School of Medicine

Ventricular Outflow Tract Obstruction

• This case presentation of left ventricular outflow tract obstruction in a middle aged woman was unusual because this condition is more common in children and young adults.
• Ventricular outflow tract obstruction is characterized by left ventricular hypertrophy, a dynamic left ventricle outflow tract gradient and autosomal dominant inheritance.
• With no clear practice guidelines, management is controversial.  Treatment options include beta blockers initially.  Invasive procedures such as septal wall myomectomy may be used for refractory cases.

Coumarbatch J, Israel N, Markova T.  Treatment options in symptomatic patient with left ventricular outflow tract obstruction. Family Practice Recertification.  2005; 27 (4): 18-26.

Balanitis and Diabetes Mellitus

• Balanitis can occur in both diabetic and nondiabetic patients and has several etiologies, including sexually transmitted diseases.
• Penile ulcers are commonly associated with sexually transmitted diseases and with poor hygiene, and they can be secondary to balanitis.
• Given that approximately 16% of the diabetic population compared to 6% of nondiabetics present with balanitis, physicians are encouraged to consider diabetes as part of their differential diagnosis of penile ulcer.

Lauder N, Binienda J.  Case study:  Postsexual penile ulcer as a symptom of diabetes. Clinical Diabetes. 2005; 23 (4): 191-192.

Distance Learning Technology is Effective in Residency Education

• Providing effective multi-site didactic teaching in residency programs remains a challenge.  We introduced a synchronous two-way audio and video Internet-transmitted distance learning methodology, and assessed residents’ satisfaction and knowledge gain at the face-to-face lecture site as compared with the distance learning site.  
• The didactic sessions were rated highly by both groups, with no significant differences on the resident satisfaction survey.  Both groups of residents scored higher on post-tests compared to the pre-tests, and there was no statistical difference in knowledge gain between the lecture and the distance learning group.
• In conclusion, synchronous interactive instructor-led distance learning is an effective method for delivering residency didactics at more than one site.  The new technology is well accepted by learners and is a promising approach to multi-site education.

Markova T, Roth L, Monsur J.  Synchronous distance learning as an effective and feasible method for delivering residency didactics.  Family Medicine. 2005; 37 (8):570-575.

Rare Case of Male Breast Cancer

• Male breast cancer represents 1% of all breast cancer nationally.  This case presentation describes a healthy 51 year old African American man who presented with a 3-day history of arm pain.
• On physician examination the patient was found to have a mass in his left breast as an incidental finding. The differential diagnosis includes osteoarthritis, tendonitis, bursitis, and metastatic bone cancer.  A biopsy confirmed the diagnosis of breast cancer. 
• The patient received chemotherapy and radiation therapy and is alive 3 1/2 years after his diagnosis. Overall 5 year survival rate for this stage IV cancer is 0-25%. 

Morris P, Markova T, Roe T. Bone pain and a worrisome family history.  Patient Care. 2006; 40 (2): 65-66.

Organizational and Learning Environments in Ambulatory Clinics

• Investigations of teaching quality in ambulatory clinics have generally focused on faculty and medical student perspectives.  We surveyed faculty, residents and nursing staff to explore clinic employees’ perspectives on organizational and learning environments and quality of teaching.
• Opinions about availability of structured learning opportunities for residents explained the most variance (35.2%) in the overall assessment of teaching quality.  The addition of job satisfaction brought the explained variance up to 46.4%.  Improvement in residents’ In-training Examination scores corresponded with higher learning and organizational environment assessment scores.
• Learning opportunities should be structured so that residents are oriented to the ambulatory clinic, have their knowledge assessed regularly, are helped to meet individual goals, and are given appropriate levels of responsibility.  Prioritizing efforts to improve job satisfaction for all employees is important because of its potential to influence quality of teaching and learning.

Roth LM, Severson RK, Probst J, Monsur J, Markova T, Kushner S, Schenk M. Exploring physician and staff perceptions of the learning environment in ambulatory residency clinics.  Family Medicine. 2006; 38 (3):177-184.

Symptoms and Emotional Abuse

• In this cross-sectional, multicenter study of victimization, 47 adult women meeting criteria for emotional abuse (past year) and no physical abuse were matched demographically with 47 non-abused women, and compared on physical and emotional symptoms, alcohol use problems, and social support problems.
• Emotionally abused women reported more physical and psychological symptoms than non-abused controls and more social support problems than non-abused controls. 
• This study supports literature that demonstrates an association between emotional abuse and physical and emotional symptoms in women who are currently suffering emotional abuse.  We recommend that physicians inquire about emotional abuse in female patients with multiple psychosocial and physical symptoms.

Porcerelli JH, West P, Binienda J.  Physical and psychological symptoms in emotionally abused and non-abused women.  Journal of the American Board of Family Medicine. 2006; 19 (2):201-204.