A tuberculosis hotline in Tyler: a Texas resource for primary health care providers for the control of infectious diseases

The Center for Pulmonary and Infectious Disease Control (CPIDC), located on the campus of The University of Texas Health Center in Tyler, manages a toll-free infectious disease consultation hotline advertised to public and private physicians and to health care agencies throughout the state. From January 1994 through December 1996, as part of a statewide initiative to curb an unprecedented increase in the incidence of tuberculosis observed since 1985, a concentrated effort was made to solicit health care providers for consultation requests that involved the diagnosis and management of tuberculosis, in particular, drug-resistant varieties. During that period, 3447 calls were made to the CPIDC by 1682 physicians and nurses. While most of the calls originated from 4 major urban areas plus health care facilities along the border, calls were received from more than half of all the counties in Texas. The value of providing an infectious disease consultation service, readily available, without charge, to all members of the health care community is discussed.     

Endothelial injury following experimental subarachnoid hemorrhage in rats: effects on brain blood flow

BACKGROUND: The leading cause of death and disability in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is cerebral vasospasm, a persistent, progressive, and often irreversible constriction of cerebral arteries. A wide array of pathological changes occur in cerebral arteries following SAH, with endothelial injury being the earliest and most consistent one. Since intact endothelium modulates many reflexes that influence vascular tone, damage to them may represent a significant contributor to cerebral vasospasm. METHODS: Changes in local cerebellar blood flow (LCBF) and pathological alterations in major cerebral arteries were studied and compared in rats at various time intervals following SAH. SAH induced by the subarachnoid injection of 0.3 ml of whole blood. Sham rats received a subarachnoid injection of 0.3 ml of isotonic saline. RESULTS: Except for an immediate but transient decrease, LCBF remained unchanged over a 3 day period following saline injection. Likewise, there were no pathological alterations in cerebral arteries of saline-injected rats. In contrast, the subarachnoid injection of whole blood produced significant changes in both LCBF and cerebral arteries. Within 30 minutes post-blood injection, LCBF became significantly decreased and remained so for 4 hours. However, within 24 hours, LCBF had returned to control levels where it remained for 3 days. Endothelial injury was observed in the basilar and middle cerebral arteries from 30 minutes through 4 hours, the same periods in which LCBF was significantly reduced. Within 24 hours, the time period in which LCBF had rebounded to control ranges, cerebral arteries showed no evidence of endothelial damage and resembled control cells. CONCLUSION: The results indicate a direct correlation between changes in LCBF and the structural integrity of endothelial cells in the early stages following SAH. The lack of chronically depressed LCBF (after 1 day) may be related to the quick structural repair of endothelium.     

Partnering with physicians to achieve quality improvement

BACKGROUND: The Maine Medical Assessment Foundation (MMAF) has successfully involved hundreds of Maine physicians in study groups to analyze data on small-area variation and assess physician decision-making patterns. In 1991 the MMAF model was replicated across a tri-state area (Maine, New Hampshire, Vermont) in an effort called the Outcomes Dissemination Project, which is funded by a five-year grant from the U.S. Agency for Health Care Policy and Research. THE OUTCOMES DISSEMINATION PROJECT: Five specialty study groups, each meeting three times a year, examine local and national utilization data, examine guidelines and research findings, participate in outcomes studies and patient education, and disseminate their findings through specialty society presentations and other feedback efforts. The MMAF study group process is based on the beliefs that medicine is a subculture with a complex set of professional values, beliefs, socialization processes, and norms, and that quality improvement efforts work best when they are nonpunitive and educational. ISSUES IN OBTAINING PHYSICIAN INVOLVEMENT: (1) Physicians are willing to change their practices if they are brought into a culturally appropriate improvement program. (2) Related specialties (for example, internists and family practitioners) can often work together effectively on issues of common interest. (3) Involving respected clinical leaders has helped establish the legitimacy of MMAF methods among physicians. (4) Area- and physician-specific data are not made public, so as to build a sense of confidentiality among participants. CONCLUSIONS: The project continues to function as a powerful education process and serves as a model for replication elsewhere.     

Aging and the dendritic morphology of the rat laterodorsal and pedunculopontine tegmental nuclei

This study is based on interviews with 37 persons fulfilling the DSM-IV criteria for kleptomania recruited through newspaper advertisements, and on 50 shoplifters interviewed directly after apprehension. Our hypothesis was that there are no absolute borders between 'pure' kleptomania according to DSM-IV and other forms of shoplifting. When asked about the latest case of shoplifting, one fifth of the shoplifters reported not having stolen the item for personal use and had later discarded it. A quarter of the kleptomaniacs reported ambivalence when asked if they needed the item in question. The degree of reported impulsivity and a feeling of not being oneself at the time of the theft was the same in the two groups. The two groups also estimated their degree of impulsivity, planning, thrill, relief, vengeance, need, pleasure on a Visual Analogue Scale (VAS) as well as the degree of psychiatric imbalance on the latest theft occasion. These estimates showed that there were no differences between the groups concerning the degree of planning, psychological imbalance and the need for the stolen item in question. The kleptomaniacs rated a feeling of inner tension before the theft higher than the shoplifters. The same was true concerning a feeling of relief during the theft and impulsivity. However, the shoplifters also rated high on all these items. Altogether, these findings support our hypothesis that many shoplifters, even if they do not fulfill all DSM criteria for kleptomania, may constitute a significant medical problem and should be offered support and treatment. Anti-depressants as well as the educational programmes developed by the Shoplifters Alternatives may be effective not only in cases of kleptomania but also for more unselected groups of non-professional shoplifters.     

Ligand-induced translocation of epidermal growth factor receptor to the nucleus of NR6/HER fibroblasts is serum dependent

Ligand-induced translocation of epidermal growth factor receptors (EGF-R) to the nucleus of NR6/HER fibroblasts has been studied by immunoelectron microscopy. Following treatment of NR6/HER cells with epidermal growth factor (EGF) for 1 h, there was a decrease in EGF-R labeling at the plasma membrane and a corresponding increase in EGF-R in the nucleus. This was preceded by a rapid and sustained increase in nuclear phosphotyrosine content, detectable within 2 min of EGF treatment. EGF-R translocation into the nucleus was completely prevented by 18 h serum starvation prior to treatment with EGF. These results indicate that translocation of EGF-R to the nucleus is a controlled process and they suggest that EGF-R may directly influence nuclear function.