Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care?

BACKGROUND AND AIM: Electronic patient-provider communication promises to improve efficiency and effectiveness of clinical care. This study aims to explore whether a secure web-based messaging system is an effective way of providing patient care in general practices. METHOD: We conducted a randomised controlled trail and recruited 200 patients from the waiting area in one primary clinic in Norway. Participants were randomised to either the intervention group, which received access to a secure messaging system, or the control group receiving standard care without such access. Primary outcome measures were number of online consultations, telephone consultations and office visits in the two groups. Data were derived from patient records and collected 1 year prior to (baseline), and 1 year after the intervention. RESULTS: Forty-six percent of the patients who were given access to the messaging system (n=99) used the online communication system on at least one occasion (ranging from 1 to 17 messages per patient per year). A total of 147 electronic messages were sent to six general practitioners during a 1-year trial period. Eleven percent of the messages were to schedule an appointment. In 10% of the messages, the GP was unable to respond adequately and recommended an office visit. The reduction in office visits over time was greater for the intervention group than for the control group (P=0.034). There was however no significant difference in the number of telephone consultations between the groups during the study (P=0.258). CONCLUSION: The use of a secure electronic messaging system reduced the number of office visits at the general practice, but not phone consultations.     

Primary gastric apoptosis-rich T-cell lymphoma co-expressing CD4, CD8, and cytotoxic molecules

In contrast to primary gastric lymphomas of B-cell type, little is known about primary gastric T-cell lymphomas. We describe three cases with remarkably similar features: diffuse growth, epitheliotropism, medium too large cell size, high apoptotic rates, and a CD3+, CD4+, CD8+, CD45RO+ immunophenotype. Clonal TCRγ gene rearrangement was shown in two cases. Epstein-Barr virus infection was excluded in two cases. Taking advantage of fresh-frozen material, we analyzed two cases further, revealing CD5–, CD16+, CD56–, CD57–, CD25+, CD30+, CD103 (αEβ7)+, bcl-2 protein+, CD95+, CD95 ligand(L)–. CD95L, however, was detected in histiocytic and fibroblastoid by stander cells. The lymphomas expressed granzyme B, perforin, and the TIA-1 antigen in various combinations. All three cases had a very unfavorable clinical course characterized by local recurrence and/or dissemination to other epithelial sites, leading to death within 6–12 months after the initial diagnosis despite surgery and aggressive antineoplastic treatment. These data suggest a novel variant of peripheral T-cell lymphoma operationally characterized as primary gastric, apoptosis-rich, CD103+, EBV-, T-cell lymphoma co-expressing CD4, CD8, CD16 and cytotoxic molecules. Received: 20 August 1999 / Accepted: 2 November 1999     

Constitutional C-band pattern in patients with adenomatosis of the colon and rectum

The pattern of polymorphism in the C-band-positive constitutive heterochromatin of chromosomes #1, #9, and #16 was studied in fibroblasts from 23 unrelated patients with adenomatosis of the colon and rectum and in peripheral lymphocytes from 78 control persons. The parameters of the heterochromatic regions analyzed were relative size, symmetry-asymmetry within homologous chromosome pairs, and frequency of inversions. The polyposis coli patients had a significantly higher frequency (p less than 0.05) of partial and total heterochromatin inversion on chromosome #9 than the control group (37.0% compared with 21.8%). In the other parameters studied, no significant differences were found between patients and controls.     

Clinical evaluation of 430 MHz microwave hyperthermia system with lens applicator for cancer therapy

The clinical efficacy of a microwave (MW) hyperthermia system using an electric-field converging (lens) applicator is evaluated for 42 malignant tumours with a maximum tumour depth of less than 7 cm. The mean of the maximum, average and minimum tumour temperature of the 42 tumours are 44,5, 42.5 and 40.7 C, respectively. The thermal parameters are higher for tumours in the chest, abdominal walls and hip than for those in the neck, groin and extremities. No apparent difference in thermal parameters according to the depth of tumour is shown. Of 40 tumours treated by hyperthermia in combination with radiotherapy, 20 (50%) showed complete regression, 14 (35%) showed partial regression, and six (15%) showed no change. This phase I and II study indicates clinical feasibility of the newly developed MW heating apparatus, and strongly suggests the usefulness of thermoradiotherapy in the treatment of localised superficial and subsurface malignancies.     

Psychosis as a predictor of response to lithium maintenance treatment in bipolar affective disorder

Sixty-six bipolar I lithium clinic patients were studied for a history of psychotic symptoms at some time during the course of their illness. Agreement between different sources of information was calculated, and the patient population was divided into psychotic and non-psychotic subgroups. Probability of remaining well on lithium for the different subgroups was analyzed by the life table method. Psychosis during mania appeared to be associated with especially good early lithium prophylaxis.     

