The cost-effectiveness of teleradiology at the Women's and Children's Hospital in Adelaide

The cost-effectiveness of teleradiology was examined in a trial conducted at the Women's and Children's Hospital (WCH) in Adelaide, from February 1998 to February 1999. The trial showed that, with the large distances between remote hospitals and metropolitan hospitals, teleradiology, relative to the transfer of remote patients, could be highly cost-effective, but that a new form of cost justification is required for teleradiology for tertiary hospitals providing second opinions in special cases. A series of compelling case studies proved the economic and social value of teleradiology at the WCH.

A randomised trial of an intervention to develop health promoting schools in Australia: the south western Sydney study

OBJECTIVE

This paper describes the evaluation of a health promoting schools intervention carried out in the south western region of Sydney, Australia. The evaluation sought to assess the project's impact on structures to support the health promoting school concept and changes in health-related policies and practices within 22 local schools.

METHODS

A randomised controlled study was employed. Intervention schools were offered seminars and training in the health promoting schools concept, encouraged to use a resource kit to help them establish their school as health promoting and invited to participate in a support network. Pre- and post measures of awareness, school structures and policies and practices to support the development of a health promoting school were taken and intervention and control schools compared.

RESULTS

There was an increased level of awareness of the health promoting school concept among intervention schools. However, there were no significant changes in health-related policies and practices at the school level, among both intervention and control schools.

CONCLUSIONS

A longer time frame and more structured support are required to influence school structures to support the development of a health promoting school.

IMPLICATIONS

To facilitate organisational change in schools, health promoting school interventions need to provide structured support for schools and recognise that change takes time. A committee to initiate action, a plan to guide work and school support are likely to facilitate the adoption of the health promoting schools approach. Further work to refine the measurement of school-based action and its outcome and the development of indicators for a health promoting school is needed.

DNA sequence elements located immediately upstream of the -10 hexamer in Escherichia coli promoters: a systematic study

We have made a systematic study of how the activity of an Escherichia coli promoter is affected by the base sequence immediately upstream of the -10 hexamer. Starting with an activator-independent promoter, with a 17 bp spacing between the -10 and -35 hexamer elements, we constructed derivatives with all possible combinations of bases at positions -15 and -14. Promoter activity is greatest when the 'non-template' strand carries T and G at positions -15 and -14, respectively. Promoter activity can be further enhanced by a second T and G at positions -17 and -16, respectively, immediately upstream of the first 'TG motif'. Our results show that the base sequence of the DNA segment upstream of the -10 hexamer can make a significant contribution to promoter strength. Using published collections of characterised E.coli promoters, we have studied the frequency of occurrence of 'TG motifs' upstream of the promoters' -10 elements. We conclude that correctly placed 'TG motifs' are found at over 20% of E.coli promoters.

Prenatal ethanol exposure reduces spinal cord motoneuron number in the fetal rat but does not affect GDNF target tissue protein

Fetal rats were exposed throughout gestation to one of three diets: an ethanol-containing liquid diet, a liquid diet with the isocaloric substitution of sucrose for ethanol or a laboratory chow control diet. At postnatal day 1 (P1), the spinal cords were taken for analyses of motoneuron number and size. These analyses revealed a significant loss of motoneurons and a reduction of motoneuron size in the ethanol-exposed animals, compared to both sucrose and chow controls. Spinal cord length and ventral horn volume were not altered as a result of ethanol treatment, so the change in motoneuron number cannot be attributed to volumetric changes. The content of the motoneuron survival factor glial cell-line-derived neurotrophic factor (GDNF) was also assessed in the P1 limb motoneuron target tissue. This analysis was undertaken because GDNF is a potent survival factor for developing motoneurons and has been shown to protect this population from ethanol neurotoxicity. Thus, its depletion could contribute to motoneuron loss. These analyses, using the ELISA assay, did not detect reductions in GDNF in the ethanol-exposed animals. Therefore, alterations in other neurotrophic factors or ethanol neurotoxicity by other means appear to be responsible for the motoneuron loss. These results are consistent with earlier studies in the chick embryo, which also found reduced motoneuron numbers as a function of developmental ethanol exposure, and point again to the general lethality of ethanol to the developing nervous system.

