ABSTRACT
Pilocarpine hydrochloride suspended in a candy-like pastille was evaluated as a topical treatment for radiation-induced xerostomia in head and neck cancer patients. This local delivery system, which differs from systemically administered pilocarpine preparations, was developed to hopefully maximize the local response and minimize the systemic side effects. A prospective, randomized, double-blind, placebo-controlled trial was undertaken to determine objective and subjective efficacy in reversing the decrease in salivation. Forty previously irradiated patients received increasingly higher pilocarpine dosages in pastilles for 5 successive weeks. At each successive dose of pilocarpine, no significant increased salivation was noted. However, 25 (74%) of 34 patients reported that pilocarpine alleviated their subjective xerostomia. Topical pilocarpine administration has shown similar results to previous systemic delivery methods for radiation-induced xerostomia, but with improved patient tolerance.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Muscarinic Agonists/administration & dosage , Parasympathomimetics/administration & dosage , Pilocarpine/administration & dosage , Radiotherapy/adverse effects , Xerostomia/drug therapy , Administration, Oral , Adolescent , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Muscarinic Agonists/adverse effects , Parasympathomimetics/adverse effects , Pilocarpine/adverse effects , Placebos , Prospective Studies , Radiotherapy Dosage , Salivation , Time Factors , Xerostomia/etiologyABSTRACT
Postgraduate medical education underwent substantial change during the 1970s: medical-school classes grew, the internship year was eliminated, and the numbers of M.D.s entering primary-care specialties increased. The purpose of this study is to develop a planning model of graduate medical education that can project the impact of these and other changes on the numbers and specialty mix of physicians completing training. The model is applied to an analysis of trends in graduate medical education and to the probable consequences of policy recommendations made by the Graduate Medical Education National Advisory Committee (GMENAC). The results show that the trend toward increasing percentages of M.D.s entering primary-care specialties from 1970 to 1976 changes to no increase from 1976 to 1980. Thus, the GMENAC policy recommendation to increase primary care further is not likely to occur spontaneously in the near future.
