Lawrence I. Kaplan

Integrating Evidence Based Medicine Into Undergraduate Medical Education: Combining Online Instruction With Clinical Clerkships

Background: Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). Description: During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. Evaluation: Paired data were available from 139 students. Postcourse test scores ( M= 77.7; 95% CI = 59–96.4) were significantly higher than precourse scores ( M= 66.6; 95% CI = 46.5–86.7), p< .001. Paired evaluations demonstrated an average improvement of 11.1 ± 20.0 points. All of the students submitted 4 independently derived questions and successfully retrieved and appraised evidence. Conclusions: Medical students successfully acquired and independently applied EBM skills following extended, online, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.

STUDIES IN MYASTHENIA GRAVIS: PRESENT STATUS OF THERAPY WITH OCTAMETHYL PYROPHOSPHORAMIDE (OMPA)

Excerpt In 1935 neostigmine1was introduced as an agent for the treatment of myasthenia gravis. It is still the drug of choice but, because of the frequency of dosage and the development of refracto...

AN ANALYSIS OF COMPLICATIONS ENCOUNTERED DURING THERAPEUTIC MALARIA

Excerpt Since the introduction by Wagner-Jauregg1in 1917 of inoculation malaria in the treatment of neurosyphilis, thousands of patients have received this form of fever therapy. At a recently orga...

SPONTANEOUS RUPTURE OF THE SPLEEN DURING MALARIA THERAPY; REPORT OF A CASE

Excerpt The rarity of spontaneous rupture of the spleen in naturally acquired malarial infections has been expressed by Manson-Bahr,1Stitt,2and Osler.3Since the introduction of malaria as a therape...

The Greatest Gift: How a Patient’s Death Taught Me to Be a Physician

The package was in plain brown paper wrapping. The note enclosed read, “Thanks for everything you did for my father. It meant more than you can ever imagine.” I teared up, remembering the day I helped the father of a colleague die peacefully. When I opened the wrapping and saw the picture of two saplings planted side by side and a certificate saying that the family planted one in my honor next to the one in their father’s, the single tear turned to a river. Although I never thought that a patient’s death would be one of the best clinical experiences of my then young career, that day increased my love for practicing medicine significantly. Medicine wasn’t always a joy for me. In my medical residency, I existed in survival mode. I was a smartass, justifying anything that would get me through the days of sleep deprivation, overwhelming workloads, and soulcrushing sadness, even if it meant gallows humor and finding hilarity in tragedy. Early in my second year, I admitted a patient with an emphysema exacerbation. I was supposed to bring him with me to morning report and present his care to the chief of medicine the next day. But the patient’s

Technical aspects of therapeutic malaria

Abstract 1.1. Technical refinements of the treatment of neurosyphilis with induced malaria have long been overlooked. An appreciation of these aspects of treatment will lead to a sound clinical approach to the problem, to an understanding of the immune mechanisms involved, and to the wider adoption of technics which are relatively simple and which aid in the production of satisfactory courses of the disease. 2.2. The quantitative parasite count eliminates confusion and waste of time in the use of therapeutic malaria by materially aiding in determining the severity of a given malaria infection and the degree of the patients resistance, in rapidly forecasting an immune response requiring intervention and retreatment without wasteful weeks or months of observation, and in the rather precise regulation of the febrile course by facilitating quantitative inoculations. 3.3. Heterologous strains of P. vivax have been shown to produce sufficient clinical activity in previously vivax-infected individuals to allow their routine use for the reinoculation of white neurosyphilis patients experiencing partially immune types of original infection (five to eight paroxysms) thus eliminating the undesirable use of quartan strains for reinfection. 4.4. Criteria for malaria inoculations in the treatment of neurosyphilis have been established: (1) White patients with a history of malaria, individuals from the Mediterranean area, Puerto Rico, or highly endemic malaria zones, and all negroes should be primarily inoculated with quartan malaria, intravenously in large doses (more than 10 million parasites). (2) All other white patients without a history of malaria should be primarily inoculated with vivax malaria, intravenously in doses of 1 million parasites. (3) Patients in group B who develop partially immune responses with less than five paroxysms should be reinoculated with quartan malaria. (4) Patients in group B who develop partially immune responses with five paroxysms or more should be reinoculated with heterologous strains of vivax malaria. 5.5. Sodium bismuth thioglycollate (thiobismol), which inhibits partially grown parasites, can be employed to regulate both vivax and quartan infections when irregular cycles occur.