Confounders contributing to the reported associations of coffee or caffeine with disease

The role of caffeine or coffee in causing or promoting the incidence of serious disease is equivocal. Two design factors may account for the discrepancies in reported findings on the effects of coffee drinking: (a) imprecision of measurement and (b) confounding variables. A study of 2,714 white U.S. adults disclosed that, of 32 risk factors analyzed by linear and logistic regression, only sex and cigarette smoking were found to be important potential confounders of caffeine and coffee intake. Partial R2 values of the other 30 risk factors were relatively small and were inconsistent for each sex. It is unlikely that any of these factors could explain any of the reported associations between caffeine or coffee consumption and certain diseases. However, certain weak associations with caffeine or coffee intake should be included in the study design when they are known to be risk factors of a disease under investigation. These factors for men are dietary fat intake, vitamin C intake, and body mass index; and for women are vitamin use, alcohol intake, stress, and perceived health status.     

Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. CHS Collaborative Research Group

Carotid sonography is being performed on more than 5,000 participants in the Cardiovascular Health Study, a prospective, multicenter study of cardiovascular disease in men and women aged 65 years and older. The sonographic methods used to examine and measure the extracranial carotid arteries are described. Initial validation studies were performed on 61 subjects with a mean age of 68.6 years. Analysis of within- and between-sonographer differences and between-reader differences were performed for selected variables. In general, the mean absolute differences for within- and between-sonographer comparisons were small, with even less variability between readers. Variability was less for the common carotid artery than for the internal carotid artery. These data suggest that carotid sonography is a reliable and reproducible method for use in the study of carotid atherosclerosis in population studies.     

Variations in an assertive outreach model.

The author reviews recent research findings examining variations in an assertive outreach model. Mental health system and client characteristics that have influenced program implementation are discussed.     

Use of the risk-rescue rating scale with adolescent suicide attempters: A cautionary note

The assessment of the medical lethality and intent of suicide attempts has been considered an important area of research for those interested in suicide. The current study examined the usefulness of the Risk-Rescue Rating Scale with 109 adolescent suicide attempters and found a restricted range of variability, which, in turn, resulted in poor interrater reliability on a number of items. Results suggest that the Risk-Rescue Rating Scale is of limited usefulness with adolescents, and alternative approaches to assessing lethality and suicidal intent with this age group are discussed.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

An Assessment of Recent Pharmacy Graduates' Knowledge and Competency,Professional Practice Functions,and Involvement in Pharmacy Teaching Programs

Study Objectives . To determine self-evaluated professional knowledge and competency, functions, demographic information, lifelong learning, degree and training status, practice sites, involvement in pharmacy teaching programs, and salary for recent pharmacy graduates. Design . A survey of recent Bachelor of Science (B.S.) pharmacy graduates of the University of Wisconsin School of Pharmacy. Measurements and Main Results . A total of 371 B.S. pharmacy graduates (55% response rate) provided information. Graduates who had an advanced degree or training (from many programs) after completing their B.S. pharmacy degree, and those who were teaching in pharmacy programs generally had higher self-rated levels of knowledge and competencies. Hospital pharmacists spent less of their work time in dispensing activities (33.82% ± 30.39%) than community pharmacists (61.04% ± 19.97%; t =8.78, df = 288, p<0.001); community pharmacists spent twice as much of their work time counseling and educating patients (16.65% ± 10.47% vs 7.13% ± 7.39%; t = 9.06, df = 288, p<0.001). The amount of time pharmacists spent in dispensing functions had a negative association with knowledge and competencies in the sections on pharmacokinetic and disease process (r=−0.277, p<0.01), patient communications (r=−0.272, p<0.01), and administrative and economic aspects of practice (r=−0.210, p<0.01) for all respondents. Pharmacists reported that they spent 13.78 ± 14.06 hours per month outside work in professional lifelong learning. There was a negative association between the time pharmacists spent dispensing and the time they spent in professional lifelong learning (r=−0.239, p<0.001), and a positive relationship between the time spent in such learning and the time providing information to prescribers and other health care professionals (r=0.214, p<0.001), monitoring patients (r=0.216, p<0.001), and performing primary care activities (r=0.176, p<0.001). Graduates reported a mean yearly salary of $46,879 ± $8183. More hospital pharmacists were involved in teaching (48, 37%) than those practicing in a community setting (19, 12%). Conclusions . Practice site, advanced degree or training, lifelong learning, involvement in teaching programs, and time spent in various professional functions were associated with pharmacists' self-rated knowledge and competencies. (Pharmacotherapy 1994;14(6):712–723)     

A comprehensive measure of pharmaceutical services: the pharmaceutical-care index

The construction, validation, and use of a numerical index for measuring the provision of pharmaceutical care are described. The 681 respondents to the 1987 Great Lakes Pharmacy Services Survey were randomly divided into two equal groups of hospitals. Data for the first group (n = 341) were used to construct and validate the pharmaceutical-care index (PCI); data for the second group were used for index analysis. Bivariate analysis of 14 major inpatient pharmaceutical services resulted in one service, admission medication histories, being dropped from the index. Multivariate analysis showed that the remaining services contributed equally to the PCI; they were therefore retained. The possible range of PCI scores was -11.166 to 26.518, with a high score indicating greater provision of service. Analysis of data for the second randomly selected group of hospitals (n = 340) showed that PCI scores differed significantly on the basis of hospital size, hospital teaching affiliation, and pharmacy director's education. The correlation between average daily census and PCI score was fair. Higher scores were associated with the presence of a clinical coordinator or a clinical pharmacist. There were weak associations between PCI score and numbers of pharmacists, pharmacy managers, drug distribution pharmacists, and clinical pharmacists. However, the number of decentralized pharmacists and the number of technicians both showed a fair association with PCI score. Hospitals that had pharmacist participation in ambulatory-care clinics or a staff development program had higher PCI scores than hospitals that did not. The provision of inpatient pharmaceutical services, as assessed by the PCI, may be influenced by hospital size, teaching affiliation, the education of the pharmacy director, and other factors. Further research is needed to extend these findings to other hospitals, expose interactions among the factors that affect pharmaceutical care, and refine the PCI.     

SUICIDE ATTEMPT DUE TO METOCLOPRAMIDE-INDUCED AKATHISIA

Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.