State of the art in standardized patient programs: a survey of osteopathic medical schools

In 2001, the authors sent a survey to all 19 schools of osteopathic medicine requesting information about how standardized patients are used for clinical teaching and skills assessment. The purpose of this survey was to identify key people involved in standardized patient programs (SPPs), to gather information on the resources allocated by osteopathic medical schools, to determine the "state of the art" of standardized patient teaching and assessment in osteopathic medical schools, and to assess which SPPs would be available to assist in the development of the new component of the National Board of Osteopathic Medical Examiners licensing examination, the Comprehensive Osteopathic Medical Licensing Examination Performance Evaluation. The survey results revealed that 12 osteopathic medical schools have SPPs that teach and assess clinical skills, including history taking; physical examination (complete and focused); genital, rectal, and breast examinations; physician-patient communication, osteopathic manipulative medicine or osteopathic manipulative treatment. Details of the 12 schools' SPPs are highlighted.     

An abnormal platelet membrane lipid composition in patients with low and high blood cholesterol

Platelet lipid composition was determined in subjects with hypercholesterolemia (HC) (9.17 ± 2.15 mmol/L), hypocholesterolemia (HYPOC) (3.29 ± 1.01 mmol/L), and normocholesterolemic controls (NC) (5.29 ± 0.82 mmol/L). Lipid composition was quantitated in washed platelets by measuring platelet cholesterol (C) and phospholipid (PL) content, C/PL molar ratio and platelet PL phosphatidylcholine (PC) to sphingmyelin (SM) ratio. There was a significant increase and a significant decrease in C/PL molar ratio in subjects with HC and HYPOC compared to normals (0.74 ± 0.06 and 0.53 ± 0.06 vs 0.59 ± 0.04, p<0.01, respectively). These alterations were due to a significant change in platelet C content, whereas, platelet PL content was stable. PC/SM ratio was markedly decreased in HYPOC compared to NC (0.80 ± 0.18 vs 2.03 ± 0.18, p<0.01, respectively). These results indicate that blood cholesterol is a major determinant of platelet membrane lipid composition. This effect may be of concern in relation to a possible excess morbidity in patients not only with HC, but also with a low blood cholesterol.     

Comparison of three methods for 17α-Hydroxyprogesterone

We compared the performance of three 17α-hydroxyprogesterone kits: the double antibody method, the coated tube method (ACTIVE™), both from Diagnostic Systems Laboratories, Inc. (DSL) and the coated tube method (COAT-A-COUNT®) from Diagnostic Products Corporation (DPC). The assay performance of the two DSL kits was very similar in terms of sensitivity, intra- and inter-assay precision, linearity of dilution, recovery, and specificity. We also analyzed 190 samples for 17α-hydroxyprogesterone values using the above three kits. Twenty-three subjects were from prepubertal population (ages 1 month–13 years), thirty subjects were normal adult males (ages 20–53 years) and the remaining subjects were females in different phase of menstrual cycle (n = 40), on oral contraceptives (n = 20), post-menopausal (n = 17), or pregnant women in their first, second, or third trimester (n = 60). In addition to these 60 pregnancy samples, we analyzed serial samples from 3 pregnancies. 17α-OHP levels paralleled the progesterone levels in all three kits. Although there was reasonable correlation between the DPC and the two DSL kits, the 17α-OHP values were found to be significantly higher with DPC kit during the 2nd and 3rd trimester of pregnancy indicating probable interference in the DPC assay by some structurally related steroids present during pregnancy. The DSL assays may be particularly well suited for measuring 17α-OHP levels during pregnancy. J. Clin. Lab. Anal. 11:179–185, 1997. © 1997 Wiley-Liss, Inc.     

Inhibition of platelet function by recombinant soluble ecto-ADPase/CD39.

Excessive platelet accumulation and recruitment, leading to vessel occlusion at sites of vascular injury, present major therapeutic challenges in cardiovascular medicine. Endothelial cell CD39, an ecto-enzyme with ADPase and ATPase activities, rapidly metabolizes ATP and ADP released from activated platelets, thereby abolishing recruitment. Therefore, a soluble form of CD39, retaining nucleotidase activities, would constitute a novel antithrombotic agent. We designed a recombinant, soluble form of human CD39, and isolated it from conditioned media from transiently transfected COS-1 cells and from stably transfected Chinese hamster ovary (CHO) cells. Conditioned medium from CHO cells grown under serum-free conditions was subjected to anti-CD39 immunoaffinity column chromatography, yielding a single approximately 66-kD protein with ATPase and ADPase activities. Purified soluble CD39 blocked ADP-induced platelet aggregation in vitro, and inhibited collagen-induced platelet reactivity. Kinetic analyses indicated that, while soluble CD39 had a Km for ADP of 5.9 microM and for ATP of 2.1 microM, the specificity constant kcat/Km was the same for both substrates. Intravenously administered soluble CD39 remained active in mice for an extended period of time, with an elimination phase half-life of almost 2 d. The data indicate that soluble CD39 is a potential therapeutic agent for inhibition of platelet-mediated thrombotic diatheses.     

