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Biomedical subjects

R G Bing-You

Publications and source records attributed to R G Bing-You.

14 recordsLinked to original sources
PubMed2000

A pilot survey study to define quality in residency education.

PURPOSE: To begin to define indicators of quality in internal medicine residency training. METHOD: In 1995, through a modified Delphi process, the Association of Program Directors in Internal Medicine's Research Committee developed a questionnaire containing 44 items (34 process and ten outcome indicators). The survey was mailed to all 418 internal medicine program directors and a convenience sample of medical residents. RESULTS: Responding at a rate of 78% (326), program directors rated several indicators as important. These included such faculty characteristics as stability, completeness, supervision, clinical skills, and teaching commitment; institutional support; amount of resident evaluation and feedback; encouragement of lifelong learning; and ability to meet its program goals. There was strong agreement between faculty and residents (r = 0.91). Items rated less important included graduates' selecting academic or generalist careers, residents' caring for elective cardiac catheterization patients, resident community service, training minorities and women, and faculty research. CONCLUSION: These results demonstrate the diversity of opinion of what defines quality in residency education and the emphasis placed on process rather than outcome indicators. To be valid, future endeavors must include all those with a stake in graduate medical education, including accrediting bodies, future employers, and patients.

Attitude of Health Personnel↗
PubMed1993

Low bone mineral density in adults with previous hypothalamic-pituitary tumors: correlations with serum growth hormone responses to GH-releasing hormone, insulin-like growth factor I, and IGF binding protein 3.

The adverse consequences of growth hormone (GH) deficiency (GHD) on bone growth in children is well described. Whether adult GHD is associated with bone loss is unknown. We evaluated 14 patients with hypothalamic-pituitary tumors (HPT) acquired during adulthood (5 men, 9 women; mean age = 48.1 +/- 4.6 years; mean BMI = 28.8 +/- 1.7) and 14 age-, sex-, and weight-matched controls. Nine HPT patients were receiving gonadal steroid replacement therapy for a mean of 11 years. All subjects had basal IGF-I and IGFBP-3 levels prior to testing with GH-releasing hormone [1 microgram/kg IV bolus; responses expressed as maximum percentage increase above baseline (PERGH)]. Bone mineral density (BMD) of the spine, hip, and total body were measured by dual-energy X-ray absorptiometry. Mean BMD Z-scores of the HPT patients were significantly lower in the femoral neck, Ward's triangle, and trochanter than in controls (all P < 0.05). Mean total body BMD (g/cm2) was also lower in the patient group (1.04 +/- 0.03 versus 1.13 +/- 0.03, P < 0.05). For the subgroup of HPT patients receiving conventional gonadal steroids, mean BMD Z-scores of the lumbar spine also were significantly lower than controls (-1.84 +/- 0.43 versus -0.57 +/- 0.46, P < 0.05). PERGH and IGF-I were correlated with Z-scores of the femoral neck (r = 0.47, P < 0.01; r = 0.45, P < 0.01) and Ward's triangle (r = 0.47, P < 0.01; r = 0.41, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1993

Serum growth hormone response to growth hormone-releasing hormone in non-obese and obese adults with hypopituitarism.

