A strangulated Spigelian hernia mimicking diverticulitis.

Spigelian hernias are true interparietal hernias that are frequently not associated with a palpable mass and, as such, are not frequently diagnosed before surgery. Reported herein, is the serendipitous discovery of an incarcerated Spigelian hernia that was discovered on a CT scan being performed for presumed diverticulitis.

Are better ratings of the patient-provider relationship associated with higher quality care for depression?

Background: The interpersonal patient-provider relationship (PPR) is an essential part of health care quality, particularly for patients with depression, yet little is known neither about how to measure this relationship nor about its association with quality of care.

Objectives: To evaluate properties of patient rating measures, understand the relation between 2 types of ratings, and determine the association of ratings with quality depression care.

Setting And Participants: 1,104 patients with current depressive symptoms and lifetime or 12-month disorder identified through screening 27,332 consecutive primary care visitors in 6 managed care organizations participating in Partners in Care (PIC).

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians.

Objective: We evaluated the effect of implementing quality improvement (QI) programs for depression, relative to usual care, on primary care clinicians' knowledge about treatment.

Design And Methods: Matched primary care clinics (46) from seven managed care organizations were randomized to usual care (mailed written guidelines only) versus one of two QI interventions. Self-report surveys assessed clinicians' knowledge of depression treatments prior to full implementation (June 1996 to March 1997) and 18 months later.

Structure and scattering in colloidal ferrofluids.

The structure of a model colloidal ferrofluid, the dipolar hard-sphere fluid, at low temperature has been investigated using Monte Carlo simulations. Extensive particle association into chainlike and ringlike clusters is observed at low density. The structure factors have been calculated, and are analyzed with the aid of simple scaling arguments.

Isotropic fluid phases of dipolar hard spheres.

Monte Carlo simulations are used to calculate the equation of state and free energy of dipolar hard sphere fluids at low temperatures and densities. Evidence for the existence of isotropic-fluid-isotropic-fluid phase transitions is presented and discussed. Condensation in the dipolar hard sphere fluid is unusual in that it is not accompanied by large energy or entropy changes.

Quality of life after pulmonary rehabilitation: assessing change using quantitative and qualitative methods.

Background And Purpose: The purpose of this study was to use quantitative and qualitative research methods to evaluate quality-of-life (QOL) changes in patients with chronic obstructive pulmonary disease after pulmonary rehabilitation.

Subjects: Twenty-nine individuals with COPD (18 women and 11 men), with a mean age of 69 years (SD=8.6, range=53-92), participated.

Who is at risk of nondetection of mental health problems in primary care?

Objective: To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians.

Design: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study.

Participants: We studied 19,309 patients and 349 internists and family physicians.

Depression and health-related quality of life in ethnic minorities seeking care in general medical settings.

Background: To examine ethnic groups differences in (a) prevalence of depressive disorders and (b) health related quality of life in fee-for-service and managed care patients (n=21504) seeking care in general medical settings.

Methods: Data are from the Medical Outcomes Study, a multi-site observational study of outpatient practices. The study screened patients of clinicians (family practice, internal medicine, cardiology, diabetology and endocrinology) for four chronic medical conditions; depression, coronary heart disease, hypertension and diabetes.

Treating depression in staff-model versus network-model managed care organizations.

Objective: To compare primary care providers' depression-related knowledge, attitudes, and practices and to understand how these reports vary for providers in staff or group-model managed care organizations (MCOs) compared with network-model MCOs including independent practice associations and preferred provider organizations.

Design: Survey of primary care providers' depression-related practices in 1996.

Setting And Participants: We surveyed 410 providers, from 80 outpatient clinics, in 11 MCOs participating in four studies designed to improve the quality of depression care in primary care.

Biosynthesis and metabolism of native and oxidized neuropeptide Y in the hippocampal mossy fiber system.

Neuropeptide Y (NPY) gene expression is known to be modulated in the mossy fiber projection of hippocampal granule cells following seizure. We investigated NPY biosynthesis and metabolism in an attempt to characterize NPY biochemically as a neurotransmitter in the granule cell mossy fiber projection. NPY biosynthesis was compared in normal control animals and in animals that had experienced a single pentylenetetrazole-induced seizure.

Increasing immunization rates among inner-city, African American children. A randomized trial of case management.

Context: Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested.

Objective: To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families.

Design: Randomized controlled trial with follow-up through 1 year of life.

Outcome after blunt traumatic thoracic aortic laceration: identification of a high-risk cohort. Western Trauma Association Multicenter Study Group.

Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome.

Methods: BTTAL data from 14 trauma centers over 11 years.

Treatment typically provided for comorbid anxiety disorders.

Objective: To study whether the extent and type of treatment for comorbid anxiety disorders varies for patients with depression, hypertension, diabetes, and heart disease treated by general medical clinicians.

Methods: Data are from 2189 general medical patients with and without comorbid anxiety disorders in the Medical Outcomes Study. Treatment data were based on clinician reports of counseling provided during a visit and patient reports of recent medication use.

Medication compliance among the seriously mentally ill in a public mental health system.

