The Primary Care Assessment Survey: tests of data quality and measurement performance.

Objectives: The authors examine the data quality and measurement performance of the Primary Care Assessment Survey (PCAS), a patient-completed questionnaire that operationalizes formal definitions of primary care, including the definition recently proposed by the Institute of Medicine Committee on the Future of Primary Care.

Methods: The PCAS measures seven domains of care through 11 summary scales: accessibility (organizational, financial), continuity (longitudinal, visit-based), comprehensiveness (contextual knowledge of patient, preventive counseling), integration, clinical interaction (clinician-patient communication, thoroughness of physical examinations), interpersonal treatment, and trust. Data from a study of Massachusetts state employees (n = 6094) were used to evaluate key measurement properties of the 11 PCAS scales.

Asian-American patient ratings of physician primary care performance.

Objective: To examine how Asian-American patients' ratings of primary care performance differ from those of whites. Latinos, and African-Americans.

Design: Retrospective analyses of data collected in a cross-sectional study using patient questionnaires.

Nineteen-year-old female with unilateral ankle pain. What is your diagnosis?

The case history of a 19-year-old female with left ankle pain of 18 months' duration is presented. The reader is encouraged to make his or her own diagnosis after reviewing the history, laboratory values, and imaging. The final diagnosis with a full explanation and differential diagnosis will follow.

Cauda equina syndrome resulting in late sequela of calcaneal gait and neuropathic heel ulcer.

The case of a 27-year-old female, 5 years after a motor vehicle accident that resulted in spinal cord damage, is reviewed. She progressed well after her accident for 4 years, at which time she developed a neuropathic heel ulceration, aggravated by her calcaneal gait and pregnancy weight gain. The rarity of such a case involving neuropathic ulceration and calcaneal gait after partial deficit of cauda equina function prompted this article.

Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study.

Objective: To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems.

Study Design: A 4-year observational study of 2235 patients (18 to 97 years of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), recent acute myocardial infarction, congestive heart failure, and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990. Those aged 65 years and older covered under Medicare and low-income patients (200% of poverty) were analyzed separately.

Osteoarticular tuberculosis.

Over the past several years there has been a dramatic rise in the incidence of tuberculosis. Peripheral skeletal tuberculosis is, more often than not, misdiagnosed as osteoarthritis or pyogenic osteomyelitis. Tuberculosis is no longer a "zebra" among differential diagnoses.

Prophylaxis in lower-extremity infectious diseases.

This article discusses a number of different situations in which prophylaxis against infection may be considered by the podiatric physician. The authors cover some of these areas, including wound and laceration prophylaxis, surgical prophylaxis, and prophylaxis against the possibility of developing bacterial endocarditis following a podiatric procedure.

A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.

Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n=2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.

The health status of adults with epilepsy compared with that of people without chronic conditions.

Study Objectives: To examine the feasibility of administering and the psychometric properties of a general health status questionnaire in adults with epilepsy, and to assess the health status of these patients.

Design: Prospective, cross-sectional, observational study.

Setting: Neurology clinic of a tertiary care medical center.

Advances in methods for assessing the impact of epilepsy and antiepileptic drug therapy on patients' health-related quality of life.

We studied 31 previously validated and newly developed generic and epilepsy-specific scales to evaluate their usefulness for assessing the impact of epilepsy and anti-epileptic drug (AED) therapy on health-related quality of life (HRQOL). Included were the MOS SF-36 Health Survey, additional measures of mental health, cognition, epilepsy-specific perception of control, behavioural problems, distress, worries and experiences, the Liverpool Epilepsy Impact and Seizure Severity scales, and a patient-completed symptom checklist. Questionnaires were completed twice by 136 patients on AED therapy in a multicentre study in the UK.

Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study.

Physical component summary (PCS) and mental component summary (MCS) measures make it possible to reduce the number of statistical comparisons and thereby the role of chance in testing hypotheses about health outcomes. To test their usefulness relative to a profile of eight scores, results were compared across 16 tests involving patients (N = 1,440) participating in the Medical Outcomes Study. Comparisons were made between groups known to differ at a point in time or to change over time in terms of age, diagnosis, severity of disease, comorbid conditions, acute symptoms, self-reported changes in health, and recovery from clinical depression.

Diabetic foot: strategies to prevent and treat common problems.

Neuropathy, peripheral vascular disease, limited joint mobility, and reduced resistance to infection all play a role in the development of foot pathology in diabetic patients. Once established, ulcerations and infections may provoke an irreversible cascade of events, culminating in limb loss. The best cure, therefore, is prevention.

Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey.

Many health status surveys have been designed for mail, telephone, or in-person administration. However, with rare exception, investigators have not studied the effect the survey mode of administration has on the way respondents assess their health and other important parameters (such as response rates, nonresponse bias, and data quality), which can affect the generalizability of results. Using a national sampling frame of noninstitutionalized adults from the General Social Survey, we randomly assigned adults to a mail survey (80%) or a computer-assisted telephone survey (20%).

In-office management of common geriatric foot problems.

Foot disorders can be a major source of pain, discomfort, and disability for older adults. Neuropathy, impaired leukocyte function, vascular insufficiency, and trauma predispose older diabetics to limb-threatening complications. Therefore, examine the diabetic patient's foot during each visit.

Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study.

Objective: To determine how patients in different kinds of practices--solo or single specialty (SOLO), multispecialty group (MSG), or health maintenance organizations (HMOs)--and with fee-for-service (FFS) or prepaid physician payment arrangements evaluate their medical care.

Design: Survey of adult outpatients after office visits, with sample weighted to represent population of patients visiting physicians in each practice type.

Setting: Offices of 367 internists, family practitioners, endocrinologists, cardiologists, and nurse practitioners, in HMOs (prepaid only), MSGs (prepaid and FFS), and SOLO practices (prepaid and FFS).

Systemic complications of human immunodeficiency virus infection.

HIV infection causes a wide spectrum of complications affecting all organ systems. These complications may be primary to the direct infection of a specific organ system by HIV or secondary to the immunodeficiency associated with HIV infection. These complications may be specific to certain stages of HIV infection.

Proteolytic response to the expression of an abnormal beta-galactosidase in Escherichia coli.

Because induction of proteolytic activity and stress-response proteins can significantly affect expression levels in recombinant Escherichia coli, the influence of low-level expression of a mutant beta-galactosidase was investigated. A single copy of the well-characterized CSH11 mutant of the lacZ gene was integrated into the chromosome. Induction of expression of the mutant beta-galactosidase caused a measurable increase in ATP-dependent intracellular proteolytic activity but resulted in no significant change in ATP-independent proteolytic activity.

Structural characteristics of an abnormal protein influencing its proteolytic susceptibility.

Structural properties of two similar beta-galactosidase fragments were investigated to determine how they influence the fragments' degradation rate in Escherichia coli. Both fragments resulting from a C-terminal nonsense mutation in lacZ, the CSH11 polypeptide and its 90 kDa degradative intermediate, exist predominantly as monomer subunits instead of in the tetrameric form characteristic of the native enzyme. However, both fragments appear to produce trace amounts of dimers and tetramers.

Temperature and induction effects on the degradation rate of an abnormal beta-galactosidase in Escherichia coli.

Intracellular protein degradation was investigated using an unstable fragment of Escherichia coli beta-galactosidase, the CSH11 mutant, as a model protein. This abnormal protein was expressed from a single copy gene in the chromosome and is converted to a detectable degradable intermediate. The in vivo degradation rates of both beta-galactosidase fragments were measured using pulse-chase radioactive labeling techniques, and their intracellular concentrations were determined using alpha-complementation assays.

Kaposi's sarcoma of the lower extremity as the first sign of AIDS.

The authors review four cases of Kaposi's sarcoma that were presented to the Foot Clinics of New York and affiliated North General Hospital during a 1-year period from the fall of 1987 to the fall of 1988. The authors conclude that it is sometimes difficult to diagnose Kaposi's sarcoma and to differentiate between the acquired immunodeficiency (AIDS) form and the classic form. Guidelines for diagnosis and a profile of the AIDS-related and non-AIDS-related Kaposi's sarcoma patient are discussed.

Nail changes associated with systemic disease and vascular insufficiency.

In some cases, nail changes may not only be the presenting sign of systemic disease, but a sensitive indicator of treatment efficacy as well. Awareness of nail dystrophies and their association with underlying pathology can aid the practitioner in the diagnosis and management of the podiatric patient.

Evaluation of an inductively-coupled plasma with an extended-sleeve torch as an atomization cell for laser-excited fluorescence spectrometry.

An inductively-coupled plasma (ICP) with an extended-sleeve torch has been evaluated as an atomization cell for laser-excited fluorescence spectrometry. Limits of detection for 20 lines are given. The detection power is almost equivalent to that obtained by excitation with a hollow-cathode lamp.