The clinical consequences of growth hormone (GH) deficiency (GHD) in adults have not been defined. Standard methods of measuring GH reserve in children may not be reliable in adults. In addition, obesity in normal adults diminishes GH responsiveness to provocative stimuli; this inhibition of GH release is reversed with pyridostigmine (PD). We investigated the use of GH-releasing hormone (GHRH) as a method to assess pituitary GH secretory reserve (as defined by peak GH response to GHRH) in both non-obese and obese (ie, > 115% ideal body mass index [BMI]) adults with hypothalamic-pituitary tumors. Nine non-obese patients (NOP) and 10 obese patients (OP) were studied with 11 non-obese controls (NOC) and 10 obese controls (OC). All study groups received GHRH (1 microgram/kg intravenous bolus) with blood sampling at -15, 0, 15, 30, 45, 60, 75, and 90 minutes. OC and OP received 120 mg PD orally 1 hour before GHRH injection. Mean serum GH responses in NOC and OC were significantly higher (P < .05) than those in NOP and OP, respectively, 15 minutes after GHRH injection, and remained so throughout the time-course of the test. Mean +/- standard error of the mean (SEM) peak GH level (microgram/L) was lower in NOP than in NOC (5.1 +/- 1.6 v 21.2 +/- 4.4, P < .01) and lower in OP than in OC (4.6 +/- 1.8 v 15.5 +/- 2.2, P < .01). Mean +/- SEM peak GH level was also lower in NOP than in OC (5.1 +/- 1.6 v 15.5 +/- 2.2 micrograms/L, P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Teaching skills improvement programmes in US internal medicine residencies.

The prevalence and nature of resident teaching skills improvement programmes (TSIP) are unknown. Although residents perceive themselves as important teachers of students, there is little information on how programme directors (PDs) view residents as teachers. A comprehensive questionnaire was sent to all 428 US internal medicine PDs in December 1990, of which 60% (n = 259) responded. Of the 259 responding programmes, only 20% (n = 51) had TSIPs. Characteristics of TSIPs were not uniform. Mean instructional time was 9 hours (range, 1-24 hours). The teacher most frequently utilized to develop and facilitate the TSIP was the PD. PDs from residencies with a TSIP indicated more strongly than PDs without a TSIP that residents contributed to students' learning. Fifty-one per cent of TSIPs required residents to attend. Evaluation/feedback as a teaching method was the most common topic covered in TSIPs. Long-term assessment of teaching skills after programme participation was done in 15% of TSIPs. Although PDs value the resident's role as teacher, current TSIPs in internal medicine residencies are few in number and lack standardization. PDs' attitudes probably influence whether residents are taught teaching skills and whether teaching skills are evaluated. Further investigation of appropriate curriculum for TSIPs and assessment of long-term effectiveness of TSIPs are needed.

Education, Medical, Undergraduate↗
PubMed1992

Serum estradiol but not gonadotropin levels decrease acutely after insulin-induced hypoglycemia in cycling women.

Although corticotropin-releasing hormone (CRH) acutely suppresses gonadotropin-releasing hormone (GnRH) secretion in animal models, its effect on the hypothalamic-pituitary-gonadal axis in humans is not well defined. To further evaluate the acute effects of adrenal axis activation on the hypothalamic-pituitary-gonadal axis in humans, we employed a model of insulin-induced hypoglycemia to stimulate endogenous CRH secretion in eight cycling women. Serum samples were obtained immediately before and 15, 30, 45, 60, 75, 90, and 120 min following iv insulin (0.15 U/kg) or saline injection. To ensure that the degree of hypothalamic-pituitary-adrenal activation in our subjects was similar to that observed in severely ill patients with hypogonadotropism, serum cortisol (F) levels were also measured in a group of acutely ill patients selected to have hypogonadotropism. All women experienced symptomatic hypoglycemia after insulin injection. Differences between serum F levels in hypoglycemic vs. control sessions were evident at 30 min (P < 0.01) and maximum at 120 min (P < 0.0001) after insulin injection. Serum estradiol levels were significantly lower following hypoglycemia than during control sessions (P < 0.001). In contrast, serum LH and FSH levels were not significantly different between control and hypoglycemic sessions. Peak serum F levels in these hypoglycemic women were similar to F levels in critically ill patients with hypogonadotropism. These results demonstrate that stress and/or hypoglycemia can acutely decrease circulating estradiol levels. In addition, these data suggest that endogenous CRH does not play a major role in acute suppression of GnRH (over 2 h) in humans. Further studies are required to identify longer term effects of CRH on GnRH secretion which may be present in hypothalamic amenorrhea or hypogonadotropic hypogonadism of critical illness.

Adult↗
PubMed1992

Medical students' perceptions of themselves and residents as teachers.

