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Biomedical subjects

K Goldenberg

Publications and source records attributed to K Goldenberg.

At least 19 recordsLinked to original sources
PubMed1991

Metastatic renal cell carcinoma (RCC): spontaneous regression, long-term survival and late recurrence.

We report 4 cases of metastatic renal cell carcinoma (RCC) with long-term survival either following radical nephrectomy alone or in combination with radio- or hormonal therapy. Two patients with lymph node metastases showed a long-term survival of 12 or more years following radical tumour nephrectomy (with lymphadenectomy) and radiotherapy. One of them exhibited a histologically proven tumour recurrence nearly 12 years after primary surgical treatment and died shortly later; the other one is still without any evidence of metastatic disease. Two other patients exhibited spontaneous regression of pulmonary metastases: one regression occurred after radical tumour nephrectomy alone, the other one after successful primary hormonal treatment and subsequent radical tumour nephrectomy. The following important aspects are emphasized: 1. Renal cell carcinoma is a very unpredictable tumour. Once the diagnosis of renal cell carcinoma is proved, a patient can never be considered cured. 2. Although adjuvant palliative nephrectomy has produced contradictory results in several reports, radical tumour nephrectomy either alone or in combination with other adjuvant therapies such as radiotherapy, hormonal or immunological treatment, can be worthwhile. Cases with long-term survival and spontaneous regression of distant metastases are proof of this. Besides, if carefully selected, the mortality rate of different adjuvant therapies is not significantly higher in patients with metastatic disease than in patients without metastases. The world literature on this subject is reviewed.

Aged↗
PubMed1991

Implementing the Association of Teachers of Preventive Medicine's recommendations into the undergraduate medical school curriculum.

In 1989, an expert panel appointed by the Association of Teachers of Preventive Medicine proposed minimum curricular content requirements for health promotion-disease prevention, including recommendations for timing, duration, and course sequencing during medical school. Making clinical preventive medicine an integral part of a primary care rotation is a central feature of the proposal. The panel presents recommendations for using the Guide to Clinical Preventive Services, which assesses the effectiveness of 169 types of prevention interventions, in both undergraduate and postgraduate medical education. Recommendations for incorporating the guide into the undergraduate medical school curriculum are outlined. The recommendations include options for using the guide as part of a curriculum in quantitative skills, in clinical preventive medicine, in a primary care rotation, as a health services and community dimension curriculum, and as part of continuing self-education. Recognizing that teaching methods and curriculum structures are varied in preventive medicine, the panel designed the recommendations to be adaptable to all medical schools' programs. The recommendations are aimed at achieving the goal of making preventive medicine an integral part of the education, training, and practice of physicians.

Clinical Competence↗
PubMed1991

The Association of Teachers of Preventive Medicine's recommendations for postgraduate education in prevention.

The Guide to Clinical Preventive Services, prepared in 1989 by the U.S. Preventive Services Task Force, assesses the effectiveness of 169 types of preventive interventions. In 1990, the Association of Teachers of Preventive Medicine formed a panel to review the guide and recommend ways it could be used to enhance both undergraduate and postgraduate medical education. This paper outlines the panel's recommendations of the types of knowledge and attitudes on which postgraduate medical education in prevention should be built. Detailed recommendations are presented, based on the summary findings of the guide, for residency education in prevention. Implementation of these recommendations will integrate preventive services into the continuum of medical care. These recommendations are presented to achieve the goal of educating physicians to approach the total patient, putting the patient's health rather than the disease process in the forefront of primary medical care.

Education, Medical, Graduate↗
PubMed1989

Medical student, resident, and faculty use of a computerized literature searching system.

The experiences of medical students, residents, and faculty with a computerized literature searching system were evaluated. Third-year medical students, internal medicine and family practice residents, and full-time and voluntary faculty at one medical school had the opportunity to use a full-text and bibliographic medical literature retrieval system free of charge for an eleven-month period. Subjects conducted nearly nine thousand literature searches over a period of 942 system hours. Questionnaire data showed that participants could learn to use and would use an electronic information system, felt capable of using the system, utilized the system for a variety of purposes and in a number of different ways, and viewed the system as a valuable tool in searching the medical literature. The results are discussed in the context of the educational needs of the four user-groups and medical education planning by institutions.

Computer User Training↗
PubMed1989

A combined primary care residency in internal medicine and pediatrics.

