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PROGRAM ENRICHMENT PROFESSIONALISM: SHOULD WE? TEACHING AUTHORS: T. E. Carter1, P. Arciaga1, J. S. Jahr1, J. Tetzlaff2, S. Steen1; AFFILIATION: 1King Drew Medical Center, Los Angeles, CA, 2 Cleveland Clinic Foundation, Cleveland, OH. INTRODUCTION: The Accreditation Council for Graduate Medical Education and the American Board of Anesthesiology ABA ; requires compliance with six core competencies -- professionalism is one of them 1, 2 ; . The ABA 2003 manual states: "Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population 3 ; ." We evaluated a teaching module that included a pre- and post-test and a didactic lecture assessing improvement. METHODS: As part of the resident education curriculum, a 30 minute presentation was scheduled to present a didactic lecture on Professionalism. No specific cases or tutorials were presented. Ten relevant questions, which were not directly addressed in the lecture, were administered as a pre- and post-test to members of the Anesthesiology Department of King Drew Medical Center, including faculty, residents, and rotating students from UCLA. Feedback from the presentation and descriptive statistics were used to evaluate the results. RESULTS: The faculty and Dean of the Medical School, residents, and students, on validated feedback, commented favorably on the lecture, including presentation, slides, and style. However, focus and additional time allotment was suggested, including specific question-matched case examples, and interactive tutorials. Specifically, of the 6 faculty members who were pre-tested, 2 of 3 which were post-tested, demonstrated a 10% improvement. Of 11 residents who were pretested, 9 of them completed the post-test and only one showed 10% improvement. One who scored 100% on the pre-test, did not take the post-test. Of the 3 medical students who took the pre-test, one significantly improved his performance by 30%. No individuals' scores decreased. DISCUSSION: It is important to note that the lecture did not specifically cover the questions asked. Based on these initial findings, it is clear that the lecture should include specifics to cover relevant topical aspects of professionalism included in the tests. For this to occur, educational modalities must be designed, which may include simulation of conditions relevant to anesthesiology and medicine in general. In conclusion, as a result of these findings, we are developing: a. Relevant, test questions to administer in a non-biased method, for which we provide a pre- and post-test following a didactic presentation of compelling topics in professionalism. b. Teaching modules with examples in interactive sessions. c. A published residency manual that documents clearly expected behaviors and actions punctuality, honesty, politeness, team cooperation ; as the patient's advocate. d. The above permits performance evaluations, which may document improvement based on personal observations by faculty, colleagues, and support teams members. REFERENCES: 1. : acgme acgme ACGME Outcomes Project; Program Requirements for Residency Education in Anesthesiology ; . 2. AAMC Core Curriculum Working Group: Graduate medical education core curriculum. AAMC, 2000. 3. The American Board of Anesthesiology, Booklet of Information, January 2002, abanes, because pentoxifylline canine.
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Fig. 9. Effect of protein kinase A PKA ; and protein tyrosine kinase PTK ; inhibitors H89 and genistein GEN on the cAMP and pentoxifylline PTX ; enhanced-incidence of phosphotyrosineimmunoreactive sperm tails. Swim-up spermatozoa were incubated with the inhibitors for 30 min and then stimulated with 1 mmol cAMP l-1 and 1 mmol PTX l-1 for 1 h in Ham's F10 plus human serum albumin at 37 C CO2 . Spermatozoa were then fixed and permeabilized with methanol and labelled with phosphotyrosine monoclonal antibody 4G10 ; and fluorescein isothiocyanateconjugated anti-mouse IgG. Data mean SE, n 10 ; are expressed as percentage of control spermatozoa incubated in medium alone; dashed line ; . However, the effect of the inhibitors should be evaluated in comparison with spermatozoa treated with cAMP and PTK. Wilcoxon's signed-rank test was used to compare cAMP and PTX versus control data. Data with inhibitors were compared against cAMP and PTX data using Welch's test or paired t test. Superscripts indicate the statistical significance of comparisons a: P 0.0001; b: P 0.001; c: P 0.05 and trental.
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Figure 3. Influence of pentoxifylline on splenocyte cytotoxicity against B16F10 cells, measured by 51Cr-release assay. The asterisk represents difference at P 0.055 by analysis of variance and pheniramine.
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1 Soya based oils are healthier than coconut oils because they are polyunsaturated. T F 2. Soya has a long history of use in China T F 3.Trans fatty acids are only found in saturated fatty oils. T F 4. Hydrogenation, used to partially solidify and stabilize vegetable oils, create trans fatty acids. T F 5. Pure Soya vegetable oils store well without refrigeration. T F 6. Coconut oil is saturated and therefore unhealthy. T F 7. All saturated fats cause heart disease. T F 8. Hydrogenated polyunsaturated vegetable oils fats have less fat than coconut oil. T F 9. French Fries cooked in animal fat absorb more fat than fries cooked in vegetable oil T F 10. "Olestra can be a tool for a healthier diet, " said Dr. John Foreyt, Director of the Nutrition Research Clinic at the Baylor College of Medicine. "Olestra works to reduce fat and calories for a very simple reason: because it tastes good." Quote from Proctor and Gamble website ; T F 11. Saturated fats are like Trans fatty acids T F 12. You can easily tell if polyunsaturated oils are rancid by the taste. T F and progesterone.
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As discussed in the Critical Accounting Policies Section, the US market has the most complex arrangements in the area of deductions from gross sales to arrive at net sales, which is the starting point for all our discussions on our sales developments. The following table shows the extent of sales deductions made in the US for our key subsidiaries affected, which are NPC, Sandoz Inc. and Novartis Consumer Health Inc. OTC ; : Gross to Net sales reconciliation in the US and propafenone.