Eighty-three medical students from one class at the University of Vermont College of Medicine were surveyed as to their perceptions of both themselves and residents as teachers. Sixty seven percent of the students felt that residents played a significant role as teachers during the first clinical year. Students estimated that one-third of their knowledge could be attributed to housestaff teaching. A large majority of students wanted to teach students during medical school (80%) and residency (93%). Ninety percent of students surveyed would participate in a workshop to improve teaching skills prior to beginning residency; of this group, forty nine students ranked the importance of components of a teaching skills workshop. The findings suggest that medical students are interested both in learning teaching skills and teaching during medical school and during residency.

Humans↗
PubMed1991

Changes in students' attitudes and values during medicine versus surgery clerkships.

A prospective study of students' attitudes and values was conducted during medicine and surgery clerkships over the first clinical year. Students who finished the surgery clerkship first were more cynical and intolerant of ambiguity than the medicine students. Surgery students also felt they lacked self-confidence and had stronger feelings of being victimized. Cynicism and attitudes towards ambiguous situations improved during the medicine clerkship. Feeling victimized was strongly correlated with their problems with self-confidence, with cynicism, and a feeling of having to submit to authority figures. The findings of this study suggest that the clerkship order significantly affects the development of students' attitudes. Students also became more punitive and less confident as the first clinical year progressed. The implications of these changes in attitude on educational planning are discussed.

Attitude of Health Personnel↗
PubMed1990

Training residents in clinical teaching skills: a resident-managed program.

A resident-managed program to improve teaching skills and examine residents' perceptions of teaching was conducted for internal medicine residents at Maine Medical Center. A modification of the Fewett (1982) teaching model was applied as an adjunct to an ongoing resident teaching program. Twenty-six of 29 residents voluntarily participated in a series of workshops over a 6 month period. A low attrition rate and high level of acceptance of the format were observed. Teaching programs are manageable by a senior resident and can be of potential benefit.

Clinical Competence↗
PubMedDate not supplied

Autoimmune thyroid dysfunction induced by interferon-alpha treatment for chronic hepatitis C: screening and monitoring recommendations.

OBJECTIVE: To analyze the proposed mechanisms of action of recombinant interferon-alpha (IFN-a) in causing autoimmune thyroid dysfunction, to identify pretreatment risk factors, and to provide recommendations for screening and monitoring of thyroid dysfunction during IFN-a therapy for chronic hepatitis C. METHODS: Selected publications were reviewed to analyze the proposed mechanisms of autoimmune thyroid disorders. In addition, we examined the interrelationship of the thyroid and the liver, the occurrence of thyroid dysfunction in patients with chronic hepatitis C before and after IFN-a therapy, and the presence or absence of antithyroid antibodies in association with thyroid disease. Case reports were selected to demonstrate various IFN-a-induced thyroid dysfunction. RESULTS: IFN-a induces thyroid dysfunction in 3 to 14% of all treated patients with chronic hepatitis C, leading to hypothyroidism, hyperthyroidism, or thyroiditis. In a few patients, thyroid disease will develop in the absence of antithyroid antibodies, a scenario that suggests a nonimmune-mediated mechanism. More frequently, patients develop antithyroid antibodies, which may progress to overt thyroid dysfunction. Through its immunomodulatory properties, IFN-a seems to act through major histocompatibility complex class I antigens to produce antithyroid antibodies and thyroid disease. CONCLUSION: In patients receiving IFN-a therapy for chronic hepatitis C infection, identifiable risk factors for developing autoimmune thyroid dysfunction are preexisting overt thyroid or autoimmune disease, subclinical thyroid or autoimmune thyroid disease, and female gender. Pretreatment screening is recommended for all patients in whom IFN-a therapy is being considered, and periodic monitoring should be performed during such therapy. Thyroid disease need not be a contraindication to IFN-a therapy; early detection of subclinical or overt thyroid disease may allow uninterrupted continuation of IFN-a treatment.

Adult↗