Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper.

In this position paper, the American College of Physicians (ACP) examines the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction, and lower costs. The paper also explores and acknowledges challenges associated with implementing patient- and family-centered models of care. On the basis of a comprehensive literature review and a multistakeholder vetting process, the ACP's Patient Partnership in Healthcare Committee developed a set of principles that form the foundation for authentic patient and family partnership in care.

Advancing Medical Professionalism in US Military Detainee Treatment.

Leonard Rubenstein and colleagues argue that professional associations should ensure that military rules do not require health professionals to choose between service to their country and ethical practice.

Using Technology to Meet the Challenges of Medical Education.

Medical education is rapidly changing, influenced by many factors including the changing health care environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. Changes in societal expectations put patient safety in the forefront, and raises the ethical issues of learning interactions and procedures on live patients, with the long-standing teaching method of "see one, do one, teach one" no longer acceptable. The educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision making, enhancement of perceptual variation, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills.

The impact of the changing health care environment on the health and well-being of faculty at four medical schools.

Purpose: Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty.

Method: A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.

Rethinking smallpox.

The potential consequences of a competently executed smallpox attack have not been adequately considered by policy makers. The possibility of release of an aerosolized and/or bioengineered virus must be anticipated and planned for. The transmission and infectivity of variola virus are examined.

Cultivating curricular reform.

Since the 1960s there has been pressure to reform medical education in a more humanistic direction. One reason this has been difficult is that most medical schools have been forced to maintain themselves on resources allocated to support research and the technology of specialized tertiary care. Nevertheless, many people believe that medical education can still change because of changes taking place outside the sciences, such as a redefinition of the meaning of health and the need to provide better health care to the U.

Improved outcomes in intensive care units for AIDS-related Pneumocystis carinii pneumonia: 1987-1991.

Respiratory failure due to Pneumocystis carinii pneumonia (PCP) is the most common complication requiring an intensive care unit (ICU) for persons with AIDS. In this study, we evaluated patterns of ICU use for ICU patients with first-episode PCP in 15 Veterans Administration Medical Centers from 1987 to 1991. Twelve percent of all patients with PCP received care in the ICU.

Status report on ambulatory care and education in the VA Western Region and western medical schools.

Since the initial 1988 Ambulatory Care and Education (ACE) conference, reported in the October 1989 supplement to Academic Medicine, the Western Region Veterans Health Administration and its 11 affiliated western medical schools have established several programs and related activities that implement strategic ACE recommendations. This report gives an update on the ACE Advisory Group; the Pilot Ambulatory Care and Education (PACE) Center at the VA Medical Center, Sepulveda, California; other innovative ambulatory care and education projects; the second ACE Development Conference; and future activities in the expanded Western Region of the Department of Veterans Affairs.

The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia.

A central issue in health policy with regard to the acquired immunodeficiency syndrome (AIDS) is whether quality of care and patient outcomes are affected by resource constraints. In an earlier study of 15 California hospitals between October 1986 and October 1987, we observed a markedly lower in-hospital mortality rate for Pneumocystis carinii pneumonia in the group of patients treated in hospitals that had a high level of experience with AIDS relative to the group treated in hospitals with low experience. We present the patterns of resource use at hospitals with high and low AIDS familiarity.

Graduate medical education in ambulatory care.

Graduate medical education is currently in transition, with educators being asked to re-examine the extent to which hospital-based teaching models still provide adequate comprehensive training. To educate future physicians adequately, the Department of Veterans Affairs (VA) will have to change its system for delivering ambulatory care services and for teaching in ambulatory care settings. Workshop discussions focused on five major areas regarding educating residents in the ambulatory setting: educational goals and objectives, clinical experiences, curriculum development and evaluation, faculty issues, and fellowship opportunities.

Psychotropic medication use during pregnancy.

Women can have severe and at times life-threatening psychiatric illness during pregnancy. When nonpharmacologic interventions have been attempted and are insufficient, psychotropic medication use is often necessary. The available data on prescription neuroleptic drugs suggest that with the proper selection, use, and supervision, they can be used during pregnancy.

Experimental Escherichia coli endocarditis in rats: roles of serum bactericidal activity and duration of catheter placement.

Studies were undertaken to investigate the relationship of the sensitivity of Escherichia coli to the bactericidal properties of serum and the ability of different strains to induce and sustain endocardial infection in rats. Strains of E. coli demonstrated different degrees of serum sensitivity, as determined by a method which employed concentrations of serum from 10 to 95% and periods of incubation as long as 24 h.

Treatment of staphylococcal pyelonephritis in rats with N-formimidoyl thienamycin.

The therapeutic efficacy of N-formimidoyl thienamycin alone or coadministered with MK0791, an inhibitor of renal dehydropeptidase-I, compared to methicillin in experimental pyelonephritis in rats was investigated. Pyelonephritis was produced with a methicillin-sensitive strain (2776) and a methicillin-resistant strain (Berman) of Staphylococcus aureus. N-formimidoyl thienamycin alone or coadministered with the inhibitor was significantly better than methicillin when treating methicillin-sensitive or methicillin-resistant infection.

Antibiotic prophylaxis against streptomycin-resistant and -susceptible Streptococcus faecalis endocarditis in rabbits.

This report describes the capacities of ampicillin, vancomycin, streptomycin, gentamicin, and combinations thereof to prevent endocarditis in rabbits challenged with either streptomycin-resistant (three strains) or streptomycin-susceptible (one strain) Streptococcus faecalis. Vancomycin (15 mg/kg) alone was effective in preventing infection with three of four strains, including two which were streptomycin resistant. Vancomycin (30 mg/kg) alone was effective against the other streptomycin-resistant strain.

Effect of iron on acute pyelonephritis and later chronic changes.

Administration of iron to rats exacerbated early inflammatory changes of pyelonephritis produced by intravenous inoculation of Escherichia coli. This effect was noted with four of eight strains of E. coli tested and was dependent on bacterial inoculum.

Variables in demonstrating methicillin tolerance in Staphylococcus aureus strains.

Certain technical considerations which affected the status of methicillin tolerance in Staphylococcus aureus strains were studied. Methods which consistently demonstrated tolerance or intolerance of a given strain were avoidance of inoculum splashing, use of stationary-phase inoculum, 24-h tube incubation, and minimization of antibiotic carry-over. These studies suggested a need for the establishment of a standardized reference for the determination of tolerance.

The role of antibiotic tolerance in the response to treatment of pyelonephritis due to Staphylococcus aureus in rats.

The effect of tolerance to methicillin on the response to treatment of hematogenous pyelonephritis due to Staphylococcus aureus was evaluated in rats. Tolerance was defined as a ratio of minimal bactericidal concentration to minimal inhibitory concentration of greater than or equal to 32. Rats that were infected with tolerant or nontolerant stains of S.