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Of phagocytes and opsonization. Infect. Immun. 60: 36823688. 4. Bozzette, S. A., F. R. Sattler, J. Chiu, A. W. Wu, D. Gluckstein, C. Kemper, A. Bartok, J. Niosi, I. Abramson, J. Coffman, C. Hughlett, R. Loya, B. Casseus, B. Akil, T. Meng, C. T. Boylan, D. Nielsen, D. D. Richman, J. G. Tilles, J. Leedom, and J. A. McCutchan. 1990. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. N. Engl. J. Med. 323: 1451 1457. Chalkiadakis, G. E., and A. Kostakis. 1985. Pentoxifglline in the treatment of experimental peritonitis in rats. Arch. Surg. 120: 11411144. 6. Chan, K.-H., K. S. Mann, and C. P. Yue. 1989. Neurosurgical aspects of cerebral cryptococcosis. Neurosurgery 25: 4448. 7. Chao, C. C., S. Hu, K. Close, C. S. Choi, T. W. Molitor, W. J. Novick, and P. K. Peterson. 1992. Cytokine release from microglia: differential inhibition by penhoxifylline and dexamethasone. J. Infect. Dis. 166: 847853. 8. Denning, D. W., R. W. Armstrong, B. H. Lewis, and D. A. Stevens. 1991. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am. J. Med. 91: 267272. 9. Dezube, B. J. 1994. Pentocifylline for the treatment of infection with human immunodeficiency virus. Clin. Infect. Dis. 18: 285287. 10. Diamond, R. D., and J. E. Bennett. 1974. Prognostic factors in cryptococcal meningitis: a study in 111 cases. Ann. Intern. Med. 80: 176181. 11. Guerra-Romero, L., J. H. Tureen, M. A. Fournier, V. Makrides, and M. G. Tuber. 1993. Amino acids in cerebrospinal and brain interstitial fluid in experimental pneumococcal meningitis. Pediatr. Res. 33: 510513. 12. Houston, E., G. Cullen, M. I. Sweeney, H. Pearsons, M. S. Fazelli, and A. C. Dolphin. 1993. Pertussis toxin treatment increases glutamate release and dihydropyridine binding sites in cultured rat cerebellar granule neurons. Neuroscience 52: 787798. 13. Louie, A., A. L. Baltch, M. A. Franke, R. P. Smith and M. A. Gordon. 1994. Comparative capacity of four antifungal agents to stimulate murine macrophages to produce tumor necrosis factor alpha: an effect that is attenuated by pentoxifylline, liposomal vesicles, and dexamethasone. J. Antimicrob. Chemother. 34: 975987. 14. Louria, D. B., N. Fallon, and H. G. Browne. 1960. The influence of cortisone on experimental fungus infections in mice. J. Clin. Invest. 39: 14351449. 15. Mahaffey, K. W., C. L. Hippenmeyer, R. Mandel, and N. M. Ampel. 1993. Unrecognized coccidioidomycosis complicating Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus and treated with corticosteroids. Arch. Intern. Med. 153: 14961498. 16. Mitchell, D. H., T. C. Sorrell, A. M. Allworth, C. H. Heath, A. R. McGregor, K. Papanaoum, M. J. Richards, and T. Gottileb. 1995. Cryptococcal disease.
Table 4. Adverse reactions to thalidomide and pentoxidylline at the end of weeks 1 and 3. Adverse reactions End of 1st week Thalidomide N 20 ; Presence Absence 5 25% ; 15 75% ; Pentox8fylline N 23 ; 7 30.4% ; 16 69.6% ; End of 3rd week Thalidomide N 19 ; 3 15.8% ; 16 64.2% ; Pentoxkfylline N 18 ; 2 11.1% ; 16 88.9 and rythmol.
Ficity of the antibody, without trying to test its sensitivity in breast cancer patients. We think that the data presented by Braun et al. provide additional information to a method i.e., false-positive results in bone marrow of patients without carcinoma ; . Since they have slightly modified the staining method, the direct comparison of the data is difficult. Until 1995, we have used bone marrow smears; we started to use cytospin preparations in 1996. For that reason, our staining protocol has changed over time. Currently, we are comparing the two staining protocols to find out the reasons for the discrepancies in the results between our group and the Munich group. Moreover, we are comparing anti-cytokeratin antibodies with mucinspecific antibodies and are trying to improve the specificity and sensitivity of the detection system. The discussion on sensitivity versus specificity reminds us of the debate about some serum tumor markers such as human chorionic gonadotropin HCG ; . It is well known that HCG is not specific for gestational trophoblastic disease, since healthy pregnant individuals and patients with some lung cancers also have elevated HCG values. Nevertheless, once gestational trophoblastic disease has occurred, the sensitivity of HCG is near to 100%. At present in Germany there are five other groups who are testing the 2E11 antibody in breast cancer. Their detection rate is in the range of 35%45%, which is in concordance with our data. We have also encouraged other groups to use our detection system to confirm our clinical findings. But any statistical analysis requires a considerable number of breast cancer patients, and no group has yet investigated an appropriate number of patients to be able to compare it with our cohort of more than 1300 patients. To our knowledge, there is only one other group that has tested tumor cell detection in more than 200 breast cancer patients with long-term followup [using anti-epithelial membrane antigen-antibody; 3 ; ]. An improvement in sensitivity can lead to a loss of specificity. However, as long as Braun and his group could not demonstrate that their tested sensitivity with 2E11 is at the same level, for example, epntoxifylline radiation.
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