Patient characteristics associated with favorable perceptions of patient-provider communication in early-stage lung cancer treatment.

Perceived quality of lung cancer communication is strongly associated with receiving potentially curative surgery for early-stage disease. The patient characteristics associated with poor quality communication in the setting of new lung cancer diagnosis are not known, although race may be a contributing factor. Using data from a prospective study of decision making in early-stage non-small cell lung cancer patients in five academic and community medical centers (N = 386), the authors used logistic regression techniques to identify patient-level characteristics correlated with scoring in the lowest quartile of a communication scale and a single-item communication variable describing shared communication. Income, lung cancer diagnostic status, and trust score were significantly associated with the overall communication scale. Lung cancer diagnostic status and trust score were also associated with patient perceptions of the single shared communication item, in addition to participation in a religious organization. Improving patient perceptions of communication with their provider is an important next step in ensuring that eligible patients receive optimal care for this deadly disease. This analysis identifies several modifiable factors that could improve patient perceptions of patient-provider communication. The fact that patient perception of communication is a predictor of the decision to undergo surgery independent of race highlights the need for broad communication interventions to ensure that as many eligible patients as possible are receiving surgery.

Prevalence of gonococcal and chlamydial infection in 2009 in 2 populations in a midwestern city.

The purpose of this cross-sectional study was to assess the 2009 prevalence of chlamydial and gonococcal infection in 2 populations in a midwestern city in the United States: patients at a public sexually transmitted disease (STD) clinic, and individuals seeking human immunodeficiency virus (HIV) counseling and testing services at an AIDS community organization. We characterized STD prevalence in a random sample of 592 STD clinic patients and a convenience sample of 471 individuals agreeing to STD testing through outreach efforts at the community organization. The STD clinic population was 59% male, 60% black, with 3.1 mean sex partners in the last year. The community organization population was 72% male, 19% black, with a mean of 4.3 partners in the last year. The prevalence of both chlamydial and gonococcal infections was consistently higher in STD clinic patients than at the community organization (18% vs 4%). Prevalence of chlamydial infection was higher than prevalence of gonococcal infection in both populations (chlamydial infection, 3% and 13% at the STD clinic and community organization, respectively; vs gonococcal infection, 1% and 7%, respectively). Factors significantly associated with increased odds of gonococcal/chlamydial infection at the STD clinic include unmarried status, younger age, at least 6 partners in the last year, and unprotected sex in the last year. At the community organization, the only factor significantly associated with increased odds of gonococcal/chlamydial infection was lower educational attainment. Our findings confirm that STD prevalence differs widely by population group. Given these differences, local approaches to STD control should also be carefully targeted to specific subgroups.

The sperm agglutination antigen-1 (SAGA-1) glycoforms of CD52 are O-glycosylated.

CD52 is composed of a 12 amino acid peptide with N-linked glycans bound to the single potential glycosylation site at position 3, and a glycosylphosphatidylinositol-anchor attached at the C-terminus. Some glycoforms of this molecule expressed in the male reproductive tract are recognized by complement-dependent sperm-immobilizing antibodies in infertile patients making this antigen an important target for immunocontraception and fertility studies. Although the amount of posttranslational modification is already remarkable for such a small polypeptide, O-glycosylation of CD52 has additionally been implicated by several studies, but never rigorously characterized. In this report, we show clear evidence for the presence of O-glycans in CD52 preparations immunopurified using the murine S19 monoclonal antibody generated against sperm agglutination antigen-1 (SAGA-1), a male reproductive tract specific form of CD52. The O-glycans have been characterized by MALDI-TOF and tandem mass spectrometry after reductive elimination and permethylation. The data indicate that the major SAGA-1 O-glycans are core 1 and 2 mucin-type structures, with and without sialic acid (NeuAc(0-2)Hex(1-3)HexNAc(1-2)HexNAcitol). Minor fucosy- lated O-glycans are also present including some struc- tures with putative Le(y) epitopes (NeuAc(0-1)Fuc(1-3)Hex(1-2) HexNAc(0-1)HexNAcitol). Analysis of O-glycopeptides by tandem mass spectrometry provided an additional level of support for the O-glycosylation of SAGA-1. Elucidation of the O-glycosylation of SAGA-1 adds to the complexity of this molecule and may help to explain its biological activity.

