A national system to support a mandated PGY-1 year: how to get there from here.
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Biomedical subjects
Publications and source records attributed to S Redding.
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Meeting the demand for postdoctoral general dentistry programs will require new, innovative, and flexible models. Many believe that these new models must be competency-based and focus on the outcomes of postdoctoral general dentistry training rather than on the structure and process of that training. The Section on Postdoctoral General Dentistry of the American Association of Dental Schools formed a broadly representative working group in the fall of 1994 to develop a set of competency and proficiency statements describing graduates of postdoctoral general dentistry programs. PGD program directors were then surveyed to determine the extent to which they felt these competencies matched their concepts of the PGD graduate. Between 44 and 65 competency statements that were rated highly by program directors could serve as the basis for a "core" set of statements to describe the abilities of graduates of postdoctoral general dentistry programs. These data should stimulate further discussion among educators, program directors, accrediting bodies, and government agencies about the future of postdoctoral general dentistry programs.
We describe a patient with recurrent episodes of oropharyngeal candidiasis who required progressively higher doses of fluconazole to control and infection. The patient was treated for 14 infections over a 2-year period with doses of fluconazole that ranged from 100 to 800 mg per day. Clinical response, two methods of in vitro susceptibility testing, and molecular epidemiologic techniques were evaluated for 12 of the 14 episodes. Ultimately, the patient became unresponsive clinically to a dose of 800 mg of fluconazole per day. In vitro susceptibility testing of isolates obtained during these successive episodes of infection revealed the development of resistance to fluconazole, and molecular epidemiologic techniques confirmed the persistence of the same Candida albicans strain throughout all 12 episodes.
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Rats drank solutions of narcotic analgesics as the only drinking fluid available in their cages. Relative to their daily water intake before the drug solutions were introduced, the rats drank more etonitazene solution, less methadone solution, and about the same volume of morphine, meperidine and levorphanol solution as water, although some rats would not drink the higher concentrations of morphine (1.0 mg/ml), levorphanol (1.0 mg/ml) and methadone (1.0 mg/ml). When naloxone (1.0 mg/kg) was administered after 12 days of drinking the drug solutions, the severity of the abstinence syndromes based on scoring of symptoms and on weight loss was morphine greater than or equal to etonitazine greater than levorphanol greater than meperidine greater than methadone. The animals showing the most severe syndrome after naloxone usually consumed more drug solution than usual during the next 24 hours, so that body weights were normal at the end of the 24-hour period. Nonprecipitated abstinence was also studied in these rats by replacing the drug solutions with water 3 to 5 days after the naloxone injection. Rats that had been drinking morphine, etonitazene and levorphanol lost weight for 2 or 3 days and then began to regain their lost weight. In contrast, rats which had been switched from methadone and meperidine solutions to water gained weight rapidly. Morphine and etonitazene drinkers which had been switched to water drank a lesser volume of water than they had been drinking of drug solution whereas some ex-methadone drinkers drank more water.
There has been increasing interest in the organization and accreditation of post-doctoral general dentistry programs (PGD). Numerous national organizations have called for increases in the number of PGD positions and programs. At the same time, there has been a movement to incorporate concepts of competency-based education into dental education programs to stress the outcomes of education rather then the process. These movements have coincided with the current accreditation standards revision cycles for GPR and AEGD programs. These events suggest that PGD educators have a major opportunity and responsibility to assess the goals and educational directions of PGD programs in light of the many changes in dental health care delivery, health policy, and dental education activities. These opportunities will be realized only if the organizations involved with PGD education can find common ground and pool their resources to promote the interests of PGD education.
As we try to develop appropriate models for end-of-life care, it is important to review theoretical applications as they relate to current models of care. It is also vital to listen carefully to what patients and theirfamily caregivers tell us about their needs at the end of life. This article explores the issue of control: its application to wellness at the end of life, and patient and family caregiver perceptions about end-of-life control. Interventions and implications for professional caregivers are proposed.
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