Sandra P. Levison

Tools for Integrating Women's Health into Medical Education: Clinical Cases and Concept Mapping

The authors describe two teaching tools, case-based learning and concept mapping, and how they support cross-disciplinary, multidisciplinary, and interdisciplinary learning, use a biopsychosocial model, and promote the integration of sex- and gender-based science into the medical curriculum. The process of case development at MCP Hahnemann University (MCPHU) is outlined in detail for a specific case. That case, which integrates three different components of womens health, is then presented in full. The authors then provide an example of a concept map dealing with women and alcohol use; the map defines current knowledge and serves as a blueprint for developing curricular goals and learning objectives for the topic. Properly constructed concept maps and cases help teach patient-centered approaches to problem solving, address sex- and gender-based differences in disease as well as in pathophysiology and pharmacology, integrate psychosocial issues—such as family dynamics, environmental stressors, access to health care, effective gender-based communication between patient and provider, and cultural variations—along with biomedical ones, and encourage a multidisciplinary approach to patient care. The authors maintain that these tools might be used to transform medical education by making it more integrated and interdisciplinary.

Renal disease in the elderly: the role of the renal biopsy.

The causes of renal disease in the young and the elderly vary in their frequency. There are many indications for renal biopsy in older patients, with the nephrotic syndrome (NS) being the most common, followed by acute renal failure. Biopsy does not carry a greater risk for older patients, but there is a greater risk of complications when there is coexistent renal insufficiency. Interpretation of the renal biopsy in elderly patients may be more complex because of changes associated with aging or intercurrent disease--arteriolar sclerosis and global sclerosis. A prospective study is needed to determine the exact prevalence of renal insufficiency, NS, and other renal diseases in noninstitutionalized elderly individuals and to determine the role of renal biopsy in making these determinations.

Influence of water diuresis on antimicrobial treatment of enterococcal pyelonephritis

In the present studies, the effect of ampicillin (40 mg intramuscularly twice a day) in combination with water diuresis, produced by the ingestion of 5% dextrose in water, was determined on renal titers of enterococci after intravenous inoculation of 4 x 10(8)-2 x 10(9) enterococci into rats. Ampicillin injections with or without diuresis were started 4 or 21 days after initiation of infection and continued for 7 or 14 days. In comparison to controls (saline injections in rats drinking tap water), diuresis plus saline injections did not lower renal titers of enterococci. Injection of ampicillin in nondiuresing rats had little effect on renal titers of enterococci after 7 days of treatment started 4 or 21 days after initiation of infection. However, 2 wk of ampicillin therapy resulted in a significant decrease in renal titers. The addition of water diuresis to ampicillin treatment markedly potentiated the effect of ampicillin alone in decreasing renal titers of enterococci after 1 or 2 wk of therapy.These studies demonstrate that diuresis resulting from administration of dextrose in water plus ampicillin starting 4 or 21 days after intravenous injection of enterococci reduces renal titers more than ampicillin or diuresis alone.