An integrated map of human 6q22.3-q24 including a 3-Mb high-resolution BAC/PAC contig encompassing a QTL for fetal hemoglobin

Genetic studies have previously assigned a quantitative trait locus (QTL) for hemoglobin F and F cells to a region of approximately 4 Mb between the markers D6S408 and D6S292 on chromosome 6q23. An initial yeast artificial chromosome contig of 13 clones spanning this region was generated. Further linkage analysis of an extended kindred refined the candidate interval to 1-2 cM, and key recombination events now place the QTL within a region of <800 kb. We describe a high-resolution bacterial clone contig spanning 3 Mb covering this critical region. The map consists of 223 bacterial artificial chromosome (BAC) and 100 P1 artificial chromosome (PAC) clones ordered by sequence-tagged site (STS) content and restriction fragment fingerprinting with a minimum tiling path of 22 BACs and 1 PAC. A total of 194 STSs map to this interval of 3 Mb, giving an average marker resolution of approximately one per 15 kb. About half of the markers were novel and were isolated in the present study, including three CA repeats and 13 single nucleotide polymorphisms. Altogether 24 expressed sequence tags, 6 of which are unique genes, have been mapped to the contig.

Essentials of the diagnosis of heart failure

Although heart failure is a common clinical syndrome, especially in the elderly, its diagnosis is often missed. A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure but also signs and symptoms that point to a specific cause of the syndrome, such as coronary artery disease, hypertension or valvular heart disease. It is important to determine whether the patient has had a previous cardiac event, in particular a myocardial infarction. The physical examination should include Valsalva's maneuver, a test that is highly specific and sensitive for the detection of left ventricular systolic and diastolic dysfunction in patients with heart failure. An electrocardiograph and a chest radiograph should also be obtained. Two-dimensional echocardiography of the heart helps differentiate systolic from diastolic dysfunction. Coronary angiography is indicated in patients with heart failure and anginal chest pain and should be strongly considered in patients with an electrocardiogram suggestive of ischemia or myocardial infarction.

Q-sort assessment of attachment security during the preschool years: links from home to school

This study investigated relations among preschoolers' secure-base behavior with mother at home, stressful family conditions, and qualities of developing relationships with peers and teachers in preschool. Preschool-age children (N = 94; 51 boys and 43 girls) and their mothers were observed during multiple home visits, and their security of attachment was assessed with the Attachment Q-Set. Children in families with lower levels of stress had more secure attachment relationships with mothers. Both boys and girls who were less securely attached to their mothers expressed significantly more anger-aggression in preschool. For boys, higher levels of family stress were also significantly related to anger-aggression and to social competence in preschool. In addition, boys who were more securely attached to their mothers were more securely attached to their preschool teachers and were more popular with peers in preschool.

Precision measurement of cosmic-Ray antiproton spectrum

The energy spectrum of cosmic-ray antiprotons ( &pmacr;'s) has been measured in the range 0.18-3.56 GeV, based on 458 &pmacr;'s collected by BESS in a recent solar-minimum period. We have detected for the first time a characteristic peak at 2 GeV of &pmacr;'s originating from cosmic-ray interactions with the interstellar gas. The peak spectrum is reproduced by theoretical calculations, implying that the propagation models are basically correct and that different cosmic-ray species undergo a universal propagation. Future BESS data with still higher statistics will allow us to study the solar modulation and the propagation in detail and to search for primary &pmacr; components.

Sub-systems for optical frequency measurements: application to the 282-nm (199)Hg(+) transition and the 657-nm Ca line

We are developing laser frequency measurement technologies that should allow us to construct an optical frequency synthesis system capable of measuring optical frequencies with a precision limited by the atomic frequency standards. The system will be used to interconnect and compare new advanced optical-frequency references (such as Ca, Hg(+ ), and others) and eventually to connect these references to the Cs primary frequency standard. The approach we are taking is to subdivide optical frequency intervals into smaller and smaller pieces until we are able to use standard electronic-frequency-measurement technology to measure the smallest interval.

