Faculty Bibliography

He said the military had investigated the cluster because of the particular severity of the pneumonia -- all patients needed assistance from mechanical ventilators to breathe. Most responded 'fairly dramatically' within days after such therapy and antibiotics, said Colonel Bob DeFraites, the Army's chief of preventive medicine. The investigators are leaning to a noninfectious cause and are focusing on one finding 'that has jumped out at us,' that nine of the 10 patients with high eosinophil counts reported that they had started smoking recently, DeFraites said. Tobacco smoke is a prime suspect because it is known to damage lungs and increase their susceptibility to pneumonia. A combination of stress, heat, dust and other factors may have acted in concert with smoking to cause illness, he said

Last week, Dr. Larry J. Anderson, an expert on respiratory diseases at the Centers for Disease Control and Prevention in Atlanta, said his team had completed tests to detect antibodies to the SARS virus in the blood specimens sent by Dr. [Frank Plummer]. The C.D.C. tests did not confirm the Canadian National Microbiology Laboratory findings that SARS antibodies were present. Dr. John MacKenzie, an Australian virologist who is temporarily helping W.H.O. deal with the threat of SARS and other emerging diseases, said the nursing home episode pointed out three major worries about laboratory testing for SARS that an advisory panel of W.H.O. would need to address in October. By then the Northern Hemisphere may be experiencing the usual seasonal outbreaks of influenza and other respiratory illnesses. Under such circumstances, the continuing lack of a reliable diagnostic test for SARS could create chaos from the continuing inability to distinguish SARS from other illnesses that, by coincidence, were producing similar symptoms like fever, headache and cough

CONTEXT: Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials. OBJECTIVE: To determine whether communications training for medical students improves specific competencies known to affect outcomes of care. DESIGN AND SETTING: A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention. PARTICIPANTS: One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001). INTERVENTION: Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development. MAIN OUTCOME MEASURES: Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance. RESULTS: Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude. CONCLUSIONS: Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture

OBJECTIVE:We introduce stratification data for three methods (Agatston, volume, mass) obtained from one single patient population. MATERIALS AND METHODS/METHODS:Measurements in 11,490 individuals scanned from 1999 to 2002 with electron-beam CT were used for this study. RESULTS:Our Agatston score ranges agree reasonably well with the Kondos values except for measurements in patients at the extreme ages, at which we sampled a wider age range and consequently had different biases of averages. Neither method is preferable because except for a small percentage of individuals near the dividing lines, stratification is the same for the three methods. When we matched them against a known "lesion" phantom, the Agatston and volume scores behave nonlinearly, and the latter grossly overestimates volume. The mass method is linear except for lesions near the edge of detectability and matches known volumes to within a small percentage. CONCLUSION/CONCLUSIONS:We provide validated risk stratification data for use with mass scoring methods.

OBJECTIVES: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P <.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P =.45) or rates of patient no-shows (5% in both groups; P =.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.

Among participants, taking ''drug holidays'' hastened the progression from infection with H.I.V. to illness with AIDS. Those who engaged in this on-again, off-again regimen, or structured intermittent therapy, experienced more AIDS-related complications and poorer immune response than did participants who took AIDS drugs continuously. Of the estimated 850,000 to 950,000 people in the United States with H.I.V., 670,000 have received a diagnosis, and about one-third of those do not receive continuing care. There is no estimate of the number of Americans with H.I.V. strains resistant to more than one drug, but experts say the figure is substantial. After 11.6 months on average, 22 of the 138 patients in the treatment-interruption group had died or become sicker, compared with 12 of the 132 participants in the control group. The treatment-interruption group also had fewer CD-4 immune cells, which H.I.V. destroys. In addition, this group showed no greater quality of life or more reduction in the amount of H.I.V. in their blood than did the control group

There is general agreement among health officials that the latest ailment ''is not behaving like SARS because the illness is mild,'' Dr. [Perry Kendall] said, adding that it does not meet the case definition of SARS, or severe acute respiratory syndrome. Epidemiologists have found no link between any new case of the respiratory ailment and earlier cases of SARS, health officials said. Other theories include the possibility of a coronavirus -- SARS has been identified as a new member of the coronavirus family -- that previously went undetected because scientists had fewer laboratory tests to identify it and were not looking for new coronaviruses as hard as they have been in the wake of SARS. The tests of the nursing home specimens, conducted in British Columbia and at the National Microbiology Laboratory in Winnipeg, Manitoba, are extremely preliminary. Early tests of 3 percent of the genome of the coronavirus appear to indicate that it is identical to the SARS virus. But because information is lacking about the other 97 percent, the health officials stressed that much more laboratory work needed to be done to determine whether the coronavirus identified in Surrey is the SARS virus or one of a number of others from the same viral family that can cause respiratory illness