Creating a Unit-Specific Charging system

A totally nurse-dependent charging system developed specifically for the labor and delivery suite at the University of Maryland Medical System is described in the article. This easy and effective method of charging was incorporated into an already existing patient census and classification system. The number of relative value units has increased by more than 30%, and the amount of revenue billed has increased by more than $800,000 in the first 10 months after implementation.     

Lymphocyte transformation in subjects with nodulo-cystic acne

Patients with severe nodulo-cystic acne are known to have elevated serum antibody levels and increased immediate hypersensitivity reactions to Propionibacterium acnes. This organism is the predominant bacterium in normal pilosebaceous follicles of human skin, and can be consistently isolated from pustular lesions in acne. Previously it had been observed that delayed cutaneous hypersensitivity reactions to P. acnes were negative in patients with acne. The present study investigated the proliferative response of lymphocytes from patients with nodulo-cystic acne to phytohaemagglutinin (PHA) and P. acnes antigen stimulation. The response to PHA stimulation was within normal limits. The response to P. acnes antigen showed a significant increase over control values obtained by testing lymphocytes from acne-free subjects. Thus cell mediated immunity to P. acnes may be present in subjects with severe inflammatory acne. These findings raise the possibility that reactions to P. acnes may contribute to intensifying the inflammatory response in acne lesions.     

The prevalence and sociodemographic correlates of high-risk and problem drinking at an industrial worksite

The study of 833 employees aimed to determine the prevalence and sociodemographic correlates of high-risk and problem drinking in an industrial population. Variables measured included stressful life events, neuroticism, job satisfaction, years of service, job classification and type of shift. As measured by a 7-day retrospective diary, 12.5% of the sample were abstainers, 78.7% were light drinkers and 8.8% were high-risk drinkers. As measured by the Mortimer-Filkins test of problem drinking, 79.2% were non-problem drinkers, 15.2% were presumptive problem drinkers and 5.7% were problem drinkers. Variables that best predicted high–risk drinking were marital status, type of shift and education. Variables that best predicted problem drinking were stressful life events, marital status, education and neuroticism. The results indicate the need for a work-based intervention and provide information to identify at-risk employees and assist in the design of appropriate treatment programmes, including assistance with social and other problems.     

Vasodepressor Syncope Due to Subclinical Myocardial Ischemia

Vasodepressor Syncope. Introduction: Vasodepressor syncope is a common cause of syncope, but the initiating event that triggers the vasodepressor response remains incompletely understood. Although ischemia due to acute right coronary occlusion may precipitate hypotension and bradycardia through the Bezold-Jarisch reflex, an ischemic precipitant for the common vasodepressor faint has not been previously identified. In the present study, we present evidence for a causal relationship between myocardial ischemia and vasodepressor syncope. Methods and Results: Two patients referred for evaluation of syncope underwent upright tilt table testing with either ST segment monitoring, sestamibi scintigraphy and echocardiography during the tilt test, or coronary angiography. Both patients had positive tilt table tests during the control study. Patient 1 was documented to have reproducible ischemic ECG changes during atypical chest pressure induced by upright tilt, despite a normal coronary angiogram with ergonovine provocation. Subsequent tilt testing with simultaneous sestamibi perfusion imaging and echocardiography revealed reversible anterolateral hypoperfusion corresponding with anterolateral hypokinesis during upright tilt that preceded syncope. Ischemic ECG changes during incremental rapid atrial pacing further suggested ischemia on the basis of microvascular disease. Follow-up tilt testing on verapamil was negative. Patient 2 developed ischemic ECG changes during the recovery phase of an exercise stress test, which was followed by a vasodepressor response and frank syncope. Coronary angiography revealed a 90% distal right coronary artery stenosis that was successfully dilated, after which follow-up tilt table testing off all other medication was negative. Conclusions: These two cases illustrate a previously unrecognized causality between myocardial ischemia and clinical vasodepressor syncope, and demonstrate that subtle manifestations of myocardial ischemia, associated with either atypical angina or silent ischemia, can provoke syncope.     