Quality attributes and storage stability of locally and mechanically extracted crude palm oils in selected communities in Rivers and Bayelsa states, Nigeria

The effect of different extraction methods on the quality of crude palm oil processed using traditional (local) and mechanical methods in selected areas of Rivers and Bayelsa States and their storage stability were investigated. Certain quality determining parameters such as free fatty acids (FFA), peroxide value (PV), saponification value (SV), moisture, impurities and volatile matter (MIV) content were determined prior to and after storage for three months. The free fatty acids (FFA) ranged from 7 to 19 percent, peroxide value (PV) ranged from 3 mEq/kg to 6 mEq/kg and moisture, impurity and volatile matter (MIV) ranged from 0.21 to 0.64 percent for locally extracted crude palm oil samples and mechanically extracted crude palm oil samples. There was no significant difference (p > 0.05) in the FFA of samples A and E before and after storage for 3 months. Also two of the locally extracted crude samples (A and E) stored better while one of the samples (D) showed a high level of deterioration as shown in its high levels of FFA, PV and IV values. Samples A and E resulted in a better quality of oil in terms of FFA (av. 7.25%) and PV (av. 4.5 meg/kg) when compared to the mechanically extracted one (sample C) with FFA (10.0%) and PV (5.78 mEq/kg). However, all the locally and mechanically extracted crude palm oil samples could not meet the industrial and international standard quality for crude palm with FFA (2-5%) and PV (2-3.5 mEq/kg). Among the three different storage containers used under different storage conditions, plastic containers (PC) resulted in a better storage stability of the crude palm oils in terms of FFA, SV, and IV than transparent bottles stored on shelves (TBS) and amber-colored bottles stored on the bare floor (BPF).

Neogene and Quaternary Volcanism of Southeastern Turkey

Potassium-argon dating indicates two episodes of basaltic magmatism in south eastern Turkey at c. 19–15 and c. 2.3–0.6 Ma. Each produced olivine-titanaugite basalts, whose chemical compositions are difficult to classify using any conventional model in both the Anatolian continental fragment and the Arabian Platform. It is proposed here that both episodes of volcanism, and the associated crustal thickening and surface uplift, result from heating of the mantle lithosphere by crustal thickening caused by inflow of plastic lower crust from adjoining regions. Thus, although this study region has remained in a plate boundary zone for tens of millions of years, its volcanism has no direct relationship to local plate motions. It is suggested instead that both episodes of volcanism are the result of loading effects caused by glacial to interglacial sea-level variations, which will cause net flow of lower crust from beneath the offshore shelf to beneath the land: the moderate glaciations of Antarctica which began in the Early-Middle Miocene, and the more intense lowland glaciations of the northern hemisphere which began around c. 2.5 Ma.

The relationship between rumination and eating disorders

OBJECTIVE

Rumination has been described as a symptom in association with eating disorders, but also as a separate disorder.

METHOD

A series of 8 female volunteers who reported rumination were systematically screened for the presence of eating disorders and other psychopathology.

RESULTS

Seven met current or prior criteria for an Axis I disorder and five had a current or prior eating disorder.

DISCUSSION

The importance of screening for eating disorders among women who ruminate, and for screening for rumination among eating disorder patients, is stressed.

Jejunostomy tube feedings should not be stopped in the perioperative patient

BACKGROUND

Anesthetic standard of care is to restrict oral intake for 8 hours before elective surgery. There is no research addressing appropriate preoperative discontinuation of jejunostomy tube (J-tube) feedings. We hypothesized that patients could be fed safely, via a J-tube, until the time of surgery.

METHODS

Patients admitted to a Level I Trauma Center, having J-tubes and undergoing a nonabdominal operation, were prospectively evaluated. Group I patients received J-tube feedings until transport to the operating room. Group II patients had tube feedings discontinued for at least 8 hours before surgery. Data were compared using the Student's t test and contingency table analysis.

RESULTS

There were 46 patients in group I and 36 in group II. There was no incidence of aspiration. Patient groups did not differ in age, mortality, length of stay, injury severity score, or ventilator days. Group I patients had tube feedings discontinued for fewer hours before and after surgery than group II patients (before surgery: 1.40 +/- 1.20 vs 11.61 +/- 5.01, respectively; p < .001; after surgery: 2.99 +/- 7.49 vs 7.11 +/- 9.03, respectively; p = .043); received more kilocalories/ grams of protein on the day of surgery (group I vs group II, 1676.15/89.57 +/- 1133.21/38.04 vs 791.14/57.58 +/-498.66/79.87, respectively; p = .001/p = .032) and more kilocalories/grams of protein on the first postoperative day (group I vs group II, 1580.74/92.57 +/- 600.53/37.96 vs 1152.47/63.53 +/- 733.96/39.40, respectively; p = .006/p = .001).

CONCLUSIONS

Patients receiving J-tubes who are undergoing nonabdominal operations may safely continue enteral nutrition at maximum protein and caloric intake until surgery.

