Assessment of significant variables to improve admission and teaching learning processes in a medical school.

Introduction: Current selection methods in medical schools emphasize academic competence only, somewhat to the detriment of other essential competencies. Academic grades are frequently considered as the predictors of good academic performance in medical schools and therefore many medical schools still select applicants predominantly on this basis. Objective: To assess this long-standing trend in order to point out the lacunae associated with it and to explore this effect with a view to improve teaching and learning process. Methodology: During this retrospective longitudinal study, we studied the students (n=539) admitted to the college of medicine, King Khalid University, Saudi Arabia, between 2006 and 2011. During these years study conditions (i.e. admission procedure, study program and assessment) remained unchanged. The scores of higher school certificate (HSC) were correlated with study duration (number of semesters) and grade point average (GPA). Pearson’s correlation and regression analysis were carried out using effect model. Results: The results of this study do not demonstrate a correlation between HSC scores and study duration (r = -.018). The relationship bet ween HSC scores and cumulative GPA was moderate positive (r = .476). The HSC scores were found to be poor predictors of the subsequent academic performance (R2 = .273). Conclusions: The HSC score is a poor predictor of the subsequent academic performance. Our intuition, and perhaps our experience, suggests that study time should be positively associated with grades. However, it is not always the case as study duration-grade association may not be true.   Keywords: School admission criteria, Medical education, Students, Undergraduate

A short-term study of the safety pharmacokinetics and efficacy of ritonavir, an inhibitor of HIV-1 protease

Background: Reverse-transcriptase inhibitors have only moderate clinical efficacy against the human immunodeficiency virus type 1 (HIV-1). Ritonavir is an inhibitor of HIV-1 protease with potent in vitro anti-HIV properties and good oral bioavailability. Methods: We evaluated the antiviral activity and safety of ritonavir in a double-blind, randomized, placebo-controlled phase 1 and 2 study of 84 HIV-positive patients with 50 or more CD4+ lymphocytes per cubic millimeter. The patients were randomly assigned to one of four regimens of ritonavir therapy, or to placebo for four weeks and then (by random assignment) to one of the ritonavir regimens. Results: During the first 4 weeks, increases in CD4+ lymphocyte counts and reductions in the log number of copies of HIV-1 RNA per milliliter of plasma were similar among the four dosage groups, but in the three lower-dosage groups there was a return to base-line levels by 16 weeks. After 32 weeks, in the seven patients in the highest-dosage group (600 mg of ritonavir every 12 hours), the median increase from base line in the CD4+ lymphocyte count was 230 cells per cubic millimeter, and the mean decrease in the plasma concentration of HIV-1 RNA (as measured by a branched-chain DNA assay) was 0.81 log (95 percent confidence interval, 0.40 to 1.22). In a subgroup of 17 patients in the two higher-dosage groups, RNA was also measured with an assay based on the polymerase chain reaction, and after eight weeks of treatment there was a mean maximal decrease in viral RNA of 1.94 log (95 percent confidence interval, 1.37 to 2.51). Adverse events included nausea, circumoral paresthesia, elevated hepatic aminotransferase levels, and elevated triglyceride levels. Ten withdrawals from the study were judged to be related to ritonavir treatment. Conclusions: In this short-term study, ritonavir was well tolerated and had potent activity against HIV-1, but its clinical benefits remain to be established

Trends in hospital resource utilization by HIV-infected persons, January 1987-June 1990

Trends in the utilization of various hospital resources by HIV-infected persons between January 1987 and June 1990 have been studied to support health care planning. Data on 126 asymptomatic and symptomatic HIV-infected persons have been recorded at a patient level and analyzed at half-yearly intervals. At a hospital level, increasing utilization trends were observed. At the patient level, a decreasing utilization intensity was measured for admissions, inpatient days, inpatient diagnostic examinations, and outpatient consultations. Increasing utilization intensity was measured for care during admissions. A constant utilization intensity was observed for outpatient diagnostic examinations and inpatient medication days. Use of interventions tended to increase at the end of the study period. Discriminating between trends in the utilization of different hospital resources can improve the management of hospital health care demands of HIV-infected people

Lifetime hospitalization profiles for symptomatic, HIV-infected persons

We explored the relationship between the incidence of hospitalization and disease progression in a group of 140 symptomatic, HIV infected patients by linking hospitalizations to the time of diagnosis, the time of death, or both. The relationship could best be described by positively skewed U-patterns or (weak) J-patterns with a high use of resources immediately following diagnosis and preceding death. The lifetime hospitalization profiles differed according to the type of insurance age, the initial diagnosis in the CDC-IV stage and the length of survival. The results not only confirm general hypotheses posed by other research groups, but also demonstrate the-existence of variations among subgroups of patients. The results can be used to improve economic assessments of the impact of AIDS in The Netherlands and the European Union. The method used has the advantage of being based on a bottom-up approach to resource utilization, involving the use of prospective data for the patients' full lifespans, and can easily be applied to other areas of health services research

Hospital cost for patients with HIV infection in a University Hospital in The Netherlands

Procise data on the utilization of health care facilities by HIV Infected patients are generally not available. Nor are there data on the related cost, effectiveness and officiency of the treatment provided. This is due mainly to the lack of a suitable method for recording demographic, medical and financial data on individual patients In hospitals. For this reason we have been developing a system of data collection, which provides a detailed cost record of each patient. The application of this system for 52 patients with HIV infection treated in a university hospital over a two-year period showed that for a patient with AIDS the mean cost of inpatient and outpatient hospital services was $19,507 per person-year. For patients with HIV infections other than AIDS the mean costs ranged from$1,769 for CDC III patients to $2,064 for CDC II patients (expressed In 1987 US dollars). Continued operation of the registration system will make It possible to analyze the causal background of costs as well as the cost-effectiveness of the treatment

A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of hiv-1 protease

Reverse-transcriptase inhibitors have only moderate clinical efficacy against the human immunodeficiency virus type 1 (HIV-1). Ritonavir is an inhibitor of HIV-1 protease with potent in vitro anti-HIV properties and good oral bioavailability. We evaluated the antiviral activity and safety of ritonavir in a double-blind, randomized, placebo-controlled phase 1 and 2 study of 84 HIV-positive patients with 50 or more CD4+ lymphocytes per cubic millimeter. The patients were randomly assigned to one of four regimens of ritonavir therapy, or to placebo for four weeks and then (by random assignment) to one of the ritonavir regimens. During the first 4 weeks, increases in CD4+ lymphocyte counts and reductions in the log number of copies of HIV-1 RNA per milliliter of plasma were similar among the four dosage groups, but in the three lower-dosage groups there was a return to base-line levels by 16 weeks. After 32 weeks, in the seven patients in the highest-dosage group (600 mg of ritonavir every 12 hours), the median increase from base line in the CD4+ lymphocyte count was 230 cells per cubic millimeter, and the mean decrease in the plasma concentration of HIV-1 RNA (as measured by a branched-chain DNA assay) was 0.81 log (95 percent confidence interval, 0.40 to 1.22). In a subgroup of 17 patients in the two higher-dosage groups, RNA was also measured with an assay based on the polymerase chain reaction, and after eight weeks of treatment there was a mean maximal decrease in viral RNA of 1.94 log (95 percent confidence interval, 1.37 to 2.51). Adverse events included nausea, circumoral paresthesia, elevated hepatic aminotransferase levels, and elevated triglyceride levels. Ten withdrawals from the study were judged to be related to ritonavir treatment. In this short-term study, ritonavir was well tolerated and had potent activity against HIV-1, but its clinical benefits remain to be established