Improved patient outcomes at a urology nurse clinic

A urology nurse clinic was developed to improve cost and quality of care outcomes for patients with benign prostatic hypertrophy amid cost constraints and the need for improved service delivery. Cost and quality of care outcomes were achieved through earlier discharge and improved assessment, education, and discharge planning for patients. The professional development of urology nurses also improved through increased practice of advanced assessment skills and broadened scope of practice.

IkappaBalpha degradation and nuclear factor-kappaB DNA binding are insufficient for interleukin-1beta and tumor necrosis factor-alpha-induced kappaB-dependent transcription. Requirement for an additional activation pathway

Two closely related IkappaBalpha kinases as well as the upstream kinase, NIK, which integrates interleukin-1beta (IL-1beta)- and tumor necrosis factor (TNF)-alpha-dependent activation of the transcription factor NF-kappaB have recently been described. However, in this emerging pathway the role of previously identified components of cytokine-induced NF-kappaB activation, namely phosphatidylcholine-specific phospholipase C and protein kinase C, remains unclear. We now show that, in A549 human alveolar epithelial cells, the activation of a stably transfected NF-kappaB-dependent reporter gene by TNF-alpha and IL-1beta is completely blocked by the phosphatidylcholine-specific phospholipase C inhibitor D609 and the protein kinase C inhibitor RO31-8220. However, IL-1beta-induced IkappaBalpha degradation as well as NF-kappaB nuclear translocation and DNA binding, as determined by Western blot and electro-mobility shift assay, respectively, are not affected by these inhibitors. A similar effect, although less pronounced, is observed with the p38 mitogen-activated protein kinase inhibitor SB 203580. On the basis of these data we propose the existence of a second signaling pathway induced by IL-1beta and TNF-alpha that is activated in parallel to the cascade leading to IkappaBalpha degradation and is specifically required for NF-kappaB-dependent transcriptional competency.

Children's views of accident risks and prevention: a qualitative study

OBJECTIVES

To examine children's accounts of injury risks and opportunities for prevention.

SETTING

Schools, youth clubs, and a holiday activity scheme in the south east of England.

METHODS

Sixteen focus groups were held with 7-11 year old children. Transcripts of the discussions were analysed using qualitative methods.

RESULTS

Children were knowledgeable about injury risks and how to reduce them. They also saw injury prevention as primarily their own responsibility. However, they were also sophisticated in their criticisms of generalised prevention advice, and evaluated safety messages in the light of local environmental and social knowledge. Personal experience was more often reported as a reason for risk reduction than formal prevention advice. Risks for injury were not isolated from other risks faced.

CONCLUSIONS

Effective educational interventions aimed at changing children's risk behaviour should build more on children's own competence and knowledge of their local environment, and stress the need to manage risks rather than avoid dangers.

Epidemiologic study of cats and dogs affected by the 1991 Oakland fire

OBJECTIVE

To identify risk factors of pets affected by the 1991 Oakland, Calif fire for being lost, found, adopted, or reunited with owners.

DESIGN

Retrospective cohort study.

ANIMALS

1,075 cats and 197 dogs affected by the fire and 221 cats and 128 dogs not affected by the fire.

PROCEDURES

Records compiled from 1991 to 1995 by the Oakland Firestorm Pet Hotline were analyzed.

RESULTS

Peak activity for the hotline was on days 3 and 4 after the fire, but decreased to a low, steady rate by day 21. Many pets were found that had been abandoned or were part of a large free-roaming population that existed at the time of the fire. Many were missing after the fire and presumed killed. The longer owners delayed looking for their pet, the lower the chance of being reunited. Pets wearing collars with the owners' names and addresses had a more than 10-fold chance of being reunited, compared with pets without collars. Increasing odds for adoption of lost pets was associated with their proximity to the fire.

CLINICAL IMPLICATIONS

Hotlines set up after sudden impact disasters, such as the Oakland Firestorm Pet Hotline, will probably register primarily abandoned animals. Reunion of pets with their owners appears to be most likely for those that receive an overall better level of care than pets found at other times. Adoption of pets after this disaster was primarily by the person who found that animal and principally resulted when the pet was found close to the disaster area.

Utility of chest radiography and cystoscopy in the evaluation of patients with localized prostate cancer

OBJECTIVES

Candidates for radical prostatectomy have been frequently evaluated with chest radiography and occasionally with cystoscopy. The utility of these studies was assessed.

