The role of chemisorbed hydroxyl species in alkaline electrocatalysis of glycerol on gold

The mechanism of energy conversion in a direct glycerol fuel cell (DGFC) is governed by the anode supported heterogeneous steps of glycerol electro-oxidation. In aerated alkaline electrolytes, glycerol also participates in a base catalyzed process, which can release certain species mixing with the anode catalyzed surface products. As a result, selective probing of the surface catalytic reactions involving such systems can be difficult. The present work addresses this issue for a gold anode by using the analytical capability of cyclic voltammetry (CV). In addition, surface plasmon resonance measurements are used to optically probe the adsorption characteristics of the electrolyte species. The net exchange current of the oxidation process and the transfer coefficient of the rate determining step are evaluated by analyzing the CV data. The interfacial reactions and their products on Au are identified by measuring the number of electrons released during the electro-oxidation of glycerol. The results indicate that these reactions are facilitated by the surface bound hydroxyl species on Au (chemisorbed OH(-) and faradaically formed Au-OH). By comparing the findings for stationary and rotating electrodes, it is shown that, convective mass transport is critical to maintaining efficient progression of the consecutive oxidation steps of glycerol. In the absence of hydrodynamic support, the main surface products of glycerol oxidation appear to be glyceraldehyde, glycerate and malonate, formed through a net six-electron route. In the presence of controlled convection, a ten-electron process is activated, where mesaxolate is the likely additional product.

A PDA-based instructional tool to monitor students' cardiac auscultation during a medicine clerkship

Cardiac auscultation is an important skill for medical students to master but students' exposure to cardiac auscultation is often unmonitored. The objective of this study was to gather data at the point of care about students' cardiac auscultation experience on a required medicine rotation using a Personal Digital Assistant (PDA) 'murmur form'. During an eight-month period, 120 M3 students used the authors' PDA-based learning tool to record information on 940 heart sounds and murmurs. Some 93% of all heart sounds/murmurs reported by students were verified by either a faculty member (56%) or a supervising resident (43%). A PDA can be a useful tool to monitor students' experiences of cardiac auscultation and to track direct observation of such skills by faculty or residents. Medical students are eager to use technology at the point of care to practice their clinical skills.

Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease

AIM

To establish whether bone disease is present at diagnosis in inflammatory bowel disease and to identify contributory metabolic abnormalities.

METHODS

Newly diagnosed patients with inflammatory bowel disease (19 males, 15 females; mean age, 44 years; range, 17-79 years; 23 ulcerative colitis, 11 Crohn's disease) were compared against standard reference ranges and a control group with irritable bowel syndrome (eight males, 10 females; mean age, 40 years; range, 19-64 years). Bone mineral density (g/cm2, dual-energy X-ray absorptiometry: lumbar spine and femoral neck) and biochemical bone markers were measured.

RESULTS

Femoral neck bone mineral density, T- and Z-scores (mean +/- s.d., respectively) were lower in inflammatory bowel disease patients than in irritable bowel syndrome controls (0.78 +/- 0.12 vs. 0.90 +/- 0.16, P = 0.0046; - 0.88 +/- 0.92 vs. 0.12 +/- 1.17, P = 0.0018; - 0.30 +/- 0.89 vs. 0.61 +/- 1.10, P = 0.0030). Lumbar spine bone mineral density and T-scores were also significantly lower in patients than controls (0.98 +/- 0.15 vs. 1.08 +/- 0.13, P = 0.0342; - 1.05 +/- 1.39 vs. - 0.14 +/- 1.19, P = 0.0304). Compared with controls, the urinary deoxypyridinoline : creatinine ratio was increased (7.66 vs. 5.70 nmol/mmol, P = 0.0163) and serum 25-hydroxy vitamin D was decreased (18.7 vs. 28.5 micro g/L, P = 0.0016); plasma osteocalcin and serum parathyroid hormone did not differ (P > 0.05).

CONCLUSIONS

The bone mineral density is reduced at diagnosis, prior to corticosteroid treatment, in both Crohn's disease and ulcerative colitis. Our data suggest that this is attributable to increased resorption rather than decreased bone formation.

