Richard P. DiCarlo

The Clinical Diagnosis of Genital Ulcer Disease in Men

We report the sensitivity and specificity of physical examination findings for diagnosing primary syphilis, chancroid, and genital herpes. The physical features of genital ulcers in 446 men were measured in accordance with a quantitative scale. Two hundred-twenty of these men had an established, single microbiological diagnosis. Forty-five (20%) had primary syphilis, 118 (54%) had chancroid, and 57 (26%) had genital herpes. There was considerable overlap in the clinical presentation of these three diseases. The classic clinical sign complex attributed to primary syphilis (painless, indurated, clean-based ulcers) was only 31% sensitive but 98% specific. The classic presentation of a chancroid ulcer (a deep, undermined, purulent ulcer) was only 34% sensitive but 94% specific. The classic description of genital herpes ulcers (multiple, shallow, tender ulcers) was only 35% sensitive but 94% specific. Inguinal lymph node findings did not contribute significantly to clinical diagnostic accuracy. These data indicate that the clinical diagnosis of genital ulcer disease can be made with reasonable certainty only for a minority of patients. Rapid, sensitive, and specific diagnostic tests for syphilis, chancroid, and genital herpes are needed.

Seroepidemiology of low and high oncogenic risk types of human papillomavirus in a predominantly male cohort of STD clinic patients.

Human papillomaviruses (HPV) infecting the genital tract are associated with warts and anogenital malignancies. Although HPV is a highly prevalent sexually transmitted disease (STD), the majority of research has focused on female cohorts due to gender specific sequelae. Our objective was to measure the epidemiological features and seroprevalences of HPV-6/11 and 16 in a predominantly male group of STD clinic patients. High-risk individuals (n=687), who attended the public STD clinic were administered a behavioural questionnaire and serum tested for antibodies against HPV-6/11 and HPV-16 capsids via capture enzyme-linked immunosorbent assay. Despite the male predominance in this study, women were significantly more likely to have antibodies against both HPV-6/11 and HPV-16. Condom use appeared to be partially protective against HPV-16 seropositivity only. In conclusion, despite exhibiting increased risk behaviour, men were less likely to be HPV seropositive. Additional studies utilizing male cohorts are warranted to further elucidate this phenomenon.

Comparison of Methylene Blue/Gentian Violet Stain to Gramʼs Stain for the Rapid Diagnosis of Gonococcal Urethritis in Men

We compared a simple, one-step staining procedure using a mixture of methylene blue and gentian violet to Gram stain for the detection of gonococcal urethritis. The sensitivity and specificity of both Gram stain and methylene blue/gentian violet stain were 97.3% and 99.6%, respectively. There was a 100% correlation between the 2 methods.

Sustaining the teaching mission: lessons learned from Katrina.

T impact Hurricanes Katrina and Rita had on Louisiana and Mississippi in 2005 is deeply etched in the minds of most people across the United States and, in fact, the world. Indeed, some continue to follow and assist in the recovery process as the Gulf Coast region struggles to rebuild. Despite the tragedy, other major institutions can benefit from the many lessons learned here at the Louisiana State University Health Sciences Center (LSUHSC)-New Orleans and thus strengthen their preparedness for a host of emergency events, including natural disasters. This article provides a brief account of LSUHSC’s 2005 Katrina experience and the lessons we have learned thus far, which are relevant to sustaining the core teaching mission, particularly in supporting its learners both personally and in terms of their medical education in the face of catastrophic disaster. Limiting our discussion to the teaching mission still involved too many aspects of institutional response and recovery worthy of consideration to cover succinctly. Therefore, we focus specifically on the learners—our medical students, residents, and fellows—and highlight the actions that contributed to learners’ well-being and academic success and to the continuation of quality educational programs that were vital to their ongoing professional development and educational advancement. Although we do not wish to minimize the enormous effort of and impact on faculty in terms of instructional adjustments, we did not describe those in as much detail. Yet the lessons summarized at the end of this article apply generally to the faculty and others who were essential in sustaining the teaching mission in the aftermath of Hurricane Katrina. Background

Design and effectiveness of a required pre-clinical simulation-based curriculum for fundamental clinical skills and procedures

Abstract Background For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine – New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2). Methods Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation. Results An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as “novice” ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as “novice” and 18.8% for GU catheterization. Conclusion The CSL design is not to replace real clinical patient experiences. Its to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Use of the Quinolones in Sexually Transmitted Diseases

Publisher Summary The quinolones as a class of antibiotics are very useful in the treatment of various sexually transmitted diseases (STDs). This is because the quinolones have excellent in vitro activity against various pathogens responsible for STDs. The prevalence of penicillin- and tetracycline-resistant strains of N. gonorrhoeae and sulfonamide-resistant strains of H. ducreyi have also increased, thereby requiring newer agents such as quinolones to treat these organisms. The efficacy of quinolones for many STDs has been established through multiple clinical trials. N. gonorrhoeae has been the most extensively studied disease, and various agents have proved efficacious. A significant problem however, is the emergence of quinolone-resistant N. gonorrhoeae in the developing countries. Thus, whenever quinolones are used for treating gonorrhea, the maximum recommended dose should be used in order to slow the emergence of resistance. Ofloxacin has proven an effective therapy for C. trachomatis , and the early data on sparfloxacin for this infection looks promising as well. Ofloxacin also has been shown to be effective in the treatment of pelvic inflammatory disease. Ciprofloxacin, norfloxacin, rosoxacin, and fleroxacin are all effective as single agents for chancroid. There are also preliminary data that suggests that quinolones may be effective for donovanosis as well. Quinolones are also active against the causative agent of chancroid, H. ducreyi . Multidose therapy is currently recommended, as the failure rates may be somewhat higher with single-dose therapy.

