Medical students' attitudes towards cancer: influence of the type of clerkship experience.

Attitudes of third-year medical students relative to patients with cancer were assessed prior to and following three different 6-week pediatric clerkships. Clerkship I (N = 139) was conducted in a public hospital where student contact with all patients occurred in wards, supervised by pediatricians in all subspecialties. Clerkship II (N = 146) was in a pediatric hospital which is a cancer center. Contact with patients with cancer was directed by oncologists and nononcologists. Clerkship III (N = 31) was similar to II, with an exposure to an oncology ward. A 51-item instrument, employing a visual analog scale, which included general, adult, and pediatric items, was used (pre- & postclerkship) to evaluate attitudes in all 316 students and 49 faculty instructors associated with the clerkships. Factor analysis of student responses to pediatric items resulted in four factors: a) early diagnosis, b) aggressive therapy, c) long-range surveillance, and d) psychosocial support in reference to patients with cancer. Post-test differences between clerkship groups in items a and b were noted, with increasing positivity correlated with increased exposure to oncology and oncologists. Attitudes of faculty nononcologists differed significantly from those of oncologists irrespective of institutional affiliation.

Effects of intensive clinical exposure on attitudes of medical students toward cancer-related problems.

The attitudes of third-year medical students toward cancer and patients with cancer was examined before and after a 6-week clerkship that included contact with pediatric patients with cancer and their families. A 51-item testing instrument was employed, which included pediatric, adult, and general oncology questions. Beginning with positive attitudes toward the importance of early diagnosis, aggressive therapy, and the complete disclosure of prognosis, the clinical exposure appeared to strengthen the two former attitudes and somewhat diminish the latter. Approval of aggressive cancer therapy was stronger for children than for adults; but approval of both aggressive therapy and intensive surveillance of patients in remission was increased in regard to adults as well as children after the clerkship. A comparison with responses of second-year medical students from another institution suggests that third-year students recognize greater personal limitations in respect to management and adopt a more "defensive" position regarding the patient. In general, during the clerkship, the students moved in the direction of attitudes that were previously designated to be appropriate for students by a multidisciplinary committee that was distinct from the instructional staff in oncology.

Medical students' concepts of childhood cancer and its management.

Medical student's attitudes toward cancer and patients with cancer were studied prior to and following a required pediatric clerkship which included contact with children on an oncology service. Emphasis in the study was placed on the students' reactions to the child with cancer, and these were compared with the same students' attitudes in the context of the adult with cancer or general oncology. Early diagnosis is regarded as of more significance, and an aggressive therapeutic response following diagnosis of more urgency when the patient is a child. These attitudes, recognizing the importance of early diagnosis and expressing strong approval of aggressive therapy for the pediatric patient, increased during the clerkship. The students strongly supported a program aimed at return of the child to his normal activities with the least delay; recognized the special significance of long-range surveillance for secondary effects in the pediatric patient; and recommended the "center" as opposed to the community hospital as the site for care of the child with cancer. In other areas of cancer management, including (a) the importance of psychosocial support, (b) the problems of emotional involvement of the physician with the patient, and (c) care of the dying patient, attitudes toward patients in the two age groups was not significantly different.

An analysis of skin prick test reactions on asthmatics in Lagos.

Skin tests were administered to 221 asthma patients at the Lagos University Teaching Hospital between 1977 and 1980. Of these, 168 patients (76 percent) had positive skin tests to one or more allergens and 53 (34 percent) had negative skin tests. Patients with positive tests tended to have a positive family history of asthma and an earlier age of onset of asthma.There was, however, no observed difference in the groups in the incidence of other allergies of urticaria, eczema, and allergic rhinitis. Results showed that 89 percent of asthmatics with positive skin tests were allergic either to house dust or to the house dust mite. Pollen allergy was comparatively rare. There is a need to prepare desensitizing antigens specific to this environment.

Congenital hypoplastic anemia (CHA) associated with congenital absence of the spleen.

A 19-year-old boy with congenital hypoplastic anemia (CHA) treated with long-term steroid therapy, presented with septic shock caused by Streptococcus pneumoniae. Peripheral blood smears revealed Howell-Jolly bodies and postmortem examination revealed the absence of the spleen, splenic vein and splenic artery. We have found no association of CHA and congenital asplenia previously reported in the literature or in a review of 12 additional patients with CHA at this institution. The case is reported to bring attention to the concurrence of these two rare conditions in one individual and to discuss the possible implications of this association.

Candidal splenic abscesses complicating acute leukemia of childhood treated by splenectomy.

Two patients with acute leukemia were found to have candidal splenic abscesses. Both patients were in remission and had normal granulocyte counts at the time the abscesses became evident. Both patients were treated with splenectomy and antifungal therapy with a definite response. The incidence and treatment of fungal splenic abscesses in leukemia patients is discussed with emphasis on the role of splenectomy.

Comparison of the metabolic effects of salbutamol administered in a one-minute bolus and a continuous infusion in patients with bronchial asthma.

A 1-min i.v. bolus injection of 300 microgram salbutamol produced transient hypokalemia in asthmatic patients, whereas continuous i.v. infusion of 10 microgram/min salbutamol for 30 for 30 min produced significant and sustained hypokalemia. The 1-min bolus infusion of salbutamol has a distinct therapeutic advantage over continuous infusion of this drug, because the hypokalemia produced by the latter may predispose to serious cardiac arrhythmias.

An isozyme of erythrocyte pyruvate kinase (PK-Los Angeles) with impaired kinetics corrected by fructose-1, 6-diphosphate.

A mutant isozyme of erythrocyte pyruvate kinase was found in a family of French-Canadian ancestry in association with hemolytic anemia. The isozyme was characterized by normal maximal activity, pH optimum, heat stability, and fructosediphosphate activation constants, but had markedly reduced affinity for the substrate, phosphoenolpyruvate. This kinetic defect was corrected almost entirely in vitro by low concentrations of fructosediphosphate.