Oklahoma physician needs

State policy makers, healthcare professionals, and advocates have been asking various iterations of the question, Do we have too many or too few physicians? In order to address this question, a relative-needs analysis was conducted for the state of Oklahoma. Six projection-needs studies were used for comparison with Oklahoma's supply of practicing physicians. This analysis found that Oklahoma did not have a surplus of primary care physicians. While the national average for primary care physicians per 100,000 was 79, Oklahoma's ratio was 68. This analysis also compares not only the number of physicians in Oklahoma per 100,000 population, it also discusses the proportion of primary care physicians in the physician workforce. Primary care physicians were found to be neither oversupplied nor undersupplied in Oklahoma. Oklahoma was found to be closer to national planning model goals than most states in the United States. Because this study combines both allopathic and osteopathic physicians and includes only those physicians in active practice, it is unique in comparison to many other studies concerning physician workforce needs.

Processing capacity defined by relational complexity: implications for comparative, developmental, and cognitive psychology

Working memory limits are best defined in terms of the complexity of the relations that can be processed in parallel. Complexity is defined as the number of related dimensions or sources of variation. A binary relation has one argument and one source of variation; its argument can be instantiated in only one way at a time. A binary relation has two arguments, two sources of variation, and two instantiations, and so on. Dimensionality is related to the number of chunks, because both attributes on dimensions and chunks are independent units of information of arbitrary size. Studies of working memory limits suggest that there is a soft limit corresponding to the parallel processing of one quaternary relation. More complex concepts are processed by "segmentation" or "conceptual chunking." In segmentation, tasks are broken into components that do not exceed processing capacity and can be processed serially. In conceptual chunking, representations are "collapsed" to reduce their dimensionality and hence their processing load, but at the cost of making some relational information inaccessible. Neural net models of relational representations show that relations with more arguments have a higher computational cost that coincides with experimental findings on higher processing loads in humans. Relational complexity is related to processing load in reasoning and sentence comprehension and can distinguish between the capacities of higher species. The complexity of relations processed by children increases with age. Implications for neural net models and theories of cognition and cognitive development are discussed.

An investigation into the effects of nicotine gum on short-term memory

Using a between-subjects 2x2x2 factorial design, 60 smokers and 60 non-smokers (equal number of males and females) performed a short-term memory task requiring delayed free recall of a visually presented supraspan word list. Using a double-blind procedure, half the subjects chewed nicotine gum and the other half chewed placebo gum prior to performing the memory task. Results support previous research findings which show that nicotine significantly improves short-term memory. Sex differences were also investigated, but findings showed no significant differences between male and female subjects. Methodological considerations are discussed and directions for future research are suggested.

In whose best interest? The impact of changing public policy on relatives caring for children with incarcerated parents

Changes in criminal justice policy have resulted in the incarceration of an unprecedented number of parents. Consequently, more children than ever before are living with grandparents and other relatives while their parents are imprisoned. Historically, child welfare and criminal justice policy have been treated as distinct and unrelated areas of policy. This article discusses the interdependence of criminal justice policy, welfare reform legislation, and kinship foster care, and the impact of this interdependence on children whose parents are in jail or in prison.

Prevalence of diabetes mellitus in elderly people in Canada: report from the Canadian Study of Health and Aging

AIMS

to estimate the age-specific prevalence of diabetes mellitus in elderly people in Canada, and to examine the effect of method of ascertainment on the estimation of prevalence.

METHOD

three measures of diabetes were used in a secondary analysis of the Canadian Study of Health and Aging--a 1991 nation-wide cross-sectional study of the prevalence of dementia in a sample of 10,263 elderly subjects (aged 65-106 years).

RESULTS

of community-dwelling subjects, 10.3% reported diabetes. Supplementing this information with clinical reports and random plasma glucose measurements increased the prevalence to 12.0% in the community, 17.5% in institutions and 12.4% overall.

CONCLUSION

diabetes is common in elderly people, although the prevalence falls in the very elderly. The method of ascertainment influences estimation of prevalence.