METHODS

A retrospective review of 236 cases of radical prostatectomy performed over 5 years was conducted. Chest x-ray results were correlated with certain comorbidities believed to be risk factors for radiographic abnormalities, including hypertension, cardiac disease, pulmonary problems, and tobacco use. Cystoscopic findings were analyzed with regard to urologic history and urinalysis results.

RESULTS

Chest radiography was normal in 208 (88.1%) and abnormal in 28 (11.9%) patients. All 28 patients with abnormalities had one or more of the aforementioned risk factors. Sixty-two individuals (26.3%) had no risk factors, and chest radiography was uniformly normal in this group. Cystoscopy was performed in 91 patients. State Ta transitional cell carcinoma of the bladder was detected in 6 of these patients (6.6%); these 6 patients all had either a history of this problem or hematuria. One individual had a mild bladder-neck contracture that did not warrant treatment. Endoscopic findings were normal in the remaining patients.

CONCLUSIONS

Chest radiography is not routinely needed to evaluate radical prostatectomy candidates. It should only be performed in patients who have or are at risk for cardiopulmonary disease. Cystoscopy is not warranted in this setting unless there is clinical suspicion of other urologic pathology.

Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications

We assessed clinical consequences and financial implications of Helicobacter pylori eradication in 175 patients with peptic ulceration, of whom 106 had been free from H. pylori infection for a mean of 3.2 years, while 69 remained infected. We used quarterly questionnaires to examine consumption of ulcer-healing medication and antacids. In the 106 successfully treated patients, gastrointestinal haemorrhage as a complication of peptic ulcer complications during the 344 patient years after eradication (0.003 per patient year) was 18-fold lower than during the 912 patient years before eradication (0.056 per patient year). Of the H. pylori-negative patients, 12-18% used ulcer-healing medication during any one of the three-month periods of the survey, compared with 34-51% of the patients with residual H. pylori infection. The average cost of the ulcer-healing drugs consumed by the H. pylori-negative patients was 30.59 pounds during the 12 months of the survey, compared with 99.05 pounds for H. pylori-positive patients. Consumption of antacids was also lower in the H. pylori-negative group. Successful eradication of H. pylori significantly reduced the annual cost of ulcer-healing drugs consumed by the patients with ulcer disease. Maintenance of ulcer remission following successful eradication of H. pylori also significantly reduced ulcer complications.

Correlation of prostate-specific antigen and prostate-specific antigen density with outcome of prostate biopsy

OBJECTIVE

We attempt to correlate prebiopsy serum prostate-specific antigen (PSA) concentration and prostate-specific antigen density (PSAD) with histologic results of prostate biopsy.

METHOD

Sixty-two consecutive patients underwent prostate biopsy because of elevated PSA greater than 4 ng/mL and/or abnormal findings on digital rectal examination (DRE). PSAD was calculated from dividing the serum PSA concentration by the prostate volume as determined by transrectal ultrasound (TRUS). PSA and PSAD were compared to biopsy outcome.

RESULTS

The mean PSAD values of the cancer versus noncancer (benign prostatic tissue, benign prostatic hyperplasia, and prostatitis) groups were significantly different (p < 0.019). However, there was great overlap in individual values. The mean PSA levels of the cancer versus noncancer groups also were significantly different (p < 0.0079). In patients with PSA levels between 4 and 10 ng/mL, 11 of 32 (34%) had positive biopsy findings for cancer. Eleven of 29 patients (38%) with normal DRE findings and elevated PSA levels (> 4 ng/mL) had positive biopsy findings for cancer. Seven of 19 patients (37%) with normal DRE findings and elevated PSA levels between 4 and 10 ng/mL had positive biopsy specimens for cancer.

CONCLUSIONS

PSAD, though suggestive, is not definitive for cancer or noncancer. Patients with inflammation (prostatitis) present in their biopsy specimens have serum PSA levels and PSAD values intermediate between those with benign tissue (without inflammation) and cancer. We think that prostate biopsy is important in patients with PSA levels between 4 and 10 ng/mL even if their DRE result is normal, as our data indicate that over one third of these patients harbor detectable prostate cancer.

