The development of professional identity in the family practice resident.
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Clinical Competence↗
Biomedical subjects
N P Grose
Publications and source records attributed to N P Grose.
A clinical librarian program in a family medicine residency.
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Cost-Benefit Analysis↗
Students' attitudes to ethics in the medical school curriculum.
A survey of 106 medical students assessing their interest in and attitudes to medical ethics in the curriculum is reported by the authors. Results indicate that 64 per cent of the students rated the importance of medical ethics to good medical care as high or critical and 66 per cent desired to learn more about the topic. However, in reports of patient encounters identifying ethical issues, less than six per cent of the students reported a frequency of more than one such patient encounter per week. The students also demonstrated a greater awareness of more obvious ethical issues than of more subtle, less publicised issues. When asked how medical ethics should be taught, the students clearly affirmed a desire for an integrated exposure to the subject throughout the medical curriculum. Possible implications of these findings for medical education are discussed.
Attitude of Health Personnel↗
Circulating anticoagulant associated with chronic active hepatitis.
Chronic active hepatitis is frequently associated with a variety of serologic abnormalities. A patient with chronic active hepatitis and a circulating anticoagulant to factors XI and XII is described. Circulating anticoagulants should be suspected in patients with chronic active hepatitis and a prolonged partial thromboplastin time. This risk of liver biopsy in these patients is unknown, but this possible hazard should be considered in all patients with chronic active hepatitis.
Adult↗
The immunizing effect of influenza A/New Jersey/76 (Hsw1N1) virus vaccine administered intradermally and intramuscularly to adults.
2The immunogenicity and reactogenicity of inactivated influenza A/New Jersey/76 (Hsw1N1) whole-virus vaccine administered intradermally (40 chick cell-agglutinating units/0.1-ml dose) and intramuscularly (im; 200 chick cell-agglutinating units/0.5-ml dose) to human adults were evaluated. Among 18-24-year-old persons initially free of detectable antibody, intradermal vaccination induced lower titers of hemagglutination-inhibiting antibodies than did im vaccination, and a sequence of intradermal and im vaccinations did not offer any serologic advantage over one im dose. In contrast, persons over the age of 24 who initially lacked detectable antibody had as good a serologic response to intradermal vaccination as to im vaccination. Among individuals who had antibody before vaccination, immunization by either route induced greater increases in titers of hemagglutination-inhibiting antibody than occurred in initially antibody-negative persons, even when the latter were given two doses of vaccine. Somewhat fewer systemic reactions occurred after intradermal than after im vaccination, but the intradermal route was associated with local reactions in almost all vaccinees and with some residual pigmentary changes. These results suggest that intradermal vaccination should be used only in very selected circumstances.
Adolescent↗
The family medical history: assessing patient understanding of diabetes mellitus.
In this preliminary study, we attempted to determine whether diabetic subjects with a positive family medical history for diabetes have a better understanding of their own disease (ie., of its course, treatment, and genetic characteristics) than diabetic subjects without diabetes in their histories. We interviewed 50 diabetic subjects and scored their responses to determine their understanding of diabetes in general and in their own cases in particular. The data were analyzed using the Student's t test and chi-square analysis. Overall, patients with positive histories did not have significantly higher understanding than patients with negative histories. However, if patients had extensive exposure to the affected relative, or if tht relative was a spouse or a parent, the patients' understanding was significantly higher (P less than 0.05). Educational level, age, and duration of diabetes did not affect patients' understanding. The data suggest that the family medical history can be a valuable teaching model, once we redefine it so as to reconcile patient concepts about illness with physician concepts of disease.
Aged↗