Andrea Manyon

Androgen metabolism in the rhesus monkey

A mixture of 3H-testosteron (T) and 14C-4-androstene-3, 17-dione (A) was injected intravenously into 2 (I and II) rhesus monkeys (Macaca mulatta). A third monkey (III) was injected with 3H-T only. Urine and bile samples were collected at intervals for 6 hours following the injection. The excretion, conjugation and aglycone metabolites of the steroids injected were studied using these samples. Of the injected dose, animal I (male) excreted 32% 3H and 23% 14C in the bile and 30% 3H and 21% 14C in the urine in 6 hours. Animal II (female), however, had a comparatively higher biliary excretion (66% 3H, 40% 14 C), but a urinary excretion (18% 3H, 13% 14C) comparable to that of animals I and III. The averages in the bile of the 3 animals were: unconjugated compounds 3%, glucosiduronates 78%, sulfates 9%, sulfoglucosiduronates 5% and disulfates 3%; and in urine, 5% unconjugated, 92% glucosiduronates and 3% sulfates. The aglycones obtained following hydrolysis were separated gy chromatography on Lipidex 5000, further purified by thin layer and paper chromatography and identified by co-crystallization. The major matabolites from 3H-T were androsterone and 5beta-androstane-3alpha,17beta-diol, whereas that from 14C-A was androsterone. Other metabolites identified were: etiocholanolone (3beta-hydroxy-5-beta-androstan-17-one); T, epitestosterone (epi-T), (17alpha-hydroxy-4-androsten-3-one); epiandrosterone (3-beta-hydroxy-5alpha-androstan-17-one) and 5alpha-androstane-3alpha, 17beta-diol. The results indicate that while androgen metabolism in the rhesus monkey is similar to that of the baboon and human in conjugate and metabolite formation, the rate of excretion was significantly different, resembline more closely that of the baboon than the human.

Impact of expanding use of health information technologies on medical student education in family medicine

The call for increased health care quality and access has facilitated the expanded use of health information technology (HIT) in the United States. In hospitals and physicians’ offices, HIT is most likely represented by the electronic health record (EHR) which, when fully deployed, provides

Family Medicine Clerkship, Tracks, and Faculty Support for Family Medicine Education in Departments of Family Medicine: An Update

Departments of Family Medicine, while experiencing financial resource diminution, are simultaneously called upon to expand their primary care bases and teaching programs, while building and testing medical homes with a goal of advancing to fiscal independence. These rapid changes, while posing unique opportunities, have the potential to diminish and de-prioritize student education as practice transformation occurs.

Translation and Validation of a Questionnaire to Assess the Diagnosis and Management of Dementia in Greek General Practice

The aim of this study was to translate and validate the Alzheimer’s Disease Knowledge scale (ADKS) in a population of Greek general practitioners (GPs). The international standards for the forward and back translation approach were followed. For the validation step, 112 GPs, treating dementia in their daily practices, were enrolled from Crete. The questionnaire was assessed for the following psychometric properties: intraclass reliability, test–retest reliability, and construct and face validity. Internal consistency of the Greek ADKS was satisfactory (α = .65). A high repeatability of the instrument was found during the retest with 27 GPs (intraclass correlation coefficient = 1.0). Factor analysis showed that all the items from the original instrument can be used in the Greek version. The inter-item correlation revealed a high cross-correlation between the items of the questionnaire (α > .6). The data confirmed the validity of the Greek version of the ADKS for measuring GPs’ knowledge on the diagnosis and management of dementia.

COMMUNITY FACULTY: CAUGHT BETWEEN THE DEAN’S OFFICE, ACADEMIC HEALTH CENTERS, DEPARTMENTS AND THE FISCAL REALITIES OF PRIMARY CARE

Many departments of family medicine are at the threshold of a possible new beginning in undergraduate medical education—a beginning that will provide medical school leaders new opportunities to address anticipated physician workforce shortages and “right-balance” physician specialty and geographic distribution using innovations in curriculum and national testing standards to achieve these changes. This new beginning will usher in expansion of medical schools’ class size as well as the establishment of new medical campuses and schools. This increase in medical school class size will require academic departments of family medicine to expand and reinforce the distributed community-based (and largely volunteer) physician faculty. These community practices provide learning opportunities for students in family medicine clerkships and often “Introduction to Clinical Medicine” courses. Many of the current family medicine community faculty teaching sites already experience “learner-saturation” not only from family medicine clerkship students, but with students from PA, Nursing, Osteopathic, and international schools competing for community clinical teaching placements. Academic departments of family medicine are challenged to maintain and now likely rapidly expand this decentralized model of clinical education. These proposed expansions raise several questions. First, can clinical teaching volunteerism support the magnitude of planned medical school expansion? Second, once voluntary teaching capacity of community faculty is exceeded, can additional capacity be financed with departmental resources? And finally, if departmental resources are inadequate, are medical schools prepared to further support the teaching involvement and necessary educational resources for community faculty? These are questions that many departments are facing or will be facing very soon. The educational model that was first established by family medicine and now used by other primary care departments rests on the tenuous volunteerism of community faculty at a time when primary care practice resources are stressed and volunteerism often is expected by leaders of medical schools and legislators who support these initiatives. Amid medical school expansion, family medicine educators also strive to standardize the community-based learning experience, to conduct meaningful evaluations and to embrace learning within practices that meet the expectations of a patient-centered medical home. The creation of this practice environment is a challenging undertaking for all clinical venues. The requirement of this new practice concept in community-based learning sites will likely decrease access to existing and new community teaching opportunities. We must also ask whether we should expect all community-based teaching sites to accomplish what academic family medicine practices have not yet consistently done. These challenges set the stage for a new model of community-based learning: community faculty potentially compensated for teaching who are members of a learning community in partnership with the academic department and for whom the departments serve as political and educational advocates, quality improvement assistants and providers of continuing medical education. In this new model of community-based learning, the presence of students could potentially be “value-added” for community and academic practices. Value is provided by facilitation of: Performance in Practice Modules as required for maintenance of certification, meaningful “bubble-up” research ideas by community faculty, academic appointments and benefits, and vigorous advocacy with payors and legislators for the appropriate fiscal advancement of primary care and enhanced reimbursement for practices embracing concepts of the patient-centered medical homes and teaching students. It is now time to collect and share best practices that advance the partnership between academic departments of family medicine and community faculty. Collectively we may be able to answer the following critical questions that may be necessary for departments to appropriately respond to this new academic challenge. What are the most successful incentives? What are the best models for faculty development? How can we enhance the learning experiences of community faculty? What is required to facilitate meaningful promotion and advancement for community faculty? How do we select and maintain community faculty committed to the institution’s educational mission? New models of family medicine department/community partnerships will produce educational innovations that include greater identification of appropriate community faculty as equal academic colleagues worthy of additional investments from the department and schools of medicine. Consider the quantitative impact of integrating the estimated 10,000 community faculty (extrapolating from a query of ADFM members in 2004 concerning the number of community faculty) into our departments as partners in the mission of advancing the future of our discipline. Sharing best practices related to relationships with our distributed community faculty across the country will facilitate the development of appropriate responses to the unique opportunities afforded by the changing medical school environment.