be a product of several methodological limitations addressed in the discussion. Such a construct requires further validation The question remains as to whether such cynicism is a learning style or a developmental phase.

The coalition said its report was the first systematic analysis of efforts to scale up antiretroviral therapy based on the research of people living in communities in six of the countries most devastated by AIDS: the Dominican Republic, India, Kenya, Nigeria, Russia and South Africa. In Russia, nongovernmental groups have made important contributions in programs to prevent H.I.V., and some have made innovative suggestions about how to scale up treatment, said Shona Schonning who represented a group of people living with AIDS. Last week, the lower house of Russia's Parliament moved to impose greater control over charities and other private organizations. If the Russian crackdown affects groups that are supporting efforts to prevent and treat AIDS ''it could be very damaging to scale up antiretroviral'' programs, Ms. Schonning said in the news conference

David Oshinsky reviews "Mirror to America: The Autobiography of John Hope Franklin."

As the C.D.C. joined with cooperative airlines to meet flights and later collect information about passengers who had contact with others who developed SARS, the epidemiologists had to compile and process by hand data collected from flight manifests, customs declarations and other sources. The new proposals call for captains to bypass local health officials and report instead to the director of the C.D.C. through quarantine officials or e-mail messages. The C.D.C., in turn, would notify local health officials. The airlines' trade group, the Air Transport Association, issued a statement late yesterday on the C.D.C. proposal: ''There no doubt is a need to update the current regulations to ensure the absolute safety of our passengers and employees. To what extent changes need to be made to existing practices will be done cooperatively with the C.D.C. through this proposed rule making.'' The group declined to elaborate

In the first controlled study of the effects of pet therapy in a random sample of acute and critically ill heart patients, anxiety as measured on a standard rating scale dropped 24 percent for those visited by a dog and a human volunteer, by 10 percent for those visited by a volunteer alone and not at all for those with no visitors

Kuschyk, whose main research field is sudden death, said his interest in roller coasters began when a journalist asked about the dangers of coasters to the heart. When Kuschyk searched databases, he found no studies in scientific journals. One potential danger is a coaster's magnetic brakes, which can interfere with the function of pacemakers and defibrillators, Kuschyk said. The study, conducted in Hassloch, Germany, involved 55 adults and Expedition GeForce, a 120-second ride that starts with a 62-meter, or 203-foot, ascent followed by a free fall. The coaster has changes in gravity of six G's in four seconds, and a maximum speed of 120 kilometers an hour, or 75 miles an hour. The author, Dr. Jurgen Kuschyk, a cardiologist at the University of Mannheim, found that one participant's heart rate reached 200 beats a minute, which could cause dangerous rhythm abnormalities

In the first controlled study of the effects of pet therapy in a random sample of acute and critically ill heart patients, anxiety as measured on a standard rating scale dropped 24 percent for those visited by a dog and a human volunteer, by 10 percent for those visited by a volunteer alone and not at all for those with no visitors. Similar results were found in measures of heart and lung function. All participants were screened for heart disease before the experiment, and their heart rates were monitored throughout the ride. Heart rates appeared to rise more from psychological stress and fear at the beginning of the ride, rather than from the increased G force, Dr. [Jurgen Kuschyk] said. After the ride, about half the participants had abnormal heartbeats even though their heart rates had returned to a normal range. One potential danger is a coaster's magnetic brakes, which can interfere with the function of pacemakers and defibrillators, Dr. Kuschyk said. He said he knew of one heart-related roller coaster death, a man in Germany who was initially resuscitated but died three days later

Dr. [Catherine J. Ryan] studied 12 common symptoms: chest discomfort; shoulder, arm, or hand discomfort; neck or jaw discomfort; back discomfort; abdominal discomfort; indigestion; nausea and vomiting; shortness of breath; sweating; dizziness and light-headedness; weakness; and fatigue. According to her analysis, using standard statistical techniques, people with the shortest delay time, a mean of 9.78 hours, had a greater probability of experiencing the largest number of symptoms. People with the longest delay time, a mean of 22.77 hours, had a moderate probability of experiencing chest pain and shortness of breath. Sweating emerged as an important factor, Dr. Ryan said

Among those affected by the delay is Dr. Gerberding's mother, Bette Gerberding, of Brookings, S.D., who asked her daughter if she should go to a neighboring state to get a flu shot, Dr. Gerberding said. Because there is no influenza outbreak in Brookings, and Mrs. Gerberding's doctor expects a shipment by the end of the month, Dr. Gerberding said she advised her mother, ''Just wait and make your appointment so that you can get it when it's available.'' President Bush's proposal to spend $7.1 billion for a possible influenza pandemic will help manufacturers expand capacity and prevent shortages for regular influenza in the long run, Dr. Gerberding said