Fundamentals of education: "Edu-Mentals"

As new accreditation standards for health professions education increasingly require end-of-life (EOL) curriculum and performance-based assessment, health professions educators struggle to shift through the educational literature to find core principles, practical strategies, emerging trends, and on-line resources to advance as educators. A new kind of resource is needed for educators in today's health care environment. Emerging literature in the field of faculty development and continuing education in health professions highlight key features of resources for health professionals. To be effective, this faculty development resource must be: timely, problem focused, practical, and easily accessible. Based on these principles, the Medical College of Wisconsin initiated a series of short, focused fact sheets for educators. Dubbed, "Edu-Mentals" to represent the fundamentals of education, the series was launched in late spring 2001 and consists of short, focused fact sheets for health care professionals based on the parts of a systematic instructional design process.

Stephen Abrahamson, PhD, ScD, educationist: a stranger in a kind of paradise

This profile of Stephen Abrahamson, Ph.D., Sc.D., is the first of six profiles to appear as part of the Exemplar project focused of six retired medical educators who transformed the field of medical education. The exemplars, all graduate degree recipients in education were interviewed by six senior present-day medical educators using a common protocol designed to elicit career chronology and the significant contributions of educationists to medical education of Dr. Abrahamson's profile was based on an in-depth two-day interview, examination of a comprehensive list of his publications, the history of the Society of the Directors of Research in Medical Education, and unsolicited conversations with several of his colleagues. Dr. Abrahamson began his career teaching high school, later receiving a masters and doctorate degrees, in preparation for a career as a teacher-educator. Through collaboration with Dr. George Miller, Dr. Abrahamson began his career as an educationist in medicine - one who studies the education process and prepares others to become teachers - by teaching medical school faculty about the science of education. Dr. Abrahamson's career was devoted to applying his evidence-based education approach to the newly emerging profession of medical education. An examination of his career shows that he made four vital contributions to medical education - defining the educationist role, serving as a teaching/mentor/network builder/friend to medical educators, curriculum change agent and innovator at USC, and demonstrating and articulating the value of offices of medical education and research in medical education. More broadly, Dr. Abrahamson identified three major contributions made by educationists to the field of medical education: the application of education principles to instructional/assessment innovations (e.g., programmed patients), an evidence-based approach to assessing education, and faculty development/teacher training. Based on his half-century of experience in medical education, Dr. Abrahamson outlined seven lessons for success as an educationist in medicine.

A pleasure to work with--an analysis of written comments on student evaluations

OBJECTIVE

Studies assessing rating scales on student evaluations are available. However, there are no data related to the written comments on these evaluations. This study was designed to evaluate these comments.

METHODS

A content analysis was performed on the narrative section of pediatric clerks' evaluations. Final evaluations were obtained from 10 outpatient clinical sites staffed by full-time faculty over 14 months. A coding dictionary containing 12 categories (7 linked to clinical skills) was used.

RESULTS

One thousand seventeen comments on 227 evaluations were coded. The mean number of comments per evaluation was 4. Learner and personal characteristics were the largest categories. Normative comments, such as "good physical exam," as opposed to more specific comments, such as "complete presentation," predominated in all categories.

CONCLUSIONS

Evaluation comments were infrequently related to basic clinical skills and were not often specific enough to lead to effective change in a student's performance. Faculty development is needed to make final evaluation comments more useful for students.

Understanding the careers of physician educators in family medicine

PURPOSE

Little is known about what contributes to the career decisions of physician educators in family medicine. This study sought to understand the variables that influence these decisions and to identify key sources of vitality for physician educators in family medicine.

METHOD

A national sample of randomly selected physician educators in family medicine responded to a postcard survey regarding their contribution(s) to education and career satisfaction. A series of exclusion criteria were applied to 399 useable responses, yielding 24 physician educators who participated in a semi-structured telephone interview focusing on their careers. Using qualitative research methods, themes were identified and categorized from the transcribed interviews and investigators' field notes.

RESULTS

The career decisions and actions of physician educators in family medicine emanated from an underlying set of values and beliefs associated with "making the world better." Participants sought challenging, diverse, and stimulating positions from which they could have an impact in ways that were consistent with their values. Three major sources of vitality (learners, colleagues, and patients) complemented the desire for challenging positions. Physician educators in family medicine, however, continually struggled to balance their personal and professional lives.