Pediatricians' pet peeves about mental health referrals

This chapter has described a number of problems encountered by pediatricians when referring their patients for mental health services; these are related to access to care, quality of providers and service, attitudes of patients and providers, and lack of adequate communication. We have discussed some of the reasons for these difficulties, provided information that may assist pediatricians in making referrals to appropriate mental health providers, and offered suggestions to facilitate the referral process. We have highlighted the utility of developing and maintaining a relationship with mental health referral sources, and noted a number of advantages of including mental health providers in pediatric practices.

Genomic structure and domain organisation of the human Bak gene

The Bcl-2 homologue, Bak, is a potent inducer of apoptosis. FISH data presented here located the gene to 6p21.3. Mapping was consistent with its location centromeric of the HSET locus and approximately 400kb from the MHC. The construction of a contig of genomic clones across the locus facilitated the sequencing of a PAC containing the gene. Comparison of the gene structure to functional and physical domains revealed a good agreement between the physical structure and the intron-exon organisation. The position of a single intron was conserved in comparison to other members of the Bcl-2 family, namely Bax, CED-9, Bcl-X and Bcl-2, but all other introns were displaced, consistent with a divergent phylogeny.

Prospective randomized controlled trial comparing Lichtenstein with modified Bassini repair of inguinal hernia

We present a prospective randomized study of 80 patients with inguinal hernia who underwent either a modified Bassini repair (n = 38) or a Lichtenstein mesh repair (n = 42). Treatment groups were matched for age, side of hernia, type of hernia and ASA grade. There was no difference in the time taken to perform the two operations: the mean time taken to perform Lichtenstein repair was 26.8 min (range 12 to 49), Bassini repair taking a mean of 27.5 min (range 9 to 51), P = 0.76. There was, however, a difference between the operating times with respect to the type of hernia present, direct hernias being the fastest to repair. Pain scores were assessed by a visual analogue scale, and there was significantly less pain in the Lichtenstein group, P = 0.028. Despite this, there was no difference between the analgesic requirements of the two groups, P = 0.073. In order to assess rehabilitation, lengths of time not working and not driving were assessed. There was no difference in either measurement, P = 0.335 and 0.467 respectively. Patients were followed up a mean of 7 weeks post-operatively (range 1 to 13 weeks). There was no significant difference between the two procedures with regard to post-operative urinary complications, wound infection or other complications. All measurements except the time taken to perform the operation were independent of the surgeon involved. The accuracy of the clinical diagnosis was also assessed, and found to be moderate, with 63% of diagnoses being correct.

The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator

This article describes the relationships between anxiety, self-efficacy, as well as the psychosocial and physiological experiences of patients with an internal cardioverter defibrillator (ICD). Although survival rates with ICDs are impressive, patients experience psychological and physiological responses to their lifesaving devices. Thirty-nine patients completed questionnaires during outpatient clinic visits. Patients' anxiety levels were correlated with fears about ICD malfunction, fear of death, fear of being shocked, loss of control, trouble related to sleeping, inability to concentrate, overprotective family members, and depression. Patients with physical symptoms had higher anxiety levels than those without physical symptoms. There was not a significant relationship between anxiety and discomfort associated with discharge, the number of discharges, or ejection fractions. Low self-efficacy was significantly related to fears about ICD malfunction as well as patients' inability to work, engage in hobbies, and drive a car. Patients with low self-efficacy had more physical symptoms and lower ejection fractions. There were no significant relationships between self-efficacy and frequency of ICD discharge or patients' discomfort during ICD discharge.

Relation between neurological status, refractive error, and visual acuity in children: a clinical study

The aims of the present study were: (1) to determine the refractive status and visual acuity of a group of 75 neurologically impaired children (5 to 192 months of age); and (2) to investigate the relation between the visual and neurological status of these children. Refractive error was determined using non-cycloplegic near retinoscopy and visual acuity was estimated using acuity cards (Keeler or Cardiff) and pattern-onset visual evoked potentials (VEP). Subjects demonstrated a markedly different distribution of refractive error from that of a neurologically normal age-matched population. Refractive error anomalies were more prevalent in children older than 5 years, suggesting abnormal refractive development. A wide range of visual acuity was found with both tests (acuity cards, 0.07 to 2.08 logMAR; VEP, O.78 to 2.68 logMAR). Visual acuity and refractive status varied with level and type of physical impairment. Level of intellectual impairment exhibited a weak relation with visual status.

