A national panel on medical education was appointed as a component of the AAMC's Mission-based Management Program and charged with developing a metrics system for measuring medical school faculty effort and contributions to a school's education mission. The panel first defined important variables to be considered in creating such a system: the education programs in which medical school faculty participate; the categories of education work that may be performed in each program (teaching, development of education products, administration and service, and scholarship in education); and the array of specific education activities that faculty could perform in each of these work areas. The panel based the system on a relative value scale, since this approach does not equate faculty performance solely to the time expended by a faculty member in pursuit of a specific activity. Also, a four-step process to create relative value units (RVUs) for education activities was developed. This process incorporates quantitative and qualitative measures of faculty activity and also can measure and value the distribution of faculty effort relative to a school's education mission. When adapted to the education mission and culture of an individual school, the proposed metrics system can provide critical information that will assist the school's leadership in evaluating and rewarding faculty performance in education and will support a mission-based management strategy in the school.

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Studies were performed in anesthetized dogs to evaluate the cardiac and systemic effects of intravenously administered dobutamine and to determine its direct effects on the renal and femoral vascular beds. The results demonstrated that dobutamine possessed an inotropic efficacy similar to that of isoproterenol and norepinephrine; its chronotropic effect was similar to or greater than that of norepinephrine. In contrast to norepinephrine, dobutamine increased cardiac output and reduced total peripheral resistance with minimal effects on mean aortic pressure. Studies on the denervated hind limb demonstrated that dobutamine stimulated both alpha and beta receptors. The dose of dobutamine which produced a 50% increase in femoral blood flow was 180 times the required dose of isoproterenol and the dose which produced a 50% increase in contractile force was 43 times the required dose of isoproterenol. Studies on the renal vasculature demonstrated that dobutamine caused no dopaminelike renal vasodilator activity and only minor vasodilation mediated by beta receptors. We concluded that dobutamine is more cardioselective than is isoproterenol. The dobutamine-induced decrease in peripheral resistance observed in the whole dog was presumably due to increased myocardial contractility coupled with a greater net effect of beta-adrenergic vasodilation than alpha-adrenergic vasoconstriction. Studies with reserpine-treated dogs showed that all dobutamine-induced effects were due to a direct action on receptors.

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SUMMARYThe effect of chronic protein-calorie undernutrition (PCU) on cardiac structure, biochemistry, myocardial function, and left ventricular dynamics was studied in young, male, Long-Evans rats. Chronic PCU produced marked cachexia of the marasmic type (body weight decreased to 48% of normally nourished control rats) and cardiac atrophy (heart weight at 57% of control). Myocardial structure on light microscopy was normal and myocardial edema (dry/wet weight) was not present. An increased left ventricular DNA content (1.82 + 0.67 BE VS. 1.25 ± 0.58 pg/mg tissue wet weight) and collagen content (70.61 ± 4.54 vs. 31.72 ± 2.44 pg/mg, P< 0.001) in the presence of normal concentrations of RNA and actomyosin suggested a decrease in myofiber size with normal contractile proteins and protein synthesis. Resting length-tension curves for left ventricular papillary muscles failed to demonstrate alterations in myocardial stiffness with PCU. Active length-tension curves demonstrated enhanced myocardial contractility in chronic PCU hearts: peak developed isometric tension at U , was 4.84 ± 0.21 vs. 3.24 ± 0.31 g/mm*, P < 0.01. The in situ heart preparation in anesthetized PCU rats demonstrated bradycardia, hypotension, and a depressed cardiac output when compared to control hearts. However, cardiac output adjusted for body weight was normal (0.048 ± 0.005 vs. 0.044 ± 0.002 ml/min per g), and ventricular function curves, using stroke work index, showed a normal cardiac reserve in PCU rats. We conclude that uncomplicated chronic PCU is accompanied by cardiac atrophy, normal or enhanced myocardial contractility, and left ventricular function that has adjusted to the decrease in body mass and metabolic requirements. Ore Res 45:144-162, 1979

SUMMARY We evaluated the ability of ST-segment analysis during submaximal exercise tolerance testing (85% predicted age-adjusted heart rate) to diagnose the presence of significant coronary artery stenosis (2 75% cross sectional area narrowing) in a group of 85 men and 92 women with chest pain syndromes and no previously documented myocardial infarctions. Disease prevalence by selective coronary angiography was 36% for men and 33% for women (NS). Predictive value of a positive exercise test (PV(+ET)) as defined by 1 mm ST-segment depression 0.08 second after the J point was significantly higher for men than for women (77% vs 47%, p < 0.05). Predictive value of a negative test (PV(-ET)) was not significantly different for men (81%) and women (78%). Analysis of the 66 men and 66 women not taking digitalis preparations again showed that PV(+ET) was significantly higher for men than for women (90% vs 45%, p < 0.01).Multivariate analysis showed that patients with angiographically significant coronary disease had significantly lower attained heart rates and shorter exercise duration than those without significant stenosis, independent of ST-segment responses. A discriminant function using ST-segment response, attained heart rate and a sex-dependent ST-segment response factor was developed. Duration of exercise was not an independent predictor by our analysis. This function improved the PV(+ET) and PV(-ET) for the total group and for the women; for men, the PV(-ET) improved, while the PV(+ET) fell slightly. This function has not yet been used prospectively.In patients with chest pain and no previously documented myocardial infarction, men have a significantly higher PV( + ET) than women, which cannot be accounted for simply by a difference in disease prevalence (i.e., Bayes' theorem).EXERCISE TESTING has been a commonly used tool for the evaluation of cardiac status for over 20 years. Despite its extensive use as a screening test for asymptomatic patients, a diagnostic test for patients with symptoms of ischemic heart disease, and as a functional test for patients with known cardiac disease, the usefulness, accuracy, and even basic methods for interpretation of the test remain controversial.Proper use of any test involves definition of the patient populations in which the diagnostic yield will be greatest. The use of exercise testing for diagnosis of coronary atherosclerotic heart disease in women with chest pain has also been controversial. Some authors '-5 Hospital from 1971-1977 were reviewed, and all patients evaluated for chest pain who had both coronary angiography and acceptable exercise tests within 6 months were identified. Patients with valvular heart disease, including mitral valve prolapse, congenital heart disease, idiopathic hypertrophic subaortic stenosis, left bundle branch block on the ECG, a history of chest surgery, or a previously documented myocardial infarction were excluded from the study. The diagnosis of a previous myocardial infarction was based on the finding of at least two of the followin...

To characterize an unusual, sex-linked recessive neuromuscular disease, we studied two families with 37 males who had involvement of distal leg and proximal arm muscle groups. Electromyography and muscle biopsy in five subjects showed features of both neuropathy and myopathy. Bradycardia and syncope in 15 involved subjects were associated with early death (before the age of 50 years). Electrocardiograms in 15 others showed a spectrum of atrial abnormalities that ranged from abnormal P waves to permanent atrial paralysis and from first-degree atrioventricular block to complete heart block. No patient exhibited clinical muscle disease without electrocardiographic atrial disease. Dilated, hypertrophied left ventricles with normal indexes of function were found in three cases with permanent atrial paralysis and chronic junctional bradycardia. Cardiomegaly and cardiac failure were not present in the other cases. We conclude that permanent ventricular pacing (instituted four patients) is indicated in many of these patients to prevent serious sequelae.