Elderly inpatients: postural reflex impairment.

We examined postural reflexes in 50 patients in a geriatric care facility. Patients aged 60 years and older who did not have orthostatic hypotension were subjected to a standing postural perturbation, and the degree of postural instability was recorded. Sixteen patients with leg amputations, recent stroke, and leg deformities were excluded. Of the remaining 34 patients, 44% had severe postural reflex impairment, and 24% had moderate impairment. Although the etiology for postural reflex impairment may be multivariant, the high percentage suggests that postural reflex dysfunction may be an important cause of unexplained falls in the elderly.

"Trick" movements in facial dystonia.

Two patients with facial dystonia (blepharospasm and/or oromandibular dystonia) presented with an unusual "trick" movement. Both patients were able to inhibit blepharospasm and oromandibular dystonia by vocalizations including singing, reading, and speaking spontaneously. The significance of "trick" movements in facial dystonia is discussed.

Revising appointment, promotion, and tenure procedures to incorporate an expanded definition of scholarship: the University of Kentucky College of Medicine experience.

Scholarly activity and scholarly productivity are key features of the academic health center (AHC) and the work of college of medicine faculty. Recent changes in the academic environment of the University of Kentucky (UK) College of Medicine led to an examination of its appointment, promotion, and tenure procedures. This, in turn, led to a re-examination of the college's definition of scholarship. This article describes three of UK's scholarship-related challenges, particularly those related to clinical departments. The authors describe some of the new procedures being implemented to address these challenges; these include new faculty designations, clearer articulation of promotion procedures, explicit recognition of multiple forms of scholarship, expectations for investment in junior faculty, and mandatory discussion of faculty success in chairs' annual reviews. Faculty reactions, positive and negative, to these changes in procedures are also presented.

Measuring faculty effort and contributions in medical education.

A national panel on medical education was appointed as a component of the AAMC's Mission-based Management Program and charged with developing a metrics system for measuring medical school faculty effort and contributions to a school's education mission. The panel first defined important variables to be considered in creating such a system: the education programs in which medical school faculty participate; the categories of education work that may be performed in each program (teaching, development of education products, administration and service, and scholarship in education); and the array of specific education activities that faculty could perform in each of these work areas. The panel based the system on a relative value scale, since this approach does not equate faculty performance solely to the time expended by a faculty member in pursuit of a specific activity. Also, a four-step process to create relative value units (RVUs) for education activities was developed. This process incorporates quantitative and qualitative measures of faculty activity and also can measure and value the distribution of faculty effort relative to a school's education mission. When adapted to the education mission and culture of an individual school, the proposed metrics system can provide critical information that will assist the school's leadership in evaluating and rewarding faculty performance in education and will support a mission-based management strategy in the school.

Selected legal issues in movement disorders.

This article explores the long-standing question of whether trauma causes Parkinson's disease, and discusses the impact of informed consent and confidentiality in issues of genetic testing for Huntington's disease. Neurologists are appropriately concerned about the legal aspects of genetic testing, and this article attempts to address that subject from a medical-legal perspective.

Medicolegal aspects of informed consent.

This article discusses informed consent and emphasizes four critical features of ethically and legally appropriate informed consent. The article also highlights some exceptions to informed consent requirements. The authors outline practical advice for avoiding litigation resulting from consent issues.

Issues in biomedical ethics.

Bioethics is the discipline of ethics dealing with moral problems arising in the practice of medicine and the pursuit of biomedical research. Physicians may confront ethical dilemmas regularly in their individual relationships with patients and in institutional and societal decisions on health care policy. Ethical problem solving requires the application of certain ethical rules and principles to specific situations. Although ethical theories differ, certain ethical rules and principles appear consistently. These include nonmaleficence, beneficence, respect for individual autonomy, confidentiality, and justice. This article discusses some of the ethical issues that arise in clinical practice, including informed consent, do-not-resuscitate orders, noninitiation and termination of medical therapy, genetic intervention, allocation of scarce health resources, and infection with the human immunodeficiency virus (HIV). Some of these problems require ethical analysis at the bedside; others require physician involvement on a broader level. Perspectives on the different ethical issues are presented; however, absolute answers to these ethical dilemmas are not provided. Interpretation of the ethical principles and the application of these principles to each clinical situation demands the thoughtful attention of the practitioner.

Computer requirements for medical school students--implications for admissions.

Computers are increasingly being used in clinical practice settings. Aware of the need to educate students regarding computer applications in medicine, the University of Kentucky College of Medicine is in the midst of developing a computer curriculum. To that end, many courses and clerkships have devised software packages for transmittal of course information and for evaluation of student performance. This paper outlines requisite computer skills that applicants applying to medical school should possess, broadly reviews how those computer skills will be used in medical school, and suggests means for attaining computer competency prior to making application to medical school.

Kentucky physicians' perspectives and preparedness for computing in medical education and practice.

PURPOSE: To examine the University of Kentucky College of Medicine's community-based faculty's (CBF) perspective on computing skills that students should acquire for future medical practice, and if the CBF currently use these skills in their daily practice. METHODS: A survey was mailed to 281 of the institution's CBF in the spring of 1997. The survey listed eight basic computing skills derived from our computing curricular objectives for students and asked respondents (a) if they use the skill, and (b) if students should learn the skill. RESULTS: 200 respondents returned a completed survey. 14 CBF (7.2%) indicated that they have all eight computer skills while 91 CBF (46.4%) indicated that students should learn all eight computer skills. 25 CBF (13%) indicated that they have none of the computer skills, while none of the CBF indicated students need none of the skills. A significant difference between primary care CBF and other specialist CBF was found with respect to self-report of computer use, but not regarding their opinions about students' need to learn computer skills. CONCLUSION: The majority of our CBF report using at least one computer skill in their practices. Regardless of specialty, CBF report that students should possess more computer skills than they themselves have. Medical educators should incorporate computing applications into the curriculum to provide appropriate computer training for future physicians.

Neural fetal tissue transplants: old and new issues.

Neural fetal tissue transplantation offers promise as a treatment for devastating neurologic conditions such as Parkinson's disease. Two types of issues arise from this procedure: those associated with the use of fetuses, and those associated with the use of neural tissue. The former issues have been examined in many forums; the latter have not. This paper reviews issues and arguments raised by the use of fetal tissue in general, but focuses on the implications of the use of neural tissue for basic concepts of personhood and personal identity.

Improving cross-cultural skills of medical students through medical school-community partnerships.

Postulating that a program integrating language skills with other aspects of cultural knowledge could assist in developing medical students' ability to work in cross-cultural situations and that partnership with targeted communities was key to developing an effective program, a medical school and two organizations with strong community ties joined forces to develop a Spanish Language and Hispanic Cultural Competence Project. Medical student participants in the program improved their language skills and knowledge of cultural issues, and a partnership with community organizations provided context and resources to supplement more traditional modes of medical education.