Faculty Bibliography

Because of the public fear of bird flu, there has been a lot of pressure on Roche to produce more supply -- even political pressure to break the patent on Tamiflu and allow the drug to be sold generically before the patent expires. Tamiflu is the newest of the neuramidase inhibitors, drugs that work by blocking the transmission of the influenza virus from cell to cell. As a drug to treat the fear of, rather than the effect of bird flu, Tamiflu can easily be misused

OBJECTIVES: The authors examined whether African Americans, compared with whites, received guideline-concordant care for bipolar I disorder. METHODS: A retrospective analysis was conducted of data for patients who received a diagnosis of bipolar I disorder in fiscal year 2001 and received care in facilities in the Department of Veterans Affairs (VA) mid-Atlantic region. Indicators of guideline-concordant care were based on prescription data and data on utilization of inpatient and outpatient services from VA databases. RESULTS: A total of 2,316 patients with a diagnosis of bipolar I disorder were identified. Their mean age was 52 years; 9.4 percent (N=218) were women, and 13.1 percent (N=303) were African American. Overall, mood stabilizers were prescribed for 74.6 percent (N=1,728) of the patients; 67.1 percent (N=1,554) had an outpatient mental health visit within 90 days after the index diagnosis, and 54.3 percent (N=1,258) had an outpatient visit within 30 days after discharge from a psychiatric hospitalization. Multivariate logistic regression analyses with adjustment for sociodemographic and facility factors revealed that African Americans were less likely than whites to have an outpatient follow-up visit within 90 days after the index diagnosis. Race was not associated with receipt of mood stabilizers or use of outpatient services after a hospital discharge. CONCLUSIONS: Although a majority of patients received guideline-concordant care for bipolar disorder, potential gaps in continuity of outpatient care may exist for African-American patients

BACKGROUND: Physician communication skills, linked to important patient outcomes, are rarely formally addressed after the pre-clinical years of medical school. We implemented a new communication skills curriculum during the third year Surgery Clerkship which was part of a larger curriculum revision found in a controlled trial to significantly improve students' overall communication competence. DESCRIPTION: In three 2 hour workshops students, learned to address common communication challenges in surgery: patient education, shared decision-making, and delivering bad news. Each 2 hour, surgeon facilitated session was comprised of a 30 minute introductory lecture, a 15 minute checklist driven video critique, a 15 minute group discussion, a 45 minute standardized patient (SP) exercise with feedback from the SP, peers, and faculty member, and a 15 minute closing summary. To date, over 25 surgery faculty have been trained to conduct these sessions. In an end-of-clerkship survey, students reported on skill changes and assessed the curriculum's educational effectiveness. EVALUATION: A survey was completed by 120 of the 160 (76%) third year students who participated in the curriculum. Fifty-five percent of students reported improvement in their communication skills and ability to address specific communication challenges. Students were satisfied with the amount and quality of teaching. CONCLUSIONS: Communication skills teaching can be implemented in the surgery clerkship, and surgeons are particularly well suited to teach about patient education, discussing informed consent and shared decision making, and delivering bad news. Structured case-based sessions are acceptable to, and improve the self-assessed skills of, surgery clerkship students. Faculty development geared toward such sessions has added benefits to educational activities in a clinical department overall.

The purpose of this study was to identify potential barriers and facilitators to Chinese immigrant participation in cancer screening and clinical trials. A series of focus groups, in English, Cantonese, and Mandarin, were conducted with physicians, community leaders, and first generation members of the Manhattan Chinatown community. Participants were asked to discuss their beliefs about cancer, cancer screening, clinical trials, and cancer health education materials. Focus group data were stratified by respondent group and analyzed for thematic content. Eleven physicians, 15 community leaders, and 38 community members participated. Some community members were not familiar with cancer screening as a preventive measure and had not received common screens such as PAP smears or mammograms. They described widespread misconceptions about cancer that act as screening deterrents, e.g. testing for cancer can cause cancer. Community members were unfamiliar with clinical trials and would not participate in a clinical trial unless 'sick,' and only on the recommendation of their physicians. Physicians did not see the relevance or value of clinical trials for their patients. Among first generation Chinese immigrants, there are many perceptual barriers to cancer screening and clinical trials recruitment. There is a need for effective culturally tailored health education on these health topics to address persistent misconceptions about cancer and to increase knowledge about cancer screening and clinical trials. Health education efforts and clinical trial recruitment in this community must involve community physicians

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