Discussants of internal medicine often invoke but seldom define "the Oslerian tradition," which has many meanings. No definition provides clear insight into the issues now relevant to American internal medicine, primarily because, as William Osler knew, the field itself shows definitional ambivalence. The tradition might be best understood as a virtuous approach to medicine and to life as taught and modeled by Osler. If we understand his philosophy and methods, we will be better prepared to use and pass on (tradere, "to deliver") something of greater value: the ability to make wise choices that are in society's best interest.

Internal Medicine↗

PubMed1994

Changing patterns of mycobacterial disease at a teaching community hospital.

OBJECTIVES: To evaluate trends in the occurrence and diagnosis of mycobacterial disease. DESIGN: Prospective surveillance study using a central tuberculosis registry at a 611-bed teaching community hospital. RESULTS: Data pertaining to 715 patients were entered into the registry between 1976 and 1991 on the basis of positive smears or cultures for acid-fast bacilli (AFB). Over time, the ratio of isolates of Mycobacterium tuberculosis to isolates of nontuberculous mycobacteria reversed (from 3.2 to 1 between 1976 and 1981 to 1 to 1.6 between 1986 and 1991). The sensitivity of the sputum AFB smear for diagnosis of pulmonary tuberculosis increased (from 0.73 to 0.96), but the positive predictive value of the sputum AFB smear declined (from 0.72 to 0.59). The acquired immunodeficiency syndrome epidemic accounted for these changes only to a small extent. CONCLUSIONS: The increasing occurrence of non-tuberculous mycobacterial disease and the declining positive predictive value of the sputum AFB smear at this hospital imply that respiratory isolation and antituberculous therapy will be used inappropriately for many patients. The development and use of newer tests for early isolation and specific identification of M tuberculosis should be accelerated.

Hospitals, Community↗

PubMed1994

Utility of the hospital tuberculosis registry.

Emerging guidelines suggest that the management of tuberculosis and suspected tuberculosis in the hospital will become an increasingly costly enterprise. The local hospital registry can be a focal point for determining the extent to which such measures are necessary at individual institutions, that existing infection control recommendations are being carried out, and that patients released from the hospital are not lost to follow-up. Consideration might be given to inclusion of all patients begun on antituberculous therapy, regardless of the results of acid-fast bacilli cultures, in view of renewed concern about patient compliance.

Contact Tracing↗

PubMed1994

"The rights of the child" revisited.

Explore the source record for details and available documents.

Adolescent↗

PubMed1994

Whither academic health centers?

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Academic Medical Centers↗

PubMed1994

A matter of time.

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Time Management↗

PubMed1993

Curvularia lunata endocarditis treated with terbinafine: case report.

A 44-year-old man developed endocarditis due to Curvularia lunata on a Carpentier-Edwards porcine heterograft with clinical involvement of the ring of the aortic valve and the aortic root. Because curative surgery was considered to be extremely high risk, he was treated with antifungal drugs for nearly 7 years. Initial treatment with amphotericin B and ketoconazole was followed by long-term treatment with terbinafine, an experimental allyamine derivative. No adverse effects were attributed to terbinafine. At surgery nearly 7 years later, the aortic valve ring and aortic root appeared to be uninvolved, and the valve was replaced uneventfully. To our knowledge, this is the first report of successful treatment of curvularia endocarditis.

Adult↗