Clinical characteristics of SOD1 gene mutations in UK families with ALS

Five to ten percent of patients with ALS have a family history of the disease, inheritance is usually autosomal dominant. Mutations of the SOD1 gene were first identified in a proportion of families with ALS by Rosen et al. The SOD1 gene encodes the enzyme copper zinc superoxide dismutase. Patients were studied from throughout the UK, where more than one individual in the family had ALS. Clinical history and examination of the individual and family were obtained, and DNA extracted from leukocytes of whole blood samples. Mutations were identified by standard sequencing methods. To date, 12 different mutations of SOD1 have been identified in 17 different families, representing around 20% of all ALS families studied. The mutations were mainly single base substitutions - H48Q, G72S, G93R, G93V, E100G, D101N, D101G, G108V, I113T, D125H, I149T - and also an insertion mutation - 132insTT - leading to a premature stop codon. The mutations were present in exons 2-5. We did not identify mutations in exon 1, although these have been identified by others in different patient samples. We have identified SOD1 mutations in around 20% of UK families with ALS studied. This is similar to that reported in other populations. Mutations have now been identified in all exons of SOD1. The individual mutations do not precisely predict disease severity, and generally it is difficult to give a specific prognosis based on the individuals' SOD1 mutations. We continue to investigate the possible pathogenic mechanisms of the SOD1 mutations. We have studied the neuropathology in patients with SOD1 mutations. We are also performing linkage studies to identify the genes involved in the 80% of families where an SOD1 mutation has not been identified.

Health-related quality of life: does rurality matter?

This study addresses the question of whether six health-related quality-of-life domains are related to population density within a rural area while adjusting for the effects of demographic characteristics and social support resources. The sample consisted of 2,178 adults aged 60 years or older who resided in eastern North Carolina between 1989 and 1991. Ordinary least squares regression estimation was used to analyze this survey data. For the analyses, rural residence was broken down into five levels reflecting population density, which was compared with analyses utilizing a collapsed dichotomous residential measure. Results indicate that a more detailed residence measure within a predominantly rural area provides valuable information that would otherwise be concealed by a dichotomous measure.

Nitrotyrosine formation in the airways and lung parenchyma of patients with asthma

BACKGROUND

Recent evidence has shown that nitric oxide (NO) levels are increased in asthmatic airways. Although the role of NO in asthma is unknown, reactive metabolites of NO may lead to nitrotyrosine formation and promote airway dysfunction.

OBJECTIVE

The aim of this study was to determine whether nitrotyrosine, as a marker of nitrating species, could be found in the airways and lung parenchyma of subjects with asthma who died of status asthmaticus or other nonrespiratory causes.

METHODS

Lung tissue specimens were obtained from 5 patients who died of status asthmaticus, 2 asthmatic patients who died of nonrespiratory causes, and 6 nonasthmatic control subjects who died of nonrespiratory causes. Lung sections were stained for immunofluorescence with use of an antinitrotyrosine antibody, followed by a indiocarbocyanine (Cy5, Jackson Immunochemicals, Westgrove, Pa)-conjugated secondary antibody.

RESULTS

Nonasthmatic lungs showed little or no nitrotyrosine staining, whereas asthmatic lungs demonstrated significantly more staining of nitrotyrosine residues distributed in both the airways and lung parenchyma.

CONCLUSION

This study demonstrates the presence of nitrotyrosine, and hence evidence of formation of nitrating species, in the airways and lung parenchyma of patients with asthma who died of status asthmaticus or other nonrespiratory causes. This finding supports the concept that widespread airway and parenchymal inflammation occurs in asthma, and, more specifically, that NO and its reactive metabolites may play a pathophysiologic role in asthma.

Induction of eotaxin expression and release from human airway smooth muscle cells by IL-1beta and TNFalpha: effects of IL-10 and corticosteroids

Eotaxin is a novel C-C chemokine with selective chemoattractant activity for eosinophils. We determined whether eotaxin could be produced by human airway smooth muscle (HASM) cells in culture and examined its regulation by interleukin-10 (IL-10) and the corticosteroid, dexamethasone. Stimulation of the cells with interleukin-1beta (IL-1beta) or tumour necrosis factor (TNFalpha) each at 10 ng ml(-1) induced the release of eotaxin protein with maximal accumulation by 24 h. Interferon-gamma (IFNgamma) alone at 10 ng ml(-1) had no effect and there was no synergy between these cytokines on the release of eotaxin. Reverse phase high performance liquid chromatographic (HPLC) analysis of supernatents from cells treated with TNFalpha (10 ng ml(-1) for 96 h showed immunoreactivity to eotaxin which eluted with the expected retention time of 34.5-35 min. Both IL-1beta and TNFalpha-induced release of eotaxin was not inhibited by dexamethasone (1 microM), however IL-10 (10 ng ml(-1)) had a significant inhibitory effect. Dexamethasone and IL-10 did not inhibit the induction of eotaxin mRNA induced by IL-1beta or TNFalpha. Thus, human airway smooth muscle cells can release eotaxin and could be an important source of chemokine production during airway inflammatory events.