Characterization of tumor-infiltrating lymphocyte subsets from human renal cell carcinoma: specific reactivity defined by cytotoxicity, interferon-gamma secretion, and proliferation

The detection of T cells with specificity for human renal cell carcinoma (RCC) has been difficult to document. In an attempt to improve our identification of RCC-reactive T cells, tumor-infiltrating lymphocytes (TIL) were expanded in interleukin-2/interleukin-4 (IL-2/IL-4) and then separated into CD4+ and CD8+ subsets using antibody-coated biomagnetic beads. TIL grown in IL-2/IL-4 expanded to greater numbers than TIL grown in IL-2 alone. From 16 patients in whom subset separation was performed, three CD4+ and three CD8+ TIL consistently had specificity for RCC that was detected by cytotoxicity, proliferation, or interferon-gamma (IFN-gamma) production. Four of the six lines were derived from the IL-2/IL-4 cultures. Two CD8+ TIL lines displayed specific lytic activity, lysing the autologous tumor but not allogeneic RCC or nonrenal tumors. Moreover, the lytic activity of these lines was blocked by anti-CD3 antibody, suggesting that tumor recognition was through the TCR/CD3 complex. Two additional TIL lines showed preferential lysis of RCC because they were cytotoxic for autologous tumor and one or more allogeneic RCC but not other tumor types. Two nonlytic CD4+ lines as well as the two CD8+ lines that were specifically lytic also produced IFN-gamma in response to the autologous tumor but not allogeneic RCC. Although these TIL lines produce IFN-gamma when stimulated with tumor alone, the addition of 5 U/ml of IL-2 significantly enhanced IFN-gamma secretion. The four TIL lines that showed specificity for RCC in terms of IFN-gamma production also had enhanced proliferation to the autologous RCC plus IL-2 but not to multiple allogeneic RCC plus IL-2. These studies demonstrate that TIL from RCC patients contain both CD4+ and CD8+ T cells that have specificity for RCC. In addition to cytotoxicity, specificity to RCC can be defined by IFN-gamma production and proliferation.

Transient and stable expression of gusA fusions with rice genes in rice, barley and perennial ryegrass

Transcriptional and translational fusions were made between the reading frame coding for beta-D-glucuronidase and sequences of either a constitutively expressed rice gene (GOS2) involved in initiation of translation or a light-inducible rice gene (GOS5). The transient expression of the fusions was studied via particle bombardment of seedling tissues of rice, perennial ryegrass and barley. Furthermore, the results of transient and stable expression were compared for cell suspensions of four rice varieties, one barley variety and one perennial ryegrass variety. The GOS2-gusA fusions were active in all three monocots studied. Best results were obtained for a construct having both a transcriptional and a translational fusion as well as intron and exon sequences (PORCEHyg). The level of GUS activity was in the range of activities as obtained by the 35S CaMV promoter transcriptionally fused to gusA. The gusA fusion with the light-inducible gene (GOS5) was active in green seedling tissues of all monocots studied. Also a weak expression compared to the GOS2 constructs was found in stably transformed rice callus. The gusA fusions with the mannopine synthase promoters 1' and 2' of the TR-DNA were transiently expressed at lower levels in cell suspensions than PORCEHyg. For stably transformed rice callus the expression of the GOS2-gusA fusion often decreased during prolonged subculture. This decrease in GUS activity and the various GUS-staining phenotypes of transgenic calli are explained by the presence of different cell types in the suspensions used and in the calli. It is presumed that the nature of the cells and their relative contribution in the calli change drastically upon further subculture.

Transient and stable expression of gusA fusions with rice genes in rice, barley and perennial ryegrass

Transcriptional and translational fusions were made between the reading frame coding for beta-D-glucuronidase and sequences of either a constitutively expressed rice gene (GOS2) involved in initiation of translation or a light-inducible rice gene (GOS5). The transient expression of the fusions was studied via particle bombardment of seedling tissues of rice, perennial ryegrass and barley. Furthermore, the results of transient and stable expression were compared for cell suspensions of four rice varieties, one barley variety and one perennial ryegrass variety. The GOS2-gusA fusions were active in all three monocots studied. Best results were obtained for a construct having both a transcriptional and a translational fusion as well as intron and exon sequences (PORCEHyg). The level of GUS activity was in the range of activities as obtained by the 35S CaMV promoter transcriptionally fused to gusA. The gusA fusion with the light-inducible gene (GOS5) was active in green seedling tissues of all monocots studied. Also a weak expression compared to the GOS2 constructs was found in stably transformed rice callus. The gusA fusions with the mannopine synthase promoters 1' and 2' of the TR-DNA were transiently expressed at lower levels in cell suspensions than PORCEHyg. For stably transformed rice callus the expression of the GOS2-gusA fusion often decreased during prolonged subculture. This decrease in GUS activity and the various GUS-staining phenotypes of transgenic calli are explained by the presence of different cell types in the suspensions used and in the calli. It is presumed that the nature of the cells and their relative contribution in the calli change drastically upon further subculture.

