Green M.J.,Penn State College of Medicine
Academic Medicine | Year: 2015
Problem Medical students experience transformative personal and professional changes during medical school. The medical education community has much to learn about how students perceive these changes, which can be dramatic and profound. Approach Over the past six years (2009-2014), the author has taught a course on medical graphic narratives (or comics) to fourth-year medical students. Comics synergistically combine words and images to tell stories and provide an effective vehicle for helping students reflect on and give voice to varied experiences. In this course, students critically read and discuss medically themed comics and create their own original comic depicting a formative experience from medical school. Outcomes To date, 58 students have taken the course, and each has produced an original comic. The author conducted a thematic analysis of their comics and identified the following themes: (1) how I found my niche, (2) the medical student as patient, (3) reflections on a transformative experience, (4) connecting with a patient, and (5) the triumphs and challenges of becoming a doctor. Pre/post course assessments indicate that students believe creating a comic can significantly improve a variety of doctoring skills and attitudes, including empathy, communication, clinical reasoning, writing, attention to nonverbal cues, and awareness of physician bias. Students' comics reveal the impact of formative events on their professional identity formation. Next Steps Medical educators should explore additional ways to effectively integrate comics into medical school curricula and develop robust tools for evaluating their short- and long-term impact. © 2015 Association of American Medical Colleges.
Gelenberg A.J.,Penn State College of Medicine
The Journal of clinical psychiatry | Year: 2010
A variety of American and European guidelines are available for clinicians treating major depressive disorder and depressive subtypes. Major Western guidelines published since 2000 make similar recommendations for all stages of treatment for depression, including a reliance on measurement-based care. First-line treatment is usually a serotonin reuptake inhibitor, psychotherapy, or a combination of pharmacotherapy and psychotherapy. Next-step treatment recommendations are switching or augmentation, depending on patient response to the initial treatment. Maintenance therapy continues the approach that led to remission. The American Psychiatric Association will release a new treatment guideline to offer information on developments made since the last guidelines were published in 2000. Despite progress made during the last decade, no major breakthroughs in the treatment of depression have occurred, and genetic testing developments allowing for personalized care remain the goal of research. (c) Copyright 2010 Physicians Postgraduate Press, Inc.
Domen R.E.,Penn State College of Medicine
American Journal of Clinical Pathology | Year: 2014
Objectives: To suggest a basic new approach for pathology training programs to consider when a resident requires remediation, probation, or dismissal. Methods: Remediation, probation, or dismissal of the poorly performing pathology resident is one of the most difficult and challenging aspects of any pathology training program. The poorly performing resident requires extra time and resources from the faculty and the program and can be disruptive for the entire program. Effective remediation requires faculty development, a well-constructed remediation or probation plan, and documentation. Results: Despite best efforts, not all remediation plans are successful and dismissal of the resident will need to be seriously considered. Conclusions: Approaches to dealing with resident performance issues can be variable and need to be tailored to the issue being addressed. © American Society for Clinical Pathology.
Paul I.M.,Penn State College of Medicine
Lung | Year: 2012
Cough due to upper respiratory tract infections (URIs) is one of the most frequent complaints encountered by pediatric health-care providers, and one of the most disruptive symptoms for children and families. Despite the frequency of URIs, there is limited evidence to support the few therapeutic agents currently available in the United States (US) to treat acute cough due to URI. Published, well-designed, contemporary research supporting the efficacy of narcotics (codeine, hydrocodone) and US Food and Drug Administration (FDA)-approved over-the-counter (OTC) oral antitussives and expectorants (dextromethorphan, diphenhydramine, chlophedianol, and guaifenesin) is absent for URI-associated pediatric cough. Alternatively, honey and topically applied vapor rubs may be effective antitussives. © 2011 Springer Science+Business Media, LLC.
George D.R.,Penn State College of Medicine
Journal of Continuing Education in the Health Professions | Year: 2011
Introduction:: Health professionals are working in an era of social technologies that empower users to generate content in real time. This article describes a 3-part continuing education minicourse called "Friending Facebook?" undertaken at Penn State Hershey Medical Center that aimed to model the functionality of current technologies in health care and encourage discussion about how health professionals might responsibly utilize social media. Methods:: Fifteen health professionals participated in the course and provided written evaluation at its conclusion. The course instructor took field notes during each of the 3 classes to document emergent themes. Results:: The course received uniformly positive evaluations, and participants identified several current tools perceived as being potentially useful in their professional lives, including news aggregators, Google Alerts, and-if used responsibly-social networking sites such as Facebook. Discussion:: Developing innovative and appropriate programming that teaches to emerging social media technologies and ideologies will be crucial to helping the health professions adapt to a new, networked era. Medical institutions would do well to foster interprofessional-and perhaps even intergenerational-conversations to share not only the dangers and risks of social media, but also the opportunities that are emerging out of a rapidly evolving online world. © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.
Joshi M.,Penn State College of Medicine
Anti-cancer drugs | Year: 2014
Taxanes are novel microtubule-stabilizing agents and have shown efficacy in non-small cell lung cancer (NSCLC) since the 1990s. Paclitaxel and docetaxel have been used either as single agents or in combination with a platinum compound. The newer generation albumin-bound taxane, nab-paclitaxel, has also shown similar efficacy in advanced NSCLC, both as a single agent and in combination with a platinum compound. Nab-paclitaxel, being Cremophor EL free, appears to have a better toxicity profile than paclitaxel. Taxane/platinum combinations still remain the foundation of treatment for advanced or metastatic NSCLC. Docetaxel and paclitaxel as single agents have also shown efficacy in the second-line setting in advanced/metastatic NSCLC. Oral formulations of paclitaxel and docetaxel are of great interest, but have yet to receive regulatory approval in this disease. The phase I-II trials have shown that these formulations are feasible in the clinical setting.
