Osler's service: a view of the charts.

It has been asserted that William Osler (1849-1919) shaped the Medical Clinic of the Johns Hopkins Hospital 'to become a pre-eminent facility, first in patient care and later in medical education'. Osler's impact on medical education in the United States is beyond dispute, but few, if any, data support the assertion that patients at the Johns Hopkins Hospital fared better than those at similar hospitals during the late 19th century. Patient records were scanty and were seldom, if ever, signed by Osler or other senior professors. The numerous publications that arose from Osler's service suggest the data were derived not from the hospital charts, but rather from a parallel system of data collection designed mainly for research. Issues raised by this review of the charts on Osler's service reverberate in American medicine.

Response to lamivudine-zidovudine plus abacavir twice daily in antiretroviral-naive, incarcerated patients with HIV infection taking directly observed treatment.

Prison inmates with human immunodeficiency virus (HIV) infection can be difficult to treat because of the complexity and intrusiveness of many combination antiretroviral therapy regimens. NZTA4007, a 24-week open-label, single-arm clinical trial involving 108 antiretroviral therapy-naive, incarcerated, HIV-infected persons, was conducted to evaluate a compact regimen (4 tablets per day) consisting of 1 lamivudine-zidovudine (150 mg/300 mg) combination tablet (COM) and one 300-mg abacavir tablet administered twice daily under directly observed treatment conditions. In the intent-to-treat observed analysis, the plasma HIV type 1 (HIV-1) RNA level remained at < or =400 copies/mL in 85% of the patients and at < 50 copies/mL in 75% of the patients. Median change from baseline was -2.41 log(10) copies/mL for the HIV-1 RNA level and +111 cells/mm(3) for the CD4 cell count. The overall adherence to prescribed doses was 94% for patients who remained enrolled in the study. COM-abacavir given twice daily was generally well tolerated, and adverse events prompted only 4 patients to withdraw from the study.