Tobacco dependence curricula in US undergraduate medical education.

CONTEXT: Tobacco use is the leading preventable cause of death in the United States. And yet only 21% of practicing physicians claim they received adequate training to help their patients stop smoking. OBJECTIVE: To assess the content and extent of tobacco education and intervention skills in US medical schools' curricula. DESIGN: A survey with 13 multiple-response items on tobacco education. Survey questions were based on the recommendations of the Agency for Health Care Policy and Research and the National Cancer Institute Expert Panel. The Liaison Committee on Medical Education included 4 of these items in a modified form on the 1997 annual questionnaire. SETTING: One hundred twenty-six US medical schools. PARTICIPANTS: Surveys were obtained from 122 associate deans for medical education (98.6%). MAIN OUTCOME MEASURES: Curriculum content in basic science and clinical science, elective or required clinical experience, hours of instruction, and resource materials. RESULTS: Inclusion of all 6 tobacco curricula content areas recommended by the National Cancer Institute and the Agency for Health Care Policy and Research was higher in basic science (63/115 [54.8%]) than in clinical science (5/115 [4.4%]). Most medical schools (83/120 [69.2%]) did not require clinical training in smoking cessation techniques, while 23.5% (27/115) offered additional experience as an elective course. Thirty-one percent (32/102) of schools averaged less than 1 hour of instruction per year in smoking cessation techniques during the 4 years of medical school. A minority of schools reported 3 or more hours of clinical smoking cessation instruction in the third (14.7%) and fourth (4.9%) years. CONCLUSIONS: A majority of US medical school graduates are not adequately trained to treat nicotine dependence. The major deficit is the lack of smoking cessation instruction and evaluation in the clinical years. A model core tobacco curricula that meets national recommendations should be developed and implemented in all US medical schools.     

Risk factors for treatment failure in orthopedic device-related methicillin-resistant Staphylococcus aureus infection

The purpose of this study was to determine the clinical and microbiological risk factors for treatment failure of methicillin-resistant Staphylococcus aureus (MRSA) orthopedic device-related infection (ODRI). A retrospective cohort study of patients with MRSA ODRI who were treated at Geneva University Hospitals between 2000 and 2008 was undertaken. Stored MRSA isolates were retrieved for genetic characterization and determination of the vancomycin minimum inhibitory concentration (MIC). Fifty-two patients were included, of whom 23 (44%) had joint arthroplasty and 29 (56%) had osteosynthesis. All 41 of the retrieved MRSA isolates were susceptible to vancomycin (MIC?≤?2 mg/L) and 35 (85%) shared genetic characteristics of the South German clone (ST228). During a median follow-up of 391 days (range, 4–2,922 days), 18 patients (35%) experienced treatment failure involving MRSA persistence or recurrence. Microbiological factors such as infection with the predominant clone and a vancomycin MIC of 2 mg/L were not associated with treatment failure. Using a Cox proportional hazards model, implant retention (hazard ratio [HR], 4.9; 95% confidence interval [CI], 1.3–18.2; P?=?0.017) and single-agent antimicrobial therapy (HR, 4.4; 95% CI, 1.2–16.3; P?=?0.025) were independent predictors of treatment failure after debridement. Therapy using a combination of antimicrobials should be considered for patients with MRSA ODRI, especially when implant removal is not feasible.     

Sensitive liquid chromatographic assay for the basic DNA intercalator (N,N-dimethylaminoethyl)-9-amino-5-methylacridine-4-carboxamide and its nitroarylmethyl quaternary prodrugs in biological samples.

Nitroarylmethyl quaternary (NMQ) ammonium salts of the basic DNA intercalator AMAC (N,N-dimethylaminoethyl-9-amino-5-methylacridine-4-carboxamide) are of interest as anticancer prodrugs. A sensitive HPLC assay has been developed for quantitation of AMAC and its NMQ prodrugs in cultured cells, plasma and tissue. Recovery of the prodrugs, without conversion to AMAC, was achieved using extraction in alkaline acetonitrile followed by immediate reneutralisation. Reversed-phase HPLC with fluorescence detection gave a detection limit of 3 fmol for AMAC, with linearity to 20 nmol (using diode array absorbance at high concentrations). This assay was used to measure cellular uptake, and hypoxic metabolism to AMAC, of three NMQ-AMAC prodrugs.     

Unusual acute neurologic presentations with Epstein-Barr virus infection

We describe two patients with serologic evidence of active Epstein-Barr virus infection who presented with unusual neurologic manifestations and minimal systemic findings of infectious mononucleosis. One girl developed an acute hemiplegic migraine syndrome followed by acute psychosis, and the other patient had severe, generalized chorea. The wide spectrum of presenting central nervous system findings associated with Epstein-Barr virus infections underscores the need to suspect this agent in a variety of acute neurologic syndromes.