CONCLUSION

The study results highlight the key variables that draw faculty into education and sustain their vitality, and the professional and personal challenges that can derail or support their careers. This information can be used to recruit, develop, and retain successful and productive physician educators in family medicine.

Working with our communities: moving from service to scholarship in the health professions

CONTEXT

As faculty at health professionals schools have become increasingly engaged with their communities in partnerships to improve health, new questions have arisen about faculty rewards for such activities. To sustain the community work of their faculty, institutions need to reconceptualize faculty rewards, promotion, and tenure that are relevant to community activities.

HISTORICAL PERSPECTIVE

Scholarship has evolved since the 17th century from a focus on character-building to the practical needs of the nation to an emphasis on research. In 1990, Boyer proposed four interrelated dimensions of scholarship: (1) discovery; (2) integration;(3) application; and (4) teaching. The challenge became the development of criteria and innovative and creative ways to assess community scholarship.

CURRENT MODELS FOR COMMUNITY SCHOLARSHIP

This paper reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship.

PROPOSED MODEL FOR COMMUNITY SCHOLARSHIP

We propose a new model for community scholarship that focuses on both processes and outcomes, crosses the boundaries of teaching, research, and service, and reshapes and integrates them through community partnership. We hope this model will generate national discussion about community scholarship and provide thought-provoking information that will move the idea of community scholarship to its next stage of development.

Scholarship in teaching: an imperative for the 21st century

At some medical schools broader definitions of scholarship have emerged along with corresponding changes in their academic reward systems. Such situations are not common, however. The definition of scholarship generally applied by medical schools is unnecessarily narrow and excludes areas of legitimate academic activity and productivity that are vital to the fulfillment of the school's educational mission. The authors maintain that creative teaching with effectiveness that is rigorously substantiated, educational leadership with results that are demonstrable and broadly felt, and educational methods that advance learners' knowledge are consistent with the traditional definition of scholarship. Faculty whose educational activities fulfill the criteria above are scholars and must be recognized by promotion. The authors specifically address scholarship in education, focusing on teaching and other learning-related activities rather than on educational research, which may be assessed and rewarded using the same forms of evidence as basic science or clinical research. They build on Boyer's work, which provides a vocabulary for discussing the assumptions and values that underlie the roles of faculty as academicians. Next, they apply Glassick et al.'s criteria for judging scholarly work to faculty members' educational activities to establish a basis for recognition and reward consistent with those given for other forms of scholarship. Finally, the authors outline the organizational infrastructure needed to support scholars in education.

Valuing educational scholarship at the Medical College of Wisconsin

Since the late 1980s faculty and staff at the Medical College of Wisconsin (MCW) have actively sought to align their school's academic culture and promotional process with its mission of educational excellence and innovation. As one of the top 50 medical schools receiving NIH funds, MCW has well-established mechanisms to evaluate and recognize the scholarship of discovery. Understanding, evaluating, and recognizing the value of individuals engaged in the scholarship of teaching, however, required changes in individuals' beliefs and in the MCW's promotion processes and organizational infrastructure. Building on the successful introduction of the MCW's Educator's PortfolioCopyright, a tool for documenting educational scholarship, a multifaceted change strategy was implemented to influence underlying beliefs and values about clinician-educators. Retrospectively, this strategy was consistent with John Kotter's eight-step change model, which the authors apply as an organizing framework for this case report of educational evolution at the MCW. Through creating a guiding coalition, developing vision and strategy, generating short-term wins, and anchoring new approaches in the MCW's culture, the MCW has made substantive progress in recognizing and rewarding educational scholarship. Changing academic cultures to value education is itself an educational process, requiring persistence and the ability to teach others about educational scholarship and its associated criteria.

