Faculty Bibliography

BACKGROUND: To date, no management approach has proven to be efficacious for the treatment of idiopathic pulmonary fibrosis (IPF). Consequently, therapeutic options remain controversial and confusing for many clinicians. We sought to formally review available evidence on treatment options for IPF and to have a diverse panel of physicians rate the 'appropriateness,' 'inappropriateness,' or 'uncertainty' of some of the available therapeutic options. METHODS: The RAND/UCLA Appropriateness Method was used to review and rate multiple clinical scenarios for the treatment of IPF. The panel was composed of nine physicians from geographically diverse areas who received a systematic review on the risks and benefits of commonly used treatments for IPF as background. RESULTS: A total of 324 clinical scenarios were rated: 25% as appropriate; 39%, uncertain; and 36%, inappropriate. The panel disagreed about 12% of the therapy indications in the final ratings, falling from 26% in the first-round ratings. CONCLUSIONS: Key themes emerged from the consensus process. Lacking evidence for a definitive therapy, it was considered most appropriate to enroll eligible patients in clinical trials and refer eligible patients for transplant evaluation. For patients without access to clinical trials, the committee was not unanimous regarding treatment recommendations. It was considered inappropriate for patients with a confident diagnosis of IPF to be treated with corticosteroids as the sole agent: corticosteroids should be used in conjunction with azathioprine. With progressive disease despite such combination use, there was agreement for the use of interferon gamma-1b in patients unwilling or unable to participate in available clinical trials

The recent lawsuit lost by Merck to the tune of many millions of dollars does not prove that Vioxx is a dangerous chemical. A dangerous precedent has been set in terms of other cases of Vioxx users against Merck. The drug company now appears vulnerable to other Vioxx allegations even when a direct cause/effect has not been shown. Merck's mistake was trying to downplay Vioxx's effects over four years and several studies, an action that made the company appear villainous in the eyes of a jury

OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes

'It's pretty pleasant to see two teams that did not know each other reach similar findings,' Dr. Lin-Fa Wang, a virologist at the Australian Animal Health Laboratory, said in a telephone interview. After collecting hundreds of bats from the wild and from Chinese markets, each team reported identifying different viruses from the coronavirus family that are very closely related to the SARS virus. SARS now appears to join a number of other infectious agents that bats can transmit. Over the past decade, bats have been found as the source of two newly discovered human infections caused by the Nipah and Hendra viruses that can produce encephalitis and respiratory disease. It was highly unlikely that insects transmitted the SARS viruses to bats, because the viruses do not grow in insect cells in the laboratory, Wang said. Most civets that are sold in China as a delicacy are farmed, Wang said, and the government should make sure civet farms are distant from bat colonies, routinely monitor farmed civets for SARS-like viruses and allow just noninfected animals to be sold in markets

The SARS virus, which killed 774 people and caused severe economic losses, particularly in Asia, as it spread to Canada and other countries, has long been known to come from an animal. Now two scientific teams independently say that the Chinese horseshoe bat is that animal and is the reservoir of the virus in nature. SARS now appears to join a number of other infectious agents that bats can transmit. Over the last decade, bats have been found as the source of two newly discovered human infections caused by the Nipah and Hendra viruses that can produce encephalitis and respiratory disease. Bats have long been known to transmit other infectious agents like the rabies virus and the fungus that causes histoplasmosis. During the SARS outbreak, attention focused on the role of Himalayan palm civets in transmitting the disease after scientists identified the virus in this species and in a raccoon dog sold in markets in Guangdong. The finding led Chinese officials to temporarily prohibit sale of civets and to cull a large number of the animals

SARS now appears to join a number of other infectious agents that bats can transmit. Over the last decade, bats have been found as the source of two newly discovered human infections caused by the Nipah and Hendra viruses that can produce encephalitis and respiratory disease. In the SARS outbreak, attention focused on the role of Himalayan palm civets in transmitting it after scientists identified the virus in this species and in a raccoon dog sold in markets in Guangdong. But W.H.O. officials and scientists elsewhere cautioned that these species were most likely only intermediaries in the transmission, largely because no widespread infection could be found in wild or farmed civets. So, the teams assembled a variety of specialists, including veterinarians, zoologists, virologists and ecologists. The Chinese horseshoe bat fits those criteria and the civets do not, Dr. [Lin-Fa Wang] said. The bat feeds on moths and other insects and generally does not bite animals. It was highly unlikely that insects transmitted the SARS viruses to bats, because the viruses do not grow in insect cells in the laboratory, Dr. Wang said. Most civets that are sold in China as a delicacy are farmed, Dr. Wang said, and the government should ensure civet farms are distant from bat colonies, monitor farmed civets for SARS-like viruses and allow just noninfected animals to go to market

'It's pretty pleasant to see two teams that did not know each other reach similar findings,' Dr. Lin-Fa Wang, a virologist at the Australian Animal Health Laboratory, said in a phone interview. After collecting hundreds of bats from the wild and from Chinese markets, each team reported identifying different viruses from the coronavirus family that are very closely related to the SARS virus. SARS now appears to join a number of other infectious agents that bats can transmit. Over the last decade, bats have been found as the source of two newly discovered human infections caused by the Nipah and Hendra viruses that can produce encephalitis and respiratory disease. In the SARS outbreak, attention focused on the role of Himalayan palm civets (long-tailed, fruit-eating mammals related to mongooses) in transmitting it after scientists identified the virus in this species and in a raccoon dog (a wild, fox-like canine with dark patches on its face similar to a raccoon) sold in markets in Guangdong

The bats apparently are healthy carriers of SARS, which caused severe economic losses, particularly in Asia, as it spread to Canada and other countries. In Asia, many people eat bats or use bat feces in traditional medicine for asthma, kidney ailments and general malaise