Cognitive impairment, depression and the specificity of autobiographical memory in the elderly

Previous research has shown that both depressed (Williams & Scott, 1988) and elderly (Winthorpe & Rabbitt, 1988) people have difficulties in being specific in autobiographical memory. However, no study has examined the joint impact of cognitive impairment and affective disturbance. In this preliminary study, 22 elderly people with memory complaints were tested with the Autobiographical Memory Test, the Brief Assessment Schedule Depression Cards, Geriatric Depression Scale and the Mini-Mental State Examination. Results showed that autobiographical specificity decreased with increasing levels of cognitive impairment. Participants were more likely to produce overgeneral memories (omissions or generic memories) than extended or specific memories. There was little relation between severity of depression and specificity in autobiographical memory, consistent with previous suggestions that overgenerality in depression is a long-term cognitive style unaffected by state depression (Brittlebank, Scott, Williams & Ferrier, 1993).

Detection of somatic mutations of the bcl-2 oncogene in B cell lymphomas with the t(14;18)

The incidence of mutations within the first 582 bp of the open reading frame of the bcl-2 gene, has been investigated in presentation lymph node samples, from 7 cases with follicular non-Hodgkin's lymphoma (NHL), 1 case with centroblactic NHL, the DOHH, cell line derived from the immunoblastic transformation of a follicular NHL and one case with benign follicular hyperplasia. A total number of 43 point mutations within the examined portion of the bcl-2 gene were detected in the cases analysed including the DOHH, cell line. Similar analysis of peripheral blood lymphocytes from 2 normal individuals that lacked the t(14;18), revealed no mutations in one case and a single 101 bp A-->G transition in clone, in the other. Missense mutations were detected in 7/8 NHLs, the DOHH2 cell line and the case of benign follicular hyperplasia. There was a significantly higher frequency of mutations within the region corresponding to the BH1, one of the two known functional domains, of the bcl-2 protein. The same position, 445 bp of the bcl-2 gene, was found to be involved in missense mutations affecting the DOHH2 cell line and 3 cases with follicular NHL.

A mucosal irritancy test device for intraoral use in dogs

The objective of this investigation was to conduct, in dogs, a 6-hour acute mucosal irritation study of a new bioerodible treatment. The main problem was to retain the test drug in situ without extraneous irritation from the retention device. A buccal cup was machined from acrylic with a chamber capacity of 0.025 ml and a flange that could be ligated to a tooth. Ten female retired breeder beagles, 7 to 8 years old, with naturally occurring moderate periodontitis were examined and the upper canine teeth scaled to remove plaque and calculus. One week later the buccal cups were placed at the gingival margin of the upper canine teeth and fixed in place with wire ligature passing through holes in the flange and around the tooth, engaging shallow nicks made in the enamel near the gingival margin so the wire would not slide up and down. The buccal cup was further stabilized with glass ionomer cement placed on the crown and over the outer surface of the cup. Buccal cups were loaded with test, placebo, or no ointment by technicians in a scheme to which examiners were blind. Hourly examinations were made, and after 6 hours the cups were removed and gingival mucosa scored for irritation by a previously described method. All dogs tolerated the test and retained the cups for 6 hours. There was no mucosal irritation from the empty cups. We conclude that this new device can be used successfully for testing new agents for short-term mucosal irritancy.

Legal issues in nonrelated infant adoption: nursing implications

PURPOSE

To highlight the legal issues surrounding nonrelated infant adoptions.

POPULATION

Parties in the adoption triad--the infant, the biological parent(s), and the adoptive parent(s).

