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Assoumou SA, Peterson A, Ginman E, James T, Pierre CM, Hamilton S, Chapman S, Goldie J, Koenig R, Mendez-Escobar E, Leaver H, Graham R, Crichlow R, Weaver T, Cotterell S, Valdez G, De Las Nueces D, Scott NA, Linas BP, Cherry PM. Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience. Ann Intern Med 2022; 175:879-884. [PMID: 35576586 DOI: 10.7326/m22-0028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Academic medical centers could play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. This article describes the vaccination program developed by the Boston Medical Center (BMC) health system (New England's largest safety-net health system), its affiliated community health centers (CHCs), and community partners. The program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination in the hardest-hit communities through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. Key strategies included a communication campaign featuring trusted messengers, a focus on health equity, established partnerships with community leaders and CHCs, and strong collaboration with local health departments and the Commonwealth of Massachusetts to ensure equitable allocation of the vaccine supply. Process factors involved the use of robust analytics relying on the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). The vaccination program administered 109 938 first doses, with 94 703 (86%) given at community sites and 2466 (2%) given at mobile sites. Mobile vaccination events were key in reaching younger people living in locations with the highest SVIs. Challenges included the need for a robust operational infrastructure and mistrust of the health system given the long history of economic disinvestment in the surrounding community. The BMC model could serve as a blueprint for other medical centers interested in implementing programs aimed at increasing vaccine uptake during a pandemic and in developing an infrastructure to address other health-related disparities.
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Affiliation(s)
- Sabrina A Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (S.A.A., C.M.P.)
| | - Alicia Peterson
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Ellen Ginman
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Thea James
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Cassandra M Pierre
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (S.A.A., C.M.P.)
| | - Sebastian Hamilton
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Sheila Chapman
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - John Goldie
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Robert Koenig
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Elena Mendez-Escobar
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Hannah Leaver
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Robert Graham
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
| | - Renee Crichlow
- Codman Square Health Center, Boston, Massachusetts (R.C., T.W., S.Cotterell)
| | - Tarsha Weaver
- Codman Square Health Center, Boston, Massachusetts (R.C., T.W., S.Cotterell)
| | - Sandra Cotterell
- Codman Square Health Center, Boston, Massachusetts (R.C., T.W., S.Cotterell)
| | - Guale Valdez
- Mattapan Community Health Center, Boston, Massachusetts (G.V.)
| | | | - Nancy A Scott
- Boston University School of Public Health, Boston, Massachusetts (N.A.S.)
| | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, and Boston University School of Public Health, Boston, Massachusetts (B.P.L.)
| | - Petrina Martin Cherry
- Boston Medical Center, Boston, Massachusetts (A.P., E.G., T.J., S.H., S.Chapman, J.G., R.K., E.M., H.L., R.G., P.M.C.)
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Koh KA, Racine M, Gaeta JM, Goldie J, Martin DP, Bock B, Takach M, O'Connell JJ, Song Z. Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations. Health Aff (Millwood) 2021; 39:214-223. [PMID: 32011951 DOI: 10.1377/hlthaff.2019.00687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending-2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.
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Affiliation(s)
- Katherine A Koh
- Katherine A. Koh ( kkoh@partners. org ) is a physician at the Boston Health Care for the Homeless Program and Massachusetts General Hospital, both in Boston, Massachusetts
| | - Melanie Racine
- Melanie Racine is the director of special projects at the Boston Health Care for the Homeless Program and a member of its Institute for Research, Quality, and Policy in Homeless Health Care
| | - Jessie M Gaeta
- Jessie M. Gaeta is chief medical officer at the Boston Health Care for the Homeless Program and a member of its Institute for Research, Quality, and Policy in Homeless Health Care. She is also an assistant professor of medicine at Boston University School of Medicine
| | - John Goldie
- John Goldie is executive director of system analytics, Boston Medical Center Health System
| | - Daniel P Martin
- Daniel P. Martin is a data scientist in the Population Health Analytics and Strategy team, Boston Medical Center Health System
| | - Barry Bock
- Barry Bock is chief executive officer of the Boston Health Care for the Homeless Program
| | - Mary Takach
- Mary Takach is a senior health policy adviser at the Boston Health Care for the Homeless Program
| | - James J O'Connell
- James J. O'Connell is president of the Boston Health Care for the Homeless Program and an assistant professor of medicine at Harvard Medical School, in Boston
| | - Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School and Massachusetts General Hospital, and a faculty member in the Center for Primary Care at Harvard Medical School
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Goldie J. Can General Practitioners' personal knowledge base be justified? MedEdPublish (2016) 2018; 7:95. [PMID: 38089239 PMCID: PMC10711988 DOI: 10.15694/mep.2018.0000095.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
This article was migrated. The article was marked as recommended. This paper explores whether, in our post-truth world the knowledge base of General Practice can be justified. It examines the different types of knowledge that make up a profession's knowledge base and how such knowledge may be justified. The justification of personal knowledge, which is often the most important for practice, requires a different approach to that of codified knowledge. A potential approach is outlined which can be evaluated against the norms of the profession. A number of methods are suggested that may foster its' development.
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Goldie J. Resolving conflicts of interests: the need for reflection. Med Educ 2017; 51:1196-1197. [PMID: 29124796 DOI: 10.1111/medu.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- John Goldie
- Department of General Practice and Primary Care, University of Glasgow, Glasgow, UK
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Goldie J, Bold J, Haigney D. P13 Diet and nutrition in the periconception period of a subsequent pregnancy following a congenital heart defect-affected pregnancy. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goldie J, Dowie A, Goldie A, Cotton P, Morrison J. What makes a good clinical student and teacher? An exploratory study. BMC Med Educ 2015; 15:40. [PMID: 25889447 PMCID: PMC4358722 DOI: 10.1186/s12909-015-0314-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/18/2015] [Indexed: 05/03/2023]
Abstract
BACKGROUND What makes a good clinical student is an area that has received little coverage in the literature and much of the available literature is based on essays and surveys. It is particularly relevant as recent curricular innovations have resulted in greater student autonomy. We also wished to look in depth at what makes a good clinical teacher. METHODS A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data was analysed using a "framework" technique. RESULTS Good clinical students were viewed as enthusiastic and motivated. They were considered to be proactive and were noted to be visible in the wards. They are confident, knowledgeable, able to prioritise information, flexible and competent in basic clinical skills by the time of graduation. They are fluent in medical terminology while retaining the ability to communicate effectively and are genuine when interacting with patients. They do not let exam pressure interfere with their performance during their attachments. Good clinical teachers are effective role models. The importance of teachers' non-cognitive characteristics such as inter-personal skills and relationship building was particularly emphasised. To be effective, teachers need to take into account individual differences among students, and the communicative nature of the learning process through which students learn and develop. Good teachers were noted to promote student participation in ward communities of practice. Other members of clinical communities of practice can be effective teachers, mentors and role models. CONCLUSIONS Good clinical students are proactive in their learning; an important quality where students are expected to be active in managing their own learning. Good clinical students share similar characteristics with good clinical teachers. A teacher's enthusiasm and non-cognitive abilities are as important as their cognitive abilities. Student learning in clinical settings is a collective responsibility. Our findings could be used in tutor training and for formative assessment of both clinical students and teachers. This may promote early recognition and intervention when problems arise.
