Collagenous colitis as a cause of chronic diarrhea.

When the usual workup for chronic diarrhea fails to provide a diagnosis and the endoscopic findings are normal, alternative etiologies must be considered. This case of collagenous colitis represents such an alternative diagnosis. The patient is a 65-year-old woman who complained of abdominal cramps and watery diarrhea for an 8-month span. The key element to her diagnosis was subepithelial collagen deposits of the mucosa of the colon. Her symptoms were resolved with supportive care, diet, and diphenoxylate. Essential features and treatment of collagenous colitis are reviewed.

Faculty development and organizational systems behavior.

Faculty development is that process that fosters improvement in faculty members' skills in teaching and research and promotes their career advancement. This study investigated the association between organizational behavior in military medical centers and the faculty development of its medical corps officers assigned to teaching positions. Such organizational behaviors as defining tasks clearly and resolving conflicts satisfactorily correlated well with the faculty members' overall satisfaction and other parameters of good faculty development. The results suggest that a strong relationship exists between the organizational behavior of an institution and the sense of identity, productivity, and continued career growth of its individual faculty members.

Lack of difference in neonatal mortality between blacks and whites served by the same medical care system.

To study the influence of health care systems on racial differences in low birthweight and neonatal mortality, an historical cohort analysis was conducted using birth and linked birth and death certificates of infants delivered in Pierce County, Washington, between 1982 and 1985. Overall, black infants had significantly higher rates of low birthweight than white infants. Black infants served by civilian medical care had approximately twice the neonatal mortality of white infants; however, black infants born in the military hospital had a neonatal mortality rate comparable to white infants. Controlling for marital status, age, parity, and income status did not appreciably change these patterns. Military care appeared to be associated with a protective effect for neonatal mortality for blacks. This effect was not due to differences in birthweight distribution or to the quantity of prenatal care received. The effect was most prominent for normal weight black infants, especially for those from low-income census tracts. The findings have possible implications for pediatric access issues for the poor and for the family practice model of perinatal care continuity.

An evaluation of prenatal care utilization in a military health care setting.

An assessment of prenatal care and birth outcomes was performed for a sample of 7,599 births at a military hospital between 1982 and 1985. Prenatal care patterns were similar to a civilian Health Maintenance Organization study's. Less adequate levels of prenatal care were significantly associated with higher risks of neonatal mortality and low birth weight. Five independent risk factors for receiving less adequate care were identified by multivariate analysis: 1) young maternal age (less than age 20), 2) black race, 3) residence off post, 4) high risk combinations of age and parity, and 5) residence in low-income census tracts.

Evaluation of a rapid theophylline test strip assay in the emergency department setting.

Test strips recently have become available to measure theophylline levels. One such test strip (AccuLevel) had not been tested in an actual clinical situation with nontechnician personnel. We prospectively evaluated the test strip on consecutive emergency department patients, comparing it with the agglutination inhibition method used by our hospital laboratory. Nurses and medics who ran the test were given only a brief demonstration and explanation of the manufacturer's instructions. The 61 test strip levels correlated highly with the laboratory results (r = 0.92, slope = 0.89, y-intercept = 0.99). The test strip results were available in less time (mean of 0.51 hours vs 1.89 hours for the laboratory, P less than .0001). The most accurate readings were obtained by those who ran the test most frequently. Caffeine intake did not influence the test. Cost was significantly lower than charges at local hospitals.

Rapid assay kits for common microbiologic agents.

Commercial rapid assay kits are available to assist in making diagnoses such as gonorrhea, rubella, and chlamydial and Group A streptococcal infections. Most assays contain either antigens to detect antibodies or antibodies to detect the antigens of the specific agents. Methods include latex agglutination, enzyme-linked immunosorbent assay, solid-phase enzyme immunosorbent assay and immunofluorescence. Rapid assay kits are best used with an understanding of their principles, their sensitivity-specificity ranges, their limitations and assets, and their cost and shelf life.