Robert P. Drucker

Myopathy in human immunodeficiency virus-infected children receiving long-term zidovudine therapy

2. Goldman J, Reicheldefer M. Evaluation of rapid colonoscopy using a new gut lavage solution. Gastrointest Endosc 1982;28: 9-1l. 3. Ernstoff J J, Howard DA, Marshall JB, Jumshyd A, McCullough AJ. A randomized blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoseopy and barium enema. Gastroenterology 1983;83:1512-6. 4. Fordtran JS, SantaAna CA, Cleveland MB. A low sodium solution for gastrointestinal lavage. Gastroenterology 1990; 98:11-6. 5. Brady CE, DiPalma JA, Morawski SG, SantaAna CA, Fordtran JS. Urinary excretion of polyethylene glycol-3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology 1986;90:1914-8. 6. Cleghorn G J, Stringer DA, Forstner GG, Durie P. Treatment of distal intestinal obstruction syndrome in cystic fibrosis with a balanced intestinal lavage solution. Lancet 1986;1: 8-ll . 7. Koletzko S, Stringer DA, Cleghorn G J, Durie PR. Lavage treatment of distal intestinal obstruction syndrome in children with cystic fibrosis. Pediatrics 1989;83:727-33. 8. Tenenbein M. Whole bowel irrigation in iron poisoning. J PEDIATR 1987;111 : 142-5. 9. Postuma R. Whole bowel irrigation in pediatric patients. J Pediatr Surg I988;23:769-70. 10. Tolia V, Fleming S, Dubois R. Use of Golytely in children and adolescents. J Pediatr Gastroenterol Nutr I984;3:468-70. II. Tuggte DW, Perkins TA, Tunnell WP. Outpatient bowel preparation for children. J Pediatr Surg 1989;24:703-4. 12. Ingebo KB, Heyman MB. Polyethylene glycol-electrolyte solution for intestinal clearance in children with refractory encopresis: a safe and effective therapeutic program. Am J Dis Child 1988;142:340-2.

Alliance for Clinical Education Perspective Paper: Recommendations for Redesigning the “Final Year” of Medical School

Background: Although medical school typically lasts 4 years, little attention has been devoted to the structure of the educational experience that takes place during the final year of medical school. Summary: In this perspectives paper, we outline goals for the 4th year of medical school to facilitate a transition from undergraduate to graduate medical education. We provide recommendations for capstone courses, subinternship rotations, and specialty-specific schedules, and we conclude with recommendations to medical students and medical schools for how to use the recommendations contained in this document. Conclusions: We provide an overview of general competencies and specialty specific recommendations to serve as a foundation for medical schools to develop robust 4th-year curricula and for medical students to plan their 4th-year schedules.

Maternal acceptance of voluntary human immunodeficiency virus antibody testing during the newborn period with the Guthrie card

In order to provide the opportunity for women delivering newborns to have human immunodeficiency virus (HIV) testing we piloted a hospitalbased voluntary HIV testing program during the newborn period using the Guthrie card. During the study period 789 women were offered newborn HIV antibody testing. Test acceptance during the newborn period (61.0%) was comparable to that reported for the prenatal period (60.6%). Overall 77.4% of women were tested in the newborn period or reported being tested in the prenatal period. Prenatal test acceptance best predicted newborn HIV test acceptance (odds ratio, 3.37; 95% confidence interval, 2.40 to 4.74). When compared to HIV testing during the newborn period prental HIV testing is preferable because it enables the recognition of HIV infection early during pregnancy and allows the mother the option to elect zidovudine therapy and potentially prevent infection in her newborn. However, when prenatal HIV testing is not routinely made available or cannot be assured, women should be offered the opportunity to be tested during the newborn period.

1087 USE OF A MICOCOMPUTER IN A DIAGNOSTIC VIROLOGY LABORATORY

Aseries of computer programs was developed using an existing data base management system (KnowledgeMan) on a microcomputer to assist with the management of a diagnostic virology lab. The primary purpose was to handle the daily routine: recording specimens and patient data, generating worksheets for the reading and processing of cultures, retrieving culture results or current status, and printing final report forms. It can also handle other lab procedures: Chlamydia cultures, Clostridium difficile toxin assays, and some serologic testing. In addition, the computer facilitates surveillance studies. It can rapidly generate a list of cultures or results for user-defined conditions: ages, hospital location, dates, or a variety of other parameters. A statistics package is included for simple analyses. Security of patient data is always a concern with computer use because of the ease of transporting large volumes of information on floppy disks. Security is provided by KnowledgeMan. All information is stored in scrambled form within files, and cannot be read if accessed from outside KnowledgeMan. On entering the system, each user is assigned a priority status. Each data type, e.g. name, age, result, is assigned up to 16 different access codes to restrict the user to certain pieces of information. The series of programs is menu-driven, and requires no computer knowledge by lab personnel. A computer can decrease significantly the paperwork done by hand, file large amounts of information in a small space, facilitate epidemiologic surveys, and provide a rapid review and analysis of the work performed by the laboratory.

1086 LONGITUDINAL ASSESSMENT OF ANTIBODY RESPONSE OF CHILDREN WITH RENAL DISEASE TO PNEUMOCOCCAL VACCINE

56 children, including nephrotic syndrome (NS) patients, renal transplant (TX) recipients and normals, aged 2 to 15 years; were given a pneumococcal vaccine containing 14 polysaccharide (PS) types. Vaccine A with 50ug of each PS type was compared to Vaccine B with 25ug of each type. Study divisions were: Group 1)16 NS patients, Vaccine A; Group 2)10NS patients, Vaccine B; Group 3)3 TX patients, A; Group 4)10 TX patients, B; Group 5)10 normals A; Group 6)7 normals, B. Antibodies were determined for each PS type before, and 1, 3, 12 and 24 months after vaccination. At 1 month: a)the two vaccines produced comparable geometric mean titers (GMT) for 7/12 PS types in normals, 2/14 in NS patients, and 2/14 in TX patients. b)Vaccine B produced higher GMTs for 4/12 PS types in normals and for 11/14 in NS patients. c)Vaccine A produced a greater GMT for 12/14: types in TX patients. The sero-conversion rates were similar within paired groups. By 24 months the GMT was ≤ the pre-vaccine level for 9/12 types in Group 1, 7/12 Group 2, 11/12 Group 3, 6/12 Group 4, 6/12 Group 5, and 3/12 Group 6. The GMT was greater than the assumed protective level of 300 ng antibody N/ml for 4/12 types in Group 1, 5/12 Group 2, 4/12 Group 3, 4/12 Group 4, 5/12 Group 5, and 10/12 Group 6 at 24 months. 25ug of PS provided a similar immune response to that induced by the currently employed 50ug dose. Waning antibody titers suggest that longitudinal assessment of protection is essential and the possible need for booster doses remains to be determined.