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Affiliation(s)
- John Goldie
- Glasgow University Medical School, Glasgow, Scotland, UK.
- Academic Unit of General Practice and Primary Care, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland, UK.
| | - Al Dowie
- Glasgow University Medical School, Glasgow, Scotland, UK.
| | | | - Phil Cotton
- Glasgow University Medical School, Glasgow, Scotland, UK.
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Jill Morrison
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
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Goldie J, Dowie A, Goldie A, Cotton P, Morrison J. The influence of structural and institutional change on teaching and culture in clinical settings: an exploratory study. Med Teach 2015; 37:189-195. [PMID: 25156502 DOI: 10.3109/0142159x.2014.947943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Learning in clinical settings is a function of activity, context and culture. Glasgow University's Medical School has undergone significant curricular change in recent years. This has coincided with change to National Health Service consultants' contracts, the introduction of the European Working Time Directive and the Modernising Medical Careers training initiative. We wished to explore teachers' and students' perspectives on the effects of change on our clinical teachers' capacity for teaching and on medical culture. METHODS A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data were analysed using a "framework" technique. RESULTS Curricular change has led to shorter clinical attachments in the senior clinical rotation, which combined with more centralised teaching have had adverse effects on both formal and informal teaching during attachments. Consultants' NHS contract changes the implementation of the European Working Time Directive and changes to postgraduate training have adversely affected consultants' teaching capacity, which has had a detrimental effect on their relationships with students. Medical culture has also changed as a result of these and other societal influences. CONCLUSIONS The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.
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Affiliation(s)
- J Goldie
- Glasgow University Medical School , UK
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Goldie J. The politics of professionalism in general practice: knowledge is power. Education for Primary Care 2014; 25:3-4. [DOI: 10.1080/14739879.2014.11494234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
CONTEXT Professionalism has become a hot topic in medical education. Professionalism needs to be assessed if it is to be viewed as both positive and relevant. OBJECTIVES The assessment of professionalism is an evolving field. This review aims to consolidate current thinking. IMPLICATIONS Assessment of professionalism has progressed from an initial focus on the development and attainment of professional identity, through identifying areas of deficiency, to the attainment of a set of identifiable positive attributes and behaviours. It is now beginning to recognise the challenge of assessing a multi-dimensional construct, looking beyond the measurement of behaviour to embrace a diversity of approaches. CONCLUSIONS Professionalism should be assessed longitudinally. It requires combinations of different approaches, assessing professionalism at individual, interpersonal and societal/institutional levels. Increasing the depth and the quality of reliability and validity of existing programmes in various contexts may be more appropriate than concentrating on developing new instruments. Increasing the number of tests and the number of relevant contexts will increase the reliability of the result. Similarly increasing the number of observers increases reliability. Feedback, encouraging reflection, can promote change in behaviour and identity formation.
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Affiliation(s)
- John Goldie
- General Practice & Primary Care, University of Glasgow, Glasgow, Scotland, UK.
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Abstract
CONTEXT Medical education is about more than acquiring an appropriate level of knowledge and developing relevant skills. To practice medicine students need to develop a professional identity--ways of being and relating in professional contexts. OBJECTIVES This article conceptualises the processes underlying the formation and maintenance of medical students' professional identity drawing on concepts from social psychology. IMPLICATIONS A multi-dimensional model of identity and identity formation, along with the concepts of identity capital and multiple identities, are presented. The implications for educators are discussed. CONCLUSIONS Identity formation is mainly social and relational in nature. Educators, and the wider medical society, need to utilise and maximise the opportunities that exist in the various relational settings students experience. Education in its broadest sense is about the transformation of the self into new ways of thinking and relating. Helping students form, and successfully integrate their professional selves into their multiple identities, is a fundamental of medical education.
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Affiliation(s)
- John Goldie
- General Practice & Primary Care, University of Glasgow, Scotland, UK.
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Lohfeld L, Goldie J, Schwartz L, Eva K, Cotton P, Morrison J, Kulamakan K, Norman G, Wood T. Testing the validity of a scenario-based questionnaire to assess the ethical sensitivity of undergraduate medical students. Med Teach 2012; 34:635-42. [PMID: 22830320 DOI: 10.3109/0142159x.2012.687845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Although medical educators acknowledge the importance of ethics in medical training, there are few validated instruments to assess ethical decision-making. One instrument is the Ethics in Health Care Questionnaire--version 2 (EHCQ-2). The instrument consists of 12 scenarios, each posing an ethical problem in health care, and asking for a decision and rationale. The responses are subjectively scored in four domains: response, issue identification, issue sophistication, and values. GOALS This study was intended to examine the inter-rater and inter-case reliability of the AHCQ-2 and validity against a national licensing examination of the EHCQ-2 in an international sample. METHODS A total of 20 final year McMaster students and 45 final year Glasgow students participated in the study. All questionnaires were scored by multiple raters. Generalizability theory was used to examine inter-rater, inter-case and overall test reliability. Validity was assessed by comparing EHCQ-2 scores with scores on the Canadian written licensing examination, both total score and score for the ethics subsection. RESULTS For both samples, reliability was quite low. Except for the first task, which is multiple choice, inter-rater reliability was 0.08-0.54, and inter-case reliability was 0.14-0.61. Overall test reliability was 0.12-0.54. Correlation between EHCQ-2 task scores and the licensing examination scores ranged from 0.07 to 0.40; there was no evidence that the correlation was higher with the ethics subsection. CONCLUSIONS The reliability and validity of the measure remains quite low, consistent with other measures of ethical decision-making. However, this does not limit the utility of the instrument as a tool to generate discussion on ethical issues in medicine.
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Affiliation(s)
- Jill Morrison
- University of Glasgow, General Practice and Primary Care, Division of Community-based Sciences, Glasgow G12 9LX, UK.