Premature mortality in the United States: the roles of geographic area, socioeconomic status, household type, and availability of medical care

OBJECTIVES

This study examined premature mortality by county in the United States and assessed its association with metro/urban/rural geographic location, socioeconomic status, household type, and availability of medical care.

METHODS

Age-adjusted years of potential life lost before 75 years of age were calculated and mapped by county. Predictors of premature mortality were determined by multiple regression analysis.

RESULTS

Premature mortality was greatest in rural counties in the Southeast and Southwest. In a model predicting 55% of variation across counties, community structure factors explained more than availability of medical care. The proportions of female-headed households and Black populations were the strongest predictors, followed by variables measuring low education, American Indian population, and chronic unemployment. Greater availability of generalist physicians predicted fewer years of life lost in metropolitan counties but more in rural counties.

CONCLUSIONS

Community structure factors statistically explain much of the variation in premature mortality. The degree to which premature mortality is predicted by percentage of female-headed households is important for policy-making and delivery of medical care. The relationships described argue strongly for broadening the biomedical model.

An ombudsman for humanitarian assistance?

The early phases of a project to design and make operational an ombudsman for humanitarian assistance (HAO) are described in this paper. Beginning with a brief historical overview of the ombudsman concept, it then outlines seven key features of a potential HAO that were identified in the initial feasibility study. The main conclusion from the feasibility study was that, in principle, it is possible to design an HAO by adapting the operational frameworks of existing ombudsman schemes so as to match the needs of the humanitarian sector. Although this seems possible in theory, there still remain some major challenges requiring practical testing in a pilot phase. The most fundamental of these is how to enable the beneficiaries of aid to make their voices heard and register their views on the management of the emergency that is affecting them. Important also, are the issues of ensuring an international jurisdiction and finding sustainable ways of financing the scheme. Finally, the paper alludes to the framework of the pilot itself and how to address the main challenges ahead.

Lay beliefs about the preventability of major health conditions

Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.

Human lens cholesterol concentrations in patients who used lovastatin or simvastatin

OBJECTIVE

To determine whether long-term therapeutic use of the hypocholesterolemic drugs lovastatin and simvastatin significantly alters the distribution and concentration of cholesterol in the human lens. Such changes might precede observable alterations in lens structure.

METHODS

Pairs of lenses (9-13 pairs) from patients (age range, 46-81 years) who had been taking lovastatin or simvastatin before their death (estimated for the previous 2-4 years) and lenses from similarly aged control subjects were divided into outer cortex and inner cortex plus nucleus by dissolution in a detergent-containing buffer. Ten minutes of dissolution removed 17% to 19% of the lens total volume, which accounted for about 20% of the width of the equatorial cortex and 75% of the width of the sagittal cortex. This fraction plus the residual lens was homogenized, saponified, and assayed for cholesterol by gas-liquid chromatography.

RESULTS

The cortex of adult control lenses contained about 4 microg of cholesterol per cubic millimeter of volume. This concentration increased to 10 to 15 microg/mm3 in the adult nucleus and decreased to about 6 microg/mm3 in the juvenile and fetal nucleus. Treatment with neither lovastatin nor simvastatin significantly altered the concentration of cholesterol in either the cortex or nuclear fractions.

CONCLUSIONS

Variations in concentration of cholesterol along the radii of the lens reflect differences in the density or packing of fiber cell membranes. The observed distribution of cholesterol supports the recent model of the adult lens structure, which, from surface to center, is the cortex, adult nucleus,juvenile nucleus, fetal nucleus, and embryonic nucleus. Finding no significant changes in concentration of cholesterol in the cortex formed during treatment with lovastatin or simvastatin reinforces the results of clinical studies that indicate a high lenticular safety of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Nevertheless, caution is encouraged in assuming a similar ocular safety in newer drugs that inhibit cholesterol synthesis at later metabolic steps.

