Faculty Bibliography

An ACE inhibitor is found to lower the risk of heart attack, stroke and the complications of diabetes. A drug that has been marketed for eight years to combat high blood pressure turns out to substantially lower the risk of heart attack, stroke and diabetes and its complications in those who have heart disease, scientists reported Wednesday. The findings suggest that at least 10 million Americans and their doctors may want to add the drug, ramipril, to standard heart therapies and that it could save tens of thousands of lives each year at a cost of about 85 cents a day, said the study's chief author, Dr. Salim Yusuf of McMaster University in Hamilton, Ontario, in an interview

Summary: The author of a study says adding ramipril to current therapies could save tens of thousands of lives a year A drug that has been marketed for eight years to combat high blood pressure turns out to produce a substantial reduction in the risk of heart attack, stroke and bypass surgery and in diabetes and its complications in those who have heart disease, scientists reported Wednesday. The findings suggest that at least 10 million Americans and their doctors may want to add the drug, ramipril, to standard heart therapies and that it could save tens of thousands of lives each year at a cost of about 85 cents a day, said the study's chief author, Dr. Salim Yusuf of McMaster University in Hamilton, Ontario

A drug that has been marketed for eight years to combat high blood pressureturns out to substantially lower the risk of heart attack, stroke, bypasssurgery, and diabetes and its complications in those who have heart disease,scientists reported yesterday. The findings suggest that at least 10 million Americans and their doctorsmay want to add the drug, ramipril, to standard heart therapies and that itcould save tens of thousands of lives each year at a cost of about 85 cents aday, said the study's chief author, Dr. Salim Yusuf of McMaster University inHamilton, Ontario, in an interview. The study was conducted among individuals with heart or blood vesseldisease but without heart failure, Yusuf said in reporting the findingsyesterday at the AHA meeting in Atlanta. Participants also had at least onerisk factor for heart disease or strokes, such as high blood pressure,elevated cholesterol levels or cigarette smoking

Each year millions of people in third world countries develop similar symptoms from malaria, a parasitic infection carried by the Anopheles mosquito, and many die. Far fewer cases occur in the United States: Mr. [Sean] Cavanaugh's is one of about a thousand. Like almost all patients here, he survived. Either way, the case underscores the importance of diagnosing once-common infections like malaria that are now rare in the United States. In 1914, malaria infected at least 600,000 Americans. Now all but about 10 cases reported here each year are among Americans who contracted malaria overseas or among people who have moved to the United States from areas where the infection remains. The infection's control in the United States came from wiping out the parasite, not by eliminating the Anopheles mosquito. It remains. That afternoon, Dr. [James] Salik referred Mr. Cavanaugh to Dr. David A. Silverman, an expert in infectious diseases at New York University. Both doctors would ask a similar question: Where have you traveled recently? Honduras in the spring, Mr. Cavanaugh told them

The infection can progress with devastating rapidity even under the best of medical care; what starts as a mild flulike infection can kill an otherwise healthy person in hours. A single case of meningococcal meningitis can prompt emergency public health drills to identify the scores of people with whom the victim came in contact before falling ill, so that each can be given immediate antibiotic therapy. The accompanying media attention intensifies the air of panic. The panel, which advises the Centers for Disease Control and Prevention on immunization practices, called on universities and health professionals last month to tell college freshmen and their parents about the availability of a well-established vaccine that is safe and effective against most subtypes of the bacteria affecting college-age Americans. (The vaccine is not recommended for general population because of the low incidence of infection, and it is not effective against the subtype of bacteria that causes most cases among infants and occasional cases in other age groups.) Scientists do not know why. The centers recently conducted an extensive survey, said Dr. Nancy E. Rosenstein, an expert there in the epidemiology of meningococcal infections, but could not come up with an answer. ''It was not smoking, drinking, attending bars or anything else we asked about,'' Dr. Rosenstein said. ''It may have something to do with the difference in the behavior of freshmen living in dormitories compared to other groups of students, and despite our study we were not able to identify what that was.''