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Abstract
This paper examines how professionalism teaching might be integrated into undergraduate medical education in the United Kingdom setting. It advocates adopting an outcome-based approach to curriculum planning, using the Scottish Deans' Medical Curriculum Group's (SDMCG) outcomes as a starting point. In discussing the curricular content, potential learning methods and strategies, theoretical considerations are explored. Student selection, assessment and strategies for optimising the educational environment are also considered.
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Goldie J, Cotton P, McConnachie A, Morrison J. Can medical students' pre-curriculum performance on the Ethics in Health Care Instrument (EHCI) be used as a predictor of future academic performance? A pilot study. Med Teach 2008; 30:334-335. [PMID: 18509880 DOI: 10.1080/01421590701753526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
CONTEXT Despite the growing literature on professionalism in undergraduate medical curricula, few studies have examined its delivery. OBJECTIVES This study investigated tutors' and students' perspectives of the delivery of professionalism in the early years of Glasgow's learner-centred, problem-based learning (PBL), integrated medical curriculum. METHODS A qualitative approach was adopted involving semistructured interviews, on a 1 in 6 sample of tutors involved in teaching in the early curricular years, and 3 student focus groups. The findings were subjected to between-method triangulation. RESULTS Involvement in teaching raised students' and tutors' awareness of their professionalism. Learning activities promoting critical reflection were most effective. The integration of professionalism across the domains of Vocational Studies (VS) was important for learning; however, it was not well integrated with the PBL core. Integration was promoted by having the same tutor present throughout all VS sessions. Early patient contact experiences were found to be particularly important. The hidden curriculum provided both opportunities for, and threats to, learning. The small-group format provided a suitable environment for the examination of pre-existing perspectives. The portfolio was an effective learning tool, although its assessment should be formalised. CONCLUSIONS Reflection is integral to professional development. Early clinical contact is an important part of the process of socialisation, as it allows students to enter the community of practice that is the medical profession. Role models can contribute powerfully to students' learning and identity formation. As students move towards fuller participation, the clinical milieu should be controlled to maximise the influence of role models, and opportunities for guided reflection should be sustained.
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Affiliation(s)
- John Goldie
- Section of General Practice and Primary Care, University of Glasgow, Glasgow, UK.
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Abstract
Evaluation has become an applied science in its own right in the last 40 years. This guide reviews the history of programme evaluation through its initial concern with methodology, giving way to concern with the context of evaluation practice and into the challenge of fitting evaluation results into highly politicized and decentralized systems. It provides a framework for potential evaluators considering undertaking evaluation. The role of the evaluator; the ethics of evaluation; choosing the questions to be asked; evaluation design, including the dimensions of evaluation and the range of evaluation approaches available to guide evaluators; interpreting and disseminating the findings; and influencing decision making are covered.
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Affiliation(s)
- John Goldie
- Department of General Practice and PrimaryCare, Community Based Sciences, University of Glasgow, UK.
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Abstract
OBJECTIVE To examine students' attitudes and potential behaviour towards informing a 12-year-old patient of her terminal prognosis in a situation in which her parents do not wish her to be told, as they pass through a modern medical curriculum. DESIGN A cohort study of students entering Glasgow University's new medical curriculum in October 1996. METHODS Students' responses obtained before year 1 and at the end of years 1, 3, and 5 to the "childhood leukaemia" vignette of the Ethics in Health Care Survey Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of the students' multichoice answers enabled measurement of the movement towards professional consensus opinion. An analysis of their written justifications for their answers helped to determine whether their reasoning was consistent with professional consensus and enabled measurement of changes in knowledge content and recognition of the values inherent in the vignette. Themes on the students' reasoning behind their decision to tell the patient or not were also identified. RESULTS Unlike other vignettes of the EHCI in which autonomy was a main theme, few students chose the consensus answer before year 1 and there was no significant movement towards consensus at any point during the course. In defence of their decision to withhold information, the students expressed strong paternalistic opinions. The patient's age was seen as a barrier to respecting her autonomy. CONCLUSIONS It is important to identify students' perceptions on entry to medical school. Transformative learning theory may provide the basis for an approach to foster doctors who consider the rights of young people. Small-group teaching is most conducive to this approach. The importance of positive role modelling is also emphasised.
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Affiliation(s)
- J Goldie
- Department of General Practice and Primary Care, Community Based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK.
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Goldie J, Schwartz L, McConnachie A, Jolly B, Morrison J. Can students' reasons for choosing set answers to ethical vignettes be reliably rated? Development and testing of a method. Med Teach 2004; 26:713-718. [PMID: 15763875 DOI: 10.1080/01421590400016399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Although ethics is an important part of modern curricula, measures of students' ethical disposition have not been easy to develop. A potential method is to assess students' written justifications for selecting one option from a preset range of answers to vignettes and compare these justifications with predetermined 'expert' consensus. We describe the development of and reliability estimation for such a method -- the Ethics in Health Care Instrument (EHCI). Seven raters classified the responses of ten subjects to nine vignettes, on two occasions. The first stage of analysis involved raters' judging how consistent with consensus were subjects' justifications using generalizability theory, and then rating consensus responses on the action justification and values recognition hierarchies. The inter-rater reliability was 0.39 for the initial rating. Differential performance on questions was identified as the largest source of variance. Hence reliability was investigated also for students' total scores over the nine consensus vignettes. Rater effects were the largest source of variance identified. Examination of rater performance showed lack of rater consistency. D-studies were performed which showed acceptable reliability could nevertheless be obtained using four raters per EHCI. This study suggests that the EHCI has potential as an assessment instrument although further testing is required of all components of the methodology.
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Affiliation(s)
- John Goldie
- General Practice and Primary Care, Community Based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
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Goldie J, Schwartz L, Morrison J. Sex and the surgery: students' attitudes and potential behaviour as they pass through a modern medical curriculum. J Med Ethics 2004; 30:480-6. [PMID: 15467083 PMCID: PMC1733948 DOI: 10.1136/jme.2003.006304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine students' attitudes and potential behaviour to a possible intimate relationship with a patient as they pass through a modern medical curriculum. DESIGN A cohort study of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS Students' pre year 1 and post year 1, post year 3, and post year 5 responses to the "attractive patient" vignette of the Ethics in Health Care Survey instrument were examined quantitatively and qualitatively. Analysis of students' multi-choice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to enter a relationship or not were also identified. RESULTS No significant movement towards consensus was found at any point in the curriculum. There was little improvement in students' performance in terms of knowledge content and their abilities to recognise the values inherent in the vignette. In deciding to enter a relationship with the patient the most frequently used reasoning was that it could be justified if the patient changed their doctor. CONCLUSIONS Teaching on the subject of sexual or improper relationships between doctors and patients, including relationships with former patients requires to be made explicit. Case based teaching would fit in with the ethos of the problem based, integrated medical curriculum.
