Faculty Bibliography

Communication with dying patients and their families requires special skills to assist them in this extremely stressful period. This article begins with a case that illustrates many of the challenges of communicating with the dying. It then reviews the literature about communication with older patients at the end of life, focusing on physician-patient discussions, decision-making, advance directives, and cultural factors. The article concludes with a practical discussion of problems that physicians may encounter when working with older patients at the end of life and their families and recommendations to improve communication

Ethambutol (EMB) is a central component of drug regimens used worldwide for the treatment of tuberculosis. To gain insight into the molecular genetic basis of EMB resistance, approximately 2 Mb of five chromosomal regions with 12 genes in 75 epidemiologically unassociated EMB-resistant and 33 EMB-susceptible Mycobacterium tuberculosis strains isolated from human patients were sequenced. Seventy-six percent of EMB-resistant organisms had an amino acid replacement or other molecular change not found in EMB-susceptible strains. Thirty-eight (51%) EMB-resistant isolates had a resistance-associated mutation in only 1 of the 12 genes sequenced. Nineteen EMB-resistant isolates had resistance-associated nucleotide changes that conferred amino acid replacements or upstream potential regulatory region mutations in two or more genes. Most isolates (68%) with resistance-associated mutations in a single gene had nucleotide changes in embB, a gene encoding an arabinosyltransferase involved in cell wall biosynthesis. The majority of these mutations resulted in amino acid replacements at position 306 or 406 of EmbB. Resistance-associated mutations were also identified in several genes recently shown to be upregulated in response to exposure of M. tuberculosis to EMB in vitro, including genes in the iniA operon. Approximately one-fourth of the organisms studied lacked mutations inferred to participate in EMB resistance, a result indicating that one or more genes that mediate resistance to this drug remain to be discovered. Taken together, the results indicate that there are multiple molecular pathways to the EMB resistance phenotype

No matter what one's age, as an adult one is entitled to a fulfilling sex life. Lamm and Couzens offer advice on how older people can have satisfying sex lives

''I have not thought of that,'' Mr. [Bill Bradley] said. He added that ''the 25th Amendment sounds a reasonable way to go,'' but that this was ''a decision that I can make down the road a little bit.'' Mr. Bradley's irregular heartbeat is technically known as lone paroxysmal atrial fibrillation. ''Lone'' means the irregular heartbeat is not caused by an underlying heart condition. ''Paroxysm'' refers to the bursts of irregular beats that come on unpredictably for unknown reasons and disappear just as mysteriously. Over time, the paroxysms sometimes become permanent. Mr. Bradley has never had a heart attack. ''I just got my heartbeat way too high and passed out,'' Mr. Bradley said. ''The last thing I remember is I looked at my watch and it said 2:12. The next thing I remember was waking up on the floor'' and wondering, ''Why did this happen?''

In their first comprehensive interviews on the topic, Bill Bradley and his three cardiologists said the former senator was in excellent physical condition and his bouts of irregular heartbeat were not a serious hazard to his health, or to his ability to serve as president, despite their recent increased frequency. Bradley and the doctors, who have treated him since 1998, confirmed that he suffers from a condition known as atrial fibrillation. It is the most common heart-rhythm disorder that doctors treat, affecting an estimated 2.2 million Americans in one form or another. Many of these people work full schedules, and some even run marathons. Dr. John F. Eisold, the attending physician to Congress and the person who first diagnosed Bradley's irregular heartbeat in 1996, did not consent to an interview. But he gave Bradley his own Senate medical records, and Bradley turned them over to [Robert H.] Heissenbuttel, who then discussed them

In their first comprehensive interviews on the topic, Bill Bradley and his three cardiologists said the former senator was in excellent physical condition and his bouts of irregular heartbeat were not a serious hazard to his health, or to his ability to serve as president, despite their recent increased frequency. Bradley and the doctors, who have treated him since 1998, confirmed that he suffers from a condition known as atrial fibrillation. It is the most common heart-rhythm disorder that doctors treat, affecting an estimated 2.2 million Americans in one form or another. Many of these people work full schedules, and some even run marathons. Dr. John Eisold, the attending physician to the Congress and the person who first diagnosed Bradley's irregular heartbeat in 1996, did not consent to an interview. But he gave Bradley his Senate medical records, and Bradley turned them over to [Robert H.] Heissenbuttel, who then discussed them

In their first comprehensive interviews on the topic, Bill Bradley and his three cardiologists said the former senator was in excellent physical condition and his bouts of irregular heartbeat were not a serious hazard to his health, or to his ability to serve as president, despite their recent increased frequency. Bradley and the doctors, who have treated him since 1998, confirmed that he suffers from a condition known as atrial fibrillation. It is the most common heart-rhythm disorder that doctors treat, affecting an estimated 2.2 million Americans in one form or another. Many of these people work full schedules, and some even run marathons

Initially, outbreaks of mass hysteria can be difficult to distinguish from bioterrorism, rapidly spreading infection and acute exposure to a toxin or other environmental hazard. And rising public concern about biological terrorism and rapid spread of news of outbreaks over the Internet are likely to increase the challenge, if not frequency of mass hysteria for health officials

Three of Mr. Bradley's recent incidents occurred just before or after debates with his lone rival for the Democratic nomination, Vice President Al Gore. But Dr. Bigger discounted the role of stress and exhaustion as triggers in Mr. Bradley's irregular heartbeat. ''One man's stress is another's pleasure,'' he said. Asked if he should have mentioned the heartbeat episodes earlier, Mr. [Bill Bradley] said no. ''If I'm sick in my stomach, do I have to tell you I'm sick in my stomach?'' Mr. Bradley said. ''If I don't sleep well at night, do I have to tell you I don't sleep well at night? I think that there is a reasonable way to proceed here, and that is the way we have tried to do it.'' ''As long as he reassures me he's in good health, I believe him,'' said Bonnie Weeks, 66, of Wapello, who asked Mr. Bradley about his condition at the event here.But Ms. Weeks, a strong supporter of Mr. Bradley, expressed worry that Mr. Bradley's health would remain a campaign issue for some people. ''I think it will be a concern because when you elect a president, you want him to be in good health,'' she said