Informed consent and the "medical student psychiatrist".

The involvement of medical students in the clinical assessment of psychiatry patients raises concerns that have ethical and possibly legal implications. Responses to a 1986 questionnaire by 91 departments of clinical psychiatry in U.S. medical schools reveal that a substantial proportion (29.3%) of these departments were not fully compliant with established guidelines for obtaining informed consent from patients for students' participation in the patients' assessment and psychiatric care. Medical educators in psychiatry should recognize the importance of consent as a topic in the educational process and should establish policies that correct the discrepancies between institutional practices and informed consent guidelines.

Pelvic examinations by medical students.

Involvement in patient care plays a critical role in medical education. Patients, however, have a right to refuse to participate in educational programs, and in the area of gynecologic care this takes on heightened sensitivity. Although the majority of clinical departments specifically inform patients of the student role, a substantial proportion do not have policies that adhere strictly to informed-consent guidelines.

A national survey concerning the ethical aspects of informed consent and role of medical students.

The authors surveyed a national random sample of medical students (10 percent of the graduating class of 1985) to identify the ways in which the students obtained informed consent from their patients and to learn the students' views of certain issues concerning informed consent. The results showed that the students introduced themselves to patients using methods that the authors grouped by levels of forthrightness. Those students who introduced themselves as medical students differed in their views on selected informed consent issues from students who introduced themselves as physicians. In general, all the students were less forthright about their status when given the opportunity to perform invasive procedures. Student gender, type of patient, and type of hospital were statistically associated with the students' behavior, according to bivariate analysis. After multivariate regression analysis, however, only the actions of the students' role models (residents and attending physicians) remained significantly associated with the students' behavior. The authors conclude that because some aspects of student behavior are at odds with the requirements of informed consent, medical educators must scrutinize the ethical dimensions of the policies they establish.

Informed consent policies governing medical students' interactions with patients.

When medical students become involved in patient care, concerns are raised that have ethical and possibly legal implications. In order to determine compliance with the guidelines of the U.S. government and the Joint Committee on Accreditation of Hospitals pertaining to informed consent, the authors conducted a study of hospital administrators, medical school department chairpersons, and medical school deans (with response rates ranging from 82.3 to 95.1 percent) concerning policies on student involvement in patient care. The results show that only 37.5 percent of all responding teaching hospitals specifically informed patients that students would be involved in care. Only 51 percent of the responding medical schools that specifically gave their students instruction or guidance on initial patient interaction as a matter of policy insisted that their students introduce themselves as students and clarify their role in patient care. The authors conclude that medical educators' compliance with the ethical requirements of informed consent is incomplete.

Role of nonagglutinating antibody in the protracted immunity of vaccinated mice to Pseudomonas aeruginosa infection.

Effective immunization against infection with Pseudomonas aeruginosa is difficult to evaluate because agglutinin levels decline rapidly. Because fractionation of hyperimmune sera often yields more specific antibody than can be accounted for by direct agglutination tests, an immunoglobulin-specific assay based on antiglobulin augmentation was used to characterize antibody responses of C3H/HeJ mice vaccinated with P. aeruginosa type 2 lipopolysaccharide. Nonagglutinating antibodies, initially detected at 2 weeks post-primary vaccination, were predominantly immunoglobulin G after 5 weeks, and they remained elevated at levels usually 32-fold higher than the direct titer throughout the 4-month study period. The sequential production of immunoglobulin M, then immunoglobulin G, followed that found in orthodox immunological responses. Sera that contained nonagglutinating antibodies but not direct agglutinins (14 to 16 weeks) enhanced phagocytosis of P. aeruginosa type 2 by macrophages from unimmunized mice and passively immunized mice against lethal challenge doses; bactericidal activity of these sera was not demonstrated in the presence or absence of complement. When challenged with 1, 10, and 100 50% lethal doses at 16 weeks, survival rates of actively immunized mice were significantly higher than those of unvaccinated mice (P < 0.001). Thus, at a time when no direct agglutinins were detectable, the augmented system detected nonagglutinating antibodies that could confer protracted resistance in vaccinated mice to pseudomonas infection.

Relation of polysaccharide content to some biological properties of endotoxins from mutants of Salmonella typhimurium.

Kessel, R. W. I. (Rutgers, The State University, New Brunswick, N.J.), Henry H. Freedman, and Werner Braun. Relation of polysaccharide content to some biological properties of endotoxins from mutants of Salmonella typhimurium. J. Bacteriol. 92:592-596. 1966.-Endotoxins were extracted by the phenol-water procedure from a variety of Salmonella typhimurium mutants with known differences in the composition of their cell wall polysaccharides. The lethality of these preparations for mice proved to be correlated with the complexity of the polysaccharide: endotoxin from the smooth parent strain and from rough strains with several sugars attached to the heptose-phosphate backbone were of high toxicity, whereas endotoxin from a mutant possessing only glucose attached to the heptose-phosphate backbone was less toxic, and endotoxin from a mutant possessing the backbone only was least toxic. All of these mutants yielded endotoxins that were equally capable of protecting mice against subsequent challenge with Pseudomonas aeruginosa. Material obtained from a heptoseless mutant by the phenol-water method proved to be neither toxic nor protective. The apparent dissociation of biological properties that can be achieved with the aid of endotoxin preparations from certain mutants is discussed in terms of possible mechanisms.