CLINICAL RELEVANCE

Does clinical use of hypocholesterolemic drugs alter lens cholesterol?

Smooth-muscle myosin heavy-chain SM-B isoform expression in developing and adult rat lung

The smooth-muscle cells composing the vasculature and airways of the lung display a variety of contractile protein phenotypes. To date, however, it has remained unclear how these phenotypes might contribute differentially to contractile activity. To address this issue, we made monospecific rabbit polyclonal antibodies against the difference peptide for the SM-B smooth-muscle myosin heavy chain (SMMHC) and used these to investigate the distribution of the SM-B isoform in lung. SM-B has a seven-amino acid insert in the head region that is known to result in a higher actin-activated adenosine triphosphatase activity and in vitro motility. During development, reactivity is first seen in the trachea and bronchi of saccular lung at the time of birth, when other SMMHC isoforms also are present. Immunoreactivity spreads distally through the airways as development proceeds, reaching the level of alveolar septae in the adult. Although the smaller vessels of the pulmonary vasculature react strongly with the SM-B antibody, reactivity is infrequently observed in large pulmonary vessels. Adult tracheal smooth muscle is highly and more uniformly reactive, commensurate with its relatively high maximal velocity of shortening. The differential expression of the SM-B isoform in vascular and airway smooth muscles demonstrated in this study may provide the molecular basis for functional differences between these smooth-muscle cell types and may provide one mechanism for adapting contractility in response to physiologic stresses in the lung.

Platelet activation in patients after an acute coronary syndrome: results from the TIMI-12 trial. Thrombolysis in Myocardial Infarction

This study was designed to determine the magnitude and time course of platelet activation during therapy of acute coronary syndromes with an oral platelet antagonist.

BACKGROUND

Platelet activation and aggregation are central to the pathogenesis of the acute coronary syndromes (ACS). However, few data are available on levels of platelet activation over time in patients with ACS, especially in the setting of chronic glycoprotein (GP) IIb/IIIa inhibition.

METHODS

The Thrombolysis in Myocardial Infarction (TIMI) 12 trial was a phase II, double-blind trial evaluating the effects of sibrafiban, an oral, selective antagonist of the platelet glycoprotein IIb/IIIa receptor in patients stabilized after an ACS. A subset of 90 of the 329 patients in the study had measurement of platelet activation as assessed by the expression of platelet associated P-Selectin on days 0, 7 and 28. Platelet activation was measured in blood samples that were fixed either immediately (spontaneous activation) or after 5 minute incubation with 0, 1 microM or 5 microM ADP in order to assess platelet responsiveness to very low or moderate stimulation.

RESULTS

At baseline there was a significant elevation of spontaneous platelet activation as compared to samples obtained from normal donors or from patients who did not have acute coronary syndromes (ACS patients 27.6+/-18.7%, Normal controls 8.5+/-4.4%, Patient controls 10.9+/-7.1%, p < 0.005 for both). In addition, there was a significant decrease in the levels of platelet activation with time during the 28 days of treatment with sibrafiban. Nevertheless, even on day 28, the TIMI-12 patients continued to show elevated platelet activation in comparison to the control groups (p < 0.05 for both).

CONCLUSIONS

These results suggest that platelets remain activated long after clinical stabilization post ACS. Although platelet activation decreased after one month of oral GPIIb/IIIa inhibition, levels remained higher than normal, suggesting the need for long-term antiplatelet therapy following ACS.

Prior treatment received by patients with bulimia nervosa

OBJECTIVE

This study examined the frequency with which subjects with bulimia nervosa (BN) presenting for treatment or follow-up studies had previously received either adequate pharmacologic treatment or cognitive-behavioral therapy (CBT).

METHOD

Semistructured telephone screening of individuals who called in response to advertisements about research studies was used to establish diagnoses and to clarify prior pharmacologic and psychotherapeutic treatments for BN.

RESULTS

Of 581 women responding, 353 (60.8%) had probable BN. Overall, 61.4% of these subjects had received psychotherapy (96.7%) but rarely CBT (6.9%). Over one half (63.7%) had received pharmacologic treatment, most commonly with fluoxetine (72.5%). Of those having received any medication treatment, 46.2% were judged to have received at least one adequate trial. Overall, 35.0% of those previously treated had received at least one prior course of adequate pharmacotherapy or CBT for BN.

CONCLUSION

Although efficacious treatments for BN have been established, they have not been received by most individuals presenting for further treatment.