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Biomedical subjects

R P Gottlieb

Publications and source records attributed to R P Gottlieb.

18 recordsLinked to original sources
PubMed2001

Documenting and comparing medical students' clinical experiences.

CONTEXT: The decentralization of clinical teaching networks over the past decade calls for a systematic way to record the case-mix of patients, the severity of diseases, and the diagnostic procedures that medical students encounter in clinical clerkships. OBJECTIVE: To demonstrate a system that documents medical students' clinical experiences across clerkships. DESIGN AND SETTINGS: Evaluation of a method for recording student-patient clinical encounters using a pocket-sized computer-read patient encounter card at a US university hospital and its 16 teaching affiliates during academic years 1997-1998 through 1999-2000. PARTICIPANTS: A total of 647 third-year medical students who completed patient encounter cards in 3 clerkships: family medicine, pediatrics, and internal medicine. MAIN OUTCOME MEASURES: Number of patient encounters, principal and secondary diagnoses, severity of diseases, and diagnostic procedures as recorded on patient encounter cards; concordance of patient encounter card data with medical records. RESULTS: Students completed 86 011 patient encounter cards: 48 367 cards by 582 students in family medicine, 22 604 cards by 469 students in pediatrics, and 15 040 cards by 531 students in internal medicine. Significant differences were found in students' case-mix of patients, the level of disease severity, and the number of diagnostic procedures performed across the 3 clerkships. Stability of the findings within each clerkship across 3 academic years and the 77% concordance of students' reports of principal diagnosis with faculty's confirmation of diagnosis support the reliability and validity of the findings. CONCLUSIONS: An instrument that facilitates students' documentation of clinical experiences can provide data on important differences among students' clerkship experiences. Data from this instrument can be used to assess the nature of students' clinical education.

Diagnosis-Related Groups↗
PubMed2001

Third-year medical student survey of office preceptorships during the pediatric clerkship.

OBJECTIVE: To assess medical students' interest in a career in pediatrics following their categorical pediatric clerkship. DESIGN: Satisfaction questionnaire to 704 third-year clerks in 5 university medical schools following the pediatric clerkship. METHODS: Analysis of the influence of the community office-based experience compared with the inpatient experience, and examination aspects of the office preceptorship most valued by the medical students. MAIN OUTCOME MEASURE: Satisfaction questionnaire addressing office-based experiences. RESULTS: Third-year pediatric clerks report that the private office setting provides a valuable learning experience, particularly when there is exposure to a wide spectrum of disease and when the preceptor had time to teach. Feelings about pediatrics as career choice rose during the clerkship from neutral to positive, and the frequency of strongly positive feelings rose from 9.2% to 28.6%. In deciding about pediatrics as a career, experiences with patients and residents in the inpatient setting still seem to count more than those experiences in the outpatient setting. CONCLUSION: Categorical pediatric clerkships provide learning environments that influence students positively toward pediatrics as a career choice. This choice is enhanced by encouraging community practitioners with students in their office to expose them to a wide variety of issues and devote time to teaching.

Career Choice↗
PubMed2000

Structured clinical observations: a method to teach clinical skills with limited time and financial resources.

OBJECTIVE: To develop and implement a methodology to teach clinical skills to medical students in busy clinical settings. METHODS: The Structured Clinical Observation (SCO) program with guidelines and observation sheets for history-taking, physical examination, and information-giving skills was created. Faculty development preceded SCO implementation for pediatric clerkship students at Jefferson Children's Health Center. SCO observation sheets were tabulated and faculty and student questionnaires were administered. RESULTS: The mean number of observations per student was 6, with 368 observations done for 63 students. SCOs were highly rated as an educational tool by faculty and students. The impact of the SCO program on faculty ability to perform clinical duties was initially minimal, but increased over the year. Observations were used primarily for feedback, but did influence outpatient clinical faculty's evaluation of two thirds of the students. Only 50% of students reported being observed in other rotations. CONCLUSIONS: SCOs are a feasible, inexpensive, qualitatively effective method of teaching clinical skills. The quantitative effect of SCOs on performance needs to be evaluated.

Clinical Clerkship↗
PubMed1996

Developmental changes in renal artery blood flow velocity during the first three weeks of life in preterm neonates.

