EMT training for medical students.
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Biomedical subjects
Publications and source records attributed to A I Sutnick.
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The incidence and mortality from cancer has been increasing steadily in southeast Asia, probably related to increased life expectancy resulting from control of some of the major diseases. There are many impediments to cancer control in that part of the world, including poverty, limited access to health services, primarily rural distribution of population, and the dependence on treatment by traditional healers. There are potentially controllable environmental factors associated with some cancers commonly seen in countries of southeast Asia. We have proposed changes in the approach to cancer control in these countries. These include political organization, professional education programs, manpower development in special areas of need, public education in cancer prevention, early detection, team approaches to diagnosis and treatment, and emphasis on epidemiology in research.
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Based on a long-standing cooperation in medicine and public health between the United States and the Soviet Union, and on the potential contributions to be made by scientists from both of these countries, the World Health Organization invited an American-Soviet collaborative team to recommend a cancer control program for the Government of India. The consultants defined the importance of cancer of the cervix uteri and of the oral cavity, which comprise one-half of India's cancer cases, as the basis for a cancer control program. They recommended incorporation of cancer control functions into the organizational structure of the Ministry of Health as well as specific recommendations in education, prevention, and early detection, diagnosis, treatment, and epidemiologic studies. The mission underscores the value of multinational cooperation on health care problems that are faced in common by the United States, the Soviet Union, and other countries of the world. In addition it serves as a basis for international friendship and understanding in the context of mutually productive activities which may provide a benefit for all nations.
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Since the Medical College of Pennsylvania, formerly the Woman's Medical College of Pennsylvania, became coeducational in 1969, there has been a continued effort to maintain the commitment of the institution to its heritage of women in medicine. An office has the role of coordinating and stimulating the establishment and maintenance of programs relevant to women in medicine throughout the institution. These programs are now available to men as well but particularly serve women's needs. They include the Summer Premedical Program, the Summer Health Policy Program, a restraining program for inactive physicians, a demonstration child care project, archives and special collections related to women in medicine, a women in medicine oral history project, and a bibliography of the literature on women physicians. The Medical College of Pennsylvania will continue its interests in the present and future needs of women physicians.
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Because of an explosive increase in the use of emergency rooms in hospitals across the country, many hospitals have found it expedient to employ full-time emergency physicians. The demand for emergency physicians has prompted the development of training programs in emergency medicine in academic medical centers. The first such training program was instituted at The Medical College of Pennsylvania in 1970. The 32 current programs in the nation are filling a real need in providing manpower for hospital emergency rooms. With the increasing identification and distribution of emergency physicians, there has been an attempt to develop emergency medicine as a distinct discipline and to establish its legitimacy in the structure of academic medical centers. A variety of problems must be addressed to clarify the role of emergency medicine in the academic setting.
Screening programs can be designed to be useful for data collection to study effectiveness of screening. High-risk populations may be identified, and screening techniques applied to a randomly selected subgroup with another subgroup serving as controls. This raises the ethical question of not applying helpful surveillance to individuals known to be at high-risk. Attention should be paid to management of controls, for example, to screen them less frequently, or at least to inform them of their increased risk and advise periodic exams. Against such recommendations is that differences between test and control groups would be minimized and the study less conclusive. Another approach is to use adaptive design, selecting the study group for a large population which is being subject to medical surveillance for some other reason. As in other clinical trails, studies of screening programs must include appropriate surveillance for controls to properly safeguard their rights and medical needs.
Controlled trials to evaluate mass screening programs for cancer detection have been singularly lacking. High cost, lack of medical manpower, and low yield have contributed to this problem. A new program in cancer detection (CANSCREEN) has been developed jointly by The Fox Chase Cancer Center in Philadelphia and the Preventive Medicine Institute in New York City. This program attempts to provide a quality cancer-detection examination with increased cost effectiveness. Features include: 1) a self-administered questionnaire on medical history, symptoms, and risk factors; 2) nonphysican examiners; 3) risk-facotr analysis with a predetermined decision logic to determine type and periodicity of examination; and 4) primary intervention (health education). This collaborative program between two institutions in two cities demonstrates the feasibility of introducing similar programs elsewhere. A data base shared by cooperating centers permits information on all patients to be used for evaluation of new techniques, end results, etc. A randomized controlled trial has been designed to evaluate the effectiveness and efficiency of the questionnaire alone and of the questionnaire and examination.
Purified and concentrated preparations of Australia antigen had no stimulating effect on leukocytes of human subjects under study when tested either on DNA-polymerase activity, 3H-thymidine uptake or chromosomal alterations. Moreover, in patients with chronic hepatitis and cirrhosis of the liver no correlation between antigenemia and chromosome aberrations in blood leukocyte cultures could be detected. On the other hand, a serum obtained from a virus hepatitis patient with Australia antigen in the blood was found to stimulate leukocyte cultures from one patient with Down's syndrome and antigenemia, one mentally retarded patient and three normal donors. This stimulating agent is obviously not associated with Australia antigen.
In a case-control study, 70 mothers and 24 fathers of children with acute leukemia (AL) were compared with 70 mothers and 24 fathers of normal children. Three significant differences (p smaller than 0.05) were found when 35 factors were compared among the mother pairs and one difference among the father pairs. Mothers of children with AL, though alike in most respects to their matched controls, had a significantly lower number of monocytes than their controls. This was a new observation. The mothers of the children with AL also had higher levels of gamma-globulin, IgA, and IgG (Philadelphia only), which confirmed previous observations. The fathers and mothers had higher levels of basophils. These findings direct attention to the immune systems, particularly the mononuclear cells, of the parents of children with AL, as a focus for further studies on the etiology and pathogenesis of childhood leukemia.
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