Vesicular pityriasis rosea: response to erythromycin treatment

Pityriasis rosea (PR) is a relatively common disease although its aetiology has not yet been identified. It occurs worldwide and there is no racial susceptibility factor. It usually affects teenagers and young adults between 10 and 35 years of age. Typical PR is much easier to diagnose than the rare atypical forms. We report a rare case of vesicular PR in a black woman who had vesicular lesions limited to her palms and soles in addition to regular typical lesions. We devised an efficient oral erythromycin treatment for this patient.     

Reducing the use of H2-receptor antagonists in the long-term-care setting.

OBJECTIVES: To examine the patterns of H2 blocker use in the long-term-care setting and to assess the effect of educational interventions designed to improve H2 blocker utilization patterns. DESIGN: Time-series quasi-experimental study and retrospective chart review. SETTING: A large academically-oriented long-term-care facility. PATIENTS: Institutionalized elderly patients with a mean age of 88 years receiving H2 blocker therapy. INTERVENTIONS: Two interventions involving group discussions with the medical staff, supporting educational materials, and physician-specific listings of patients receiving H2 blockers were employed sequentially over a 32-month period. RESULTS: Each intervention resulted in substantial reductions in medication use (59.6% and 32.1%, respectively). Indications for H2 blocker use were determined retrospectively for patients identified as receiving therapy prior to the interventions (n = 110). Forty-one percent were found to be receiving therapy for reasons unsubstantiated by the medical literature. These patients were more likely to be discontinued from therapy than those receiving therapy for substantiated indications (P less than 0.01), consistent with the primary focus of the educational interventions. CONCLUSIONS: These results suggest that the excessive use of H2 blocker therapy in the long-term care setting responds to educational interventions with therapeutically appropriate reductions in utilization. Repeated interventions are necessary to maintain such reductions over time although there may be some reduction in the effectiveness of the intervention with repetition.     

Physician motivations for nonscientific drug prescribing

Although there is increasing concern about inappropriate physician prescribing and how to devise programs to improve drug therapy decisions, little research has been published documenting the reasons for such misprescribing. We analyzed the motivations reported by 141 physicians who were part of a large multi-state randomized controlled trial of 'academic detailing.' The physicians were identified from state Medicaid prescribing records as moderate to high prescribers of cerebral or peripheral vasodilators, propoxyphene, or cephalexin, and were visited by clinical pharmacists serving as outreach educators in a medical school-based prescribing improvement program. Physicians' motivations for their prescribing patterns were discussed in an informal, interactive manner; all responses were recorded in detail by the pharmacists immediately following each visit. Of the 110 responses elicited, the most common reason offered by physicians for use of these medications was patient demand (51 statements, or 46%). Physicians also frequently attributed their prescribing of these drugs to intentional use of placebo effect (24%). An equally common reason was prescribers' assertion that their own clinical experience indicated that these drugs were actually therapies of choice in the conditions presented (26%), despite evidence from the research literature that this was not the case. Such indications included the use of the 'vasodilators' for senile dementia or peripheral vascular disease, cephalexin for viral upper respiratory infections, and propoxyphene instead of acetaminophen or aspirin for mild pain. Greater attention must be paid to physicians' attitudes and motivations concerning suboptimal prescribing if programs are to succeed in replacing these practices with more rational clinical decision-making.     

Sociodemographic and behavioral characteristics of HIV antibody-positive blood donors.

This paper describes the sociodemographic and behavioral characteristics of 173 blood donors who were confirmed by Western blot tests to have antibodies to human immunodeficiency virus (HIV), the etiologic agent for acquired immunodeficiency syndrome (AIDS). Seropositive donors were predominantly young, unmarried, and male, and major risk factors could be identified for almost all donors. However, more than 20 per cent of the study participants were women, and many participants were not aware that they were at risk of infection. The heterogeneity of the study population, the lack of awareness among many subjects of risk factors and self-exclusion procedures, and the high level of distress among many subjects after notification, emphasize the need for intensive, well-designed education and support programs.     

环孢菌素A阻断人HL－60抗药性细胞于G_1期而诱导敏感细胞凋亡

进一步研究了抗三尖杉酯碱的ＨＬ－６０细胞（ＨＲ２０）抗细胞凋亡的机制及该抗性和抗药性的关系。结果表明，环孢菌素Ａ（ＣｓＡ）２０，１０μｇ·ｍｌ￣（－１）诱导ＨＬ－６０细胞发生凋亡，而阻断ＨＲ２０细胞于Ｇ＿１期，就不能诱导细胞发生凋亡。低浓度的ＣｓＡ明显增加柔红霉素在ＨＲ２０细胞内的积聚，其逆转抗药性作用与阻断细胞周期运行无关。ＣｓＡ１０μｇ·ｍｌ￣（－１）处理ＨＲ２０细胞，可引起５０ｋＤａ的蛋白质高度磷酸化。结果提示：环孢菌素Ａ阻断抗三尖杉酯碱的ＨＬ－６０细胞于Ｇ＿１期，而诱导敏感的ＨＬ－６０细胞发生凋亡，其阻断作用与抗药性无关