Changes in color Doppler imaging measurements of renal artery blood flow velocity have been reported previously during fetal life and during the first week postnatally in term and preterm infants. This study reports longitudinal, developmental changes in renal artery and aortic blood flow velocities occurring postnatally, from birth to day 1 of life, at 1 week, and at 2 to 3 weeks of age in 14 premature babies (mean gestation, 30 +/- 4 (SD) weeks; birth weight, 1.45 +/- 0.57 kg), and identified by means of color Doppler imaging and pulsed Doppler spectral analysis. Results indicate that a significant increase in renal artery systolic blood flow velocity occurs within the first week of life (from 40 +/- 3 (SEM) cm/sec at birth or on day 1, to 53 +/- 3 cm/sec on day 7, to 51 +/- 4 cm/sec on day 14 to 21; repeated-measures analysis of variance, p = 0.004), concurrently with a significant increase in abdominal aortic blood flow velocities, both systolic (from 40 +/- 4 at birth or on day 1, to 70 +/- 8 on day 7, to 76 +/- 8 cm/sec on day 14 to 21; p <0.001) and diastolic (from 4 +/- 2 at birth or on day 1, to 11 +/- 2 on day 7, to 11 +/- 2 cm/sec on day 14 to 21; p = 0.00 1). Systemic blood pressure did not increase concomitantly during the some period. Neither the presence of respiratory distress syndrome or patent ductus arteriosus nor treatment with indomethacin altered developmental increases in observed renal artery blood flow velocities. The presence of an umbilical artery catheter in the high thoracic position in five infants, however, created turbulence at the level of the renal arteries, significantly increasing renal artery systolic flow velocity from 32 +/- 4 to 44 +/- 5 cm/sec (p = 0.009) and increasing renal resistive index from 0.90 +/- 0.03 to 0.96 +/- 0.04 (p = 0.046). These results suggest that renal artery blood flow velocity increases during the first postnatal week in preterm infants and is likely related to increases in aortic blood flow velocity and reduction in renal vascular resistance.

Analysis of Variance↗
PubMed1994

Renal failure in the neonate associated with in utero exposure to non-steroidal anti-inflammatory agents.

In utero exposure to non-steroidal anti-inflammatory agents (NSAIAs) can produce combinations of oligohydramnios, a bleeding diathesis, ileal perforation, premature closure of the ductus, and acute or chronic renal injury. NSAIAs induce renal dysgenesis in fetal monkeys and renal structural abnormalities in the developing human fetus. We report oligohydramnios and renal failure associated with in utero exposure to early, prolonged, high-dose indomethacin in four neonates, and to ibuprofen in one neonate. Four of the affected neonates were one of twins. In each set of twins, only one of the pair was affected. One set of twins was proven to be identical, whereas the other three sets seemed to be identical. It is possible that the histopathological findings of uncertain or incomplete tubular differentiation may be the result of a direct effect of NSAIAs on developing or "immature" tubules. Therefore, the advantages of NSAIAs as tocolytics need to be weighed against the complication of severe renal injury.

Acute Kidney Injury↗
PubMed1991

Transient renal insufficiency in the neonate related to hyperuricemia and hyperuricosuria.

Transient renal insufficiency in the neonate is frequently the result of hypoperfusion of the kidneys due to circulatory compromise and is associated with a normal renal ultrasound scan. We describe an infant with transient renal insufficiency associated with hyperuricemia, hyperuricosuria and increased echogenicity of the renal medullary pyramids. Transient uric acid nephropathy may be a more common occurrence in the neonate than previously recognized.

Acute Kidney Injury↗
PubMed1983

Dehydration and fluid therapy.

In the clinical setting, dehydration implies loss of both water and electrolytes. This is indeed what occurs in diarrhea, which is the most common cause of dehydration in children. The treatment of diarrhea is detailed first, followed by consideration of several less common conditions leading to dehydration in early infancy, including acute adrenal insufficiency and pyloric stenosis.

Acidosis↗
PubMed1977

"Flecked retina" --an association with primary hyperoxaluria.

A child with hyperoxaluria, probable Type I, was noted to have a "flecked retina" on funduscopic examination at age 2 1/2 months; it persisted throughout his seven years of life. The relationship of the ocular findings to his metabolic disease is discussed.

Calcium↗
PubMedDate not supplied

Noninvasive diagnosis and follow-up of childhood renal vein thrombosis by ultrasound, Doppler, and renal scintiscan.

Childhood renal vein thrombosis (RVT) usually occurs in infants less than one year of age, and in recent years, more RVTs are diagnosed with the help of various diagnostic imaging modalities. RVT produces immediate physiologic, anatomic, and functional changes within the involved kidney or kidneys and these changes can be detected readily and noninvasively by Doppler ultrasound, ultrasound scan, and renal scintiscans. Childhood RVTs are associated with substantial morbidity, and the earlier the diagnosis and treatment, the better the prognosis. The most important factor in the diagnosis of childhood RVT is a high clinical index of suspicion. With a high degree of clinical suspicion, one can make the specific diagnosis of RVT using the noninvasive methods. Such methods can also be used for follow-up of patients with RVTs.

Child↗