Achievement of non-cognitive goals of undergraduate medical education: perceptions of medical students, residents, faculty and other health professionals.

Background: Professionalism is increasingly emphasised in medical education. Non-cognitive goals, including values, attitudes and skills, remain challenging to define and measure. The purpose of this study was to better understand these goals and their achievement in the MD programme.

Ten-year experience with mission-based budgeting in the faculty of medicine of Dalhousie University.

The Faculty of Medicine of Dalhousie University (the Faculty) has applied a mission-based approach to the allocation of the academic budget since 1993. Over the ensuing decade, large shifts in budgets to academic departments have been effected, and two goals that required special emphasis-the successful implementation of a tutorial-based undergraduate medical curriculum and an increase in research activity-have been achieved. This has occurred despite significant reductions in the overall academic budget over the ten-year period.

Complementary and alternative medicine: an integrated approach required.

Methods of verification of the efficacy and safety of health interventions must be congruent with the underlying health beliefs. It is therefore inappropriate to require scientific validation of health interventions that are not based on science. On the other hand, there is no justification for different standards of validation of health products from alternative sources that are used by the public in a manner similar to prescription and over-the-counter drugs.

Undergraduate and postgraduate medical education in Canada.

An overview of medical education at both the undergraduate and postgraduate levels in Canadian faculties of medicine is provided. Particular attention is focused on changes that have occurred in the 1990s and their effect on medical students and on educational programs. Also considered are the effects of reductions in the number of entry-level positions for residency training and the changes in educational requirements for licensure on senior medical students.

Double-blind placebo-controlled pilot trial of acemannan in advanced human immunodeficiency virus disease.

We assessed the safety and surrogate markers' effect of acemannan as an adjunctive to antiretroviral therapy among patients with advanced HIV disease receiving zidovudine (ZDV) or didanosine (ddI) in a randomized, double-blind, placebo-controlled trial of acemannan (400 mg orally four times daily). Eligible patients of either sex had CD4 counts of 50-300/microl twice within 1 month of study entry and had received 26 months of antiretroviral treatment (ZDV or ddI) at a stable dose for the month before entry. CD4 counts were made every 4 weeks for 48 weeks.

A phase I/II study of 2'-deoxy-3'-thiacytidine (lamivudine) in patients with advanced human immunodeficiency virus infection.

In a phase I/II trial assessing the toxicity, pharmacokinetics, and activity of the (-)enantiomer of 2'-deoxy-3'-thiacytidine (3TC, lamivudine), 97 patients with AIDS or advanced human immunodeficiency virus (HIV) disease were administered 3TC at 0.5-20.0 mg/kg/day.

Linking budgets to desired academic outputs at Dalhousie University.

In 1993, faced with continuing university budget reductions and dissatisfaction with the budget-allocation process, the Faculty of Medicine at Dalhousie University undertook a financial planning process. The goal was to develop a new resource-allocation model to better link academic budget support to desired academic outputs over a three-year period. Department heads categorized academic outputs (e.

Development of HIV-1 resistance to (-)2'-deoxy-3'-thiacytidine in patients with AIDS or advanced AIDS-related complex.

Objective: To determine the rate of development of in vitro HIV resistance to (-)2'-deoxy-3'-thiacytidine (3TC) and relate the effect of dose to emergence of resistance.

Methods: HIV-infected men and non-pregnant women, aged > or = 18 years, with a CD4 count < or = 300 x 10(6)/l cells were followed in a Phase I/II study, in which they were evaluated for tolerance to 3TC and effect of this agent with regard to viral susceptibility. Peripheral blood and plasma samples were collected at regular intervals for analysis.

Proposed guidelines for housestaff interaction with pharmaceutical companies.

The relationship between the medical profession and the pharmaceutical companies is complex, since industry depends on physicians for research and development, and for sales of its products. As a result, physician interactions with industry could undermine the patient-centered medical ethic, and jeopardize the physician-patient relationship. There is evidence that physicians are influenced by their encounters with the pharmaceutical industry.

Oral corticosteroids in patients with mild Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome (AIDS).

Objective: To assess the effect of oral corticosteroids in patients with mild Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome (AIDS).

Design: Prospective, double blind, placebo controlled, randomized trial.

Methods: Included were AIDS patients having their first episode of P.