Making a case for the teaching scholar

Medical schools are increasingly cognizant of their inability to critically evaluate faculty who support the core mission of education. To address this need, the Project on Scholarship was initiated by the Group on Educational Affairs (GEA) of the Association of American Medical Colleges. Building on and expanding previous definitions of scholarship and the associated criteria emerging in higher education, the project developed a set of "teacher as scholar" scenarios. These scenarios contained varied types of evidence for teaching scholarship and were discussed at the 1999 GEA regional meetings. Two major conclusions/recommendations emerged from these discussions: (1) the use of commonly accepted scholarship criteria (clear goals, appropriate methods, significant results, effective communication) provides a framework for identifying the types of evidence needed to document teaching scholarship, and (2) medical schools must create an infrastructure for promoting educational scholarship. This infrastructure must support the reliable and valid collection of evidence of educational scholarship and the continuous development of faculty as teaching scholars.

A technique for simulation of the point spread function of a gamma camera

A technique for simulating the point spread function (PSF) of gamma-camera images which treats primary photons and detected scattered photons separately is described. The primary photon PSF was measured at different distances in air from the camera. The scatter PSF was also assessed with different thicknesses of water between the point and the camera, and fitted to a circularly symmetric bi-exponential function. An analysis of the variation of detected scattered radiation based on the results is presented. Simulation of the PSF at a given distance from the camera and thickness of attenuating medium was then possible from the sum of the appropriate primary photon PSF corrected for attenuation and the appropriate scatter PSF. The accuracy of the technique has been studied with variation in depth, density and uniformity of thickness of the attenuating medium.

The costs versus the perceived benefits of an LCME institutional self-study

PURPOSE

To calculate the costs versus the perceived benefits of an institutional self-study done to satisfy the requirements of the Liaison Committee on Medical Education's (LCME's) accreditation process.

METHOD

From postcard questionnaires, the authors determined the hours spent over 18 months from 1994 to 1996 on the institutional self-study by 131 self-study committee members and 64 database compilers at the Medical College of Wisconsin. The committee members also rated the potential utility of the self-study process and the probability that the concerns identified by their subcommittees would be addressed. Administrative costs (self-study coordinating team's hours, supplies, and other expenses) were tracked using calendars and budget subaccount numbers. Personnel costs were calculated using salary data from the Association of American Medical Colleges and the College and Universities Personnel Administrators' survey.

RESULTS

Supplies and equipment for the self-study cost $12,158, and the personnel costs, based on an 81% response rate, were estimated at $207,384, for a total of $219,542. The participants in the self-study rated the process as moderately useful, but believed that there was only a medium degree of probability that concerns they had identified would be addressed.

CONCLUSION

Considering the costs of self-study, the process might be more useful if attention were focused less on identifying concerns and more on an institution's demonstrated ability to successfully respond to problems.

Clinical teaching rounds. A case-oriented faculty development program

OBJECTIVE

To improve clinical teaching with emphasis on improving provision of feedback through a faculty development series modeled on clinical rounds.

METHOD

Seven 1-hour conferences were held for the pediatric faculty during the academic year 1994-1995. Clinical rounds were emulated, with a simulated learner functioning as the patient with a chief complaint of some instructional problem. The conferences progressed from discussion about teaching in a particular situation, to videotapes of clinical teaching, and finally to live clinical teaching. Evaluation of the conferences was assessed by attendance records, participants' evaluations of the conferences, and comparing student and resident evaluations of faculty who attended (i.e., those who attended > or = 2) with faculty who did not attend. Comparisons were made for the academic year before and after the conferences using paired t tests.

RESULTS

Forty percent of the faculty attended 2 or more conferences. Mean conference ratings were 4.00 to 4.35, (1 is poor; 5, excellent). Faculty who attended had a significant improvement in ratings for feedback (P = .01) and overall teaching effectiveness (P = .04). Ratings for faculty who did not attend did not change.

CONCLUSION

These conferences were well received by the faculty and are an effective way to improve clinical teaching.

Ambulatory teaching "lite": less clinic time, more educationally fulfilling

Typically, the primary instructional method for ambulatory care education is direct interaction between a preceptor and a learner during a patient encounter. This paper describes instructional strategies teachers and learners can use in ambulatory care training that can occur before or after scheduled clinic hours, thus providing instruction without disrupting a preceptor's busy clinic. First, they describe how preceptors and clerkship or residency-program directors can orient learners prior to their arrival at assigned sites, so that learners are better prepared to assume their patient-care responsibilities. Then they discuss strategies for making use of various types of conferences and independent learning activities to enhance learners' clinical experiences. Conferences and independent study projects that occur before clinic hours can help learners bring a higher level of thinking and clinical sophistication to their role in the ambulatory care site; conferences and independent study activities that occur after clinic hours give learners an opportunity to reinforce and expand on what they have learned during clinic. In this way, learners' educational experiences are enhanced, the best use is made of preceptors' time and expertise, and clinic efficiency is not disrupted.

