Graduate survey of the South Carolina Area Health Education Consortium family practice residency programs.

The results of this study demonstrate several interesting characteristics of the graduates of the SC AHEC associated family medicine residency programs: 45 percent practice in South Carolina, 63 percent live further than 120 miles from their residency program, 96 percent are satisfied with their specialty choice, and 56 percent are involved in teaching medical students and residents. Furthermore, these graduates have the following tendencies: to practice in the traditional solo or group practice; to practice in a suburban community, town or rural community and a setting size less than a population of 100,000 persons; to care for the aging adult and geriatric population; to provide nursing home care; and to utilize house calls to provide patient care). As the current health care system continues to be redesigned, this information will be essential for assessment and planning purposes.

Process reengineering for the filmless environment.

Facilities that are converting to filmless operations can learn from the University of Kentucky Chandler Medical Center's (UKMC) experience: that dramatic reengineering processes must take place before radiologists' productivity can increase. To convert a radiology department to soft copy interpretation, a piece-by-piece implementation of new systems or upgrades is customary. The first step may be to link each modality that is already digital into modality-specific mini-PACS, then to link the mini-PACS. Bringing other modalities on-line as new equipment is purchased and expanding the image information system (IIS) to the remainder of the healthcare facility rounds out the transition and may take several years. The downside of this kind of evolutionary approach is that the radiology department temporarily operates in two environments, the traditional film and the new filmless environments. To make the move from film to filmless, an administrator and the radiology staff must reengineer nearly every departmental process. Total quality management (TQM) techniques offer tools that are ideal for the task. Other recommendations include using a multidisciplinary team of staff members who are familiar with film-handling to create flow charts of all departmental processes. Each step should be validated to show its value to the overall process, the department or the institution. Next, flow charts of the expanded or new processes should be developed with input from the IIS manager, referring physicians and key IS personnel. Follow with estimates of staffing requirements that meet the needs of the completed flow charts and, finally, train staff members for the implementation of the new processes.

Dystonic-like reaction following cisapride therapy.

A 43-year-old woman with gastroesophageal reflux disease developed a dystonic-like reaction approximately 3 days after starting oral cisapride therapy. Office evaluation revealed a patient who moved her head rhythmically from side to side as she stared into space, generally unresponsive to external stimuli. She had increased tone of the sternocleidomastoid muscles bilaterally, with occasional tongue protrusion, and a slow shuffling gait. Following discontinuation of cisapride, the patient recovered completely.

Voices of leadership in a community under stress: personal observations by officials on an epidemiologic mistake.

We studied the responses of leaders in a suburban community in western Canada near Edmonton, Alberta, that was affected by a false allegation of increased cancer risk. In 1986, a cancer agency responded to community concerns by conducting a study of cancer incidence (1979-1983) and reported elevations on the order of 25 per cent over expected for most sites. Reanalysis of these data several months later revealed an error in the population figure used to calculate the rates. Correction brought the rates into line with Alberta as a whole and comparable to those for other communities surrounding Edmonton. We interviewed elected and appointed public officials in one affected community as well as non-official community leaders and realtors to determine their subjective impression regarding the effect of the incident on their communities and to rule out alternative explanations for the drop in housing prices in association with the incident we have reported elsewhere. Their narrative responses were particularly interesting and articulate, and are quoted at length. Their collective perceptions appear to confirm the impression of a profound impact on the community, reflected in housing prices, and attribute at least part of the impact to the disclosure that a high official in the community was afflicted by cancer. Most felt that there remained a great deal of latent concern in the community and at least some felt that a subsequent public issue involving transmission line rights-of-way near the community reactivated this latent concern.

Hyponatremia: dangers of treatment.

Hyponatremia is a common clinical diagnosis. Rapid correction may result in neurological deterioration due to myelinolysis in the central pons and extrapontine areas of the brain. Rapid correction may result in serious neurological sequela, including death and has no significant advantage. Slow correction of chronic hyponatremia appears to be the treatment of choice.