Repair of full-thickness cartilage defects in rabbit knees with free periosteal graft preincubated with transforming growth factor.

This study compared different concentrations of transforming growth factor-beta 1 (TGF-beta1) used for short-term preincubation in vitro of large periosteal explants to determine the effect of chondrogenesis and the fate of repair cartilage over time. Eighty-two rabbits were divided into four groups: group A, non-grafted; group B, non-incubated grafted; group C, 100 ng/mL recombinant human (rh) TGF-beta1 preincubated grafted; and group D, 20 ng/mL rhTGF-beta1 preincubated grafted. Rabbits from each group were sacrificed at intervals between 2 and 24 weeks. Histologic slides were stained with safranin O and were scored based on a subjective scoring system. Group A healed with non-cartilaginous material. Group B healed with hyaline cartilage-like material with progressive thinning of this regenerated layer; at 24 weeks, this layer was fibrous tissue. Group C enhanced repair with hyaline cartilage-like material but accelerated early degeneration and osteophyte formation; the cartilage became fibrous tissue at 24 weeks. Group D did not enhance cartilaginous repair. At 24 weeks, all groups had the same result. The 100 ng/mL rhTGF-beta1 preincubation in vitro with periosteum enhanced early osteochondral repair but did not show prolonged durability. Clinical application of this growth factor necessitates further study.

Transplanted bone marrow cells localize to fracture callus in a mouse model.

Bone marrow contains many cellular elements that may contribute to fracture repair. We used a pluripotential stromal cell in a mouse model to demonstrate the presence of transplanted cells in fracture hematoma and subsequently in maturing fracture callus. Cells were transduced with traceable genes (lac Z and neomycin resistance) and traced in vivo after intravenous injection into syngeneic mice. These transduced cells home to bone marrow, suggesting that they might be detected in fracture callus. Cells were injected intravenously into mice and stabilized femoral shaft fractures were induced. Control mice received intravenous lactated-Ringer's solution prior to fracture. Callus tissue and marrow were examined histologically from I to 10 weeks after fracture to detect transplanted cells. Transplanted cells were detected in fracture callus in areas, and at times, of most active bone formation. Control specimens showed minimal staining of the callus tissue. Levels of the traceable gene in fracture callus increased, reached a peak between 3 and 4 weeks after fracture, then diminished and disappeared by 10 weeks post-fracture as woven bone at the fracture site was replaced by lamellar bone with cells from the host mouse. The results show that pluripotent bone marrow cells home to the marrow after systemic injection and localize in fracture callus.

A macro perspective of non-clinical student internship programs.

Internships are advantageous to both health care organizations and students. Intern employers benefit in many ways such as completing meaningful backlogged projects, savings on benefits, using internships as a recruiting tool, and becoming a partner in the educational process. There are drawbacks to internships such as increased managerial time to supervise interns and monitor projects, contingent workforce issues with which to deal, and assignment of routine tasks only. Indicators for administration of meaningful internship programs as well as evaluation concerns are discussed. This article addresses college and university internships excluding applied health care clinical rotations.

Managerial competencies necessary in today's dynamic health care environment.

The traditional functions of management--planning, organizing, leading, and controlling--continue to be the key activities used to enable the organization to accomplish its goals and objectives. Though significant changes have occurred in all organizational structures, processes, and managerial styles, these traditional functions remain a constant. What has undergone significant change, as this article examines, are the skills and competencies within each function, which managers must develop and employ if they are to be successful practitioners in today's dynamic health care organizations.