Effectiveness of a prospective physician self-audit transfusion-monitoring system.

BACKGROUND: The purpose of this study was to search for a more effective transfusion-monitoring system than the existing system of retrospective peer review. STUDY DESIGN AND METHODS: This research used a study-control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood-ordering process: 1) the number of crossmatches ordered per admission, 2) the transfusion-to-crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self-auditing. The study used two outcome indicators to reflect overall blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month. RESULTS: The prospective physician self-audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.

Ethnic distribution of the glutathione transferase Mu 1-1 (GSTM1) null genotype in 1473 individuals and application to bladder cancer susceptibility.

Polycyclic aromatic hydrocarbons, found in cigarette smoke, food and industrial materials, are potential human carcinogens. Deficiency of detoxifying enzymes, such as glutathione transferases, may affect the metabolic fates of these chemicals and raise cancer risks in exposed individuals. The GSTM1 null genotype is a common form of glutathione transferase deficiency. Because knowledge of its ethnic distribution would be useful in epidemiologic studies, we measured the frequencies of the GSTM1 null genotype among healthy blacks, whites, Asian Indians, Chinese, Japanese, Koreans, Filipinos, Samoans and Hispanics. Rapid genotyping was done by use of a PCR assay, with dried blood spots on blotter paper as DNA templates. The frequency of the null genotype ranged from 0.31 among blacks to 0.88 among Samoans. The PCR assay was also applied to a pilot study of 114 bladder cancer cases from Kaiser Permanente Medical Center, Harbor City, California. DNA for these cases was obtained from paraffin-embedded surgical specimens. The overall odds ratio for bladder cancer with the GSTM1 null genotype was 1.4 (95% confidence interval 0.94-2.1), indicating no statistical difference in null genotype frequencies among bladder cancer patients compared to a healthy population. Large epidemiologic studies, which can be accomplished with dried blood spots or paraffin-embedded tissue specimens, may be useful for further assessment.

Stability of salivary cotinine sent through the U.S. mail for verification of smoking status.

Until now mass media smoking cessation studies have relied almost exclusively on self-reports of smoking cessation because biochemical confirmation has not seemed practical. This study investigated the reliability of mailed salivary cotinine specimens for the determination of smoking status. Two simultaneous saliva specimens were obtained from 10 smokers and 10 nonsmokers. One of each pair was frozen immediately. The other was sent through the local U.S. mail and then subjected to additional physical agitation and heat before being frozen. All specimens were subsequently analyzed for cotinine. No cotinine was detectable in any of the nonsmokers' specimens. There was excellent correlation between the paired smokers' specimens. These results show that the mailing of saliva specimens for cotinine analysis is practical and provides accurate data on smoking status. It is an approach which could easily be used in mass media smoking cessation studies to biochemically confirm smoking behavior.

Magnetic resonance imaging of a glomus tumor of the fingertip.

Magnetic resonance imaging has been shown to help in the diagnosis of a glomus tumor in an unusual location in a fingertip. We report a case where magnetic resonance imaging confirmed the presence of a lesion before operation.

Relaxation skills for the patient, dentist, and auxiliaries.

The aforementioned stress reduction techniques can be useful for some people, but not all individuals will benefit to the same degree with a similar technique. Those who manifest severe stress symptoms, such as ulcers, hypertension, and migraine headaches, are advised to seek a medical evaluation before attempting relaxation or any other type of stress reduction method. The relaxation skill most beneficial for an individual's own needs might be best sought through a qualified therapist. Those who desire reduction in general tension, or who wish a rejuvenation during the workday, may well benefit from less controlled stress reduction techniques, such as taped instructions, breathing, and imagery methods. A trained therapist can provide the most appropriate relaxation method for an individual's needs. We, as health care providers, can enlighten our patients about methods which can aid them in dealing with anxiety and stress and thus gain better control over the pace of their lives and ours.

Multiple approaches to the reduction of dental fear.

Participant modeling, symbolic modeling, and graduated exposure were compared with each other and with two control treatments for effectiveness in reducing fear of dentistry in 33 adults who had avoided dental treatment for from 1 to 10 yr. Assessment of in-chair psychological responsiveness and overt behavior showed no significant pre-post change for any group although all of them reported significant reduction in state anxiety and expected pain. During the 24 months following treatment, from 50 to 87.5% of the subjects were able to return to regular dental care with the highest "return" rate appearing in the participant modeling condition.

Antecedents of dental fear.

Early dental experiences were described in essay form by 225 college students reporting either "high" or "low" fear of dentistry. Antecedent factors which appeared to differentiate the two groups most clearly included pain experiences and dentist behaviors. Results were interpreted as supportive of a social-learning model of dental fear acquisition and their implications for dental training and practice were discussed.

Cocaine effects on sleep parameters in the rat.

Cocaine in 6 mg/kg doses was administered orally and intraperitoneally to rats and sleep EEG's recorded. Cocaine significantly reduced total sleep time, slow-wave sleep, and sleep latency. Rapid eye movement sleep (REM) was significantly suppressed during the first half of the sleep recording. These effects were evident by both routes of administration. The effects of cocaine on total sleep time in animals parallels that observed in man.