CONCLUSIONS

Current adoption laws have been influenced by a historical stigmatization of adoption by society, states' sovereignty rights, and individual's constitutional rights. Controversies surrounding nonrelated infant adoptions have highlighted the inadequacies of the present system of adoption laws and regulations. Nurses can take a proactive role in their practice by acquiring a clear understanding of the legal issues surrounding adoption.

PRACTICE IMPLICATIONS

Knowledge about state adoption laws, regulations, and resources, as well as the legal issues surrounding infant adoption, will allow the nurse to take a proactive role in formulating and providing supportive interventions that assist all parties through the process.

Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. The Antidepressant Study Group

This study compares the clinical course of tricyclic antidepressant and fluoxetine overdose. The study was a prospective case series of 9 urban hospital systems. Consecutive sampling of overdose patients presenting to emergency departments provided the participants for the study. The therapy was determined by each institution. Clinical, laboratory, economic impact, and coroners' information was gathered. Of 622 patients, 482 were excluded because of significant coingestants or lack of laboratory confirmation, leaving 124 tricyclic antidepressant and 16 fluoxetine cases. Twenty-seven percent of tricyclic antidepressant patients were alert on arrival to the emergency department; only 12.9% remained alert. The following were significantly more frequent after tricyclic antidepressant overdose: agitation, tachycardia, QRS prolongation, terminal R-wave deviation, intubation, coma, and admission to the intensive care unit. The mean tricyclic plus metabolite level was 777.6 ng/mL (range = 20-5260 ng/ mL), and the mean fluoxetine plus metabolite level was 496.4 ng/mL (range = 120-1930 ng/mL). There were two tricyclic antidepressant deaths. Of 179 total drug-ingestion deaths from the coroners' records, 38 were from tricyclic antidepressants and none from fluoxetine. Thus, tricyclic antidepressant overdoses resulted in more toxicity and more frequent admissions to the intensive care unit than did fluoxetine overdoses.

Concrete strategies for sensitizing youth-serving agencies to the needs of gay, lesbian, and other sexual minority youths

In the past few years, several authors have detailed the needs of gay and lesbian youths and the obstacles youth-serving agencies face in addressing their needs. How administrators and practitioners can make changes in agencies that are not adequately serving sexual minority youths has been unclear. This article uses the experiences of two youth-serving agencies to offer recommendations on agency philosophies concerning the social realities of sexual minority youths and on several ways of creating a safe, welcoming, and productive environment.

Nitric oxide inhibition of transforming growth factor-beta and collagen synthesis in mesangial cells

Culture of mesangial cells (MCs) in 5.6 vs. 30.0 mmol/l glucose for 3 weeks induced a sustained increase in protein kinase C (PKC) activity, transforming growth factor (TGF)-beta1 mRNA, bioactive TGF-beta, and collagen synthesis. Nitric oxide (NO), generated exogenously by the NO donor S-nitroso-N-acetyl, D,L-penicillamine (SNAP) or endogenously after the exposure of MC to interleukin-1beta (IL-1beta), suppressed bioactive TGF-beta in MCs cultured in 5.6 or 30.0 mmol/l glucose and suppressed or abolished increases in TGF-beta1 mRNA and collagen synthesis induced by high concentrations of glucose or phorbol 12,13-dibutyrate without altering values obtained with normal glucose concentrations. SNAP had a transient suppressive effect on PKC activity, which may explain at least in part some of the actions of SNAP. The selective inhibitor of PKC, bisindolylmaleimide (GFX), mimicked NO action. The ability of SNAP and IL-1beta to suppress TGF-beta and collagen synthesis was not mediated by cGMP, since the cGMP analog, 8-Br-PET-cGMP, did not mimic NO action and an antagonist of cGMP-dependent protein kinase, Rp-8-pCPT-cGMPs, did not prevent the inhibitory actions of SNAP. N-omega-L-arginine methyl ester (NMMA) increased TGF-beta in glomerular capillary endothelial cells (GCECs) and stimulated collagen synthesis by MC in a co-culture with GCECs. Captopril inhibited TGF-beta and collagen synthesis and increased cGMP in co-cultures of GCECs and MCs. These effects of captopril were abolished by NMMA, implying mediation by NO. Thus, endogenous NO produced by GCECs may modulate TGF-beta production by both GCECs and MCs and act to suppress matrix protein synthesis by MCs.

