Marketing hospitals to physicians in the United States.

This paper discusses the application of multidimensional scaling (MDS) in formulating the strategies for marketing a hospital to physicians. An extensive hospital factor survey was used to provide information for interpreting the MDS results, and to formulate specific strategies to: attract new physicians to the hospital; and, to make the hospital attractive to affiliated physicians for patient referrals. We conclude that MDS provides a unique approach for formulating strategies for similar non-conventional situations.     

Increased platelet activation and fibrinogen in Asian Indians. Potential implications for coronary risk

Aims To determine whether Asian Indians (Indians), a group knownto have high rates of coronary heart disease, have increasedplatelet activation and fibrinogen levels relative to whiteAmericans of European origin (whites). Methods and Results Forty healthy, non-smoking Indians, aged 25–45, were matchedwith 40 healthy whites for age (within 3 years) and gender.Platelet activation was tested in blood exiting a bleeding timewound at 1 and 2min post-incision (wound-induced activation),as well as in venous blood stimulated in vitro with collagen,using whole blood flow cytometry. Other risk factors, includingfibrinogen levels, family history of diabetes or coronary heartdisease, fasting insulin and lipid levels, and Lp(a) were alsoassessed. Fibrinogen levels were higher among Indians than whites,even after adjustment for gender or family history of coronaryheart disease (P<0·05). Indians had higher levelsof wound-induced glycoprotein IIb/IIIa binding and plateletsecretion (P-selectin expression) than whites, with the greatestdifferences found when comparing the upper quintile of activationfor each group (Ps<0·05). Indians with a family historyof coronary heart disease (n=15) had higher levels of plateletsecretion (wound-induced and in vitro) than Indians withouta family history (Ps<0·05), while the relationshipwas reversed among whites. Platelet activation measures werenot consistently related to other coronary risk factors, whilefibrinogen was related to triglyceride and insulin levels amongIndians. Conclusion Indians have elevated fibrinogen and platelet activation levelsrelative to whites. These factors may contribute to the increasedcoronary risk observed in Indians.     

Increased detection by restaining of acid-fast bacilli in sputum samples transported in cetylpyridinium chloride solution.

SETTING: Seventeen health facilities in a Tuberculosis Unit, and the Tuberculosis Research Centre (TRC), Chennai, India. AIM: Evaluation of restaining by the auramine-phenol method for detection of acid-fast bacilli (AFB) in direct smears of samples transported in cetylpyridinium chloride (CPC) solution. METHODS: Among patients attending the above health facilities, 730 samples were collected in CPC and transported to the TRC. Two direct smears were prepared from each sample, one stained by the usual auraminephenol method (primary staining) and the other stained again by the same method (restaining) for examination by fluorescence microscopy. All the samples were processed for culture of Mycobacterium tuberculosis. RESULTS: A significantly higher proportion (49.6%) of samples were positive by restaining compared to primary staining (32.5%, P < 0.0001). Of 362 samples positive by restaining, 38.7% were negative by primary staining. The yield of different grades of smears was significantly higher with restaining than with primary staining (P < 0.0001). More smear-negative culture-positive smears were observed with the primary than with the restaining method (178/400 [44.5%] vs. 78/ 400 [19.5%], P < 0.001). CONCLUSION: The rate of detection of AFB in direct smears made from sputum samples transported in CPC was higher on restaining than on primary staining.