Henry Tulgan

Aneurysms of the coronary artery

Abstract Ten cases of arteriosclerotic aneurysms of the coronary arteries have been reported. In addition, all cases of coronary artery aneurysm in patients over the age of 16 years have been compiled and tabulated. Certain statistical conclusions have been drawn. Arteriosclerotic coronary arterial aneurysms were found in association with abdominal aortic aneurysms in 8 of 10 cases. This association has been noted previously. Pathogenesis has been briefly considered. The cases we have reported represent the result of a meticulous technic of dissection of the coronary circulation. Aneurysms of the coronary artery are probably not as rare as the previously low number of case reports might have indicated and represented 1.4 per cent of the autopsies at Albany Medical Center Hospital during the period of study.

Sarcoidosis: A Case Presenting with Dysphagia and Dysphonia

Excerpt Sarcoidosis is a generalized granulomatous disease of unknown etiology that affects many tissues and is characterized pathologically by epithelioid tubercles with little or no necrosis. Ove...

How a Teaching Hospital Implemented Its Termination Policies for Disruptive Residents

The development of Policy Standards for Termination that both protect and support residents while safeguarding sponsoring institutions has become increasingly necessary. To date, however, there has been little in the literature that discusses policies that have undergone thorough testing to the highest levels of the U.S. judicial system. Berkshire Medical Center (BMC), an acute-care community teaching hospital affiliated with the University of Massachusetts Medical School, developed a set of specific policies to cope fairly with the resident dismissal process. The authors describe a nine-year legal test of these policies in the case of a resident whose disruptive behavior required their implementation. Also presented is a summary of due process as it applies in such cases. The dismissed resident tested the policies through the Courts of the Commonwealth of Massachusetts all the way to the United States Supreme Court, the Equal Employment Opportunity Commission, and the Massachusetts Department of Industrial Accidents. At every level the termination action was upheld. The resident had previously been in two graduate medical education programs at other institutions, and neither of them had communicated issues of concern that would have forewarned BMCs program about potential problems. A plea for honest and open communication between programs is made. This may help to avoid the lengthy, expensive, and potentially serious consequences of such situations. However, the authors emphasize that when such situations arise, strong policies serve as an ultimate legal protection.

PROLONGED SURVIVAL AFTER CATHETER EMBOLUS.

Excerpt The increasing use of polyethylene catheters in the administration of intravenous fluids is not without the hazard of embolization. Several reports in the literature (1-4) have already reco...

Electrocardiographic Misrepresentation of Impending Pacemaker Failure

Abstract An electrocardiogram of a 19-year-old girl with a permanent transvenous pacemaker mimicked pacemaker failure. This was caused by circuit design impairments of the electrocardiograph model ...

Performance improvement CME in psychiatry: implementing black box warning informed consent

Objective. Performance improvement continuing medical education (PI CME) is a recent educational methodology designed better to link educational content and outcomes in the context of limitations in the effectiveness of traditional CME. This study examines the ease of use and effectiveness of psychiatric CME in a small hospital. Methods. All staff psychopharmacologists assessed their performance in providing informed consent of black box risks of prescribed psychiatric medications in a 3-month period. Staff were educated regarding black box risks of all commonly prescribed psychiatric medications, and their performance in the following quarter was reassessed. Significance of change following the educational intervention at 3 and 6 months was determined by Chi square analysis. Results. PI CME was clearly successful in supporting behaviour change, χ2(1, N=60) =20.86, p=0.000, far outstripping traditional CME efforts. Changes in behaviour persisted over time, χ2(1, N=61)=4.04, p=0.044. This PI CME event received the highest possible rating by CME participants, and took few staff resources to implement. Conclusions. PI CME is an educational technology that can be carried out, without significant burdens to participants or educators, in psychiatric departments of small hospitals. PI CME can be much more effective than traditional CME in bringing about desired behaviour change in psychiatrist behaviours. Hospital-based PI CME may have other benefits, such as meeting criteria for Maintenance of Certification.

The Albany Two-Way Radio Conferences, 1955–1981: A Retrospective Look at a Program Providing Interactive Continuing Medical Education at a Distance

Despite early widespread recognition of the necessity of continuing medical education (CME) for practicing physicians and surgeons, medical schools and national medical organizations were slow to mobilize to address the need. One pioneering program, developed by the Albany Medical College in New York, not only provided CME, but did so in a live distance education format that allowed for interaction between the participants and the faculty presenters. The Albany Program commenced in 1955 using what was then state-of-the-art technology; it exemplified principles and practices that can be seen as the precursors for the distance education approaches used to reach physicians today. This short article describes the contributions of the Albany Two-Way Radio Conferences and places them in the context of developments in national organizations and policies in the 20th century.

Subgroup demographic may have skewed ALLHAT results.

To the Editor: Results of the recent Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)1 have generated much excitement and controversy. The reported superior performance of thiazide diuretics brought the trial under scrutiny for reasons that include experimental design, population characteristics, primary and secondary endpoints, and statistical analysis.2,3 We propose an alternative explanation for the drug’s superior performance based on the new field of pharmacogenetics. The drug’s result may be a function of the genetic predisposition of the study’s subjects. It has been shown that more than 76% of African American men have the C825T polymorphism, a predisposition that confers a superior response to thiazides.4 As 35% of the subjects in the ALLHAT study were African American, the influence of this polymorphism could have skewed the results. Responses to angiotensin-converting enzyme inhibitor can also be predicted and may influence outcome.5 Thus, there appear to be subgroups within subject pools that 3. Messerli FH, Weber MA. ALLHAT—all hit or all miss? Key questions still remain. Am J Cardiol. 2003;92:280-281.