The effects of standardization and reference values on patient classification for spine and femur dual-energy X-ray absorptiometry

The effect of two methods for standardizing dual-energy X-ray absorptiometry (DXA) measurements on patient classification by the T-score has been determined for a group of over 2000 patients. The methods proposed by the International DXA Standardization Committee and the European Community's COMAC-BME group were used in conjunction with young reference data from the major DXA manufacturers, the COMAC-BME group and the third US National Health and Nutrition Examination Survey (NHANES III). The two standardization techniques produced dissimilar classifications as measured by the kappa statistic (kappa = 0.34-0.90), especially for the femoral neck, with up to 24.3% of patients reclassified from osteopenic to normal and 18.6% reclassified from osteoporotic to osteopenic when the standardization method was changed. Considering the effects of both reference data and standardization techniques together, there was a wide variation of patient classification, with the number of patients classified as osteoporotic varying from 9.6% to 21.1% for the postero-anterior spine L2-4 region and from 2.3% to 27.6% for the femoral neck. The agreement between different classifications ranged widely, from very poor to excellent (kappa = 0.02-0.98). The creation of standardized reference data must be an important priority in order to harmonize patient management using standardized BMD measurements. The choice of standardization technique, however, must be addressed in light of the results presented here.

A descriptive, cross-sectional study of formal mentoring for faculty

BACKGROUND AND OBJECTIVES

Professional academic skills (PAS) encompass the values, collegial relations, and career management skills essential for faculty success. Mentoring has been proposed as a way for junior faculty to acquire these skills. In this paper, we present a summary of literature on formal mentoring and report an evaluation of a formal mentoring program (FMP) on the PAS development of junior family medicine faculty.

METHODS

A descriptive, cross-sectional study was used to examine FMP impact on two groups of junior faculty with 18 months (n = 8) and 6 months (n = 10) of program exposure. We developed a Likert-type questionnaire to assess PAS development and used semistructured interviews to identify unintended outcomes of program participation. A qualitative, template analysis helped surface themes from the descriptive data.

RESULTS

The FMP had an overall positive impact on junior faculty PAS development, with greatest improvements in their understanding of academic values. Proteges with longer program experience had greater gains. Unintended benefits included improved preparation to mentor others and increased perceptions of a supportive academic environment.

CONCLUSIONS

Formal mentoring programs can improve the PAS of junior faculty and positively impact an organizational culture that supports faculty development.

Analysis of an international emergency medical service train-the-trainer program

STUDY OBJECTIVE

To assess the effectiveness of an international emergency medical services (EMS) train-the-trainer program.

PARTICIPANTS

Seven bilingual Polish physicians attended a 350-hour US-based EMS training program. The physicians returned to Poland to train Polish-speaking EMS personnel.

INTERVENTIONS

The Polish training was assessed by means of a pretest, a final examination, a series of skill stations, and a retrospective self-assessment instrument created by the authors. The retrospective self-assessment instrument, using a six-point Likert scale, measured the degree of self-reported competence before and after training in three areas: basic trauma, advanced medical, and basic medical.

RESULTS

One hundred seventy-nine Polish students were assessed. Pretest scores ranged from 17% to 100% (mean, 74% +/- 11%). Ninety-one percent passed the final examination (mean, 91% +/- 4.0%; range, 74% to 99%). All students passed all skill stations. The before-and-after instrument indicated that the Polish students' prior competence ranged from not competent (Likert score 1) to fully competent (Likert score 6). Mean scores were: basic trauma, 2.6 +/- 4; advanced medical, 2.5 +/- 7; and basic medical, 2.8 +/- 7. After-course scores demonstrated improved competence. Before-and-after instrument score differences were significant for each area (P < .0001).

CONCLUSION

Despite differences in language, culture, technology, and resources, an international train-the-trainer program can be evaluated. In addition to standard testing, a retrospective before-and-after self-assessment instrument provides corroborative evidence of program success.