The authors describe the development and evaluation of a primary care residency program encompassing both internal medicine and pediatrics. The combined residency is a four-year program of alternating six-month rotations in the two disciplines. One-fourth of the program is ambulatory medicine and includes training in a clinic for children and adults. Patient demographics are maintained for each resident, and an ambulatory-medicine-focused curriculum consisting of weekly conferences and self-directed independent study is used. The program is routinely evaluated and is highly rated by patients and residents. Factors critical to its success include emphasizing goals and experiences in outpatient versus inpatient care, developing an ambulatory practice to help support resident salaries, adequately preparing residents to take the board examinations in both disciplines, and providing a comprehensive primary care curriculum.

Ambulatory Care↗
PubMed1988

Effects of thiazide on erythrocyte sodium and potassium concentrations and Na+K+ATPase in hypertensive patients.

The mechanism of thiazide induced sodium and potassium transport across the cell membranes of humans has not been extensively studied. To assess the effects of thiazide diuretics on erythrocyte sodium transport and potassium distribution we measured intracellular sodium and potassium, sodium-potassium ATPase activity (with and without ouabain) and total body potassium in normokalemic and mildly hypokalemic hypertensive patients. We also measured serum and urine sodium, potassium, calcium and magnesium, plasma renin activity and serum aldosterone levels. The study patients, on long-term thiazide, had measurements obtained during, one month after cessation and one month after resumption of thiazide. In this study of normokalemic and mildly hypokalemic hypertensives there were no significant measurement changes, in contrast to previous studies of severely hypokalemic hypertensives. These results suggested that thiazide did not routinely affect erythrocyte active membrane transport and potassium distribution in the absence of severe hypokalemia.

Aldosterone↗
PubMed1988

Use of a predictor for total body potassium content: application to nutrition and hypertension.

Total body potassium (TBK), measured at different institutions, has no reference standard for comparison. A useful reference formula, however, based on body size and age, has been derived at the Brookhaven National Laboratory. This formula was used to help calibrate a simple whole body counter for measuring total potassium and applied to nutrition and hypertension studies. A sodium iodide detector was used for counting gamma rays emitted by potassium-40 to estimate TBK. The mean ratio (+/- S.D.) of adjusted TBK measurements to predicted values was 1.002 +/- 0.047. The ratio of lean body mass estimated by the TBK measurement to that derived from skin fold thickness was 1.069 +/- 0.056. In hypertensives on low dose thiazide, the ratio of TBK measurements to predicted values was 0.994 +/- 0.052. Thus, our TBK measurements were adjusted in close agreement with a predictor formula, provided higher estimates of lean body mass than did skin fold thickness, and showed no change in thiazide treated hypertensives.

Adult↗
PubMed1987

Survey of combined residency programs in internal medicine and pediatrics on curricula.

Combined residency programs in internal medicine and pediatrics began to emerge during the past decade. Combined programs provide four years of training that leads to board eligibility in both disciplines. To learn more about the curricula of these programs, the authors sent a questionnaire to the directors of the 81 known combined programs. Sixty-eight such programs were active as of July 1986. Of these, 54 had been active in the 1985-86 academic year and had a total enrollment of 390 residents, an average of 7.2 residents per program. Fourteen new programs were activated in July 1986 and enrolled 46 residents, with an average of 3.3 residents per program. Virtually all the programs emphasized training in primary care and included the use of outpatient clinics where residents often work with nonphysician health-care providers. Many programs provided instruction in the use of community resources, preceptorships, and outpatient-oriented conferences and emphasized data-gathering skills. Areas that need to be addressed by program directors and the accrediting organizations are discussed by the authors.

Ambulatory Care↗
PubMed1987

An elective in primary care internal medicine for students in the preclinical years.

A two-week elective to introduce first- and second-year medical students to primary care internal medicine was developed and evaluated. Course time is divided between conference sessions (25 percent) provided by full-time clinical faculty members and office experience (75 percent) provided by volunteer clinical faculty members (general internists in private practice and in prepaid health plans). Evaluations by the students (n = 58) who took the elective consisted of a questionnaire assessment of the conference session topics, the student's ability to carry out course objectives, and the preceptor's teaching activities. The conference topics were highly rated, with a mean score of 4.1 on a rating scale ranging from 1 (unfavorable) to 5 (favorable). The course objectives and teaching activities were also well rated, with a mean score of 4.1 and 3.9, respectively, on a rating scale ranging from 1 (none) to 5 (outstanding).

Curriculum↗