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Affiliation(s)
- J Goldie
- Department of General Practice, University of Glasgow, Glasgow, Scotland, UK.
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Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of a modern medical curriculum on students' proposed behaviour on meeting ethical dilemmas. Med Educ 2004; 38:942-949. [PMID: 15327675 DOI: 10.1111/j.1365-2929.2004.01915.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the impact of a modern medical curriculum on students' proposed behaviour on encountering ethical dilemmas. DESIGN Cohort design. SETTING University of Glasgow Medical School. SUBJECTS The first intake of students into Glasgow's new curriculum (n = 238). Main outcome measure Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS The probability of giving a consensus answer was lowest pre-Year 1 and highest post-Year 1. It reduced slightly post-Years 3 and 5, but remained significantly higher than at pre-Year 1. The performance of students undertaking a 1-year intercalated BSc, however, appeared to regress on testing post-Year 4. CONCLUSIONS While the first year of the curriculum had a positive impact on students, the remainder of the curriculum did not impact to the same extent. These findings support the recommendation that small group teaching, the predominant teaching method in Year 1, should be preferred to lecture and large group teaching, the predominant method of the remaining curricular years. Full integration of ethics and law teaching within the rest of the curriculum is recommended, particularly during the clinical years. This has training implications for all medical teachers involved in the curriculum. The assessment of ethics should be incorporated into all formal examinations. It is recommended that ethics be addressed as part of a wider approach to professionalism in order to promote integration.
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Affiliation(s)
- John Goldie
- Department of General Practice, Division of Community Based Services, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, Scotland, UK.
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Goldie J, Schwartz L, Morrison J. Students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. J Med Ethics 2004; 30:371-6. [PMID: 15289522 PMCID: PMC1733914 DOI: 10.1136/jme.2002.002204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. DESIGN Cohort design. SETTING University of Glasgow Medical School, United Kingdom. SUBJECTS A cohort of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS Students' responses before and after year 1, after year 3, and after year 5 to the assisted suicide vignette of the Ethics in Health Care Survey instrument, were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to withdraw treatment or not were also identified. RESULTS Students' answers were found to be consistent with professional consensus opinion precurriculum and remained so throughout the curriculum. There was an improvement in the knowledge content of the written responses following the first year of the curriculum, which was sustained postcurriculum. However, students were found to analyse the section mainly in terms of autonomy, with few responses considering the other main ethical principles or the wider ethical perspective. Students were unclear on their legal responsibilities. CONCLUSIONS Students should be encouraged to consider all relevant ethical principles and the wider ethical perspective when deliberating ethical dilemmas. Students should have a clear understanding of their legal responsibilities.
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Affiliation(s)
- J Goldie
- Department of General Practice and Primary Care, Division of Community Based Services, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, Scotland, UK.
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Goldie J, Schwartz L, McConnachie A, Morrison J. Students' attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum. Med Educ 2003; 37:368-375. [PMID: 12654122 DOI: 10.1046/j.1365-2923.2003.01471.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To examine students' attitudes and potential behaviour with regard to whistle blowing as they progress through a modern undergraduate medical curriculum. DESIGN Cohort design. SETTING University of Glasgow Medical School. SUBJECTS A cohort of students entering Glasgow University's new learner-centred, integrated medical curriculum in October 1996. METHODS Students' pre- and post-Year 1, post-Year 3 and post-Year 5 responses to the whistle blowing vignette of the Ethics in Health Care Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes in students' reasoning behind their decisions of whether or not to whistle blow were also identified. RESULTS There was little improvement in students' performance as they progressed through the curriculum in terms of their proposed behaviour on meeting the whistle blowing scenario. There was also no improvement in the quality of justifications provided. Students' reasoning on whether or not to whistle blow was found to change as the curriculum progressed. CONCLUSIONS The EHCI has the potential to elicit students' attitudes towards ethical issues at entry to medical school and to measure change as they progress through the curriculum. Students should be encouraged to contemplate dilemmas from all ethical standpoints and consider relevant legal implications. Whistle blowing should be addressed as part of the wider domain of professionalism.
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Affiliation(s)
- John Goldie
- Department of General Practice, University of Glasgow, UK Cancer Care Ontario, Toronto, Ontario, Canada.
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Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of three years' ethics teaching, in an integrated medical curriculum, on students' proposed behaviour on meeting ethical dilemmas. Med Educ 2002; 36:489-497. [PMID: 12028400 DOI: 10.1046/j.1365-2923.2002.01176.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the impact of 3 years' ethics teaching (30 hours mainly small group teaching in year 1, 14 hours mainly lecture-type teaching in years 2 and 3) on students' proposed behaviour on encountering ethical dilemmas. DESIGN Cohort design. SETTING University of Glasgow Medical School. SUBJECTS A cohort of 111 students entering Glasgow University's new learner-centred, integrated medical curriculum; where ethics learning is formally assessed in years 1 and 5 only; in October 1996. MAIN OUTCOME MEASURE Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS The instrument was completed pre- and post- year 1 and post- year 3 by 77%(85) of the cohort. There is a significant increase in the number of consensus answers given following the first year of the curriculum, but no further improvement was found. The odds ratio for giving the consensus answer post- year 1 relative to pre- year 1 was 1.42, 95% Confidence Interval (1.19, 1.71), P = 0.0001. Comparing post- year 3 to pre- year 1, odds ratio 1.30 (1.08, 1.57), P = 0.0062. Post- year 3 compared to post- year 1, odds ratio 0.91 (0.76, 1.10), P = 0.34. CONCLUSIONS While small group ethics teaching can be effective in developing students' normative identification with the profession of medicine, its effectiveness is dependent on the amount of small group teaching provided. The lack of formal assessment in years 2 and 3 is also felt to contribute to the lack of impact. This information will inform future curriculum development.
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Affiliation(s)
- John Goldie
- Department of General Practice, University of Glasgow, UK.
