Tapping the power of information: an orientation for academic medical centers.

In September 1994 the Association of American Medical Colleges' (AAMC's) Advisory Panel on the Mission and Organization of Medical Schools (APMOMS) established a working group to address both the long-term and the immediate implications of the expanding capacity of and need for information technology (IT) within academic medical centers (i.e., medical schools and teaching hospitals). Over a two-year period, group members assessed the utilization of IT through surveys of current practices and interactions with acknowledge leaders in the field. They also had discussions with deans and other institutional leaders. The group developed the consensus that proper use of currently available IT is crucial to virtually every aspect of academic medicine's clinical, educational, and research missions. Moreover, current IT technology will be further enhanced by the powerful new applications that are nearing deployment. All group members agreed that IT must become a core competency of academic and medical centers (AMCs), the profession, and individual physicians and scientists to ensure the survival of AMCs in the current highly competitive environments. The authors outline their arguments for the development of strong information systems within AMCs and present basic characteristics of systems that show promise for successful implementation. The y review some of the major institutional obstacles that have hindered the planing and implementation of IT. They conclude with a list of practical institution strategies for success in planning and implementing IT systems, and suggestions for how the AAMC can help members achieve success in these activities.

How medical schools can maintain quality while adapting to resource constraints.

To gain a better understanding of the effects on medical schools of ongoing transformations in medical practice, science, and public expectations, the Association of American Medical Colleges (AAMC) formed the Advisory Panel on the Mission and Organization of Medical Schools (APMOMS) in 1994. Six working groups were appointed to address different issues of importance. This article is a report of the findings and recommendations of the Working Group on Adapting to Resource Constraints. That group was charged to consider how leaders in academic medicine can respond to the challenges of external forces and the anticipated diminishing of resources, and to focus on medical schools and how they can maintain quality while reengineering to effect needed changes. The group members developed their thinking within four categories: size of the academic enterprise; organizational models and their relationships to the clinical enterprise; faculty tenure and compensation; and partnerships with capital-intensive entities. Three recommendations for action, to which the APMOMS unanimously agreed, were made to the AAMC, which has already acted upon them in ways described in the article. The group also developed a series of "ideas for consideration," which represent a range of the members' perspectives. The working group did not seek (and probably could not have obtained) unanimous agreement on many of the issues that these ideas focus upon. The ideas are presented as a series of resolutions designed to stimulate discussion and foster better-informed planning.

Octreotide-associated biliary tract dysfunction and gallstone formation: pathophysiology and management.

Octreotide exerts a wide range of biological actions, many of which have important clinical applications, notably in treatment of acromegaly, gastroenteropancreatic endocrine tumors, and secretory diarrhea. In most patients, octreotide is well tolerated. Side effects are primarily gastrointestinal and are usually transient. Short term (< or = 1 month) octreotide therapy appears to pose minimal risk of gallstone formation, but the risk may increase with longer treatment periods. Chronic octreotide administration may increase the incidence of small, cholesterol gallstones that are typically asymptomatic. The mechanism of octreotide-associated gallstone formation is not delineated but may involve inhibition of gallbladder emptying, hepatic bile secretion, and sphincter of Oddi motility, as well as modification of bile composition. Gallbladder stasis may sequentially lead to increased bile concentration, precipitation of cholesterol and calcium salts, retention of biliary precipitates, and maturation of gallstones. Octreotide-associated gallstones are usually asymptomatic and do not require surgical or medical therapy. Some physicians advocate periodic gallbladder ultrasound evaluations, but, in most cases, the results would not influence management of asymptomatic patients. Symptomatic gallstones may require surgery or nonsurgical treatments after an appropriate work-up. Gallstone prevention strategies (e.g., bile acid or nonsteroidal anti-inflammatory drug therapy) during long term octreotide therapy are under investigation. Currently, clinicians may want to consider noninvasive strategies to reduce gallstone incidence, such as timing octreotide injections in relation to meals or periodic cessation of octreotide treatment. Octreotide is a valuable therapeutic option in managing a variety of hypersecretory states associated with high morbidity and mortality (e.g., acromegaly, carcinoid syndrome, and VIP-secreting tumors), so the benefits of long term octreotide therapy (such as increased quality of life) outweigh the risk of asymptomatic gallstone formation in many patients.