The cholinergic nervous system and immediate hypersensitivity: I. Eccrine sweat responses in allergic patients

The cholinergically innervated human eccrine sweat gland is a readily available organ permitting the assessment in allergic patients of cholinergic reactivity with few or no adrenergic influences. The sweat responses of four matched groups (male allergic, female allergic, male control, and female control) to intradermal Mecholyl from 0.1 μg to 100 μg was compared; the 45 male and 45 female allergic patients demonstrated statistically significant increases in sweat responses to essentially all concentrations of Mecholyl examined. No difference in the sweat responses of patients with allergic rhinitis alone as compared with patients with both allergic rhinitis and allergic asthma was noted. Five patients with intrinsic asthma most closely resembled the allergic groups in their responses and 8 patients with vasomotor rhinitis sweated at or below the control groups. The increased sensitivity of allergic patients to cholinergic stimulation as measured by eccrine sweat responses suggests that this hyperresponsiveness may be one of the underlying defects in allergic disease.     

Comparative haematological and plasma chemistry values in purpose-bred squirrel, cynomolgus and rhesus monkeys

Haematological and blood chemistry data have been compared for three species of purpose-bred primates, Macaca mulatta (rhesus monkey), Macaca fascicularis (cynomolgus monkey), Saimiri sciureus (squirrel monkey). These species were housed over a 9-month period in identical conditions (diet, tap water, room temperature and relative humidity, and lighting regime) in our primate facility. Blood and urine assays were conducted using the same pre-analytical conditions (blood sampling procedure, anticoagulant and storage of sample), and analytical methods (reagent and equipment).The results indicated that squirrel, rhesus and cynomolgus monkeys have essentially biologically similar values for all of the parameters examined. However, haemoglobin level, reticulocyte, plasma total cholesterol, triglyceride, albumin and urea nitrogen values, and urinary osmolality in cynomolgus monkeys were statistically lower than those of rhesus monkeys. Erythrocyte count, plasma ALT, calcium and potassium in cynomolgus monkeys were statistically higher than those of rhesus monkeys. Erythrocyte count, haemoglobin level, haematocrit, reticulocyte, plasma total bilirubin and chloride and urinary osmolality in cynomolgus monkeys were statistically lower than those of squirrel monkeys. Leucocyte count, plasma total protein, albumin and calcium in cynomolgus monkeys were statistically higher than those of squirrel monkeys. Squirrel monkeys showed marked deviations in four assays from the other two species: ratio of lymphocytes to neutrophils, AST, ALT and urine volume.The results obtained in this study will be used as baseline data for haematology and clinical chemistry characteristics for three species of purpose-bred monkeys.     

ECLIPS: An extended clinical laboratory information processing system

The clinical laboratory is regarded as a component of the medical care system extending from physician to laboratory staff and back to physician. From this concept a computer-based system of laboratory information is derived, emphasizing: (1) total laboratory responsibility for the test and its request, and (2) physician-oriented output reports.     

吗氯贝胺与米帕明治疗抑郁症多中心双盲对照试验

目的 :以经典抗抑郁药物米帕明为阳性对照药采用随机双盲双模拟方法对吗氯贝胺和米帕明治疗抑郁症的疗效和安全性进行研究。方法 :共纳入病人 2 0 0例 ,分别口服吗氯贝胺 3 0 0 -60 0mg d或米帕明75 -2 5 0mg d。结果 :两组病人Hamilton抑郁量表 (HAMD)以及Hamilton焦虑量表 (HAMA)总分在治疗结束时均显著下降 (P <0 0 0 1)。两组之间疗效无显著差异 (p >0 0 5 )。治疗结束时HAMD减分率分别为吗氯贝胺组 0 74± 0 2 4,米帕明组 0 74± 0 2 4(P >0 0 5 ) ;有效率吗氯贝胺组 79 4% ,米帕明组 85 4% (P >0 0 5 )。吗氯贝胺组有 10种不良反应发生频率显著低于米帕明组 ,主要是抗胆碱能、中枢神经系统及心血管系统不良反应。吗氯贝胺的疗效指数也显著高于米帕明组。结论 :吗氯贝胺是一种安全有效的抗抑郁药物     

Cytogenetic studies of bone marrow and extramedullary tissues and clinical course during metamorphosis of chronic myelocytic leukemia

Of 33 consecutive patients with chronic myelocytic leukemia, examined during metamorphosis, 82% showed chromosome abnormalities in addition to the Ph1. Aberrations most frequently encountered were +8 (39%), +22q - (30%), and i(17q) (18%). Translocations other than the Ph1 were observed in four cases and - Y clones in four cases. Discrepancies in the cytogenetic pattern between bone marrow and extramedullary tissues or blood were noted in a total of 15 patients. In six cases, transformation occurred in extramedullary organs at a time when it was not present in the marrow. In three cases the bone marrow transformation was preceded by a lymph node blastic infiltrate; in one case, by a skin infiltrate; and in one case, by a subdural blastoma. Clonal abnormalities additional to the Ph1 were identified in the tumor tissue from all these cases. Patients with primary extramedullary transformation tended to have a lower median age at onset of metamorphosis, shorter survival, and higher incidence of chromosome abnormalities than the cases without extramedullary involvement. Patients with only Ph1-positive cells and no other anomalies had a slightly longer duration of metamorphosis and longer total survival. Basophilia and thrombocytopenia were more marked in cases with i(17q) than in the rest of the series.