Survey on the clinical skills of osteopathic medical students

As part of the standard-setting methods used by the National Board of Osteopathic Medical Examiners for its Comprehensive Osteopathic Medical Licensing Examination clinical skills performance evaluation (COMLEX-USA Level 2-PE), a self-administered survey was distributed electronically and by mail to deans of colleges of osteopathic medicine, directors of graduate medical education programs, osteopathic medical students, and experts chosen demographically to represent osteopathic physicians in the United States. Groups were asked to rate fourth-year osteopathic medical students and interns on their clinical skills and acceptable pass rates and expected pass rates on the COMLEX-USA Level 2-PE. The surveys were not used systematically to compute the passing standards but to provide additional support for their validity. The viewpoints of the deans differed from those of the students, osteopathic graduate medical education program directors, and experts regarding clinical skills proficiencies and acceptable pass rates. However, all of the groups agreed that, on average, some students and interns do not have adequate clinical skills. These results provide additional support for requiring acceptable performance on a comprehensive clinical skills examination before admission to osteopathic graduate medical education programs.     

Glucoregulatory endocrine responses to intermittent exercise of different intensities: plasma changes in a pancreatic beta-cell peptide, amylin

Amylin, a peptide hormone released from the beta cells of the pancreas and cosecreted with insulin, is reported to inhibit the release of postprandial glucagon and insulin and to modulate gastric emptying. Changes in insulin and glucagon are important for controlling blood glucose levels under conditions in which metabolic rate is elevated, such as during and following exercise. Amylin may participate in the regulation of blood glucose levels in response to exercise, although the role of amylin has not been investigated. The purpose of the study was to determine the effects of a progressive, intermittent exercise protocol on amylin concentrations and to compare its response to circulating levels of insulin, glucagon, cortisol, and glucose. Seven well-trained males completed an intermittent exercise trial on a treadmill at four progressive exercise intensities: 60%, 75%, 90%, and 100% of maximum oxygen consumption (.VO(2)max). Blood samples were collected before exercise, after each exercise intensity, and for 1 hour following the exercise protocol. Subjects also completed a control trial with no exercise. Amylin and insulin rose from baseline (5.79 +/-.78 pmol/L and 4.76 +/-.88 microIU/mL) to peak after 100% .VO(2)max (9.16 +/- 1.35 pmol/L and 14.37 +/- microIU/ml), respectively and remained elevated during much of recovery. Thus, a progressive intermittent exercise protocol of moderate to maximum exercise intensities stimulates increases in amylin levels in well-trained individuals in a similar fashion to that of insulin, whereas glucagon concentrations only increase after the greatest exercise intensity, then quickly decline. Future studies should examine the effects of higher amylin concentrations in exercise recovery on glucoregulation.     

Phase Ib/II Trial of Gemcitabine,Cisplatin, and Lenalidomide as First‐Line Therapy in Patients With Metastatic Urothelial Carcinoma

Background.

Outcomes with current chemotherapy in metastatic urothelial carcinoma (MUC) remain poor. Lenalidomide, an antiangiogenic and immunomodulatory agent, enhances the effects of chemotherapy in preclinical studies. In this phase Ib/II study, we sought to determine a tolerable dose of lenalidomide in combination with gemcitabine and cisplatin (GCL) in patients with MUC and to explore the safety and activity of this regimen.

Methods.

Patients with chemotherapy-naïve MUC received gemcitabine 1,000 mg/m² on days 1 and 8 and cisplatin 70 mg/m² on day 1 every 21 days. In phase Ib, there were four planned escalating dose levels of lenalidomide (10, 15, 20, and 25 mg) daily on days 1–14.

Results.

Seven patients received GCL in phase Ib. The dose of lenalidomide was not escalated beyond 10 mg because of cytopenias requiring repeated dose delays and reductions. Two additional patients were enrolled in phase II, but the study was ultimately terminated due to poor tolerability and slow accrual. The most frequent grade ≥3 adverse events were cytopenias and diarrhea. Three of the nine patients experienced an objective response (one complete response, two partial responses).

Conclusion.

Chronic administration of the GCL regimen was poorly tolerated because of additive and cumulative myelosuppression.