Robert J. Winter

Standard Parameters of Diabetic Control: Are They Reliable?

To evaluate the reliability of the tradional methods to assess short-term control of diabetes, 25 children with insulin-dependent diabetes were studied with a 24-h glucose profile in addition to the traditional assessment techniques. Patient compliance was elminated as much as possible from the experimental design. The correlation of the routine methods with the 24-h glucose profile was excellent, and a scoring system for control was empirically derived. The single method of assessment that correlated best with the overall control score was the traditional daily urine test. In 6 of the 25 subjects studied, relative hypoglycemia was observed, occurring asymptomatically at night, and was followed by a hyperglycemic rebound. Traditional assessment techniques did not detect this event. Five additional patients had symptomatic daytime hypoglycemia. We conclude that the traditional daily urine tests are adquate indicators of day-to-day control in most diabetic patients, given adquate compliance. Our data also suggest that asymptomatic nocturnal hypoglycemia occurs frequently in children with diabetes, although clinical proof is difficult in the absence of a 24-h glucose profile.

Carbohydrate homeostasis in chronic lymphocytic thyroiditis: Increased incidence of diabetes mellitus

Twenty-one patients were seen with the diagnosis of chronic lymphocytic thyroiditis in the Endocrine Clinic during 1965-1972. Three patients developed clinical diabetes mellitus at intervals from one month to three years after the diagnosis of thyroiditis was confirmed. An additional patient, a member of the study group reported here, had asymptomatic glucose intolerance initially and developed insulin-dependent diabetes mellitus six months after the diagnosis of thyroiditis was established. Standard glucose tolerance tests were performed on 12 additional patients. One of these patients had unequivocal evidence of chemical diabetes; one other had a borderline abnormal oral glucose tolerance test. The remaining ten patients had normal glucose and insulin values during the OGTT. These studies indicate that children with chronic lymphocytic thyroiditis are at increased risk of developing diabetes mellitus when compared with the normal childhood population.

Research during residency training

This report describes the experience of one residency program in which completion of a research project is a requirement. Although the goals and structure of the requirement are very specific, residents are free to design and conduct any project of their choice that is original, ethical, and scientifically sound. Over the period of this requirement, more than 300 residents have completed a project. Since inauguration of new guidelines for this requirement in 1985, nearly one third of the projects has been published or presented at a regional or national meeting. The benefits of the requirement on resident education and career development are discussed.

Critique of a clinical curriculum from examination performance.

No abstract available.

Reforming medical education: Preparing students for medical practice in the 21st century

Background: The shortcomings of traditional medical curricula have been debated, and reforms proposed, for decades. The faculty of Northwestern University Medical School addressed this need for major curricular change and implemented a totally new preclinical curriculum. Summary: The new curriculum was predicated on a commitment to small‐group interaction replacing some, but not all, lecture‐based teaching. This hybrid curriculum contains the best elements of lecture‐based and

A Comparison of Educational Interventions: Multimedia Textbook, Standard Lecture, and Printed Textbook

sel directed, interactive learning. It does so through horizontal integration of the basic

Pediatric Resident Attitudes About Technologic Support of Vegetative Patients and the Effects of Parental Input—A Longitudinal Study

st ence disciplines into 3 courses spanning the first 2 years of medical school. Vertical integration of clinical disciplines into this framework occurred through a rigorous curriculum in communication skills, fundamental clinical skills, and problem‐based learning sessions. An experiential curriculum exposes students to the social, behavioral, and ethical foundations of medicine. Conclusions: The feasibility of wide‐sweeping curricular re...