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Abstract
OBJECTIVE To evaluate the effectiveness of small-group ethics teaching in an integrated medical curriculum. DESIGN A quasi-experimental, pre- and post-test, non-equivalent control group design. SETTING University of Glasgow Medical School. SUBJECTS 111 first-year students from Glasgow University's new learner-centred medical curriculum, with a control group of 51 students from the last year of the traditional curriculum. MAIN OUTCOME MEASURE Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS There was a significantly greater increase in the number of post-test consensus answers in the experimental group (P=0.0048): the odds ratio for obtaining the post-test consensus answer in the experimental group compared with the control group was 1.73 (95% confidence interval 1.28-2.33). Significant movement towards consensus occurred in the areas of autonomy, confidentiality and consent. Among controls there was a significant move away from consensus in the area of "whistle blowing" on colleagues (P=0.017). CONCLUSION Small-group ethics teaching, in an integrated medical curriculum, had a positive impact on the first-year students' potential ethical behaviour. It was more effective than a lecture and a large-group seminar-based course in developing students' normative identification with the profession of medicine.
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Affiliation(s)
- J Goldie
- Department of General Practice, University of Glasgow, 4 Lancaster Crescent, Glasgow G12 0RR, UK
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Abstract
BACKGROUND Despite the recent increase in activity in the field of medical ethics education, few evaluative studies have been carried out. Most studies have taken place in North America, in curricula where teaching is discipline-based, and have concentrated on outcome rather than on the curricular processes adopted. AIM To evaluate the process of medical ethics education in the first year of a new learner-centred, problem-based, integrated medical curriculum. METHOD A qualitative, multi-method approach was adopted using open questionnaires, focus groups and tutor evaluation rating scales. The study involved all 238 students in the first year of the new medical curriculum, and the 30 clinical tutors who facilitated ethics learning. A stratified sampling technique was used to choose focus group participants. RESULTS Small group teaching proved highly acceptable to both students and tutors. Tutors' teaching skills were central to its effectiveness. Tutors played an important role in promoting students' appreciation of the relevance of medical ethics to clinical practice, and in establishing a climate where constructive criticism of colleagues' actions is acceptable. Course integration, including the provision for students of clinical experiences on which to reflect, was an important aid to learning. Students and tutors were noted to be driving the ethics curriculum towards having a contextual rather than theoretical base. CONCLUSION This evaluation identified those aspects of the medical ethics course which contributed to its effectiveness and those which detracted from it. This information will be used to inform future development.
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Affiliation(s)
- J Goldie
- Department of General Practice, University of Glasgow, Glasgow, UK
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Abstract
Medical ethics education, it has been said, has 'come of age' in recent years in terms of its formal inclusion in undergraduate medical curricula. This review article examines the background to its inclusion in undergraduate curricula and goes on to examine the consensus that has arisen on the design of ethics curricula, using Harden's curriculum and S.P.I.C.E.S models as templates. While there is consensus on content for undergraduate medical ethics education, there is still significant debate on learning and teaching methods. Despite the broad agreement on the need to apply adult education principles to ethics teaching, there would appear to be some tension between balancing the need for experiential learning and achieving the 'core curriculum'. There are also as yet unresolved difficulties with regards to resources for delivery, academic expertise, curriculum integration and consolidation of learning. Assessment methods also remain contentious. Although there is consensus that the ultimate goal of medical ethics, and indeed of medical education as a whole, is to create 'good doctors', the influence of the 'hidden curriculum' on students' development is only beginning to be recognized, and strategies to counteract its effects are in their infancy. The need for proper evaluation studies is recognized. It is suggested that the areas of debate appearing in the literature could be used as a starting point for evaluation studies, which would form the empirical basis of future curriculum development.
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Affiliation(s)
- J Goldie
- Senior Clinical Tutor, Department of General Practice, University of Glasgow, 4 Lancaster Crescent, Glasgow G12 ORR, UK
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Gleave ME, Miayake H, Goldie J, Nelson C, Tolcher A. Targeting bcl-2 gene to delay androgen-independent progression and enhance chemosensitivity in prostate cancer using antisense bcl-2 oligodeoxynucleotides. Urology 1999; 54:36-46. [PMID: 10606283 DOI: 10.1016/s0090-4295(99)00453-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bcl-2 expression is upregulated in prostate cancer cells after androgen withdrawal and is associated with the development of androgen independence and chemoresistance. Induction of apoptotic cell death after androgen ablation, or chemotherapy, may be enhanced through functional inhibition of bcl-2. In this report, we tested the effects of antisense bcl-2 oligodeoxynucleotides (ODN) with androgen ablation and taxane therapy on time to androgen-independent (Al) progression in the androgen-dependent Shionogi tumor model. Treatment of Shionogi tumor cells in vitro with 500 nmol/L antisense bcl-2 ODN decreased bcl-2 mRNA by 85%, compared with treatment with 500 nmol/L mismatch control ODN. Although bcl-2 expression levels in Shionogi cells were not changed by docetaxel treatment, docetaxel treatment induced bcl-2 phosphorylation. Consequently, the formation of bcl-2/Bax heterodimer formation was inhibited in a dose-dependent manner. Treatment of Shionogi tumors in vitro with either 500 nmol/L antisense bcl-2 ODN or 10 nmol/L docetaxel alone did not induce apoptosis or reduce growth rates. However, combined treatment reduced the concentration that reduces cell viability by 50% (IC50) of docetaxel from 100 nmol/L to 10 nmol/L and induced characteristic apoptotic DNA laddering and cleavage of the poly(ADP-ribose)polymerase (PARP) protein. Adjuvant in vivo administration of antisense bcl-2 ODN and polymeric micellar paclitaxel after castration resulted in a significant delay in time to Al recurrence when compared with administration of either agent alone. Furthermore, combined treatment of mice bearing Al recurrent Shionogi tumors with antisense bcl-2 ODN and micellar paclitaxel synergistically induced tumor regression and growth inhibition when compared with treatment with either agent alone. These findings suggest that down-regulation of bcl-2 by antisense ODN chemosensitizes Al Shionogi tumors to taxanes, over and above the effects of taxane-induced phosphorylation of bcl-2. Antisense bcl-2 ODN combined with taxanes may be a novel approach to the treatment of both established and emerging Al disease.