Individual differences in children's response to pain: role of temperament and parental characteristics

Sixty-five families were enlisted in a study exploring factors associated with distress behavior in 5-year-old children receiving diphtheria-tetanus-pertussis immunizations. At a home visit 1 month before the immunization, the following measures were obtained: (1) the Behavioral Style Questionnaire, a measure of temperament: (2) parental self-reports of medically related attributes (eg. "good patient"); (3) parental attitudes toward pain in children and responsiveness to their child's pain; and (4) parental prediction of distress at upcoming immunization. The child's distress behavior during the immunization was evaluated using a modification of the Procedure Rating Scale-Revised and, after the procedure, the child's assessment of his or her pain was elicited using the Oucher. Children's mean Procedure Rating Scale-Revised score was 2.57 of a possible 11. Thirty-one (48%) had low (less than or equal to 1) and 7 (11%) had high distress scores (greater than or equal to 2 SD above the mean). Factors positively correlated with distressed behavior included more "difficult child" cluster characteristics, the individual temperamental dimension of adaptability, but few parental attitudes and attributes. Parent's predictions of distress were the strongest correlates. These findings document the variation that children demonstrate in response to pain and offer some insight into associated innate and environmental factors. These results imply that treatment strategies derived from parental knowledge and tailored to individual characteristics of the child may be most effective in alleviating pain-related distress in medical settings.

The influence on blood pressure during daily activities of a single session of aerobic exercise

Previous research has examined the effectiveness of a single session of aerobic exercise in lowering blood pressure responsivity to the subsequent presentation of a nonexercise stressor in the laboratory. This case study was designed to explore the possibility that a single session of aerobic exercise might lower blood pressure for up to 4 hours postexercise as the subject engaged in his usual activities at home and at work. The subject was an untrained, unmedicated, borderline hypertensive who underwent ambulatory blood pressure monitoring as he maintained a normal schedule of activities over a 5-day period. On 2 of the 5 days, the subject exercised at 8:30 AM for 30 minutes at 70% VO2max. Blood pressure readings on days when the subject read for 30 minutes were compared with readings on days when he exercised. He showed an average reduction in systolic blood pressure of 26.4 mm Hg at 2 hours after exercise, 24.2 mm Hg at 4 hours afterward, and 12.2 mm Hg at 9 hours after the exercise. Changes in diastolic blood pressure and heart rate were smaller and less consistent. The authors concluded that the modifying influence of a single session of aerobic exercise on blood pressure responsivity to subsequent laboratory-based stressors may also extend to the natural environment. The discussion addresses theoretical, methodological, and clinical considerations in the use of aerobic exercise to modify excessive blood pressure reactivity.

The Duke AFM Program. Intensive induction chemotherapy for metastatic breast cancer

Forty-five patients have completed treatment with AFM, an intensive induction chemotherapy regimen composed of Adriamycin (doxorubicin, Adria Laboratories, Columbus, Ohio), 5-fluorouracil, and methotrexate with folinic acid rescue. This regimen was designed to produce rapid and extensive tumor shrinkage prior to high-dose alkylating agent chemotherapy with autologous marrow support. The overall response rate was 91%, and 38% of patients achieved complete clinical responses after a mean of 70 days on treatment. Hematologic and mucosal toxicity were extensive, but no toxic deaths were noted. AFM is a potent remission induction regimen for metastatic breast cancer, but its considerable toxicity suggests caution in its use for routine breast cancer treatment.

