Faculty Bibliography

Using an international network of experts in medical education, the Institute for International Medical Education (IIME) developed the Global Minimum Essential Requirements (GMER) as a set of competence-based outcomes for graduating students. To establish a set of tools to evaluate these competences, the IIME then convened a Task Force of international experts on assessment that reviewed the GMER. After screening 75 potential assessment tools, they identified three that could be used most effectively. Of the 60 competences envisaged in the GMER, 36 can be assessed using a 150-item multiple-choice question (MCQ) examination, 15 by using a 15-station objective structured clinical examination (OSCE), and 17 by using a 15-item faculty observation form. In cooperation with eight leading medical schools in China, the MCQ, OSCE and Faculty Observation Form were developed to be used in an assessment program that is scheduled to be given to all seven-year students in October 2003.

OBJECTIVES: The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and/or at-risk drinking. MATERIALS AND METHODS: Veterans (N= 97) with depression and/or at-risk drinking were identified by systematic screening and assessment. Eligible subjects received either telephone disease management (TDM) program or usual care based on random assignment of their clinician. The TDM program consisted of regular contacts with each subject by a behavioral health specialist (BHS) to assist in assessment, education, support, and treatment planning. Symptomatic outcomes were assessed at 4 months. RESULTS: Overall response rates favored those assigned to TDM compared with those assigned to usual care (39.1% responded vs. 17.6%, p= 0.022). Response rates within the separate diagnostic groups also favored TDM, but this was only significant for depressive disorders. CONCLUSIONS: Although the sample size was modest and the sample was limited to veterans, findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem. Findings also suggest that a health specialist can focus and manage patients with different diagnoses, thus expanding the role beyond just depression care. TDM may be a viable, low-cost, model for primary care clinicians to deliver manual guideline-adherent behavioral health care, especially in a VA clinical setting

Staphylococcus epidermidis is a significant cause of nosocomial disease. However, the taxonomy of this pathogen, particularly at subspecies level, is unclear. A multilocus sequence typing (MLST) scheme has therefore been investigated as a tool to elucidate taxonomic relationships within this group, based on genetic relatedness. DNA sequences for internal fragments of seven housekeeping genes were compared in 47 geographically and temporally diverse S. epidermidis isolates that were obtained from clinical infections. Twenty-three different allelic profiles were detected; 17 of these were represented by single strains and the largest profile group contained 17 isolates. Diversity of the same collection of isolates was investigated by using PFGE of SmaI-digested genomic DNA to test the discrimination and validity of the MLST approach. Isolates within the largest profile group were resolved into four distinct PFGE clusters on the basis of their SmaI digest patterns. Isolates within other profile groups that contained multiple isolates had matching PFGE SmaI patterns within each group. It appears that MLST is an effective method for grouping S. epidermidis strains at the subspecies level; however, it is not as discriminatory as it has been for other species for which MLST schemes have been established and, used alone, would not be a useful method for epidemiological studies. In addition, it was demonstrated that this method was effective for confirming the identity of S. epidermidis CoNS (coagulase-negative) isolates

The panel also recommended determining the amount of SARS virus in blood, respiratory secretions and other body fluids as a way of measuring response to antiviral and other drugs. But such measurements could be difficult to obtain if SARS re-emerged in poor countries. Doctors still do not know how best to treat SARS patients who have breathing difficulties, Dr. [Simon Mardel] said. One method is invasive ventilation, when a patient is connected to a ventilator, a procedure that generally requires sedation and temporary paralysis. A second method involves blowing oxygen into the lungs through a mask. Both carry the risk of transmitting the virus to hospital employees

It 'is a matter of urgency to get better analysis and review,' said Dr. Simon Mardel, a WHO official who led the two-day meeting that ended Friday. He said thousands of potential therapies and compounds had been tested so far as researchers try to determine treatments for SARS, or severe acute respiratory syndrome

Doctors still do not know how best to treat SARS patients who have breathing difficulties, [Simon Mardel] said. One method is invasive ventilation, in which a patient is connected to a ventilator through a tube inserted in the windpipe, a procedure that generally requires sedation and temporary paralysis. A second method is noninvasive: A mask is fitted over the face and oxygen is blown into the lungs. Both carry the risk of transmitting the virus to hospital employees

The African nations are Mozambique, Rwanda, South Africa and Tanzania, which have about one-third of all AIDS cases there. In the Caribbean, the aid will go to the Bahamas; Dominican Republic; Haiti; the Organization of Eastern Caribbean States, which includes Antigua and Barbuda; Dominica; Grenada; St. Kitts and Nevis; St. Lucia, St.Vincent and the Grenadines; Anguilla and Montserrat; and the British Virgin Islands. More than 90 percent of Caribbean AIDS patients live in these areas

If a major outbreak of SARS, or severe acute respiratory syndrome, occurs, then the system of sending specimens for independent confirmation will become less critical, said Dr. Malik Peiris of the Queen Mary Hospital in Hong Kong. The World Health Organization credits Peiris with discovering the SARS coronavirus. The agency recognized the risk that SARS might spread if tests were delayed. We admit that we might well miss the first case or even the first cluster, [John MacKenzie] said. The panel, he said, is recommending limiting SARS testing for now largely because scientists do not have enough specimens of the serum portion of blood from patients who were infected during the epidemic earlier this year. The serum contains antibodies to the virus and is needed for purposes of scientific controls in diagnostic testing. Laboratory scientists need positive serum to make quite sure that what you're seeing is what you expect to see, MacKenzie said