The business of emergency medicine: a nonclinical curriculum proposal for emergency medicine residency programs.

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs.

Antioxidants in prevention of cataracts in South India: methodology and baseline data*.

Purpose: To describe the methodology and baseline data for the Antioxidants in Prevention of Cataracts (APC) study in South India.

Methods: The APC study is a prospective, 5-year, randomized, triple-masked, placebo-controlled, field-based clinical trial to examine the effect of antioxidants (combination tablet of vitamins A, C, and E) on progression of cataract. The primary outcome variable is cataract progression (nuclear opalescence), evaluated with the slit-lamp biomicroscope by the Lens Opacification Classification System III method.

Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India.

Aims/background: To determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in Madurai, south India, and to identify the specific pathogenic organisms responsible for infection.

Methods: All patients with suspected infectious central corneal ulceration presenting to the ocular microbiology and cornea service at Aravind Eye Hospital, Madurai, from 1 January to 31 March 1994 were evaluated. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined, and corneal cultures and scrapings were performed.

Cataract progression in India.

Aims: The study was undertaken to test the feasibility of using the LOCS III cataract grading scale in the field and to determine the rate of cataract progression over a 1 year period of time.

Methods: For 150 subjects between the ages of 33 and 55 who attended the refraction clinic at Aravind Eye Hospital in Madurai, India, lens abnormalities were graded at the slit lamp using the LOCS III scale. One year later, 99 of the subjects were re-evaluated by the same methodology to assess the amount of lens change.

Incidence of corneal ulceration in Madurai district, South India.

Objective: To determine the incidence of corneal ulceration in Madurai District, South India.

Design: Retrospective incidence study.

Setting: General community.

Antibiotic supplementation of intraocular irrigating solutions. An in vitro model of antibacterial action.

Purpose: The addition of antibiotics to infusion solutions for cataract surgery is becoming increasingly popular. The authors developed an in vitro model to evaluate antibacterial effects of this use of antibiotics.

Methods: Clinical isolates and/or reference strains of the following organisms were examined: coagulase-negative Staphylococcus spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, Streptococcus spp, Enterococcus spp, Proprionibacterium acnes, Moraxella nonliquifaciens, and Pseudomonas aeruginosa.

Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal.

Corneal ulceration is one of the most frequent causes of blindness in developing countries. Between September 1985 and August 1987, 405 patients with corneal ulceration were examined at Tribhuvan University Teaching Hospital in Kathmandu, Nepal. Males and females were equally affected.

Cellular response to inflammation at the limbus.

The role in ocular (limbal) inflammation of the rich vascular and lymphatic supply is discussed in detail. The distribution of lymphocytes, mast cells, Langerhans cells, macrophages and other cellular elements are discussed as well as their individual and collective response to inflammation whether due to infectious or non-infectious disease states. Among the non-infectious causes of limbal cellular inflammation are the four types of hypersensitivity response.

Use of recombinant interferon in HSV-1 recurrence in the rabbit.

The use of recombinant human interferon alpha subtype D (RIFN alpha D) was effective in reducing shedding of herpes simplex virus type-1 induced by iontophoresis of 6-hydroxydopamine and epinephrine. A post stimulation treatment schedule of RIFN alpha D, one drop four times a day was as effective as pretreatment, using the same dose regimen. The levels of interferon (IFN) present in the assay system are not sufficient to produce an antiviral effect.

Interferon effects on herpes simplex virus in rabbit and human cell cultures.

The effects of four subtypes of recombinant human alpha interferon (RIFN alpha), (A,B,D, and the hybrid A/D) were tested on six strains of herpes simplex virus (HSV). RIFN alpha -D was the most effective subtype in rabbit kidney cells, which is consistent with our previous in vivo results in the rabbit herpetic keratitis model. In human corneal cells, however, RIFN alpha -D was one of the least effective IFN subtypes tested.

Trimethoprim-polymyxin B ophthalmic solution in treatment of surface ocular bacterial infections.

A safety and efficacy study comparing the clinical and bacteriologic effectiveness of trimethoprim-sulfacetamide-polymyxin B-neomycin-gramicidin in a group of patients with surface ocular bacterial infections was conducted. The results demonstrated TSP to be as effective as the other solution (both clinically and bacteriologically), with fewer adverse experiences. A second study was conducted comparing TSP with trimethoprim-polymyxin B (TP) and found TP to be superior to TSP in effecting bacteriologic cures.

Recombinant human interferon alpha D in HSV-1 recurrence in the rabbit.

Recombinant human interferon alpha subtype D (RIFN alpha D) was effective in reducing the shedding of herpes simplex virus type-1 (HSV-1) induced by 6-hydroxydopamine iontophoresis followed by topical epinephrine application in previously infected rabbit corneas. A treatment schedule of RIFN alpha D, two drops QID was superior to one drop BID. RIFN alpha A also appeared to be effective in reducing viral shedding.

Use of recombinant interferon to prevent recurrent herpesvirus shedding.

Iontophoresis with 6-hydroxydopamine was performed in rabbits previously infected with herpes simplex virus, McKrae strain. Viral shedding into the tear film was significantly decreased by the use of recombinant alpha interferon subtype D given as one drop qid. Interferon was noted in the tear film of rabbits 16-18 hours after the last placement of interferon drops into the inferior cul-de-sac.

The effect of K-582, a new antifungal agent, on experimental Candida keratitis.

K-582, a new basic peptide antibiotic, was tested in rabbits with experimental Candida keratitis. It was shown that the K-582-treated group showed statistically highly significant therapeutic effects on days 2 and 3, as compared with the control group (day 2: P less than 0.001; day 3: P less than 0.

Biologic properties of the thymocyte-activating factor (CETAF) produced by a rabbit corneal cell line (SIRC).

Rabbit corneal epithelial cell cultures produce a cytokine (CETAF) that greatly enhances the proliferation of C3H/HeJ mouse thymocytes. The rabbit corneal cell line SIRC was used to generate CETAF activity in the culture supernatant. CETAF was then partially purified by Sephacryl S-200 gel filtration, where peaks of activity eluted in a molecular weight range of 95,000-55,000 (CETAF I) and 30,000-15,000 (CETAF II).