Core morphological concepts of disease for second-year medical students.

With the increasing emphasis on independent learning and early patient contact, the time in the undergraduate medical curriculum for formal teaching of morphology of disease is decreasing. Thus, we thought it advisable to identify those core morphological entities of disease that should not get lost in the new paradigm. Our approach was to list all disease processes in Robbins Pathologic Basis of Diseases, 5th edition, that have distinguishing gross or microscopic characteristics. Appropriate portions of this list of 952 morphological entities from the Robbins textbook were distributed to 46 clinical specialists and pathology faculty. Each of these was asked to strongly agree, agree, disagree, or strongly disagree with the following for each entry on the list: "For purposes of developing concepts of disease, an M2 physician in training should recognize classical examples or a diagrammatic representation of the following lesions, and distinguish them from each other." Responses resulted in a consensus core list of 63 general disease process lesions and 545 organ system lesions, for a total of 608. These 608 core morphological entities were incorporated into our course by means of (1) a computer program with over 1,022 images and clinical-pathological correlations, and (2) a core list of morphological objectives for each unit in the course. In general, entities were judged noncore material if they were rare or were microscopic lesions of primary interest to pathologists and provided no major pathomorphologic concepts. The computer program as a supplement to glass slides and gross specimens has been very well accepted by students, and satisfactory performance on examinations has been maintained in spite of a 25% reduction in pathology course contact hours.

Cigarette continuity programs and social support for smoking.

OBJECTIVE: To describe smokers' participation in cigarette continuity programs and the prevalence and structure of cooperative teams of smokers. METHODS: Cross-sectional survey of smoking histories and continuity-program participation by individuals and their family members in a convenience sample of 176 current smokers at the University of Kentucky Chandler Medical Center, Lexington. Fisher exact test or chi2 tests were used to compare proportions. RESULTS: One of 3 smokers collected coupons for a continuity program. Three quarters of the collectors redeemed their own coupons, and one quarter gave coupons to another collector. Coupon collectors reported an average team size of more than 2 members. One fifth of collectors were teammates with another generation of family members, and one quarter of collectors aged 24 to 35 years were teammates with their children. Smokers were often aware of their relatives' coupon-collecting habits. CONCLUSIONS: Continuity programs have been a popular means of reinforcing smoking, especially within families and groups of friends. Continuity programs are novel in encouraging smoking and brand loyalty between generations. Continuity-program participants need to be aware of the risk of promoting smoking initiation by their children. Health advocates could use similar strategies to promote smoking cessation and prevention within families and other social groups.

Supracapsular phacoemulsification: a capsule-free posterior chamber approach.

We describe a technique that relocates the phacoemulsification process outside the capsular bag by transposing the nucleus through an intact 5.0 to 6.0 mm capsulorhexis. The upside-down nucleus is then returned to the posterior chamber, positioned above the anterior capsule in the "supracapsular space" where it remains throughout the phacoemulsification procedure of choice: cracking, chopping, manual prechoping, or traditional sculpting. The chief advantage of supracapsular phacoemulsification is greater efficiency, which is manifested in reduced emulsification time and energy. Disadvantages include the possibility of mild postoperative corneal edema during the earliest part of the learning curve, as well as inadvertent damage to the iris in cases with suboptimal pupil dilation.

Crack and flip phacoemulsification technique.

The crack and flip phacoemulsification technique combines the advantages of circumferential division of the nucleus and nucleofactis techniques. As such, it adds safety and control to the procedure. We describe each of the surgical maneuvers, including machine settings, and explain the rationale for maneuvers and machine settings.

Medical equipment purchasing: how can it be made efficient and economical?

Over the years, hospital purchasing groups have been able to realize significant savings for their member hospitals on a variety of supplies. One area where they have weak historically, however, is in capital equipment; specifically, advanced diagnostic and clinical hardware. Authors Dillman and Holzman suggest reasons for this weakness and recommend some possible solutions.

Levator myectomy in synkinetic ptosis.

A procedure for obliterating levator palpebrae superioris function is useful in stopping synkinetic movements of the upper lid in jaw winking and related disorders. The central element of the procedure is division of the levator muscle above Whitnall's ligament. This process obliterates the synkinetic movement completely without extensive dissection and injury to eyelid structures. Eight patients observed for up to five years have had complete and permanent resolution of synkinesis with no complications.

Solutions to Environmental and Economic Problems (STEEP).

This article describes one model for organizing and mobilizing scientific resources to address the highly complex and costly problem of soil erosion in the Pacific Northwest. With a U.S. Department of Agriculture grant to the agricultural experiment stations in Washington, Oregon, and Idaho, as well as supplementary state and federal funds, STEEP awards intermediate-term (15 year) grants for research in five areas: tillage and plant management, plant design, erosion and runoff predictions, pest management, and socioeconomics of erosion control. Most of the research projects require collaboration across disciplines and, in some instances, across state boundaries. After 6 years of effort the results obtained with STEEP indicate that the model might be applicable to other regions and problems.

Residential preferences, quality of life, and the population turnaround.

PIP: The author discusses the role of residential preferences and the search for a better quality of life as determinants of urban-rural migration in the United States^ieng