Doctors and substance misuse: types of doctors, types of problems

The casenotes of 144 doctors who had received treatment for substance misuse were analysed. There were no differences between general practitioners (h = 61) and hospital doctors (n = 58) in terms of their substance misuse histories or the problems they incurred. Differences emerged between the consultant (n = 24) and the non-consultant (n = 34) grades of hospital doctor. The consultants were older at onset of problematic use (42.6 ±8.6 vs. 29.9 ± 9.8 years); they suffered fewer career problems and misused fewer substances. The most frequent pathways into substance use were personality difficulties (76 subjects, 52.8%) and anxiety or depression (46 subjects, 31.9%). A history of depression (n = 36) was associated with perceived stress at work (p = 0.014), and at home (p = 0.06). Past neurotic disturbances (n = 20) were associated with personality difficulties (p = 0.035), anxiety or depression (p = 0.004), and with an earlier onset of problematic substance use (30.2 ± 8.3 vs. 36.5 ± 9.8 years, p = 0.014). Principal components of possible antecedents yielded one major component on which all elements loaded; this was labelled the ‘disturbance score’. This score showed a reduction with increasing age of onset of problematic substance use.     

Patterns of alcohol consumption: beverage effects on gender differences

This Data Note reports findings from 22 102 current drinkers who responded in the US National Interview Survey in 1988. Mean estimated alcohol intake of males exceeded that of females by a factor of two. Males drank more per occasion (ratio 1.45) and drank on more occasions (1.41). Mean ethanol content per drink was slightly less for males (ratio 0.95) attributable to a decreased proportion of drinks being wine and liquor. When beverage preferences were taken into account, the drinking patterns of males and females showed no meaningful differences among persons with similar levels of overall ethanol intake. The results do not support the view that the difference between ethanol consumption of males and females are due primarily to males drinking more per occasion. Apparent differences in drinking patterns are attributable to differences in preferred beverage.     

HIV and AIDS in South Africa: what is an appropriate public health response?

Ninety-eight cases of acquired immune deficiency syndrome (AIDS)were reported in the Republic of South Africa by the end of1987, and 166 by mid-December 1988. By 12 February 1990, 353cases of AIDS had been reported: 326 in South Africans and 27in people from either elsewhere in southern Africa or abroad.The South African patients comprised two main groups: whitemen with the pattern of infection typical of homosexual andbisexual men; and heterosexuals exhibiting the pattern commonin much of central and southern Africa. There have been a smallnumber of people with haemophilia affected with AIDS, but onlyone injecting drug user with AIDS to date. There is evidenceof considerable spread of the epidemic into the South Africanblack population; migrant labour, the high prevalence of sexuallytransmitted diseases and suspicion of government-directed familyplanning programmes have all contributed to this. Seropositivityrates in South African blacks are noted to be rising rapidlyand the doubling time is considered to be about 8.5 months.The government and some employers have adopted discriminatorymeasures to control the disease, including the screening ofmigrant workers and the repatriation of those found to be seropositive.Public health leadership from the state authorities has beeninappropriate. We argue for greater involvement of homosexual,worker, community and public health personnel in developingpolicies of control for human immunodeficiency virus (HIV) infectionin South Africa, if the response is to be ethical, non-discriminatory,sensitive, prevention-orientated and effective.     

Focus-group methods: effects on village-agency collaboration for child survival

In the West African nation of Togo an essential element of healtheducation in support of child survival is the training of mid-levelhealth workers to conduct focus-group interviews with caretakersof children under 5 years of age. The intent is to develop thecapability of the National Health Education Unit to establishqualitative data bases that complement survey data on maternalpractices related to child health. These data are used to designand evaluate the health education component for programmes ofchildhood immunization, the control of diarrhoeal diseases,and malaria. Following a five-day training programme in late 1986, healthworkers collected and prepared for analysis data from 81 focus-groupinterviews involving a total of 324 mothers living in nine ruralTogolese villages. In addition, two unanticipated effects wereobserved during and after training. First, the focus-group methoddemocratized data gathering by forcing health workers out oftheir perceived roles as experts and teachers, and mothers outof being helpless villagers and learners. Second, by stimulatingthis shift in roles, the focus-group process enhanced the developmentof community competence, thereby promoting collaborative programmeplanning by health workers and target villages. Dramatic increases in childhood immunization rates offer evidencethat focus-group interviews can play an important role in stimulatingthe needed interaction between clients and providers to planand carry out a community education ‘mini-campaign’in each village. It is from such group processes that collectiveawareness of needs, and actions to resolve them, can arise.Child survival projects should consider training mid-level healthworkers to gather focus-group data as an action-research approachto planning, implementing and evaluating their community healtheducation programmes.     

Menopause: a problem for breast cancer patients

Many women who are treated for breast cancer will subsequently undergo the menopause, either as a result of cancer treatment or as a natural process. For this group of women hormone replacement therapy is currently not recommended and so women lose a major option to help control menopausal symptoms. The extent of this problem has not been widely researched and alternative methods of coping with menopause in this group have not been explored. This paper reviews the menopause in relation to these women and suggests avenues for future research.