History of specialty residency funding in Canada.

Specialty residency training in Canada has evolved from its origin in teaching hospitals through an era dominated by universities to the present when public accountability is emerging as a dominant influence. The predominant educational strategies, including experimental learning, role modelling, continuum of training, independent thinking, self-directed learning and research experiences, have been influenced by the diversity of roles expected of the resident, including that of an employee, a student, a teacher and, more recently, a part of the policy instrument of governments in controlling physician resources.

Clinical correlates of in vitro HIV-1 resistance ot zidovudine. Results of the Multicentre Canadian AZT Trial.

Objective: To describe the rate of development of in vitro HIV resistance to zidovudine (ZDV) and its prognostic implications within the Multicentre Canadian AZT Trial (MCAT).

Methods: HIV-infected subjects in Centers for Disease Control (CDC) stages IIB, III and IVC-2 with CD4 cell counts > 270 x 10(6)/l were treated with ZDV as part of a dose-range study. Participating volunteers underwent prospective clinical and laboratory evaluations at regular intervals.

Characterization of zidovudine resistant variants of HIV-1 isolated from patients on prolonged therapy.

As part of a clinical trial to assess zidovudine related toxic effects, the authors followed 48 initially asymptomatic individuals who received prolonged therapy with this drug at several tertiary care institutions. Blood samples had been obtained for viral isolation every three months and had yielded infectious HIV-1 progeny in over 94 percent of cases. After one year of therapy, over 30 percent of individuals had developed variants of HIV-1 that displayed in vitro resistance to zidovudine.

Aerosol pentamidine-induced bronchoconstriction. Predictive factors and preventive therapy.

Objective: To describe the frequency of aerosol pentamidine-induced bronchoconstriction, its relationship to non-specific airway responsiveness, and its response to preventive therapy using salbutamol, ipratropium bromide, or sodium cromoglycate.

Methods: Consecutive HIV-infected individuals starting prophylactic AP were eligible if they had not been previously treated with this agent. Simple spirometry was performed before and 10 min after a single 60-mg dose given through an ultrasonic nebulizer.

Clinical significance and characterization of AZT-resistant strains of HIV-1.

A number of laboratories have now independently confirmed that zidovudine (AZT)-resistant strains of human immunodeficiency virus type 1 (HIV-1) may be isolated from patients undergoing prolonged therapy with this drug. In certain instances, such drug-resistant viral isolates have been obtained from patients with clinical acquired immune deficiency syndrome (aids), while in others, isolation of drug-resistant strains has been achieved in the case of HIV seropositive, asymptomatic subjects. Most of the evidence points to a series of mutations within the polymerase gene of HIV-1, which encodes viral reverse transcriptase, as being responsible for development of the drug-resistant phenotype.

Canadian multicenter azidothymidine trial: AZT pharmacokinetics.

The study objective was to describe the pharmacokinetics of azidothymidine (AZT) in a large population of early, asymptomatic human immunodeficiency virus (HIV)-infected individuals. The study design was a multicenter, prospective, descriptive single-dose pharmacokinetic study. Each of 66 fasting, male, HIV-infected homosexuals older than 18 years of age and in CDC classifications II, III, and IVC2 received a single 400-mg oral dose of AZT with subsequent pharmacokinetic measurements performed during an 8-h period for AZT and its major metabolite, glucuronylazidothymidine (GAZT).

Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia.

Oxygen consumption is pathologically dependent on oxygen delivery in ARDS and sepsis. We asked whether oxygen consumption is dependent on oxygen delivery in severe acute respiratory failure secondary to AIDS-related PCP. In five patients who had AIDS-related PCP, diffuse bilateral pulmonary infiltrates, no evidence of bacterial infection, and acute respiratory failure requiring mechanical ventilation with arterial oxygen tensions less than 75 mm Hg while breathing at least 50 percent oxygen, and PEEP greater than 10 cm H2O, we determined oxygen delivery and consumption by calculation from thermodilution cardiac output and arterial and mixed venous oxygen contents.

Corticosteroids prevent early deterioration in patients with moderately severe Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome (AIDS).

Objective: To determine whether oral corticosteroids can prevent early deterioration in patients with acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia.

Design: Prospective, double-blind, placebo-controlled, randomized trial.

Methods: Included patients were having their first P.