CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Hypertension guidelines from different organizations often specify different treatment thresholds, and none explicitly state how these thresholds were chosen. This study was undertaken to determine the treatment thresholds of family physicians and hypertensive patients for mild, uncomplicated essential hypertension. A subject's treatment threshold can be determined by eliciting the minimum reduction in cardiovascular risk that he or she feels outweighs the inconvenience, costs and side effects of antihypertensive therapy (the minimal clinically important difference [MCID]). ⋯ Guidelines that set treatment thresholds on the basis of physician or expert opinion may not accurately reflect the preferences of hypertensive patients. There is a need for patient decision aids and attention to patient preferences when initiation of antihypertensive therapy is considered for the prevention of cardiovascular disease. Further research is needed to define treatment thresholds for other chronic conditions and in other groups.
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Globally the proportion of tuberculosis cases caused by drug-resistant strains is increasing. Interruptions in the drug supply, improper drug prescription and nonadherence to treatment protocols promote drug resistance through mechanisms that are now well understood. The treatment of tuberculosis must take into account the possibility of drug resistance and include at least 2 drugs, preferably 3, to which the isolate is proven or anticipated to be susceptible.
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An increasing number of admissions of patients requiring complex and acute care coupled with a decreasing number of pediatric postgraduate trainees has caused a shortage of house staff available to provide after-hours on-call coverage in the Department of Pediatrics at Toronto's Hospital for Sick Children. The Clinical Assistant program created to deal with this problem was short on staff, did not provide adequate continuity of care and was becoming increasingly unaffordable. The Clinical Departmental Fellowship program was created to address the problem of after-hours clinical coverage. ⋯ We describe the hiring process, job description and evolution of the program since its inception in 1996. This program has been mutually advantageous for the individual fellows and their sponsoring divisions as well as the Department of Pediatrics and the Hospital for Sick Children. We recommend the introduction of similar programs to other academic medical departments facing staff shortages.