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MESH Headings
- Androgens/metabolism
- Animals
- Antineoplastic Agents, Phytogenic/therapeutic use
- Blotting, Northern
- Blotting, Western
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Disease Progression
- Docetaxel
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Gene Targeting
- Genes, bcl-2/drug effects
- Genes, bcl-2/genetics
- Male
- Mice
- Oligodeoxyribonucleotides, Antisense/therapeutic use
- Paclitaxel/analogs & derivatives
- Paclitaxel/therapeutic use
- Prostatic Neoplasms/drug therapy
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
- Proto-Oncogene Proteins c-bcl-2/biosynthesis
- Proto-Oncogene Proteins c-bcl-2/genetics
- RNA, Messenger/metabolism
- Taxoids
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Affiliation(s)
- M E Gleave
- The Prostate Centre, Vancouver General Hospital, British Columbia, Canada
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Gleave M, Tolcher A, Miyake H, Nelson C, Brown B, Beraldi E, Goldie J. Progression to androgen independence is delayed by adjuvant treatment with antisense Bcl-2 oligodeoxynucleotides after castration in the LNCaP prostate tumor model. Clin Cancer Res 1999; 5:2891-8. [PMID: 10537358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Bcl-2 has emerged as a critical regulator of apoptosis in a variety of cell systems and is up-regulated during progression to androgen independence in prostate cancer cells. The objectives of this study were to characterize changes in Bcl-2 after androgen withdrawal and during progression to androgen independence in the human prostate LNCaP tumor model and determine whether adjuvant use of antisense Bcl-2 oligodeoxynucleotides (ODNs) with androgen ablation delays progression to androgen independence. Bcl-2 expression in LNCaP cells is down-regulated to undetectable levels by androgen in vitro and up-regulated after castration in vivo. Antisense Bcl-2 ODN treatment reduced LNCaP cell Bcl-2 messenger RNA and protein levels by >90% in a sequence-specific and dose-dependent manner at concentrations >50 nM. Bcl-2 mRNA levels returned to pretreatment levels by 48 h after discontinuing treatment. Athymic male mice bearing SQ LNCaP tumors were castrated and injected i.p. with 12.5 mg/kg/day with two-base mismatch ODN control, reverse polarity ODN control, or antisense Bcl-2 ODN. Tumor volume in control mice gradually increased 5-fold (range, 3-6) by 12 weeks after castration compared to a 10-50% decrease in precastrate tumor volume in mice treated with antisense Bcl-2 ODN. Changes in serum PSA paralleled changes in tumor volume, increasing 4-fold faster above nadir in controls than in mice treated with antisense Bcl-2 ODN. After decreasing 70% by 1 week after castration, PSA increased 1.6-fold above precastrate levels by 11 weeks in controls while staying 30% below precastrate levels in antisense-treated mice. In a second group of experiments, LNCaP tumor growth and serum PSA levels were 90% lower (P<0.01) in mice treated with antisense Bcl-2 ODN compared with mismatch or reverse polarity ODN controls. These results support the hypothesis that Bcl-2 helps mediate progression to androgen independence and is an appropriate target for antisense therapy.
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Affiliation(s)
- M Gleave
- Department of Cancer Endocrinology, British Columbia Cancer Agency, Vancouver, Canada
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De Jong G, Gelmon K, Bally M, Goldie J, Mayer L. Modulation of doxorubicin resistance in P388/ADR cells by Ro44-5912, a tiapamil derivative. Anticancer Res 1995; 15:911-6. [PMID: 7645981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe here investigations into the ability of a tiapamil derivative, Ro44-5912 to overcome multidrug resistance (MDR) in doxorubicin (ADR)-resistant murine leukemic P388 cells. This compound has the formula: C27H39NO4S2.1:2C6H8O6, a M. W. of 858 and is structurally similar to verapamil, an established inhibitor of P-glycoprotein (PGP). We have compared the MDR modulating properties of Ro44-5912 with verapamil in P388ADR cells. Doxorubicin concentration required to achieve 50% inhibition of growth (IC50) for P388ADR cells was found to be 24 microM. In contrast, treatment of P388ADR cells with Doxorubicin and 3 microM verapamil decreased the IC50 value to 2.5 microM. A further decrease was observed with 3 microM Ro44-5912 treatment, where an IC50 value of 1.1 microM was obtained. Doxorubicin accumulation was also determined by flow cytometry in order to determine whether the increased levels of chemosensitivity observed for Ro44-5912 were reflected by increased cellular drug uptake. The results revealed that Ro44-5912, at equivalent concentration, increased doxorubicin accumulation in P388ADR cells beyond that obtained with verapamil whereas no effects were seen with the parental P388 cells. The effect of Ro44-5912 on the binding of C219 monoclonal antibody to PGP in MDR cells was also studied and found not to decrease C219 expression on P388ADR cells.
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Affiliation(s)
- G De Jong
- Department of Medical Oncology Laboratory Operations, British Columbia Cancer Agency, Canada
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Jia WW, McDermott M, Goldie J, Cynader M, Tan J, Tufaro F. Selective destruction of gliomas in immunocompetent rats by thymidine kinase-defective herpes simplex virus type 1. J Natl Cancer Inst 1994; 86:1209-15. [PMID: 8040888 DOI: 10.1093/jnci/86.16.1209] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Thymidine kinase-deficient herpes simplex virus type 1 [tk(-) HSV-1] replicates well in dividing cells but not in nondividing cells such as neurons, suggesting a potential use in the treatment of brain tumors. PURPOSE We attempted to examine the efficacy of using tk(-) HSV-1 for treating brain tumors in immunocompetent animals. METHODS 9L glioma cells were cultured and subsequently implanted intracerebrally in immunocompetent, adult male Long-Evans rats. A thymidine kinase-defective HSV-1 virus, KOS-SB, was used to infect 9L cells in culture, and the viability of the infected cells was compared with that of mock-infected (i.e., uninfected) cells. We also injected the virus intratumorally and determined the mortality of the tumor-bearing animals. Tumor regression and viral spread following virus injection were examined by histologic and immunocytochemical assays. RESULTS In vitro, the tk(-) virus destroyed cultured 9L cell monolayers at multiplicities of infection of 0.1 and 1.0 within 48 hours. With the same quantity of virus, no remarkable difference in survival of neural cells was found. Foscarnet, an antiviral drug that acts independently of tk activity, blocked viral replication by greater than 99% at a concentration of 100 micrograms/mL. The mortality of animals bearing tumors declined with an increase in the amount of virus injected. Histologic examination showed that the HSV-1 treatment caused severe tumor regression. Immunocytochemistry using an anti-HSV-1 antibody revealed only a weak staining within the regressing tumors, and few immunopositive neurons were evident in the surrounding brain tissue. CONCLUSIONS The results indicate that tk(-) HSV-1 mutants can selectively and effectively destroy glioma cells both in vitro and in vivo in normal, immunocompetent animals. IMPLICATIONS Our failure to detect viral spread associated with regressing tumors suggests that some other cytopathic factors might be involved in the tumor regression. Regardless of the precise mode of tumor cell killing, HSV-1 may be useful for treating brain tumors.