Lochmann T.L.,Penn State College of Medicine
Virus research | Year: 2013
The assembly and release of retrovirus particles from the cell membrane is directed by the Gag polyprotein. The Gag protein of Rous sarcoma virus (RSV) traffics through the nucleus prior to plasma membrane localization. We previously reported that nuclear localization of RSV Gag is linked to efficient packaging of viral genomic RNA, however the intranuclear activities of RSV Gag are not well understood. To gain insight into the properties of the RSV Gag protein within the nucleus, we examined the subnuclear localization and dynamic trafficking of RSV Gag. Restriction of RSV Gag to the nucleus by mutating its nuclear export signal (NES) in the p10 domain or interfering with CRM1-mediated nuclear export of Gag by leptomycin B (LMB) treatment led to the accumulation of Gag in nucleoli and discrete nucleoplasmic foci. Retention of RSV Gag in nucleoli was reduced with cis-expression of the 5' untranslated RU5 region of the viral RNA genome, suggesting the psi (Ψ) packaging signal may alter the subnuclear localization of Gag. Fluorescence recovery after photobleaching (FRAP) demonstrated that the nucleolar fraction of Gag was highly mobile, indicating that there was rapid exchange with Gag proteins in the nucleoplasm. RSV Gag is targeted to nucleoli by a nucleolar localization signal (NoLS) in the NC domain, and similarly, the human immunodeficiency virus type 1 (HIV-1) NC protein also contains an NoLS consisting of basic residues. Interestingly, co-expression of HIV-1 NC or Rev with HIV-1 Gag resulted in accumulation of Gag in nucleoli. Moreover, a subpopulation of HIV-1 Gag was detected in the nucleoli of HeLa cells stably expressing the entire HIV-1 genome in a Rev-dependent fashion. These findings suggest that the RSV and HIV-1 Gag proteins undergo nucleolar trafficking in the setting of viral infection. Copyright © 2012 Elsevier B.V. All rights reserved.
Anson J.A.,Penn State College of Medicine
Anesthesiology | Year: 2014
Intraosseous vascular access is a time-tested procedure which has been incorporated into the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation. Intravenous access is often difficult to achieve in shock patients, and central line placement can be time consuming. Intraosseous vascular access, however, can be achieved quickly with minimal disruption of chest compressions. Newer insertion devices are easy to use, making the intraosseous route an attractive alternative for venous access during a resuscitation event. It is critical that anesthesiologists, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure. Copyright © 2014, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.
Fitzpatrick L.R.,Penn State College of Medicine
International Reviews of Immunology | Year: 2013
Several experimental approaches have been utilized, in order to critically examine the roles of IL-17 family members in intestinal inflammation. These approaches have included: (1) the use of IL-17A and IL-17F-deficient mice, (2) specific antibodies directed against IL-17, (3) an IL-17 vaccine, (4) methods to block the IL-17 receptor and (5) small-molecule inhibitors of IL-17. Previous studies found somewhat conflicting results in preclinical models of Inflammatory Bowel Disease (IBD), using specific strains of IL-17-deficient mice. This paper will review the preclinical results using various pharmacological approaches specific IL-17 antibodies, an IL-17 receptor fusion protein, IL-12/IL-23 p40 subunit and IL-17 vaccine approaches, as well as a small molecule inhibitor (Vidofludimus) to inhibit IL-17 in animal models of IBD. Recent clinical results in patients with IBD will also be discussed for Secukinumab (an IL-17A antibody), Brodalumab (an IL-17 receptor antibody) and two small-molecule drugs (Vidofludimus and Tofacitinib), which inhibit IL-17 as part of their overall pharmacological profiles. This review paper will also discuss some pharmacological lessons learned from the preclinical and clinical studies with anti-IL-17 drugs, as related to drug pharmacodynamics, IL-17 receptor subtypes and other pertinent factors. Finally, future pharmacological approaches of interest will be discussed, such as: (1) Retinoic acid receptor-related orphan nuclear receptor gamma t (Rorγt) antagonists, (2) Retinoic acid receptor alpha (RARα) antagonists, (3) Pim-1 kinase inhibitors and (4) Dual small-molecule inhibitors of NF-κB and STAT3, like synthetic triterpenoids. © 2013 Informa Healthcare USA, Inc.
Fitzpatrick L.R.,Penn State College of Medicine
International Journal of Inflammation | Year: 2012
This review identifies possible pharmacological targets for inflammatory bowel disease (IBD) within the IL-23/IL-17 axis. Specifically, there are several targets within the IL-23/IL-17 pathways for potential pharmacological intervention with antibodies or small molecule inhibitors. These targets include TL1A (tumor necrosis factor-like molecule), DR3 (death receptor 3), IL-23, IL-17 and the receptors for IL-23 and IL-17. As related to IBD, there are also other novel pharmacological targets. These targets include inhibiting specific immunoproteasome subunits, blocking a key enzyme in sphingolipid metabolism (sphingosine kinase), and modulating NF-κB/STAT3 interactions. Several good approaches exist for pharmacological inhibition of key components in the IL-23 and IL-17 pathways. These approaches include specific monoclonal antibodies to TL1A, IL-17 receptor, Fc fusion proteins, specific antibodies to IL-17F, and small molecule inhibitors of IL-17 like Vidofludimus. Also, other potential approaches for targeted drug development in IBD include specific chemical inhibitors of SK, specific small molecule inhibitors directed against catalytic subunits of the immunoproteasome, and dual inhibitors of the STAT3 and NF-κB signal transduction systems. In the future, well-designed preclinical studies are still needed to determine which of these pharmacological approaches will provide drugs with the best efficacy and safety profiles for entrance into clinical trials. © 2012 Leo R. Fitzpatrick.