Translating family medicine's educational expertise into academic success

BACKGROUND

Today's family medicine educator occupies a position of increasing stature in medical education. The recognition of education as scholarship creates a framework for the evaluation of clinician-educators for promotion. A system is needed to document educational excellence, peer review, and public dissemination.

METHODS

The Educator's Portfolio, a 10-category system for organizing educational expertise, was developed in a family medicine department for use as a promotion document. The effectiveness of the Educator's Portfolio in documenting faculty candidates' educational activities was assessed in two ways. Members of the department rank and tenure committee were surveyed to assess their ability to evaluate faculty teaching contributions using the portfolio, and faculty promotion results were tracked for the first 2 years of portfolio use at the Medical College of Wisconsin.

RESULTS

The ability to judge candidates' educational activities via a portfolio was rated to be excellent or very good by 100% of respondents, as compared with using a traditional curriculum vitae alone. Promotion results indicate successful promotion of faculty using the Educator's Portfolio.

CONCLUSIONS

As a method for evaluating scholarship in education, the Educator's Portfolio is an important addition to a candidate's promotion packet.

Deconvolution of planar scintigrams by maximum entropy

Planar scintigrams are deconvolved with a point spread function using the maximum entropy method with the aim of improving image quality. The technique requires the specification of several parameters. These are related to the level of noise present in the data and our a priori knowledge of the object imaged. The performance of the technique is tested for a wide range of these parameters using images of a Williams phantom in scattering material and a figure of merit, derived from the detectability of the smallest cold spot, is calculated. For close to optimal values of the parameters a factor of two improvement in the figure is found. A processed bone image shows improved contrast and resolution. Maximum entropy processing could be used to increase image quality or allow comparable image quality with reduced imaging time or patient dose.

An alternative approach to defining the role of the clinical teacher

BACKGROUND

A number of studies have attempted to identify the components of the clinical teacher role by examining learners' numerical ratings of items on researcher-generated lists. Some of these studies have also compared different groups' perceptions of clinical teaching, but have not directly compared the perceptions of first- and third-year residents. This study addressed two questions: (1) What do residents consider important components of the clinical teacher role? (2) Do first- and third-year residents perceive this role similarly?

METHOD

A content analysis was performed on the comments written on evaluation forms by 268 residents about 490 clinical teachers over a five-year period (1980-81 through 1984-85) at a large family practice residency. Of 5,664 forms completed by the residents, 2,388 (42%) contained written comments; comments were on 1,024 (46%) of the first-year resident's forms, 701 (41%) of the second-year residents' forms, and 663 (39%) of the third-year residents' forms. Themes in these comments were coded into a coding dictionary of 157 categories, within 37 clusters, within four roles.

RESULTS

The ten highest-ranked categories (Global; Teaching: General; Knowledgeable; Gives Resident Responsibility; Supportive; Miscellaneous; Interested in Teaching; Clinical Competence; Makes Effort to Teach; and Gives Resident Opportunity to Do Procedures) accounted for 41% of the themes coded. The first- and third-year residents differed in the clusters they used to describe their clinical teachers on evaluation forms (chi 2 = 149.86, df = 36, p < .0001).

CONCLUSION

The results suggest that content analysis can be used to validly and reliably study residents' written evaluative comments about their teachers. This study contributes to the definition of the clinical teacher role, showing the relative importances of its components, and also supports Stritter's Learning Vector theory, finding the anticipated differences between the comments made by first- and third-year residents.

Penetrating injury from hammering with subtle ocular damage

Penetrating ocular injuries are usually associated with major disruption of the globe and vision loss. On occasion, the signs and symptoms accompanying an intraocular foreign body can be subtle. Such a case is presented in this paper and hammer injuries as a cause of penetrating ocular injury are reviewed.

Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives

We surveyed faculty and residents from seven hospitals affiliated with three academic internal medicine training programs about their perceptions of the informational and service benefits vs the risks of ethical compromise involved in interactions with pharmaceutical sales representatives. Questionnaires were returned by 467 (81%) of 575 physicians surveyed. Residents and faculty generally had somewhat negative attitudes toward the educational and informational value of detailing activities at their institutions but indicated that representatives supported important conferences and speakers. Residents were more likely than faculty to perceive contacts with sales representatives as potentially influencing physician decision making. Sixty-seven percent of faculty and 77% of residents indicated that physicians could be compromised by accepting gifts. More than half of the physicians who suggested that such compromise was possible indicated that acceptance of gifts worth more than +100 from drug companies would be likely to compromise a physician's independence and objectivity. A majority of both faculty and house staff favored eliminating presentations by pharmaceutical representatives at their hospitals. Only 10% thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives.

Clinical features of occipital infarction

Occipital infarction may only cause visual symptoms. A homonymous visual field defect of various configurations is the most common clinical finding. Additionally, central vision, color vision and visual associative function also may be impaired. In this paper three cases of occipital infarction are presented and the clinical features of this condition discussed.

Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff

OBJECTIVE

To determine the nature, frequency and effects of internal medicine housestaff and faculty contacts with pharmaceutical representatives (PRs).

DESIGN AND SETTING

The authors surveyed internal medicine faculty at seven midwest teaching hospitals and housestaff from two of the teaching programs. The survey asked about type and frequency of contacts with PRs and behavior that might be related to these contacts. T-tests and logistic regression were used to estimate the relationship between reported physician contacts and behavioral changes.

PARTICIPANTS

Two hundred forty faculty (78%) and 131 house officers (75%) responded to the survey.

RESULTS

Faculty and housestaff averaged 1.5 brief contacts per month with PRs. Housestaff averaged more than one meal/month at pharmaceutical company expense. Twenty-five percent of faculty and 32% of residents reported changing their practices at least once based on PR contact. Independent predictors of faculty change in practice were brief or extended conversations and free meals. Predictors of faculty requests for formulary addition were brief conversations and receipt of honoraria or research support. Only brief conversations independently predicted housestaff changes in practice.

CONCLUSION

Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

Retinal macroaneurysms: the natural history in four patients

Macroaneurysms of the retinal arterioles are a clinical entity distinct from the aneurysmal dilations associated with Coats' disease, Leber's disease, Eales' disease, and angiomatosis retinae. The pathogenesis is not completely understood, but they are closely associated with systemic hypertension, generalized atherosclerosis, and age. Macroaneurysms have been classified into three major groups: exudative, hemorrhagic, and quiescent. Four examples of macroaneurysms are presented with photographic documentation. The clinical appearance, natural history, complications, and management of this retinal entity are discussed.

A survey of sued and nonsued physicians and suing patients

To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.

Knowledge of AIDS among health care students

To assess the level of understanding about AIDS among future health care professionals, we developed and administered a 31-item test covering five AIDS-related knowledge domains to selected undergraduate students, medical school applicants, medical students and pre-clinical nursing students. The percentage of correct answers ranged from 74% for questions about mechanisms of transmission to 59% for items related to testing and interpretation. Seventy-two percent of questions on clinical illness and disease were answered correctly. The number of questions answered correctly was a function of educational level. The students were generally knowledgeable about the risk factors related to sexual transmission, interpretation of the AIDS antibody test, and symptoms of AIDS. They were less informed about issues related to occupational acquisition of human immunodeficiency virus (HIV) and clinical details. Medical educators need to develop educational programs providing accurate and up-to-date knowledge about this disease.

Compressive optic neuropathy secondary to chronic sinusitis

The paranasal sinuses surround the orbit on three sides. The thin bony walls of the sinuses are an ineffective barrier to the spread of infection to either the orbit or the intracranial cavity. In this report a case of compressive optic neuropathy secondary to chronic sinusitis is presented. The anatomical and physiologic relation between the sinuses and the orbit are reviewed and sinusitis is discussed.

Treatment of sprained ankles by physiotherapists at professional soccer clubs

Fifty-three physiotherapists working at professional soccer clubs responded to a postal questionnaire on the treatment of sprained ankles. Elevation, the application of ice and compression bandaging were commonly recommended for the first 24-48 hours followed by early mobilisation. A variety of other physiotherapy techniques were used and non steroidal anti-inflammatory drugs commonly dispensed. The application of these techniques to routine casualty practice is considered.