Affecting residents' literature reading attitudes, behaviors, and knowledge through a journal club intervention.

Objective: To investigate whether a limited teaching intervention, based on principles of adult education, could change residents' literature reading attitudes, behaviors, and knowledge.

Design: The educational intervention supplemented an ongoing bimonthly journal club. The effects on residents were studied prospectively before and four months following the intervention.

Medication refusal: suggestions for intervention.

The civil rights and deinstitutionalization movements of the 1960s gave rise to legal and ethical challenges to the physician's authority to prescribe psychoactive medication to patients who refuse such medication. While no definitive legal ruling has been rendered in this area--and may never be rendered--a review of the important cases to date identifies consistent themes of patient competency, the possibility of physical threat, risks versus benefits, due process, and patient advocacy, all of which form the framework for intervening with patients who choose to refuse medication while preserving their right to do so.

Gonococcal wound infection.

We have reported a gonococcal infection in a surgical incision made ten months before the onset of urethral discharge. Gonococcal wound infections may arise from direct contamination or possibly by blood-borne dissemination. Principles guiding therapy are similar to those for wound infections from other organisms, with attention to adequate drainage, removal of foreign body, appropriate antibiotics, and elimination of contributing sources of infection.

Abdominal aortic aneurysm infected with Campylobacter fetus subspecies fetus.

We report a survivor of Campylobacter fetus septicemia from an infected abdominal aortic aneurysm who was successfully treated with an anatomic graft reconstruction and antibiotics. According to a survey of the English-language medical literature this was the fourth such patient successfully treated. C.

Nurse-initiated health promotion prompting system in an internal medicine residents' clinic.

Although cure of many diseases depends on early detection, screening schemes have been difficult to implement in busy clinic environments. We describe the testing of a nurse-initiated prompting system for six health promotion and disease prevention procedures in an internal medicine residents' clinic at a university-affiliated community program. Maneuvers investigated were breast examination, pelvic examination and Pap smear, rectal examination in men, mammogram, stool guaiac test, and blood glucose determination.

Infrequency of blacks among patients having carotid endarterectomy.

We reviewed demographic data on patients having 2,256 carotid endarterectomies in eight large hospitals in North Carolina to determine the frequency of blacks among these patients. Blacks comprised only 4.6% of the patients having carotid endarterectomy even though they comprised 26% of all patients discharged and 22% of the general population of the state.