Predictors of coronary artery disease in patients with cocaine-associated myocardial infarction. Cocaine-Associated Myocardial Infarction (CAMI) Study Group

PURPOSE

To identify clinical criteria predictive of underlying coronary artery disease in patients with cocaine-associated myocardial infarction.

PATIENTS AND METHODS

Using a retrospective cross-sectional study design at 29 acute care hospitals, we identified 70 patients with cocaine-associated myocardial infarction who had a determination of the presence or absence of coronary artery disease. Clinical characteristics of patients with coronary artery disease (> 50% stenosis on cardiac catheterization or reversible ischemia on stress test) were compared with patients without coronary artery disease (< 50% stenosis on cardiac catheterization).

RESULTS

Compared with patients without coronary artery disease (n = 21), patients with coronary artery disease (n = 49) were older (42 versus 31 years; P < 0.001), had more traditional cardiac risk factors (2.3 versus 1.5; P < 0.001), more frequent history of hypertension (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.4 to 20.4); more frequent family history of myocardial infarction (OR, 4.4; 95% CI, 1.3 to 15.1), more bradydysrhythmias (OR, 8.0; 95% CI, 1.0 to 65.5), and more likely to have an inferior infarct location (P = 0.04).

CONCLUSION

Age, number of cardiac risk factors, location of myocardial infarction, and bradydysrhythmias predict underlying coronary artery disease in patients with cocaine-associated myocardial infarction. If validated, this knowledge may be used to develop a medically appropriate, cost-effective evaluation strategy for patients following cocaine-associated myocardial infarction.

Obstructive sleep apnoea: diagnosis and management

Snoring and the associated syndrome of sleep apnoea can have severe effects on the lives of sufferers and their families. This article discusses why obstructive sleep apnoea is potentially fatal, and how it may be identified and managed.

Intralesional fluorouracil/epinephrine injectable gel for treatment of condylomata acuminata. A phase 3 clinical study

BACKGROUND AND DESIGN

A new intralesional sustained-release chemotherapy is under development as a treatment for condylomata acuminata; it is administered as an injectable gel that consists of fluorouracil and epinephrine with a purified bovine collagen as the gellant (fluorouracil/epinephrine gel). In this randomized, double-blind study, we evaluated the safety and efficacy of this intralesional treatment in 401 patients, using 2 active drug formulations (fluorouracil/epinephrine gel and fluorouracil gel alone) and a placebo. Each lesion was injected once a week for up to 6 weeks, and patients were followed up for 3 months.

RESULTS

A total of 359 patients with 1926 condylomata underwent evaluation. For all lesions treated with fluorouracil/epinephrine gel, the complete response (CR) rate was 77%. For all patients treated with fluorouracil/epinephrine gel, the CR rate was 61%. The fluorouracil/epinephrine gel was significantly more effective (P < .002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with CRs were as follows: fluorouracil/epinephrine gel group, 50%; fluorouracil gel group, 58%. No clinically significant drug-related systemic reactions occurred. Finally, the type and severity of local tissue reactions of patients with a positive pretreatment collagen skin test result (6/401 [1.5%]) were similar to those of patients with a negative collagen skin test result.

CONCLUSION

The fluorouracil/epinephrine injectable gel is a safe and effective treatment for condylomata acuminata.

Oral pilocarpine improves radiotherapy-induced dry eyes

We report a patient with angiosarcoma of the scalp, who was treated with radiotherapy that included both orbits. Following treatment, he developed dry eyes, which improved with oral pilocarpine. Although this drug is used to stimulate salivary flow in patients with radiotherapy-induced xerostomia, it has not been reported before as a treatment for dry eyes following radiotherapy.