Kaua'i Rural and Public Health Selective: A Family Medicine Residency First.

Governmental public health professionals and community physicians often have limited understanding of each other's roles and responsibilities. To increase the connection between public health and primary care as well as to incorporate rural health care in graduate medical education training, a new "Kaua'i Rural and Public Health Selective" brings Family Medicine resident physicians (Residents) into the local health department on Kaua'i. This first-time collaboration between the Kaua'i District Health Office (KDHO) and University of Hawai'i John A.

Rhabdomyolysis in the Context of Designer Benzodiazepine Misuse.

Designer benzodiazepines belong to a class of lab-created psychoactive compounds, with limited federal regulation, no toxicity testing, and reported high potency, leading to substantial overdose risk and harmful clinical syndromes. Benzodiazepine misuse has been previously documented to be associated with rhabdomyolysis, with elevated creatine kinase (CK) during and after acute episodes of intoxication. Here, we present a case of profound rhabdomyolysis and associated acute kidney injury (AKI) after acute designer benzodiazepine intoxication.

Implications for a System of Care in Hawai'i: Primary Care Integration of Substance Use Disorder Treatment.

Primary care physicians (PCPs) in Hawai'i face many challenges in treating patients with substance use disorders (SUD) who tend to have higher medical complexity and thus require more resources. PCPs play a vital role in identifying early misuse, integrating and coordinating care for patients with SUD including office-based interventions like medication-assisted treatment, and connecting patients to community treatment programs. In addition to enormous burdens to care for and increasingly complex patient panels, the challenges include lack of education on addiction medicine, insufficient resources and SUD treatment programs in the office and community, low reimbursement for the complexity of care provided, and an overall physician shortage which drives higher patient volume and less time for any given physician.

A case of buprenorphine-precipitated withdrawal managed with high-dose buprenorphine.

Background: Buprenorphine-naloxone has a very high affinity for the mu-receptor and can cause precipitated opioid withdrawal, typically more severe than withdrawal that occurs naturally, when administered while a full mu-opioid receptor agonist remains in a person's system. To avoid precipitated withdrawal, one needs to be in mild to moderate opioid withdrawal at the time of buprenorphine-naloxone induction. Recently, there have been reported cases of precipitated withdrawal occurring in patients taking fentanyl knowingly or unknowingly, despite them being in adequate opioid withdrawal at the time of induction.

Hepatitis C in Arkansas: updates on epidemiology, testing and treatment.

Hepatitis C infection is the most common blood-borne infection in the United States with an estimated 2.7 million individuals suffering from chronic infection. Of those who are infected with Hepatitis C virus, 75-85% develop chronic infection.

A humid climate state during the Palaeocene/Eocene thermal maximum.

An abrupt climate warming of 5 to 10 degrees C during the Palaeocene/Eocene boundary thermal maximum (PETM) 55 Myr ago is linked to the catastrophic release of approximately 1,050-2,100 Gt of carbon from sea-floor methane hydrate reservoirs. Although atmospheric methane, and the carbon dioxide derived from its oxidation, probably contributed to PETM warming, neither the magnitude nor the timing of the climate change is consistent with direct greenhouse forcing by the carbon derived from methane hydrate. Here we demonstrate significant differences between marine and terrestrial carbon isotope records spanning the PETM.

Time in continuity clinic as a predictor of continuity of care for pediatric residents.

Objective: In 1996, the Residency Review Committee-Pediatrics recommended doubling time in continuity clinic to 2 half days per week. It has yet to be demonstrated that increased time in clinic yields greater continuity of care. The objective of this study was to determine whether increasing the number of half days spent in clinic improves continuity of care for residents.

Comparison of continuity in a resident versus private practice.

Background: There is widespread agreement among pediatric educators that continuity (following a panel of patients on a first contact basis for all their health care) is an important part of the education of pediatricians.

Objective: To measure continuity in a pediatric residency practice and to compare this continuity with 2 nearby private general pediatric group practices. We also examined measures of continuity suggested in the literature.

A novel potassium channel gene, KCNQ2, is mutated in an inherited epilepsy of newborns.

Idiopathic generalized epilepsies account for about 40% of epilepsy up to age 40 and commonly have a genetic basis. One type is benign familial neonatal convulsions (BFNC), a dominantly inherited disorder of newborns. We have identified a sub-microscopic deletion of chromosome 20q13.

Sustained proliferation accompanies distraction osteogenesis in the rat.

