Faculty Bibliography

Smallpox can be confused with chickenpox. In making the diagnosis, a doctor touches the skin. Smallpox lesions tend to feel as if they are deep in the skin, in contrast to the lesions of chickenpox, which feel superficial. Chickenpox itches; smallpox lesions can be very painful

Officials at the Centers for Disease Control and Prevention, which is taking the steps, say they have no evidence that anyone is readying a terrorist attack using smallpox, a disease that was eradicated worldwide 21 years ago. But they say smallpox is so deadly that it is important to prepare for any attack. Smallpox is of particular concern because of its potential to spread quickly. Tens of millions of Americans under the age of 30 are susceptible to smallpox because they were never vaccinated; the United States stopped smallpox immunizations in 1972. Tens of millions of older people who were vaccinated decades ago are thought to have decreased protection because the vaccine may have worn off. Another major concern is that generations of American doctors have never seen a case of smallpox. The only ones who have are a few hundred doctors who participated in the World Health Organization's smallpox eradication program decades ago

Tens of millions of Americans younger than 30 are susceptible to smallpox because they were never vaccinated; the United States stopped smallpox immunizations in 1972. Tens of millions of older people who were vaccinated decades ago are thought to have decreased protection because the vaccine may have worn off. Smallpox can be confused with chickenpox. In making the diagnosis, a doctor touches the skin. Smallpox lesions tend to feel as if they are deep in the skin, in contrast to the lesions of chickenpox, which feel superficial. Chickenpox itches; smallpox lesions can be very painful. Since smallpox was eradicated, the centers have sent epidemiologists to investigate suspect illnesses a few times a year. [James M. Hughes] said the centers already had dispatched smallpox experts on short notice three times in the last month to evaluate specific cases

There is no definitive answer, in part because the initial symptoms of influenza, anthrax and other infections can resemble one another. And yet it may not be safe to wait for a confirmed diagnosis of inhalation anthrax before a course of antibiotics is begun, because early antibiotics treatment appears to be essential to saving anthrax patients' lives. In addition, at least one inhalation anthrax patient has reported a sore throat as among his early symptoms, and a sore throat is not a common symptom of influenza, Dr. [David Gilbert] said. Some inhalation anthrax patients have also experienced a feeling of heaviness in the chest. For the broad population to pay careful attention to early symptoms may have taken on even greater importance with Kathy T. Nguyen's death of inhalation anthrax in New York City today, less than a week after she experienced her first, mild symptoms. Ms. Nguyen, 61, became ill at a time when federal health officials had begun urging doctors to pay special attention to postal workers who complained of mild, vague symptoms, because those symptoms might develop into a flulike illness that has often preceded the more severe symptoms of anthrax

OBJECTIVE: Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN: Controlled cohort study. PARTICIPANTS: All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS: Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS: Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P < .05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P < .05), but did not further improve auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION: In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.

Learn how one rural community hospital overcame staffing and funding shortages to create a successful, collaborative orientation program for its critical care nurses.

This article seeks to understand the effects of welfare-state spending on infant mortality rates. Infant mortality was chosen for its importance as a social indicator and its putative sensitivity to state action over a short time span. Country fixed-effects models are used to determine that public health spending does have a significant impact in lowering infant mortality rates, net of other factors, such as economic development, and that this effect is cumulative over a five-year time span. A net effect of health spending is also found, even when controlling for the level of spending in the year after which the outcome is measured (to account for spurious effects or reverse causation). State spending effects infant mortality both through social mechanisms and through medical ones. This article also shows that the impact of state spending may vary by the institutional structure of the welfare state. Finally, this study tests for structural breaks in the relationship between health spending and infant mortality and finds none over this time period.

A patient in whom transesophageal echocardiography was performed to evaluate a possible source of cerebral embolization. The fact that the probe could not be passed easily beyond 35 cm from the incisors suggested esophageal obstruction or compression. A mass was seen posterior to the left atrium that was heterogenous and contained blood vessels, suggesting a malignancy. There were no complications of the procedure. Esophageal adenocarcinoma was confirmed on biopsy. Transesophageal echocardiography may be diagnostic of paracardiac mediastinal masses, both benign and malignant. Great care must be taken if passage of the probe through the esophagus is met with resistance, to avoid serious complications

Feeling exhausted is normal under some circumstances, but it may also signal a treatable medical problem. Lamm and Couzens describe how to discern whether fatigue is caused by sleep problems, depression, or heart disease

For the handful of patients I cannot reassure, who continue to believe that they have anthrax or insist on medication for anthrax, there is only one thing I can do. I am compelled to admit that there is one condition that can mushroom beyond any physician's ability to intervene--a condition fueled by speculation, resistant to all treatment including antibiotics. The main risk is still psychological. To calm the panic, sometimes it is necessary to administer tests to prove to a patient that he doesn't have the disease. I am against unnecessary antibiotics, but I am for increased surveillance. Our laboratories must gear up to handle more nasal swabs and antibody tests for anthrax. For years I have been checking HIV antibodies on patients with almost no risk just so their dating lives could be more comfortable