BACKGROUND: Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffection, possibly improving health care. OBJECTIVE: To document conceptual development, item construction, and use of content experts in designing multidimensional measures of physician job satisfaction and global satisfaction scales for assessing physicians' job perceptions across settings and specialties. DESIGN: Using previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel, distinct job facets and statements representing those facets were developed. RESULTS: Facets from previously validated instruments included autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status. New facets included intrinsic satisfaction, free time away from work, administrative support, and community involvement. Physician status items were reconfigured into relationships with peers, patients, staff, and community, yielding 10 hypothetical facets. Global scales and items were developed representing satisfaction with job, career, and specialty. CONCLUSIONS: A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests

BACKGROUND: Physician job satisfaction has been linked to various patient care and health system outcomes. A survey instrument that concisely measures physicians' satisfaction with various job facets can help diverse stake-holders to better understand and manage these outcomes. OBJECTIVE: To document the development and validation of a multidimensional physician job satisfaction measure and separate global satisfaction measures. DESIGN: Self-administered questionnaire: Physician Worklife Survey (PWS). SUBJECTS: A pilot study employed a national American Medical Association Masterfile sample of US primary care physicians and random samples from four states. Responses (n = 835; 55% return rate) were randomly assigned to developmental (n = 560) or cross-validation (n = 275) samples. A national sample (n = 2,325; 52% response rate) of physicians was used in a subsequent validation study. RESULTS: A 38-item, 10-facet satisfaction measure resulting from factor and reliability analyses of 70 pilot items was further reduced to 36 items. Reliabilities of the 10 facets ranged from .65 to .77. Three scales measuring global job, career, and specialty satisfaction were also constructed with reliabilities from .84 to .88. Results supported face, content, convergent, and discriminant validity of the measures. CONCLUSIONS: Physician job satisfaction is a complex phenomenon that can be measured using the PWS

OBJECTIVE AND METHODS: This study was undertaken to find the role of fluorine-18-fluorodeoxyglucose (F18-FDG) in the diagnostic work-up of febrile Acquired Immune Deficiency Syndrome (AIDS) patients. Forty-seven (42 male and 5 female; mean age = 40.3 years) febrile patients with AIDS underwent imaging with F18-FDG by Dual Head Coincidence Imaging (DHCI). Findings were correlated with other imaging modalities.RESULTS: Our data show good sensitivity for scanning with F18-FDG by DHCI in determining the extent of Castleman's disease, lymphoma, Kaposi's sarcoma (KS), adenocarcinoma, and germ cell carcinoma. Various opportunistic infections also manifest with increased F18-FDG uptake.CONCLUSION: Total-body imaging can be done with F18-FDG with better resolution and a shorter procedure time compared to imaging with Gallium-67 (Ga-67). Furthermore, F18-FDG is more sensitive than Ga-67 for evaluating extent of involvement in various pathologies affecting AIDS patients. The new technology of DHCI is a good alternative for hospitals with no dedicated positron emission tomography (PET) scanner

Three hundred and twenty isolates of Staphylococcus aureus were typed by DNA sequence analysis of the X region of the protein A gene (spa). spa typing was compared to both phenotypic and molecular techniques for the ability to differentiate and categorize S. aureus strains into groups that correlate with epidemiological information. Two previously characterized study populations were examined. A collection of 59 isolates (F. C. Tenover, R. Arbeit, G. Archer, J. Biddle, S. Byrne, R. Goering, G. Hancock, G. A. Hebert, B. Hill, R. Hollis, W. R. Jarvis, B. Kreiswirth, W. Eisner, J. Maslow, L. K. McDougal, J. M. Miller, M. Mulligan, and M. A. Pfaller, J. Clin. Microbiol. 32:407-415, 1994) from the Centers for Disease Control and Prevention (CDC) was used to test for the ability to discriminate outbreak from epidemiologically unrelated strains. A separate collection of 261 isolates form a multicenter study (R. B. Roberts, A. de Lencastre, W. Eisner, E. P. Severina, B. Shopsin, B. N. Kreiswirth, and A. Tomasz, J. Infect. Dis. 178:164-171, 1998) of methicillin-resistant S. aureus in New York City (NYC) was used to compare the ability of spa typing to group strains along clonal lines to that of the combination of pulsed-field gel electrophoresis and Southern hybridization. In the 320 isolates studied, spa typing identified 24 distinct repeat types and 33 different strain types. spa typing distinguished 27 of 29 related strains and did not provide a unique fingerprint for 4 unrelated strains from the four outbreaks of the CDC collection. In the NYC collection, spa typing provided a clonal assignment for 185 of 195 strains within the five major groups previously described. spa sequencing appears to be a highly effective rapid typing tool for S. aureus that, despite some expense of specificity, has significant advantages in terms of speed, ease of use, ease of interpretation, and standardization among laboratories

Many factors can cause a lack of energy, but people who are willing to confront these obstacles often end up feeling renewed and revitalized. Tips for increasing one's energy level are presented and include get enough sleep, keep stress under control, remain active and eat right