These studies were conducted to compare the local cellular proliferation patterns in the rat tibia during distraction osteogenesis with those during nondistracted fracture healing. Bone specimens from distraction osteogenesis and nondistracted fracture groups were analyzed 2, 10, and 20 days after surgery. Proliferation was determined by metabolic labeling with [3H]thymidine and by immunocytochemistry with an antibody to proliferating cell nuclear antigen.

Techniques for evaluating residents and residency programs.

A comprehensive, functioning evaluation system is an important component of a residency program. It should focus on the residency program as well as on the residents and should provide feedback to the residents, their teachers, and the program director. Such a system allows residents and their faculty advisors to receive timely, ongoing, formative feedback concerning resident progress.

Searching for human epilepsy genes: a progress report.

Application of new genetic techniques has brought remarkable discoveries in the study of genetic diseases. The potential benefits from applying such technology to idiopathic epilepsies include improved understanding of cellular mechanisms and potential new methods of prevention and treatment. The complex problems involved in studying the hereditary epilepsies include: defining of specific phenotypes; detecting genetic and non-genetic heterogeneity; and specifying the appropriate mode of inheritance and penetrance.

Effectiveness of computer-generated appointment reminders.

Previous studies of appointment reminders among general pediatric patients have been done exclusively among low socioeconomic populations in clinics with low continuity of care and using block scheduling methods. This study of mailed computer-generated appointment reminders took place in a setting with patient demographics and practice techniques similar to those of many private pediatric practices. During a 6-month period, 901 appointments that were made more than 7 days prior to the scheduled date were randomly assigned to receive reminder postcards or to serve as controls.

Computerized patient scheduling in outpatient residency practices.

A computerized appointment system is described that accommodates the special needs unique to residency training programs. Appointments are scheduled automatically according to the type of problem with which the patient presents to the office as well as the differing time requirements of faculty physicians and residents at various levels of training. The system provides for the easy and flexible scheduling of residents and the automation of appointment reminders.

In-training examinations as predictors of resident clinical performance.

Previous attempts to predict resident clinical performance based solely on measures of cognitive skills have been uniformly unsuccessful. For the past 8 years, a formative residency evaluation system has been used that includes yearly comprehensive oral in-training examinations (OITEs) assessing each resident's performance in the three areas of professional competence: cognitive, psychomotor, and affective. The results of these examinations and scores received on the written in-training examination (WITE) given by the American Board of Pediatrics were compared with faculty ratings received during the subsequent year of residency.

Benign familial neonatal convulsions linked to genetic markers on chromosome 20.

Recurrent seizures, commonly known as epilepsies, occur in 1.7% of the general population by age 40. The factors that initiate or underlie seizures are not well understood, but trauma, infectious disease and genetics have been implicated.

A multiuser MUMPS language patient/physician scheduling system for microcomputers.

A microcomputer based patient and physician scheduling system is described that accommodates the special needs unique to residency training programs. Appointments are scheduled automatically according to the type of problems the patient brings to the office as well as the differing time requirements of attending physicians and residents at various levels of training.

Implementation of multiuser MUMPS language database systems on microcomputers.

This paper outlines the problems involved in implementing multiuser MUMPS language database systems on microcomputers and discusses practical solutions. Examples of the techniques presented are derived from experience with a large database system, PTIN/PTQ/MEDAR, running on an IBM AT with up to 10 separate users.

Predicting resident clinical performance with in-training examinations.

Yearly oral in-training examinations that assess resident performance in the three domains of professional competence (cognitive, psychomotor, and affective) given over a seven year period correlated highly with subsequent resident clinical performance and also predicted with a high degree of significance, sensitivity, and specificity those "problem" interns whose clinical performance placed them in the lower 10% of interns. Scores received on written in-training examinations were not significantly correlated with clinical performance and did not identify "problem" residents.

Estimates of need for transfusions during hypertransfusion therapy in sickle cell disease.

The relationship between Hemoglobin S (Hb S) level and simultaneous values of reticulocyte count, hemoglobin (Hb), and hematocrit (Hct) were studied in six patients with sickle cell disease who were receiving a transfusion protocol because of cerebrovascular accidents. There was good correlation between Hb S and reticulocyte count (r = 0.601), Hb (r = -0.

Significant attitude changes among residents associated with a pediatric nurse practitioner.

In the study reported here, significant changes in attitudes occurred over a three-year period among pediatric residents who had close association with a pediatric nurse practitioner (PNP) in their residency program. Residents entering the training program had an overall uncertain attitude toward PNPs but did respond favorably to the PNP's participation in the care of well children, patient education, and follow-up care. The greatest number of attitude changes toward the PNP took place after the first year of interaction between the residents and the PNP.