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Affiliation(s)
- W W Jia
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada
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Souhami RL, Brodin O, Duchesne G, Goldie J, Green M, Kies M, Mattson K, Mulshine J, Saijo N, Saunders M. Second IASLC Workshop on Combined Radiotherapy and Chemotherapy Modalities in Lung Cancer. Biological basis of combined therapy. Lung Cancer 1994; 10 Suppl 1:S3-5. [PMID: 8087524 DOI: 10.1016/0169-5002(94)91659-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Veldhuyzen van Zanten SJ, Tytgat KM, Pollak PT, Goldie J, Goodacre RL, Riddell RH, Hunt RH. Can severity of symptoms be used as an outcome measure in trials of non-ulcer dyspepsia and Helicobacter pylori associated gastritis? J Clin Epidemiol 1993; 46:273-9. [PMID: 8455052 DOI: 10.1016/0895-4356(93)90075-c] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Most trials of non-ulcer dyspepsia (NUD) and Helicobacter pylori associated gastritis (HPAG) have not used validated methods of measuring symptoms. Three attributes are necessary for use of symptom severity scoring systems as outcome measures in clinical trials: reproducibility, responsiveness to change and validity compared to corroborating measures. The objective of this study was to establish that selected gastrointestinal symptoms recorded as a series of 5-point Likert Scales meet the 3 criteria for use as outcome measures in clinical trials. Patients with NUD (Helicobacter pylori-negative) and HPAG were studied. A preliminary assessment of 24 patients was used to select the 8 most frequently occurring and most severe symptoms. These symptoms were then scored in a further 55 patients to assess their utility as outcome measures. Observations were made at 3 time points, enrollment (T1), after 1 week with no intervention (T2) and after 4 weeks of therapy for either disease (T3). The study took place in a university hospital outpatient gastroenterology service. Symptom scores were reproducible before treatment (symptom scores at T1 and T2 were correlated), responsive (symptom scores changed after treatment between T2 and T3) and valid (symptom score changes corresponded to changes in general health status). Scoring of gastrointestinal symptom severity using 5-point Likert Scales satisfies the 3 criteria for use as outcome measures in clinical trials of NUD and HPAG.
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Affiliation(s)
- S J Veldhuyzen van Zanten
- Department of Anatomic Pathology, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
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van Zanten SJ, Goldie J, Hollingsworth J, Silletti C, Richardson H, Hunt RH. Secretion of intravenously administered antibiotics in gastric juice: implications for management of Helicobacter pylori. J Clin Pathol 1992; 45:225-7. [PMID: 1556230 PMCID: PMC495478 DOI: 10.1136/jcp.45.3.225] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To study whether differences in eradication rates of antibiotics may be explained by differences in secretion of antibiotics in gastric juice. METHODS A single intravenous dose of either ampicillin 500 mg, erythromycin 500 mg, or metronidazole 500 mg was administered to four healthy Helicobacter pylori negative volunteers on different days. Antibiotic concentrations were measured in gastric juice before and every 10 minutes after administration of the drug for two hours and after one hour in serum. RESULTS No ampicillin was detected in gastric juice. Erythromycin concentrations in gastric juice showed considerable individual variation and reached maximum concentrations of 2.2-4.8 mcg/ml between 30 and 80 minutes after dosing. Metronidazole concentrations in gastric juice showed much less individual variation and maximum concentrations of 5-6 mcg/ml were reached within 30 minutes and remained high during the study period. CONCLUSION Metronidazole and erythromycin are secreted across the gastric mucosa, but ampicillin is not.
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Affiliation(s)
- S J van Zanten
- Department of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
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Goldie J, Veldhuyzen van Zanten SJ, Jalali S, Richardson H, Hunt RH. Inhibition of urease activity but not growth of Helicobacter pylori by acetohydroxamic acid. J Clin Pathol 1991; 44:695-7. [PMID: 1890207 PMCID: PMC496771 DOI: 10.1136/jcp.44.8.695] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The in vitro effects of acetohydroxamic acid (AHA), a potent urease inhibitor, were studied to determine the effect on the urease activity and growth of 38 strains of Helicobacter pylori. AHA in concentrations of 50-1000 mg/l had a noticeably reversible inhibitory effect on the urease activity of the organism but no effect on growth.
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Affiliation(s)
- J Goldie
- Department of Laboratory Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Veldhuyzen van Zanten SJ, Tytgat KM, Hollingsworth J, Jalali S, Rshid FA, Bowen BM, Goldie J, Goodacre RL, Riddell RH, Hunt RH. 14C-urea breath test for the detection of Helicobacter pylori. Am J Gastroenterol 1990; 85:399-403. [PMID: 2327381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The high urease activity of Helicobacter pylori can be used to detect this bacterium by noninvasive breath tests. We have developed a 14C-urea breath test which uses 5 microCi 14C with 50 mg nonradioactive urea. Breath samples are collected at baseline and every 30 min for 2 h. Our study compared the outcome of the breath test to the results of histology and culture of endoscopically obtained gastric biopsies in 84 patients. The breath test discriminated well between the 50 positive patients and the 34 patients negative for Helicobacter pylori: the calculated sensitivity was 100%, specificity 88%, positive predictive value 93%, and negative predictive value 100%. Treatment with bismuth subsalicylate and/or ampicillin resulted in lower counts of exhaled 14CO2 which correlated with histological improvement in gastritis. The 14C-urea breath test is a better "gold standard" for the detection of Helicobacter pylori than histology and/or culture.
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Goldie J, Veldhuyzen van Zanten SJ, Jalali S, Hollingsworth J, Riddell RH, Richardson H, Hunt RH. Optimization of a medium for the rapid urease test for detection of Campylobacter pylori in gastric antral biopsies. J Clin Microbiol 1989; 27:2080-2. [PMID: 2778071 PMCID: PMC267742 DOI: 10.1128/jcm.27.9.2080-2082.1989] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We developed a buffered azide-free urea medium which is sensitive, specific, and nontoxic for rapid detection of Campylobacter pylori in gastric biopsies. Detection of urease produced by the organism provides the basis for the test. The substrate is urea in monobasic sodium phosphate buffer, and phenol red provides indication of the pH change that results from urease activity. A rapid change from yellow to red occurs in the presence of C. pylori, even at low concentrations of the organism. A slower color change occurs with higher concentrations of other urease producers, such as Yersinia enterocolitica and Proteus mirabilis. Experience with 51 patients with our medium showed excellent results in detection of C. pylori in gastric mucosal biopsies. In clinical research and practice, a rapid bedside test will be helpful for rapid diagnosis of C. pylori-positive patients.