In for the long haul: sustaining and rebuilding educational operations after Hurricane Katrina.

In 2005, Hurricane Katrina and the subsequent levee breaks left 80% of New Orleans under water for weeks. Within 4 short weeks, the Louisiana State University Health Sciences Center at New Orleans had relocated its campus temporarily to Baton Rouge and resumed operations. Many lessons were learned in the first year of recovery and disseminated to the field regarding emergency and disaster preparedness and response. As we approach the second anniversary of the nations most devastating natural disaster, we reflect on the long haul of rebuilding and offer new insights and lessons for sustaining operations and enhancing long-term rebuilding efforts.

Changes in undergraduate medical education, admissions, and student outcomes at LSU School of Medicine: three years after Katrina.

M has been written about the effects of Hurricane Katrina on the Louisiana State University Health Sciences Center (LSUHSC) School of Medicine in New Orleans1–4 and the importance of disaster planning for all medical schools. As we approach Katrina’s third anniversary, it is useful to reflect on the storm’s longer term effects on the school. This brief report summarizes the current status of our admissions process and undergraduate medical education curriculum. Pre-Katrina (July 2005) and immediate post-Katrina (July 2006) measures are used as benchmarks for comparison. The article also examines outcomes for the students most seriously affected by Katrina: the medical school classes of 2006, 2007, 2008, and 2009. Outcomes on the United States Medical Licensing Exams (USMLE) and in the National Resident Match Program (NRMP) remained essentially unchanged. This suggests that we were able to minimize the storm’s overall impact on medical student education. Additionally, we believe that new clinical rotations have actually strengthened medical student education as a whole. The school is well positioned to provide quality medical education in New Orleans’ changing demographic and health care environment.

Louisiana State University Health Sciences Center School of Medicine at New Orleans.

• Undergraduate medical education (UME) • Graduate medical education (GME) • Office of Medical Education Research and Development (OMERAD) • Learning Center • AHEC Program The assistant dean of undergraduate medical education has responsibility for oversight and management of the undergraduate curriculum under the direction of the associate dean for academic affairs and the dean. The UME office also works closely with the Office of Student Affairs to coordinate schedules and other student activities with the needs of the curriculum. Two courses are administered directly by the OME, but most courses and clerkships are departmentally based. The OMERAD was established in October 2002 as a schoolwide central resource and consultant center for promoting excellence, innovation, research, and scholarship in teaching and education. The OMERAD provides resources and consulting expertise for all courses and faculty members in the school of medicine.

309 CREATING A RICH LEARNING AND TEACHING ENVIRONMENT BASED ON THE PRINCIPLES OF ADULT LEARNING TO TEACH EMERGENCY CASE MANAGEMENT TO MEDICAL UNDERGRADUATE STUDENTS WITH USE OF THE HUMAN PATIENT SIMULATOR

Purpose LSU School of Medicine developed and implemented an innovative, year-long curriculum for junior medical students using the high fidelity Human Patient Simulator (METI, Inc.). Teaching methods are based on principles of adult learning in student-focused and highly interactive simulation sessions using specific patient scenarios. Methods Beginning in July 2003, junior medical students on the New Orleans campus participate in a series of eight HPS simulation sessions whose content was identified by the participating clerkship directors (acute thermal injury, gastrointestinal [GI] bleeding, pneumothorax, congestive heart failure [CHF], atrial fibrillation, bronchial asthma attack, septic shock, and eclampsia). Each case represents a modified simulation version of the standard treatment protocol of a given medical condition. Scenarios include simulators scripted responses to both correct and incorrect interventions that result in successful and unsuccessful outcomes. The model-driven script-controlled responses of the simulator provide immediate feedback to the students based on their interventions. Simulator automatically detects most of the performed interventions and interprets their appropriateness in accordance with scripted protocol. Simulators feedback provides a mechanism of reinforcement or punishment for correct or incorrect behaviors correspondingly. Instructor enters data of interventions that simulator cannot detect automatically. This approach allows students to integrate active analysis of the patients status and responses to treatment with synthesis of appropriate clinical algorithm. At the end of the session, the students debrief the case and compare their performances with the standard protocols (PALS, ACLS etc.). Methods A pre/post test design was used to examine knowledge gains as a measure of curriculum effectiveness. Each scenario-based quiz consisted of ten multiple-choice questions. Results Complete data were available for pre/post test total scores (n = 599) across the six scenarios for which tests were administered. Post-pre test score differences ranged from 35.49 to 45.18 (p < .0001). Conclusion The knowledge gains observed for initial implementation of the HPS curriculum are encouraging and supportive of the use of adult learning methods.