Medication non-compliance, a pervasive problem among persons with serious, chronic mental illness, has been linked to increased inpatient resources use in public mental health systems. The objective of this analysis was to determine which factors are associated with medication compliance in this population so that more appropriate screening and intervention programs can be designed. Using knowledge gained from clinical research on compliance in schizophrenia and research testing the Health Belief Model as a conceptual framework in studying compliance behavior, we conducted a secondary analysis of data collected in the Mississippi public mental health system in 1988.

Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers.

Background: The comorbidity of psychiatric disorders with chronic health conditions has emerged as a topic of considerable clinical and policy interest, in part owing to the evidence that anxiety disorders themselves are associated with morbidity. However, the implications for health-related quality of life that result from anxiety disorders, which are comorbid to chronic medical or psychiatric illness, are not well understood, especially in primary care samples.

Methods: A 2-year observational study of 875 adult patients with hypertension, diabetes, heart disease, and current depressive disorder or subthreshold depression receiving care from general medical providers was conducted.

Having faith: experiencing coronary artery bypass grafting.

Even though coronary artery bypass grafting (CABG) is a commonly performed procedure, it is perceived by the client as a life-threatening event. When one is faced with a crisis, spiritual issues become extremely important. The purposes of this qualitative study were to discover what the spiritual needs are for CABG clients and how these needs are met during hospitalization.

Prevalence of comorbid anxiety disorders in primary care outpatients.

Objective: To estimate the extent to which anxiety disorders (eg, panic disorder, phobia, and generalized anxiety disorder [GAD]) co-occur in patients with major medical and psychiatric conditions.

Design: Observational study.

Setting: Offices of primary care providers in three US cities, with mental health specialty providers included for comparative purposes.

Severity of depression in prepaid and fee-for-service general medical and mental health specialty practices.

This study compares severity of depression for patients of general medical clinicians, psychiatrists, and nonphysician therapists receiving prepaid or fee-for-service care. Cross-sectional severity comparisons were conducted among 715 outpatients with current major depression or dysthymia, by independent assessment. Severity was assessed by counts of current and lifetime depressive symptoms, prognostic and treatment response indicators, and global measures of psychological and physical sickness.

Degradation of immunoglobulin G by periodontal bacteria.

Several subgingival microorganisms were tested for their ability to utilize human immunoglobulin G (IgG) as a substrate for growth. This was done using a protein-free chemically defined medium, supplemented with IgG. Stimulation of growth was observed for Capnocytophaga ochracea, Porphyromonas asaccharolytica, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella oralis, Lactobacillus catenaforme and Streptococcus intermedius.

Clinician specialty and treatment style for depressed outpatients with and without medical comorbidities.

Background: The advent of clinical practice guidelines for the management of depression increases the importance of understanding variation across clinician specialty groups in treatment styles for depression and the role of medical comorbidities.

Methods: Data are reported by clinicians (N = 470) and patients (N = 2545). Multiple regression was used to compare the treatment styles (counseling and prescribing antidepressants) of family physicians with those of psychiatrists, medical subspecialists, internists, psychologists, and other therapists for depressed patients with different medical comorbidities.

Blunt traumatic thoracic aortic lacerations in the elderly: an analysis of outcome.

We found no previous work examining outcome after blunt traumatic aortic laceration (TAL) that has focused on elderly patients (age > 55 years) with this lesion. A 20-year retrospective review from two trauma centers of survival outcome for patients with TAL was performed to assess the effects of surgical therapy in the elderly cohort. Seventy-five cases were identified.

Joint Commission for Accreditation of Hospital Organization education standards: perioperative applications.

The Joint Commission for Accreditation of Hospital Organization, as a major accrediting body for health care organizations, has identified patient and family education as a critical element in the delivery of quality health care services as a means to improve overall outcomes for consumers. This belief is evidenced in the fact that they have created a new chapter in the accreditation manual that targets this aspect of the care delivery process. Health care organizations are now being challenged as a requirement for accreditation to show that they have operationalized education in their care delivery processes.

Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the medical outcomes study.

Objective: The purpose of this study was to compare use of minor tranquilizers and antidepressant medications by depressed outpatients across different treatment settings.

Method: The study subjects were 634 patients with current depressive disorder or depressive symptoms who visited general medical clinicians, psychiatrists, psychologists, or other therapists. Data on use of medication in different types of clinical practices with different types of payment plans were gathered from structured interviews by study clinicians and from surveys of patients.

The use of lectins in monitoring degradation of oligosaccharide chains in mucin by oral streptococci.

The ability of utilize mucin oligosaccharides as sources of carbohydrate and energy is believed to be an important mechanism in the ecology of oral streptococci. In this study we have used digoxigenin-labelled lectins of various specificities to monitor changes in the nonreducing end groups of oligosaccharide chains following their degradation by Streptococcus oralis Ny 586 and Streptococcus sanguis Ny 584. The reaction of degraded mucin with peanut lectin, that recognizes the core disaccharide Gal (1,3)GalNAc in O-glycans, revealed a more extensive degradation of oligosaccharide by S.