Interlaboratory variability in serum lipid measurements.

Identification of elevated blood cholesterol has become a priority in the effort to reduce coronary heart disease. Previous data indicate that considerable laboratory variability in lipid testing exists in the United States. To determine the interlaboratory variability of serum lipid measurements in the Little Rock area, split serum samples from three subjects were sent to ten area laboratories. The average coefficient of variation among the ten local laboratories was 3.20% for total cholesterol, 9.46% for HDL-cholesterol, 7.73% for triglycerides, and 5.95% for calculated LDL-cholesterol. The results indicate that clinicians cannot assume that adequate standardization for lipid determinations exists for all laboratories. Without accuracy and precision data for the specific laboratory, caution should be used in the strict application of guidelines for classification and treatment of patients with abnormal serum-lipid measurements.

Oat bran supplementation for elevated serum cholesterol.

The National Heart, Lung, and Blood Institute (NHLBI) has recommended intensive dietary treatment as first-line therapy for patients with high cholesterol levels. The NHLBI has also encouraged research into the effectiveness and safety of alternative diets and further study of human behavior as it relates to adherence to diets. Based on these recommendations and previous studies suggesting a hypocholesterolemic effect of oat bran dietary supplementation, 16 family practice outpatients with elevated cholesterol levels were enrolled in a 12 week study designed to assess the practicality and effectiveness of adding four oat bran muffins per day to the diet. Subjects were randomized into immediate intervention and delayed intervention groups. The combined group had a significant decrease in total cholesterol of 7.9 percent (p less than .03) and in LDL-cholesterol of 10.1 percent (p less than .03) but there was no significant difference with respect to lipid changes between the immediate group and the delay group when the delay group was serving as a control for the immediate group. The results taken in conjunction with evidence in the literature indicate that the simple addition of oat bran muffins to the diet of certain family practice outpatients is well tolerated and probably effective in lowering serum total and low density lipoprotein cholesterol.

Nitrous oxide analgesia for outpatient procedures.

Nitrous oxide analgesia is a safe alternative to parenteral narcotics for outpatient surgical procedures. This type of analgesia is effective, well tolerated by most age groups, easily administered, rapidly reversible and associated with a low incidence of serious side effects. Hypoxia can be prevented by using fail-safe equipment, by observing prescribed limitations on nitrous oxide concentrations and by administering 100 percent oxygen on termination of nitrous oxide administration.

Pharmacy teaching for family practice residents.

Because undergraduate training in pharmacology is insufficient preparation for prescribing drugs appropriately, comprehensive systematic education in clinical pharmacy is essential for family practice residents. A pharmacy curriculum could contribute to improved treatment of disease, decreased health care costs, decreased iatrogenicity and morbidity, lower risk of litigation, and better communication among physicians, pharmacists, and patients. The pharmacy curriculum which has been developed at the family practice residency program in Little Rock, Ark. focuses on problem-solving activities in the clinical setting, primarily utilizing problems from the residents' patient caseloads. A long-term plan of the department is to follow residents into practice in order to examine utilization of what they learned from the pharmacy curriculum.