Misunderstanding in the classification of diabetes mellitus. What's in a name?

To assess whether physicians, residents, medical students, hospital diagnosis coders, and patients properly use the designations insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) that were established by criteria of the National Diabetes Data Group, we reviewed clinic and hospital records and administered questionnaires. Although essentially all cases of true IDDM were identified as such and most cases of NIDDM not requiring insulin therapy were correctly identified by all groups, patients with NIDDM on insulin therapy were misidentified as having IDDM by 38% of residents in internal medicine clinics and 68% of primary care and surgical subspecialty residents. On a survey, of 22 patients with NIDDM on insulin therapy, 17 (77%) considered themselves to have IDDM. Thus, patients who have NIDDM by the established criteria who are on insulin therapy are commonly mislabeled as having IDDM. We present an approach for dealing with this problem by adapting nomenclature focusing on insulin deficiency and resistance. It would probably also be helpful to separately identify the subset of patients with "insulin-deficient diabetes" who are ketosis-prone. It is important to use immunologic profiling (islet cell antibody testing) and insulin sensitivity or deficiency testing (C-peptide levels).

A format for scripted clinical oral examinations.

A format for scripted clinical oral examination in general medicine is presented. Using this format, untutored pairs of teachers were consistent in grading third-year clerkship students. This measure of performance appeared to evaluate an aspect of clinical skills not assessed by the National Board Medical Examination or clinical performance assessments. Acceptance by teachers was good.

The association between season of birth and the risk for schizophrenia.

Many epidemiologic studies have been conducted to discover factors that might bear on the origins of schizophrenia. In general, the results of these studies have been contradictory. One consistent finding, however, is an association between season of birth and the risk for schizophrenia. This paper reports a test of the hypothesis that season of birth is associated with the risk for subgroups of the schizophrenic population. The results of regression analyses of data from Monroe County, New York, are reported. All white residents who were reported to have been diagnosed schizophrenic for the first time during the period January 1, 1969, to December 31, 1971, and who were hospitalized at least one day in the five-year period following the first schizophrenic diagnosis formed the group of schizophrenic patients. The population data used for the denominators of the incidence rates consisted of all white residents living in Monroe County, New York, as of April 1, 1970. An effect of month of birth on the risk for schizophrenia was related to the sex and the age of subsets of the whole population.