The clinical course of pulmonary embolism.

Background: Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available.

Methods: We prospectively followed 399 patients with pulmonary embolism diagnosed by lung scanning and pulmonary angiography, who were enrolled in a multicenter diagnostic trial.

Taking the initiative to cut health care costs. Report on a policy change to limit bronchopulmonary segmental drainage.

Before the study reported here began, the number of bronchopulmonary segmental drainage procedures performed each month at the University of Maryland Hospital averaged 7,200. Adoption of a policy allowing unnecessary treatment to be stopped on the basis of therapeutic objectives reduced this figure by more than two thirds, to a present level under 2,000. Comparison of the incidence of pulmonary infection and the average length of hospital stay during the six months before and the six months after the policy change showed no appreciable change.

Intensive medical student support groups: format, outcome, and leadership guidelines.

The authors report on a five-year experience with process-oriented discussion groups at annual four-day, off-campus retreats attended by students, faculty members, and "significant others." Group sessions comprised 17 hours of each retreat, which also included community activities and recreation time. Group leaders represented a diversity of professional backgrounds.

Bronchial reactivity in experimental infections with influenza virus.

In an attempt to develop an objective, quantitative test to assess the reactogenicity of candidates for attenuated influenza virus vaccines, the clinical responses and bronchial reactivity to methacholine were assessed in 36 normal volunteers lacking antibody to both hemagglutinin and neuraminidase (doubly seronegative) who were inoculated with either wild-type or temperature-sensitive attenuated influenza A (H1N1) virus by intranasal droplets. Five of six volunteers infected with wild-type virus developed systemic and/or febrile illness that lasted for a mean of five days. Nineteen of 30 persons who received attenuated virus developed infection without febrile or systemic illness.