Detection of human immunodeficiency virus in infected CEM cells using fluorescent DNA probes and a laser-based computerized image cytofluorometry system

Quantitative nonradioactive methods to measure the human immunodeficiency virus (HIV) in individually infected cells are needed for the direct assessment of HIV infection, for the evaluation of antiviral chemotherapy and for testing the efficacy of vaccines. As a first step in accomplishing this goal, we built an argon ion laser-based computerized image cytofluorometry (ALCIC) system and determined this instrument's ability to quantitatively measure HIV nucleotides in infected lymphocytes. ALCIC consisted of a 43-mW argon ion laser connected to a Zeiss Universal microscope via a fiberoptic cable, a charged coupled-device video camera, a video frame grabber and array processor and a Micro Vax II computer using computer programs written in FORTRAN. HIV RNA and DNA were detected in infected CEM lymphocytes in culture by in situ hybridization using acetylaminofluorene (AAF)-labeled HIV-DNA probes, a rabbit anti-AAF antibody and a fluorescein-labeled goat anti-rabbit antibody. ALCIC measurements showed that 61% of the CEM cells were infected and that quantitative differences were distinguishable within this group. The levels of fluorescein isothiocyanate (FITC) fluorescence were sixfold or more greater than that observed with the same system using a 100-W mercury lamp for illumination; the improved intensity of the laser-based system is due to greater excitation intensity of the laser and the matching of the excitation spectrum to the peak wavelength of FITC. ALCIC has potential clinical value for determining the effect of antiviral agents on HIV infection and for assessing the susceptibility of different cell types to infection.

Maximal aerobic exercise following prolonged sleep deprivation

The effect of 60 h without sleep upon maximal oxygen intake was examined in 12 young women, using a cycle ergometer protocol. The arousal of the subjects was maintained by requiring the performance of a sequence of cognitive tasks throughout the experimental period. Well-defined oxygen intake plateaus were obtained both before and after sleep deprivation, and no change of maximal oxygen intake was observed immediately following sleep deprivation. The endurance time for exhausting exercise also remained unchanged, as did such markers of aerobic performance as peak exercise ventilation, peak heart rate, peak respiratory gas exchange ratio, and peak blood lactate. However, as in an earlier study of sleep deprivation with male subjects (in which a decrease of treadmill maximal oxygen intake was observed), the formula of Dill and Costill (4) indicated the development of a substantial (11.6%) increase of estimated plasma volume percentage with corresponding decreases in hematocrit and red cell count. Possible factors sustaining maximal oxygen intake under the conditions of the present experiment include (1) maintained arousal of the subjects with no decrease in peak exercise ventilation or the related respiratory work and (2) use of a cycle ergometer rather than a treadmill test with possible concurrent differences in the impact of hematocrit levels and plasma volume expansion upon peak cardiac output and thus oxygen delivery to the working muscles.

The visual evoked potentials to the light emitting diode compared to the flash and pattern reversal stimulus

Light-emitting diode (LED), flash (FL) and pattern reversal (PR) stimuli were used to elicit visual evoked potentials (VEPs) in 16 normal subjects (32 eyes) and 39 patients (78 eyes) with signs of visual system abnormality. Latencies and amplitudes (plus standard deviations) of 5 components of each response, correlation coefficients of the normal and abnormal responses and false negatives and positives are presented for the 3 kinds of stimuli. The data show that responses to LED stimuli are very similar to those of FL stimuli and should be useful in the operating room to monitor the visual pathways, if various endogenous factors known to affect late responses can be stabilized.

Radiosensitivity of peripheral blood lymphocytes in autoimmune disease

The proliferation of peripheral blood lymphocytes, cultured with Con A, can be inhibited by ionizing radiation. Lymphocytes from patients with conditions associated with autoimmunity, such as rheumatoid arthritis, systemic lupus erythematosus and polymyositis, are more radiosensitive than those from healthy volunteers or patients with conditions not associated with autoimmunity. The nuclear material isolated from the lymphocytes of patients with autoimmune diseases is, on average, lighter in density than the nuclear material from most healthy controls. This difference in density is not related to increased sensitivity to ionizing radiation but the degree of post-irradiation change in density (lightening) is proportional to the initial density, i.e. more dense nuclear material always shows a greater upward shift after radiation. The recovery of preirradiation density of nuclear material, 1 h after radiation exposure, taken as an indication of DNA repair, correlates with the radiosensitivity of lymphocyte proliferation (Con A response); failure to return to pre-irradiation density being associated with increased sensitivity of proliferative response. These results require extension but, taken with previously reported studies of the effects of DNA methylating agents, support the idea that DNA damage and its defective repair could be important in the aetio-pathogenesis of autoimmune disease.

Controlled trial of clinical utility of serum salicylate monitoring in rheumatoid arthritis

A crossover double-blind controlled trial was performed on 36 patients with rheumatoid arthritis to assess the necessity for serum salicylate monitoring in determining optimal dosage. There was no clinically or statistically significant increase in the clinical improvement of patients associated with serum monitoring but potentially toxic serum levels occurred without tinnitus when serum monitoring was not used.

