Stephen E. Goldfinger

Colchicine therapy for familial mediterranean fever. A double-blind trial.

Abstract Eleven patients with long standing familial Mediterranean fever were studied in a double-blind trial using daily colchicine or placebo. During 60 courses of placebo, 38 attacks of familial...

The Effectiveness of the Xanthine Oxidase Inhibitor Allopurinol in the Treatment of Gout

Excerpt The clinical benefits derived from controlling the hyperuricemia of patients with gouty arthritis have been well-established (1, 2). This has been achieved by using uricosuric drugs to incr...

Absorption of Digoxin in Patients with Malabsorption Syndromes

Abstract Gastrointestinal absorption of digoxin was evaluated by use of a recently developed radioimmunoassay to measure serum levels. Eleven patients with malabsorption syndrome (nine with malabsorption and two with maldigestion due to pancreatic insufficiency) were compared with a control group of 10 patients who had no intestinal disease. All subjects received 0.25 mg of oral digoxin daily, and steady-state serum levels, reached after six days in all subjects, were determined. The mean steady-state serum digoxin level for the nine patients with malabsorption was significantly less than that for the control group (p less than 0.001), whereas levels for the two patients with pancreatic insufficiency were not significantly different from control values. These data indicate that digoxin is poorly and erratically absorbed by patients with malabsorption on the basis of mucosal defects or hypermotility but may be more normally absorbed by patients with pancreatic insufficiency.

A Matter of Influence

Some of us remember, dimly, a type of ethical decision that arose during our training days many years ago. Was it acceptable to receive a none-too-sturdy medical bag as a gift from Pharmaceutical M...

The Problem-Oriented Record: A Critique from a Believer

Abstract The problem-oriented medical record has been extensively described and widely recommended by many. Its true value in patient care, teaching, and clinical research must now be proved. Potential shortcomings of the system include overemphasis on style and compartmentalization, uncritical acceptance of a data base, inefficiencies in the process of data retrieval, lack of criteria for problem formulation, and an expectation that problem orientation alone will permit effective record auditing.

Residency Training in Primary Care Internal Medicine: Report of an Operational Program

The Primary Care Program at the Massachusetts General Hospital is designed to develop competence in the full range of problems encountered by general internists delivering primary care. House staff spend 3 years in the program, which starts with internship, includes a senior residency, and fulfills the requirements for board eligibility in internal medicine. Half of the training is provided in outpatient care settings. House staff assume responsibility for organization and operation of an ambulatory medical unit. In addition, there is supervised instruction in office gynecology, orthopedics, ear, nose and throat, dermatology, and psychiatry. Close integration with the traditional inpatient-oriented training program is maintained to ensure commensurate growth and competence in management of acute, life-threatening disease.

Treatment of Gout

GOUT is a consequence of hyperuricemia. It is of interest that our generally accepted upper limit of normal for serum unite, a concentration greater than 7 mg per 100 ml, corresponds closely to the...

Academia-industry collaboration in continuing medical education: description of two approaches.

Introduction: Although concerns have been raised about industry support of continuing medical education (CME), there are few published reports of academia‐industry collaboration in the field. We describe and evaluate Pri‐Med, a CME experience for primary care clinicians developed jointly by the Harvard Medical School (HMS) and M/C Communications. Methods: Since 1995, 19 Pri‐Med conferences have been held in four cities, drawing more than 100,000 primary care clinicians. The educational core of each Pri‐Med conference is a 3‐day Harvard course, “Current Clinical Issues in Primary Care.” Course content is determined by a faculty committee independent of any commercial influence. Revenues from multiple industry sources flow through M/C Communications to the medical school as an educational grant to support primary care education, Pri‐Med also offers separate pharmaceutical company–funded symposia. Results: Comparing the two educational approaches during four conferences, 221 HMS talks and 103 symposia were presented. The HMS course covered a wide range with 133 topics; the symposia focused on 30 topics, most of which were linked to recently approved new therapeutic products manufactured by the funders. Both the course and the symposia were highly rated by attendees. Discussion: When CME presentations for primary care physicians receive direct support from industry, the range of offered topics is narrower than when programs are developed independently of such support. There appear to be no differences in the perceived quality of presentations delivered with and without such support. Our experience suggests that a firewall between program planners and providers of financial support will result in a broader array of educational subjects relevant to the field of primary care.

The relevance to clinical practice of the certifying examination in internal medicine

AbstractObjective: To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. Design: Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: directors of the American Board of Internal Medicine (ABIM) and practicing general internists. Each judge rated the relevance of items on a five-point scale. Participants: 54 current or former directors of the ABIM and 72 practicing general internists; practitioners were nominated by directors and their ratings were included if they spent > 80% of their time in direct patient care. Results: The directors’ mean rating of all 576 items was 3.98 (SD=0.62); the practitioners’ mean rating was 4.11 (SD=0.82). The directors assigned to 27 items ratings of less than 3 and the practitioners assigned to 42 items ratings of less than 3; seven of these items received low ratings from both groups. There were differences in the two groups’ ratings of the relevance of various medical content categories, but the mean rating of core items was higher than that of noncore items and the mean rating of items testing clinical judgment was higher than that of items testing knowledge or synthesis. Conclusions: These findings suggest that the initial certifying examination is relevant to clinical practice and that many of the examination items are suitable for use in recertification. Differences in perception appear to exist between practitioners and directors, and the use of practitioner ratings is likely to be a routine part of judging the suitability of items for Board examinations in the future.

Hypersensitivity hepatitis due to phenazopyridine hydrochloride.

IN 1966 Hood and Toth1 reported a case of recurrent bouts of jaundice and abnormalities of liver-function tests after repeated brief courses of phenazopyridine hydrochloride (Pyridium, Warner-Chilc...