Faculty Bibliography

A group of women who took the drug, tamoxifen, in a large study had 45 percent fewer cases of breast cancer than a group of women who took a placebo, or dummy pill. Health officials said the drug helped women in all age groups and, calling the results historic, said they hoped the findings would lead to the development of drugs to prevent other cancers. But because tamoxifen also carries risks of life-threatening adverse effects, like cancer of the womb and blood clots that reach the lungs from veins in the legs, women were left with a complex decision about the best course to protect their health. Thus they were cautioned not to rush to demand the drug until statisticians and other experts have time to do the further analyses needed for doctors to tailor the findings to individual women. Such analyses should take about two months, Dr. Harold Varmus, the head of the National Institutes of Health, in Bethesda, Md., said in a brief interview. ''As with any medication, the decision to begin tamoxifen therapy is a very complex one,'' said Dr. Leslie Ford of the National Cancer Institute, also in Bethesda. Dr. Ford said that ''even if a woman is at increased risk of breast cancer, tamoxifen therapy may not be appropriate for her'' and ''there are no simple answers.''

For the first time, a drug has been shown to prevent breast cancer among women at high risk for the disease, a jubilant group of federal health officials said yesterday. Women who took the drug, tamoxifen, had 45 percent fewer cases of breast cancer than a group of women who took a dummy pill, or placebo. The drug helped all age groups in a large study, they said. The health officials called the study results historic and said they hoped they would lead to development of drugs to prevent other cancers. But because tamoxifen also carries risks of life-threatening adverse effects, such as cancer of the uterus, and blood clots that migrate to the lungs from veins in the legs, women were cautioned not to rush to demand the drug until statisticians and other experts do further analyses so that doctors can interpret the findings for individual women

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

OBJECTIVE: To develop a self-report instrument that would provide information about the different levels of the disablement process, and that (1) was suitable for persons with spinal cord disease (SCD), (2) could be completed quickly, (3) could be mailed, (4) had acceptable reliability, and (5) would be clinically useful. STUDY DESIGN: Test-retest using a convenience sample. METHODS: Review of the literature and an expert panel were used to develop the instrument. It was mailed to 49,458 individuals in June 1995 and a second mailing was done in August 1995. A subset of 725 individuals who responded to both mailings was used to examine the instrument's test-retest reliability. RESULTS: The instrument has a 4th grade reading level and has questions on causal disease, disease severity, impairment, activities of daily living (including a self-reported version of the Functional Independence Measure, the SRFM), and resource utilization. Individual item test-retest reliability was high for a mailed questionnaire; all kappa coefficients were near or above .60 and most were over .70. Intraclass correlation coefficient for the SRFM was .90 and internal consistency (Chronbach's alpha) was .96. CONCLUSION: This instrument provides a new, rapid way to obtain information relative to the differing levels of the disablement process

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

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