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Chlorotic and necrotic lesions typical of powdery mildew caused by L. taurica were observed in several tomato (Lycopersicon esculentum) and pepper (Capsicum annuum) fields in Santa Cruz State, Bolivia near the town of Mairana during September 2004. The tomato cultivars affected were Santa Clara, Superman, and Cool 45. Symptoms included bright yellow chlorotic lesions or brown necrotic lesions on different age leaves. Examination of samples collected from several fields revealed sporulation of L. taurica on abaxial leaf surfaces. The fungus had branched conidiophores, a tapered or pyriform apical conidium, with other conidia being more cylindrical (1,2). Conidial size was approximately 60 × 18 μm. Only the Oidiopsis stage was observed. Disease severity was high and caused a significant amount of leaf necrosis and partial defoliation on tomato. Only sporadic lesions were observed on pepper cv. YoloWonder and no significant foliar damage was observed. The growing region receives approximately 75 mm of rainfall annually with most of the rainfall occurring between October and April. Thus, powdery mildew was observed near the end of the normal 5-month dry season. It is likely that the disease has been in the region for some time based on observations from field personnel. Although reported from several other South American countries, to our knowledge, this is the first report of this disease in Bolivia. References: (1) H. J. Boesewinkel. Bot. Rev. 46:167, 1980; (2) J. C. Correll et al. Plant Dis. 71:248, 1987.

Objective: To compare the current status of faculty development practices in Canadian medical schools with the status of such practices in 1986., Design: Mail survey., Setting: All 16 Canadian medical schools., Participants: Faculty development coordinators at the medical schools., Outcome Measures: Existence of faculty development committees, funding for faculty development activities, types of activities and recognition of faculty participation in such activities., Results: Completed responses were received from all schools. They indicated a significant, positive evolution in faculty development since the previous survey, conducted in 1986. Most schools have established a faculty development committee and provide funds for such activities as workshops, sabbatical leaves and conference attendance. Although traditional development practices are prevalent, there is now widespread emphasis on computer technology, information retrieval, management skills and research. Experienced faculty and other experts are more widely used for consultation on teaching. Very little has been done to evaluate the impact of faculty development., Conclusion: Faculty development in Canadian medical schools has undergone a major, positive transition during the last 10 years.

Objective: To develop a consensus-based list of inappropriate practices in prescribing for elderly people., Design: Mail survey of a 32-member national panel., Setting: Academic medical centres across Canada., Participants: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists., Outcome Measures: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy., Results: The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies., Conclusion: The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.

Objectives: To determine (a) whether the risk of a potentially inappropriate drug combination (PIDC) increases with the number of physicians involved in the medical management of an elderly patient and (b) whether the risk of a PIDC is reduced if a patient has a single primary care physician or a single dispensing pharmacy, or both., Design: Cross-sectional retrospective provincial database study., Participants: A regionally stratified random sample of 51,587 elderly medicare registrants in Quebec who (a) visited at least one physician in 1990, (b) were not living in a health care institution for the entire year and (c) had been dispensed at least one prescription for a cardiovascular drug, a psychotropic drug or a nonsteroidal anti-inflammatory drug (NSAID)., Outcome Measures: Information on all physician visits and drugs dispensed during 1990. Physician claims were used to identify the number of physicians involved in a patient's management and whether the patient had one primary care physician. Prescription claims were used to identify the number of PIDCs, prescribing physicians and dispensing pharmacies., Results: The prevalence of PIDCs ranged from 4.0% (among those in the NSAID group) to 20.3% (among those in the psychotropic drug group). Of the PIDCs identified, 17.6% to 25.8% resulted from contemporaneous prescribing by different physicians. The number of prescribing physicians was the most important risk factor for a PIDC in all drug groups (odds ratio [OR] 1.44 to 1.71). The presence of a single primary care physician lowered the risk for cardiovascular and psychotropic PIDCs (OR 0.70 and 0.79 respectively) but not for NSAID PIDCs (OR 0.94). The use of a single dispensing pharmacy lowered the risk of a PIDC in all drug groups (OR 0.68 to 0.79)., Conclusion: The greater the number of physicians prescribing medications for an elderly patient, the greater is the risk that the patient will receive a PIDC. A single primary care physician and a single dispensing pharmacy may be "protective" factors in preventing PIDCs.

Objective: To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs)., Design: Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Régie de l'assurance-maladie du Québec., Setting: Quebec., Participants: Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year., Main Outcome Measure: Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people., Results: Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs., Conclusion: The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and avoidable risk factor for drug-related illness in elderly people.

Objective: To determine the status of ambulatory care training of core internal medicine residents in Canada., Design: Mail survey., Participants: All 16 program directors of internal medicine residency training programs in Canada., Outcome Measures: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors., Results: All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails., Conclusions: Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs.

Grand rounds have long been the principal educational activity of departments of medicine at teaching hospitals. Several recent articles have suggested that there has been a general deterioration in the quality of grand rounds. To evaluate their status in Canada we mailed a questionnaire to the chairmen of the departments of medicine at the 53 Canadian teaching hospitals; of the 48 responses received (91%), 38 were from chairmen, 5 were from senior department members, and 5 were from chief residents. The results indicated that grand rounds continued to be the principal teaching exercise of the departments. Of the respondents 98% felt that the quality had improved or stayed the same. The overall attendance was considered to have improved or remained unchanged for the past decade by 75%; 25% thought that it had declined. The diminished emphasis on patient-related topics concerned 10%. The respondents gave numerous suggestions, which should help organizers to improve the impact of grand rounds on learning.

The use of a Q-switched pulsed Ruby laser was studied in removing tattoos. The results were very satisfactory, but there are several major disadvantages which at present would probably preclude the use of this therapy on a routine basis.

In a fatal case of self-poisoning with lithium carbonate there was a progressive increase in serum lithium concentration for 48 hours after ingestion of the overdose. It is suggested that the continuous increase in serum lithium concentration reflects prolonged absorption of lithium from relatively insoluble aggregates of lithium carbonate in the gastrointestinal tract. In this case there was an interval of 45 hours between ingestion of the overdose and the onset of central nervous system depression. Simultaneous peritoneal dialysis and hemodialysis were effective in rapidly reducing the serum lithium concentration but there was little concomitant change in the patient's level of consciousness. The terminal event was a respiratory complication of the comatose state.

The interassessor reliability of faculty assessments was evaluated in a study aimed at enhancing the educational value of marking medical student case reports. After criteria for case report assessment were developed, three student write-ups were sent for evaluation to 17 volunteer faculty members with extensive teaching and assessment experience. Content analysis of their narrative comments and analysis of their global ratings of the student reports revealed marked disparities in the criteria the different assessors felt were important and an unacceptable spread in the ratings assigned to the reports. The study showed that the current case report assessment method was unreliable and that it should be replaced by a standardized assessment instrument.

Twelve Canadian medical schools that had an organized faculty development program were surveyed to evaluate the extent to which such programs were used and to estimate their effectiveness. Common practices included sabbaticals and programs designed to improve instructional skills. The main problems included underfunding, poor participation and inadequate instructor evaluation.

To develop guidelines for conducting ward rounds, all trainees in the Department of Medicine residency program at Montreal General Hospital were asked to identify the clinical instructors who were most successful at conducting rounds. The nine instructors mentioned most often were asked to write a description of how they conducted ward rounds. The common characteristics were empathy to the needs of trainees, interest in being with and facilitating the learning of trainees at all levels, and accessibility. Implementation of the guidelines resulted in heightened awareness of the importance of the teaching function of clinical ward rounds as well as increased emphasis on making rounds useful and enjoyable.