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Affiliation(s)
- J Goldie
- Department of Laboratory Medicine and Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Goldie J, Riddell RH, Veldhuyzen van Zanten SJ, Jalali S, Richardson H, Hunt RH. Media for the culture of Campylobacter pylori. Am J Gastroenterol 1989; 84:79. [PMID: 2643300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Veldhuyzen van Zanten SJ, Goldie J, Riddell RH, Hunt RH. Campylobacter pylori infection. Ann Intern Med 1988; 109:925-6. [PMID: 3190047 DOI: 10.7326/0003-4819-109-11-925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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McGuire WL, Goldie J, Hryniuk W, Tormey DC. Drug dosage intensity--a panel discussion. Breast Cancer Res Treat 1987; 9:87-100. [PMID: 3620720 DOI: 10.1007/bf01807361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There is now widespread interest in the subject of drug dose intensity in cancer treatment. Recent retrospective analyses have shown a clear-cut benefit for those patients receiving either the intended drug dosage in a particular regimen or the highest dosage achievable through an escalation scheme. In this discussion, the participating physicians will review dose intensity in light of these retrospective studies, highlighting the particular tumor types in which benefits have been demonstrated. Other important issues will be discussed, such as scheduling of drug combinations and the importance of using toxicity as a biologic response monitor of drug efficacy. The panelists will also provide opinions as to the best design for a prospective clinical trial to test dose intensity.
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Murray N, Shah A, Brown E, Kostashuk E, Laukkanen E, Goldie J, Band P, Van den Hoek J, Murphy K, Sparling T. Alternating chemotherapy and thoracic radiotherapy with concurrent cisplatin-etoposide for limited-stage small-cell carcinoma of the lung. Semin Oncol 1986; 13:24-30. [PMID: 3020695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Seventy patients with limited-stage small-cell lung cancer (SCLC) were given six courses of chemotherapy alternating two drug combinations: a combination of cyclophosphamide, doxorubicin (Adriamycin [Adria Laboratories, Columbus OH]) and vincristine (CAV) was alternated with cisplatin and etoposide at 3-week intervals. Thoracic radiotherapy was administered concurrently with the first cisplatin-etoposide chemotherapy. Prophylactic cranial irradiation (PCI) was administered after the completion of all chemotherapy. No maintenance treatment was used. Seventy-six percent of patients achieved a complete clinical response. The median survival was 78 weeks and the 2-year survival rate was 32% with an average follow-up of 3 1/2 years. Seventeen percent are currently alive and disease free. Cisplatin and etoposide can be administered concurrently with thoracic irradiation with acceptable toxicity. Our results justify further clinical research using alternating chemotherapy and concurrent thoracic irradiation and cisplatin-etoposide chemotherapy.
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Graubner M, Klimo P, Connors J, Goldie J. Intensive chemotherapy for aggressive lymphomas —Clinical implications of the Goldie-Coldman hypothesis. J Cancer Res Clin Oncol 1986. [DOI: 10.1007/bf02580188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Murray N, Shah A, Wilson K, Goldie J, Voss N, Fryer C, Klimo P, Coy P, Hadzic E, Gudauskas G. Cyclic alternating chemotherapy for small cell carcinoma of the lung. Cancer Treat Rep 1985; 69:1241-2. [PMID: 3004724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eighty-two previously untreated patients with small cell cancer of the lung were treated with six cycles of two alternating drug regimens: a new combination of mitomycin, methotrexate, and etoposide; and cyclophosphamide, doxorubicin, and vincristine. No maintenance chemotherapy was used. Consolidative thoracic irradiation and prophylactic cranial irradiation were employed. The median survival time for 32 limited-disease patients was 59 weeks, and for 50 extensive-disease patients was 35 weeks. Four-year survival was 12% for limited-disease patients and 2% for extensive-disease patients. These results were not superior to conventional combination chemotherapy regimens.
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Abstract
Despite recent developments in the treatment of breast cancer, metastatic breast cancer remains an incurable disease. Postoperative adjuvant treatment may improve the survival of a subgroup of node positive, Stage II breast cancer patients, but the proportion of failures is still high. Preoperative adjuvant chemotherapy, an example of a new approach in scheduling of available agents, is based on sound theoretical and experimental principles. In this report, the authors summarize the background data on the rationale for preoperative adjuvant chemotherapy and present preliminary results of this study in which preoperative treatment starting with one course of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) was given to newly diagnosed patients with breast cancer. Analysis of the first 43 patients given such treatment has shown that the side effects were comparable to those seen in patients treated with conventional postoperative chemotherapy, and that the delay time between diagnosis and starting chemotherapy has been substantially reduced compared to the historic group of patients. Additional aspects of this study include the introduction of fine-needle aspiration as the only diagnostic method for obtaining the tissue diagnosis of breast cancer, as well as a more intensive interaction between the surgeons from private practice and the oncology institute.
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Shah A, MacDonald W, Goldie J, Gudauskas G, Brisebois B. 5-FU infusion in advanced colorectal cancer: a comparison of three dose schedules. Cancer Treat Rep 1985; 69:739-42. [PMID: 4016784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ninety-four patients with advanced colorectal adenocarcinoma were treated by continuous iv 5-FU infusion on three different dose schedules. Thirty-three patients received a 72-hour infusion of 5-FU (30 mg/kg/24 hours) every 3 weeks (Group A); 31 received a 72-hour infusion of 5-FU (30 mg/kg/24 hours) every 2 weeks (Group B); and 30 received a 48-hour infusion of 5-FU (30 mg/kg/24 hours) every week (Group C). Although this was a sequential nonrandomized study of the dose schedules, the groups were comparable with respect to various prognostic factors. Response rates were as follows: Group A--three patients had minor response (9%) and 30 had no response (91%); Group B--five patients achieved partial response (16%), nine had minor response (29%), and 17 had no response (55%), and Group C--one patient achieved complete response (3%), eight achieved partial response (27%), five had minor response (17%), and 16 had no response (53%). The median survival time for Group A was 9 months, for Group B was 9.5 months, and for Group C was 14 months. Intensifying the dose schedule of 5-FU by increasing the frequency of administration has significantly improved response rates. A prolongation of the median survival time of patients treated with a 48-hour infusion at 1-week intervals was noted, although this was not statistically significant.
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Goldie J. Letter: Maternity fee. Br Med J 1975; 1:518. [PMID: 1125616 PMCID: PMC1672539 DOI: 10.1136/bmj.1.5956.518-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Goldie J. Increase in N.I. Payment for Self-employed. West J Med 1974. [DOI: 10.1136/bmj.4.5937.169-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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