Interpretation of Doppler segmental pressures in peripheral vascular occlusive disease

Measurement of Doppler segmental arterial pressures in the lower extremity using narrow pneumatic cuffs has become a standard noninvasive diagnostic technique. Correlation between arteriographic and noninvasive studies was available for 345 aortoiliac segments and 326 femoropopliteal segments. If stenoses of 50% or greater and occlusions were considered hemodynamically significant, the sensitivity to aortoiliac disease was 97%, but only 67% to femoropopliteal disease. The specificity for hemodynamically insignificant disease was 50% and 68%, respectively. Accuracy was influenced by the presence of associated aortoiliac or femoropopliteal disease. The sensitivity to hemodynamically significant femoropopliteal disease was 55% if there was associated aortoiliac disease, and 89% in its absence. In the presence of significant femoropopliteal disease, specificity for the absence of aortoiliac disease decreased from 70% to 41%.

Impedance plethysmography. Noninvasive diagnosis of deep venous thrombosis and arterial insufficiency

The versatility of impedance plethysmography (IPG) in the diagnosis of arterial and venous disease was evaluated in the clinical setting. Eighty-eight consecutive patients suspected of acute or chronic deep venous thrombosis (DVT) and undergoing ascending venography were evaluated using IPG. Venous capacitance (VC) and venous outflow (VO) were expressed as a per cent impedance change (% delta I). The evaluation was considered as abnormal if the VC was less than 1.85% delta I and the VO less than 0.95% delta I. The overall accuracy was 90 per cent with a sensitivity of 92 per cent and specifity of 93 per cent. Arterial blood flow (ABF) was measured in normal volunteers (20 limbs) and patients with intermittent claudication (20 limbs) and rest pain (16 limbs). Resting ABF (cc/100 ml/min) did not differ (P greater than 0.05) in the normal volunteer (4.3 +/- 0.4) and patients with intermittent claudication (4.6 +/- 0.5), but both were significantly greater (P less than 0.05) than ABF in patients with rest pain (3.2 +/- 0.2). Peak ABF during reactive hyperemia (RH) was significantly greater (P less than 0.001) in normal volunteers (24.8 +/- 1.6) than in claudicators (10.5 +/- 1.3), and both flows were significantly greater (P less than 0.0001) than the peak ABF in patients with rest pain (5.3 +/- 0.5). IPG may be used in the assessment of arterial and venous disease. It provides a sensitive test with which to screen patients with suspected DVT. In addition, it is a valuable adjunct in differentiating normal limbs from those with intermittent claudication and/or rest pain.

Oculoplethysmography and pulsed Doppler ultrasonic imaging in diagnosis of carotid arterial disease

The individual and combined diagnostic accuracy rates for fluid-filled oculoplethysmography and pulsed Doppler ultrasonic imaging in the detection of extracranial carotid artery insufficiency were calculated. Results of the two techniques were compared with those of contrast arteriograms which were available for 109 patients, 210 arteries, for computations of sensitivity and specificity. Sensitivities for oculoplethysmography and ultrasonic imaging were 84 and 87 per cent, while specificities were 87 and 81 per cent, respectively. These values were not significantly, p greater than 0.05, different. Results of oculoplethysmography and ultrasonic imaging agreed in four-fifths of the arteries, producing a sensitivity of 98 per cent and a specificity of 97 per cent. In the remaining arteries, the results of the two tests did not agree, resulting in a sensitivity of 71 per cent and a specificity of 79 per cent. Fluid-filled oculoplethysmography and pulsed Doppler ultrasonic imaging are diagnostic tests of comparable accuracy which, when used together, provide accurate hemodynamic and anatomic information in the diagnosis of extracranial carotid arterial disease.

A canonical correlation analysis of the Alcohol-Use Inventory and the Human Service Scale

The responses of 312 persons with alcoholism to the Alcohol-Use Inventory and Human Service Scale were subjected to canonical correlation analysis. Results indicate that the relationship between alcohol-use constructs and psychological need satisfaction can be explained by two axes: a personal security--social dimension and a personal stress--environmental dimension. Microanalysis of the variates indicated that emotional need satisfaction was differentially influenced by social and physiological variables.

