Prevalence of rotavirus antibodies in a non-human primate colony

A total of 51 monkeys maintained in a colony at the Institute of Primate Research (Kenya) and housed in doors with natural lighting in a group cage were used in this study. Monkeys belonging to 3 species were selected at random and blood samples collected. The serum samples were screened for presence of neutralizing antibodies (VTN) to rhesus rotavirus (RRV) by virus neutralization assay. Virus neutralization was determined by 60% reduction in fluorescent focus units (ffu). 96% of the animals screened had naturally occurring antibodies to rhesus rotavirus. Another group of 11 lactating monkeys (5 baboons, 6 vervets) and their infants were screened further for presence of IgG and IgA antibodies in serum and breast milk (mothers). Overall, the mothers had higher titres of both IgG and IgA than the infants. Taken together, these results demonstrate rotavirus infection is endemic in this primate colony. This mimics the human situation, hence, captive non human primates (such as the baboons) could be a suitable model for testing rotavirus candidate vaccines and for investigating the possible application in humans of passive-active immunization strategy.     

Estimating treatment cost functions for progressive diseases: a multiproduct approach with an application to breast cancer

Using the theory of multiproduct cost functions, a treatment cost function is derived for diseases which progress through a number of stages. The output classes are conceived as the stages at detection of the disease, with the unit of output within each class being the treated case. The derivation clarifies the assumptions underlying various specific functional forms for the treatment cost function. An empirical application to the treatment of breast cancer is provided, producing evidence on an important issue in the economics of screening programs, viz. whether detection of breast cancer at an earlier stage results in treatment cost savings.     

The percentage of articles which were accepted or rejected for publication in the Dutch Journal of Medicine in 1997

OBJECTIVE: To determine the acceptance and rejection percentages of articles submitted to the editors of the Nederlands Tijdschrift voor Geneeskunde (NTvG) in 1997. DESIGN: Retrospective. METHOD: The data on all articles reviewed by the editors of the NTvG in 1997 were extracted from the registration system in April 1998. These included the outcome of the review process (rejection or acceptance for publication or no definite decision yet), the article category (e.g., original article, review article), and whether the article had been solicited by the editors or was a spontaneous submission. RESULTS: In 1997, 845 articles were received. Of these 28% (240) were rejected and 59% (497) were accepted for publication. On 13% (108) no decision had been made (in April 1998). Of the articles decided upon 36% were rejected (extrapolated). 705/845 (83%) articles were unsolicited: of these 33% (235) were rejected and 54% (382) accepted; on 13% (88) the decision was pending. The solicited articles numbered 140 (17%); of these 4% (5) were rejected and 82% (115) were accepted; on 14% (20) no decision had been made yet. CONCLUSION: The rejection of articles submitted to NTvG in 1997 was 36% (in 1990 38%). Solicited articles were rejected less frequently than unsolicited ones. The yearly number of articles submitted and the rejection percentage have not changed drastically during the last eight years.     

Physical examination--the significance of Homan's sign]

Homans's sign is often used in the diagnosis of deep venous thrombosis of the leg. A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis. However, Homans's sign has a very poor predictive value for the presence or absence of deep vein thrombosis, like any other symptom or clinical sign of this disease.     

Importance of supplementary testing for diagnostic proficiency at the bedside

Two patients are described who were originally published in Reports of medical cases (1827; 1831) by Richard Bright. The first patient suffered from haematuria and oedema (dropsy) and died after acute epiglottitis. At autopsy the kidneys were swollen and haemorrhagic (acute glomerulonephritis in present terms). The second patient died after two episodes of acute headache and decreased consciousness. At autopsy an aneurysmatic dilatation of a brain artery was found. Today the diagnosis of acute glomerulonephritis or subarachnoid haemorrhage would have been made from the history and physical examination, and newly developed laboratory and histological techniques would have been helpful in securing it. But even nowadays, clinical skills are still continually expanding by feedback from new diagnostic techniques.     

Uniform safety of beating heart surgery using the octopus tissue stabilization system

BACKGROUND AND PURPOSE: Minimally invasive coronary artery bypass grafting (CABG) has been facilitated by the introduction of the Octopus Tissue Stabilization system (OTS). OTS improves exposure immobilizing the heart with minimal hemodynamic effects allowing multivessels off cardiopulmonary bypass (CPB) CABG. The purpose of this study was to compare the utilization and clinical outcome of the OTS in three geographically distinct centers. METHODS: 239 patients who underwent OTS-CABG at Allegheny University Hospital/Medical College of Pennsylvania, Harrisburg Hospital, and Park Nicollet Clinic/HealthSystem Minnesota were reviewed. Age, acuity of patients, and number and type of vessels bypassed were recorded. Complications, mortality, length of hospital stay, incidence of conversion to CPB and blood transfusions, and operating room costs were compared to risk matched control patients who underwent CPB CABG during the same period. RESULTS: Results were similar in all three centers. The average age was 62.3 years. Emergent operation was necessary in 7%-10% of patients, the operations averaged 1.8 grafts/patient. Arteries bypassed were LAD, DIAG, OM, RCA, PDA, and RPLB. There were 96% of operations completed without CPB. Morbidity was low (12%). Atrial fibrillation and blood transfusion rate were decreased. Mortality was 0 compared with a predicted mortality of 1.6%. Hospital length of stay was shorter and operating room costs were 61% lower. CONCLUSIONS: OTS provides predictable reproducible immobilization allowing the performance of single and multiple off-pump CABG to almost all coronary branches with minimal morbidity and decreased costs in a variety of patients. Similar findings from three different centers suggests that these results are easily reproducible.     

The Changing Landscape of Health Care Financing and Delivery: How Are Rural Communities and Providers Responding?

Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking; the creation of new strategies for managing patient care; and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices; a few were signing contracts for capitated care, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health care organization and financing reach the levels achieved by urban communities.     

Rural Health Research: Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?

Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board-certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecologists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician-gynecologists need training outside their traditional specialty areas to optimally care for their patients.