The effect of an ambulatory internal medicine rotation on students' career choices.

Purpose: To assess the effect of an ambulatory care experience on medical students' perceptions of internal medicine and their choices of careers (as measured by residency selections).

Method: In 1990-91, the 196 third-year students enrolled in the 12-week internal medicine clerkship at the University of Texas Medical School at San Antonio were randomized to a curriculum that included a three-week ambulatory care component or to a traditional, exclusively inpatient curriculum. The ambulatory curriculum included the evaluation of walk-in-patients, exposure to community internists, and a lecture series.

How well can the chest radiograph diagnose left ventricular dysfunction?

Objectives: To review the diagnostic utility of the chest radiograph for left ventricular dysfunction.

Data Sources: Structured MEDLINE searches, citation reviews of relevant primary research, review articles, and textbooks, personal files, and data from experts.

Study Selection: Studies of patients without valvular disease that allowed calculation of the sensitivity and specificity of selected radiographic signs compared with a criterion standard of increased left ventricular preload or reduced ejection fraction.

The clinical evaluation for diagnosing obstructive airways disease in high-risk patients.

Objective: We measured the ability of the medical history, physical examination, and peak flowmeter in diagnosing any degree of obstructive airways disease (OAD).

Design: Prospective comparison of historical and physical findings with independently measured spirometry.

Setting: University outpatient clinic.

Gallstone characteristics in Mexican Americans and non-Hispanic whites.

Mexican Americans have an elevated risk of gallstones. Their increased rates may be due to genetic admixture with Native Americans, who have extremely high prevalences of cholelithiasis. Native Americans are believed to have almost exclusively cholesterol stones, whereas only 73% of non-Hispanics are reported to have such stones.

Preoperative HIV testing: is it less expensive than universal precautions?

Universal precautions are officially recommended to prevent HIV transmission in health care settings but for elective surgery some advocate routine preoperative HIV testing. These strategies have not been tested in clinical trials but universal precautions are very expensive and not cost-effective. Thus, for elective surgery, routine testing might save resources by permitting selective use of additional barrier precautions.

Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans.

Patients' cultural beliefs may affect acceptance of health care, compliance, and treatment outcomes. This article discusses cultural views of health and illness, folk beliefs and customs, cultural barriers to care, and alternative health-care systems, with particular emphasis on Mexican Americans and African Americans, including curanderismo, rootwork, and voodoo. Physicians who wish to provide appropriate and acceptable care in a cross-cultural setting should integrate these beliefs with conventional medicine.