Faculty Bibliography

OBJECTIVE: To assess the effect of a screen for problem drinking on medical residents and their patients. DESIGN: Descriptive cohort study. SETTING: Veterans Affairs Medical Clinic. PATIENTS: Patients were screened 2 weeks before a scheduled visit (n = 714). Physicians were informed if their patients scored positive. MEASUREMENTS AND MAIN RESULTS: Physician discussion of alcohol use was documented through patient interview and chart review. Self-reported alcohol consumption was recorded. Of 236 current drinkers, 28% were positive for problem drinking by the Alcohol Use Disorders Identification Test (AUDIT). Of 58 positive patients contacted at 1 month, 78% recalled a discussion about alcohol use, 58% were advised to decrease drinking, and 9% were referred for treatment. In 57 positive patient charts, alcohol use was noted in 33 (58%), and a recommendation in 14 (25%). Newly identified patients had fewer notations than patients with prior alcohol problems. Overall, 6-month alcohol consumption decreased in both AUDIT-positive and AUDIT-negative patients. The proportion of positive patients who consumed more than 16 drinks per week (problem drinking) decreased from 58% to 49%. Problem drinking at 6 months was independent of physician discussion or chart notation. CONCLUSIONS: Resident physicians discussed alcohol use in a majority of patients who screened positive for alcohol problems but less often offered specific advice or treatment. Furthermore, residents were less likely to note concerns about alcohol use in charts of patients newly identified. Finally, a screen for alcohol abuse may influence patient consumption.

Survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in New York City serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families

Concerned that an estimated 250,000 Americans do not know they are infected with the AIDS virus, Federal health officials yesterday urged wider use of blood tests, particularly of a little-used test that can provide results in an hour or less. The single rapid test that is available in the United States has not come into wide use, in part because of doctors' reservations about its interpretation and because of Federal guidelines that said test results should not be given until preliminary findings are confirmed. The only rapid test approved by the Food and Drug Administration and marketed in the United States is made by Murex Diagnostics Inc. of Norcross, Ga. Once the sample is prepared, the test can provide results in 10 minutes

BACKGROUND:The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. To date, there has been no systematic measurement of health status in the VA. The Veterans Health Study has developed methods to assess patient-based health status in ambulatory populations. OBJECTIVES/OBJECTIVE:To describe the health status of veterans and examine the relationships between their health-related quality of life, age, comorbidity, and socioeconomic and service-connected disability status. METHODS:Participants in the Veterans Health Study, a 2-year longitudinal study, were recruited from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Study patients received questionnaires of health status, including the Medical Outcomes Study Short Form 36-Item Health Survey; and a health examination, clinical assessments, and medical history taking. Sixteen hundred sixty-seven patients for whom we conducted baseline assessments are described. RESULTS:The VA outpatients had poor health status scores across all measures of the Medical Outcomes Study Short Form 36-Item Health Survey compared with scores in non-VA populations (at least 50% of 1 SD worse). Striking differences also were found with the sample stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), scores were considerably lower among the younger patients; for the eighth scale (physical function), scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (>65 years). The mental health scores of young veterans were substantially worse than all other age groups (P<.001) and scores of screening measures for depression were significantly higher in the youngest age group (51%) compared with the oldest age groups (33% and 16%) (P<.001). CONCLUSIONS:The VA outpatients have substantially worse health status than non-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; the young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health-related quality of life in young veterans. As health care systems continue to undergo a radical transformation, the Department of Veterans Affairs should focus on the provision of mental health services for its younger veteran.

State health officials began an investigation and eventually determined that the most probable cause of Harry's death was an adverse reaction to use of a nonprescription drug phenylephrine, the same medication that is sold over the counter as Neo-Synephrine, which is used to relieve nasal congestion related to allergies and ear infections. Doctors used phenylephrine to control bleeding during the removal of the boy's adenoids. The reaction may have been due to its use with a beta blocker drug, which is commonly used to lower high blood pressure. The surgeon instructed a nurse to instill phenylephrine drops in the nose to help stop bleeding. Three minutes later the surgeon began to operate on the left ear. But Harry's blood pressure shot up. Surgery stopped while an anesthesiologist injected a drug to reduce the pressure. In another seven minutes, the ear surgery resumed

State health officials began an investigation and eventually determined that the most probable cause of Harry's death was an adverse reaction to use of a nonprescription drug, phenylephrine, the same medication that is sold over the counter as Neo-Synephrine, which is used to relieve nasal congestion related to allergies and ear infections. Doctors used phenylephrine to control bleeding during the removal of the boy's adenoids. The reaction may have been due to its use with a beta blocker drug, which is commonly used to lower high blood pressure. Harry underwent the operation because repeated ear infections had left him with a hearing loss and a speech problem. After Harry underwent anesthesia and a breathing tube was inserted in his windpipe, a surgeon removed the adenoids without complication. The surgeon instructed a nurse to instill phenylephrine drops in the nose to help stop bleeding. Three minutes later the surgeon began to operate on the left ear. But Harry's blood pressure shot up. Surgery stopped while an anesthesiologist injected a drug to reduce the pressure. In another seven minutes, the ear surgery resumed. But because the event had a deadly consequence and use of phenylephrine is common, Dr. DeBuono went a step further. The commissioner appointed a panel of 10 specialists headed by Dr. Jacqueline E. Jones, who directs pediatric otolaryngology at New York Hospital, to determine the rarity of the reaction. The panel was also charged with clarifying a body of conflicting information about use in operating rooms of phenylephrine and other drugs, like cocaine, that constrict blood vessels

David M. Oshinsky reviews the book "The Children" by David Halberstam

Stricter control of antibiotic use and more stringent prevention measures are needed to stop the growing and related problems of drug-resistant and hospital-acquired infections, experts said today at a scientific meeting here. Among the measures proposed were mandatory auditing of antibiotic use, controlling the prescription of such drugs, officially rebuking doctors who overuse them, enforcing hand-washing practices among hospital employees, improving quality control in laboratories, and intensifying public education about the hazards of antibiotics. A major concern is that two million Americans pick up infections in hospitals each year, the cost of which runs to an estimated $4.5 billion. Of these infections, 70 percent are due to microbes that are resistant to one or more antibiotics, and in 30 percent to 40 percent of the infections, the causative microbe is resistant to the first-line treatment drug, a recent study has found

ATLANTA - In a major turnaround, the scientist who led the campaign that eradicated smallpox and eliminated the need for vaccination worldwide now says the United States should resume making the vaccine to deal with the threat of biological warfare. The scientist, Dr. Donald Henderson, a former deputy White House science adviser and dean emeritus of Johns Hopkins School of Public Health, spoke at an international meeting on new and emerging diseases Tuesday. U.S. 'ill-prepared' The United States is ill-prepared to confront a terrorist attack using biological weapons, and health officials need more money to prepare against such attacks, Henderson and other experts in infectious diseases said at the meeting, which was partly sponsored by the Centers for Disease Control and Prevention. The speakers said their new concern reflected the Iraqi buildup of biological weapons, terrorism attacks in Japan, and a breakdown in security at Russia's advanced bioweapons center in Koltsovo near Novosibirsk