Widening the lens on standardized patient assessment: what the encounter can reveal about the development of clinical competence.

The standardized patient (SP) examination is used in a majority of medical schools to test clinical skills. This examination usually yields both numerical ratings of clinical skill and narrative comments by patients or observers, yet most empirical studies of SP assessment focus on the numerical ratings only. This quantitative focus can lead to a narrow conceptualization of the nature and development of clinical competence.

Human antimicrobial peptides: analysis and application.

Antimicrobial peptides are innate host defense molecules that have a direct effect on bacteria, fungi and enveloped viruses. They are found in evolutionarily diverse species ranging from prokaryotes and plants to invertebrate and vertebrate animals. Humans express several families of antimicrobial peptides in myeloid cells and on various epithelial surfaces where they are poised to defend against pathogens.

Orbital and dorsolateral frontal perfusion defect associated with behavioral response to cholinesterase inhibitor therapy in Alzheimer's disease.

The authors retrospectively explored the behavioral and functional imaging profile of Alzheimer's disease (AD) patients who respond to cholinesterase inhibitor therapy by using the Neuropsychiatric Inventory (NPI) and baseline [99mTc]HMPAO SPECT. Thirty AD patients were divided into three groups (Responders, Nonresponders, and Unchanged) based on their behavioral response to donepezil. Responders had significantly (P < or = 0.

Achieving informed consent when patients appear to lack capacity and surrogates.

Obtaining informed consent is a frequent and important part of the practice of orthopaedic surgery. However, the process can be complicated, especially when there are impediments to communication and unusual decisions. An approach that considers each of the elements of informed consent permits the clinician to enhance the role of autonomy in patient decisions while maximizing the probability of achieving successful informed consent.

The orthopaedic surgeon and industry. Ethics and industry incentives.

Physicians may receive various gifts and incentives from companies that make pharmaceuticals and medical devices. Although such incentives may benefit patients and physicians, they often pose serious conflicts of interest that violate a physician's professional responsibility. The physician-patient relationship is predicated on the physician acting in the best interest of the patient.

Endoscopic diagnosis of sarcoidosis in a patient presenting with bilateral exophthalmos and pansinusitis.

Sarcoidosis is a chronic granulomatous disease of unknown etiology. Otolaryngologic and ophthalmologic manifestations occur in 15 to 55% of afflicted individuals, respectively. Neck masses, parotid enlargement, and facial nerve palsy are the most common presenting otolaryngologic complaints, while lacrimal gland enlargement, uveitis, and upper eyelid masses often call the attention of the ophthalmologist.

Economic evaluation studies in nuclear medicine: a methodological review of the literature.

Background: The growing need for evaluation of the utility of new nuclear medicine technologies has spawned a few economic studies ranging from preliminary indications of cost savings to complete decision analysis models incorporating costs and quality of life. The objective of the current study was to evaluate the methodological quality of economic analyses of nuclear medicine procedures which targeted cost-effectiveness or cost-utility issues published in the medical literature during the years 1985-1999.

Methods: A computerized literature search was used to identify original investigations from the medical literature which included an economic analysis of a nuclear medicine procedure.

Sodium-calcium exchange: a molecular perspective.

Plasma membrane Na(+)-Ca2+ exchange is an essential component of Ca2+ signaling pathways in several tissues. Activity is especially high in the heart where the exchanger is an important regulator of contractility. An expanding exchanger superfamily includes three mammalian Na(+)-Ca2+ exchanger genes and a number of alternative splicing products.

Positron emission tomography and the changing paradigm in coronary artery disease.

While lowering cholesterol with HMG-CoA reductase inhibitors appears to affect little if at all the severity of coronary artery stenoses, at least over the time periods studied, it markedly reduces cardiac morbidity and mortality. The beneficial effects of these agents have therefore been attributed to plaque stabilization and improved coronary vasomotor function. This then has shifted the emphasis of detection and treatment of coronary artery disease from the assessment of structural to functional alterations.

Cell differentiation in vascular calcification.

Ectopic tissue formation is commonly found in calcified atherosclerotic plaques. This suggests that cell differentiation plays an important role in vascular calcification, even though the origin of the cells involved is unclear. Calcifying vascular cells (CVCs), derived from bovine aortic media, have been used as an in vitro model for vascular calcification.

Telomeres and HIV disease.

Telomere measurement, envisioned as a novel approach to elucidate T-cell dynamics in HIV disease, failed to reveal any consistent pattern in CD4+ T cells. By contrast, significant telomere shortening, as well as other hallmarks suggestive of replicative senescence, was observed within the CD8+ T-cell subset. Telomere studies have thus provided unanticipated insight into a novel facet of memory CD8+ T lymphocyte dynamics that may explain the exhaustion of the protective antiviral immune response.

Brain microvascular P-glycoprotein and a revised model of multidrug resistance in brain.

1. P-Glycoprotein is a 170-kDa transmembrane glycoprotein active efflux system that confers multidrug resistance in tumors, as well as normal tissues including brain. 2.

Models of child-family interactions for children with developmental delays: child-driven or transactional?

Child-driven and transactional models of child-family interactions were tested with 80 children who had developmental delays and their families. Children's cognitive competence, personal-social competence, behavior and communication "hassle," and family accommodations to the children were assessed at child ages 3, 7, and 11. Accommodations were summarized as internal (within the family) and external (use of outside resources) intensity and types.

Lens alpha-crystallin: function and structure.

alpha-Crystallin is a major lens protein, comprising up to 40% of total lens proteins, where its structural function is to assist in maintaining the proper refractive index in the lens. In addition to its structural role, it has been shown to function in a chaperone-like manner. The chaperone-like function of alpha-crystallin will help prevent the formation of large light-scattering aggregates and possibly cataract.

Effect of estrogen on cellular metabolism of the human anterior cruciate ligament.

Previous studies from this laboratory have established the presence of estrogen receptors in the human anterior cruciate ligament. The purpose of this study was to investigate the effects of 17 beta-estradiol on cell proliferation and procollagen levels, as an indicator of collagen synthesis, in the human anterior cruciate ligament fibroblasts. Fibroblast proliferation and procollagen synthesis in response to near log concentrations of 17 beta-estradiol (at 0.

Neuropsychiatric aspects of corticobasal degeneration.

Neuropsychiatric symptoms are present in the majority of patients with CBD. Depression is common in this group of patients and contributes to the morbidity of the disease. Depression is more severe in CBD than in many other neurologic disorders.

Benign versus malignant solid breast masses: US differentiation.

Purpose: To investigate the general applicability and interobserver variability of ultrasonographic (US) features in differentiating benign from malignant solid breast masses.

Materials And Methods: One hundred sixty-two consecutive solid masses with a tissue diagnosis were reviewed. Three radiologists reviewed the masses without knowledge of clinical history or histologic examination results.