Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians最新文献

Angiodysplasia of the gastrointestinal tract is common in the population 60 years of age and older and may be the cause of acute and/or chronic bleeding. Colonic angiodysplastic lesions are presumed to be degenerative in nature, secondary to either intermittent obstruction of the submucosal veins or hypoxemia. The pathogenesis of upper intestinal angiodysplasia is most likely related to a degenerative process. The clinical presentation varies from an incidental finding in an otherwise asymptomatic person to occult bleeding or an acute massive hemorrhage. Endoscopy and angiography are useful diagnostic modalities. Management options include surgery, endoscopic obliteration, or angiographic embolization of an identified bleeding angiodysplastic lesion(s). In a subset of patients who have angiodysplasia associated with Osler-Rendu-Weber disease or chronic renal failure, hormonal therapy with estrogen-progesterone may be efficacious.

A paucity of data exists regarding the smoking prevention and cessation practices of African-American physicians. Advice from a physician is an important strategy in helping patients quit smoking. This article presents the results of a national survey conducted in the mid- 1980s of African-American physicians about their attitudes and practices toward smoking cessation and prevention. In this study, an adjusted response rate of 54% was achieved, yielding 188 returned questionnaires. Four specific smoking intervention practices were examined as dependent variables: (1) exploring patients' feelings about smoking; (2) discussing smoking with patients' families; (3) providing educational materials to patients; and (4) recording patients' smoking status in the medical charts. The proportion of African-American physician smokers in this study (16%) was greater than the reported rates (5% to 10%) of other physicians but well below the national average for African Americans (32.9%) in 1987. In bivariate analyses of the professional and demographic predictors, age, medical specialty, practice setting, physician smoking status, and certain attitudinal variables were significantly related to smoking intervention practices. Multivariate logistic regression analysis showed that older physicians were less likely to discuss smoking with a patient's family and to record patient smoking status and that respondents who felt their advice was effective were more likely to explore a patient's feelings about smoking.

This article reviews the tension between "gatekeeping," routinely practiced by managed care to limit utilization of care and, presumably, cost, and the increased demands of purchasers (such as Medicaid), consumer groups, and the National Council for Quality Assurance for mental health screening, outreach, and access to specialty care, particularly for vulnerable populations. Using examples from Harvard Pilgrim Health Care in Boston, the second oldest health maintenance organization in the country, the argument is advanced that early detection, coordination with primary care, and readily available expert consultation actually diminish cost while reducing morbidity and improving satisfaction.

Greater attention has been given recently to information technology and telecommunication reforms and their use for the improvement of health care service delivery. Broadly defined, telemedicine is the use of advanced telecommunications technologies for the purposes of making diagnoses, conducting research, transferring patient data, and/or improving disease management and treatment in remote areas. The emphasis is on use of telecommunications technologies at remote sites. This article provides a brief overview of telemedicine, its potential clinical applications, and the various benefits and leading issues surrounding it. It also describes selected telemedicine projects conducted at the University of Maryland School of Medicine in Baltimore.

A 9-month-old nonimmunized white female patient presented with a paroxysmal cough and a white blood cell count of 114,000/mm3. A nasopharyngeal culture was positive for Bordetella pertussis. Hyperleukocytosis is a rare complication of pertussis and is attributed to lymphocytosis-promoting factor. Hyperleukocytosis with pulmonary leukostasis can result in significant hypoxemia, although it did not occur in the case presented.

Behavior problems in children and adolescents have traditionally been blamed on the family. Recent information from neuroscience research challenges this assumption. Increased understanding of childhood behavior and psychiatric disorders has the potential to enhance treatment effectiveness and outcome. Changes in mental health delivery systems toward culturally competent, community-based systems of care are likely to improve the access of minority children to mental health care. Specific diagnoses and new medications may help children who have severe disorders avoid placement out of the home. Families have been instrumental in these advances by advocating better services and treatments for their children.

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.

Telemedicine offers significant advantages in bringing consulting support to distant colleagues. Our aim in this study was to evaluate the role of telementoring in the training of advanced laparoscopic surgical procedures. Student surgeons received a uniform training format to enhance their laparoscopic skills and intracorporeal suturing techniques and specific procedural training in laparoscopic colonic resections and Nissen fundoplication. Subsequently, operating rooms were equipped with three cameras. A telestrator (teleguidance device), instant replay (to critique errors), and CD-ROM programs (to provide reference information) were used as intraoperative, educationally assistant tools. In phase 1, four colonic resections were performed with the mentor in the operating room (group A), and four colonic resections were performed with the mentor on the hospital grounds but not in the operating room (group B). The voice and video signals were received at the mentor's location using coaxial cable. In phase 2, two Nissen fundoplications were performed with the mentors in the operating room (group C), and two Nissen fundoplications were performed with the mentors 5 miles away from the operating room (group D) using existing land lines at the T1 level. We found no differences in the performances of the surgeons or the outcomes of the operations between groups A and B and groups C and D. Intraoperative problems were tackled effectively. Preliminarily, we conclude that the telementoring concept is potentially a safe and cost-effective option for advanced training in laparoscopic operations. Further investigation is necessary before routine transcontinental patient applications are attempted.

Essential hypertension is a complex polygenetic disorder with different "intermediate phenotypes" among diverse racial/ethnic groups. Differences have been identified in the renin-angiotensin system, prevalence of salt sensitivity, ion-transport mechanisms, and calcium homeostasis, yet no unifying hypothesis as to the genetic mechanisms responsible for the excess prevalence and severity of hypertension among African Americans has emerged. Environmental factors, such as access to health care, socioeconomic status, stress, diet, and obesity, account for some of the differences in the prevalence of hypertension worldwide.

This study's purpose was to determine the college majors and career choices of students who participated in the Minority High School Student Research Apprentice Program (MHSSRAP) at the Medical College of Georgia School of Medicine, sponsored by the National Institutes of Health. A tracking system was initiated to follow up the participants to determine college majors during matriculation and career choices after graduation. The tracking included telephone interviews and questionnaires mailed to 55 participants from 1981 to 1994, the length of the program. The typical student in the cohort is an African-American man residing in a metropolitan area (70%) of Georgia. Sixty percent of the research apprentices come from working class parents. All 55 (100%) apprentices matriculated to a college or university. Thirty-one students (56%) had biology as their undergraduate major in college; 15%, liberal arts; 11%, chemistry; 7%, allied health disciplines; and 11%, other. Twenty-nine (53%) of these students graduated from college. Twenty-three of 29 (79%) graduates chose a medical or health science career, and 17 of 29 students (59%) matriculated into medical school. In Georgia, 30.1% of white students graduate from high school, and 14.6% obtain a baccalaureate degree. In contrast, 28% of blacks graduate from high school, and 7.5% graduate from college. We concluded that the Minority High School Student Research Apprentice Program is an important link in the student pipeline from high school to research careers and/or biomedical science careers. The research experience at an academic medical center and a college science major have great influence in the choice of medicine as a career.