Relationship of sociodemographic and drinking variables to differentiated subgroups of alcoholics

The results suggest that the sociodemographic variables of age, living arrangements, number of dependents, the drinking variable, and the client's perception of the type of drinker he is are the most strongly related to the derived typology. The exact relationship of these variables, as well as the variables that were moderately related to the typology, is not apparent. There is a pattern, however, that appears to run through the categories of the classification. The evidence suggests that for alcoholics to be in their prime earning years, living with their spouses, perceiving themselves as alcoholic, possessing marketable skills, and a recent history of abstinence seems to increase the likelihood of psychological need satisfaction. The antithesis--to be alcoholic, less than 30 or older than 50 years old, living by oneself or with parents, perceiving oneself as a social or problem drinker, and possessing a recent history of drinking--seems to decrease the likelihood of psychological need satisfaction. There seems to be a relationship between drinking behavior and psychological need satisfaction. As a group, the members of Clusters Two, Three, and Four are unable to abstain for longer than a week; Clusters Two and Three both possess physiological problems of adjustment. The members of Clusters One and Five tend to be able to abstain for longer periods. Cluster One is devoid of physiological difficulties, whereas Five has borderline problems. The physiological subscale of the Human Service Scale assesses the absence of symptoms associated with poor health (Realges & Butler, 1976). It appears that aberrant drinking does not necessarily result in self-perceived physiological-health complaints. These results are at variance with the belief that ethanol ingestion by an alcoholic and the resulting pathological complications are the predominant difficulties encountered by these persons. Thus it seems to us that a distraught life situation (that is, the lack of social and demographic assets--marriage, education, and so on) contributes to self-perceived severity of psychological need deprivation and not solely aberrant drinking. Therefore, in terms of recovery from alcoholism, these results argue against a unidimensional approach toward the treatment of alcoholism; that is, an approach that focuses solely on the drinking as "the" problem. A more strategic approach would include a thorough medical, psychiatric, psychological, social and vocational evaluation of the alcoholic's life situation, which in turn would permit mobilizing the efforts of a multidisciplinary team whose goal would be to maximize the resources and enhance the life situation of the alcoholic. It is hoped that the results of this study serve to increase our understanding of those factors that influence aberrant drinking.

A review of treatment and rehabilitation legislation regarding alcohol abusers and alcoholics in the United States: 1920-1971

A review of various legislative and judicial decisions in the area of alcohol abuse and alcoholism is presented. With heightened awareness of alcoholism as our nation's number one drug problem, the federal government has developed a national institute to coordinate multimodal prevention, treatment, and rehabilitation programs. It is noted that several historical cases promoted the courts and investigating committees to recommend to our states that the crime of public drunkenness be removed. The recently developed Uniform Alcoholism Intoxication Treatment Act is discussed along with some of the intervention techniques being employed to deal with drinking drivers.

Attitudes regarding alcoholism among a group of drinking drivers

Ninety-four drinking drivers were surveyed to assess their attitudes on nine factors related to alcoholism and the alcoholic. Each of the factors was assessed according to Marcus' criterion. Two factors were extracted which differed from those of the general population norm group. These drinking drivers were positive in their belief that periodic excessive drinkers can be alcoholics and negative in their attitude regarding alcoholism as an illness. It was noted that apart from these two factors, these drinking drivers were equally ambivalent in their attitudes toward alcoholism and the alcoholic when compared to the norm group.

Rehabilitation need patterns of men alcoholics

The Human Service Scale questionnaire revealed 4 general rehabilitation-need patterns in a group of 376 men alcoholics.

Medicine at McMaster; an innovative programme for undergraduates

An innovative programme in undergraduate medical education, developed at the McMaster Medical School in Hamilton, Canada, is described. A number of features distinguish the McMaster approach from the more traditional system. Among these is a firm commitment to well-defined goals which stress the need for comprehensive patient care and an awareness of changing patterns of health delivery. Emphasis is placed on the student as the focal point in the educational process and a flexible curriculum provides the medium through which all facets of this novel system can best find expression.

Attitudes regarding drug abuse among a group of ex-addict staff members

Thirteen male and 11 female ex-addict staff members of a therapeutic community were surveyed to assess their attitudes on nine factors related to drug abuse and the drug abuser. Each factor was assessed according to the critieria established by Marcus. Both male and female groups held positive beliefs that psychological problems were contributing factors in the development of addiction. Among the remaining eight factors there was considerable variation in agreement regarding these male and female ex-addicts' attitudes toward drug abuse and the drug abuser.