Overexpression of G protein-coupled receptor kinase-2 in smooth muscle cells attenuates mitogenic signaling via G protein-coupled and platelet-derived growth factor receptors.

BACKGROUND: Neointimal hyperplasia involves activation of smooth muscle cells (SMCs) by several G protein-coupled receptor (GPCR) agonists, including endothelin-1, angiotensin II, thrombin, and thromboxane A(2). Signaling of many GPCRs is diminished by GPCR kinase-2 (GRK2). We therefore tested whether overexpression of GRK2 in SMCs could diminish mitogenic signaling elicited by agonists implicated in the pathogenesis of neointimal hyperplasia. METHODS AND RESULTS: Overexpression of GRK2 was achieved in primary rabbit aortic SMCs with a recombinant adenovirus. Control SMCs were infected with an empty vector adenovirus. Inositol phosphate responses to endothelin-1, angiotensin II, thrombin agonist peptide, and platelet-derived growth factor (PDGF) were attenuated by 37% to 72% in GRK2-overexpressing cells (P<0.01), but the response to the thromboxane A(2) analogue U46619 was unaffected. GRK2 also inhibited SMC [(3)H]thymidine incorporation stimulated not only by these agonists (by 30% to 60%, P<0.01) but also by 10% FBS (by 35%, P<0. 05). However, GRK2 overexpression had no effect on epidermal growth factor-induced [(3)H]thymidine incorporation. Agonist-induced tyrosine phosphorylation of the PDGF-beta receptor, but not the epidermal growth factor receptor, was reduced in GRK2-overexpressing SMCs. GRK2 overexpression also reduced SMC proliferation in response to endothelin-1, PDGF, and 10% FBS by 62%, 51%, and 29%, respectively (P<0.01), without any effect on SMC apoptosis. CONCLUSIONS: GRK2 overexpression diminishes SMC mitogenic signaling and proliferation stimulated by PDGF or agonists for several GPCRs. Gene transfer of GRK2 may therefore be therapeutically useful for neointimal hyperplasia.

Prevention of hot tap water burns--a comparative study of three types of automatic mixing valve.

To prevent fatal outbreaks of Legionnaires' disease, particularly in hospitals and other health-care premises, building services engineers are recommended to store and operate hot water systems at a temperature of 60 degrees C. However, water at this temperature can cause serious scalding. It is therefore advised that mixing valves be installed in the hot water supply pipework to provide hot water at safe temperatures for washing and bathing. Electricity Association Technology Ltd (EATL) investigated the performance of three makes of automatic mixing valve. Tests showed that with constant supply conditions there was little difference in performance between the three valves when blending hot and cold water. However, the ability of the valves to respond to the loss of the cold water supply was quite valve was able, consistently, to shut the hot water off in the event of cold water failure. These results suggest that where it is necessary to safeguard people or patients against any risk of scalding, e.g. young children and handicapped patients, a quality thermostatic valve should be installed rather than a cheaper tempering valve.

Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes.

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes.

The prevention of hot tap water burns--a study of electric immersion heater safety.

A household survey conducted in 1986 as part of a study into the prevention of hot tap water burns found that 50 per cent of the immersion heater installations visited produced hot water at temperatures of 60 degrees C or greater. The Electricity Research and Development Centre has carried out a new detailed survey of over 200 electric immersion heater installations to ascertain the effectiveness of thermostats in controlling hot water temperatures. This survey found that immersion heater thermostats were effective and reliable devices, but it was disturbing to record the 71 per cent of the thermostats inspected were set at temperatures greater than 65 degrees C. Hot water temperature measurements showed that only 20 per cent of the homes had hot water with a temperature greater than 65 degrees C at the tap. One possible reason for this may have been the use of hot water by the residents before the temperature measurements were made because, while conducting the survey, it was not possible to have the immersion heater switched on in every apartment due to the time switching arrangements. For the age group surveyed, with an average age of 72 years, the provision of a device to indicate the remaining hot water in a storage cylinder was thought to be helpful but more than half the respondents indicated that they did not want new kinds of remote temperature control.(ABSTRACT TRUNCATED AT 250 WORDS)

Propofol sedation for outpatient upper gastrointestinal endoscopy: comparison with midazolam.

The objectives of this study were to assess midazolam and propofol as sedative agents for outpatient gastrointestinal endoscopy, with particular reference to recovery profile, amnesic effects, and haemodynamic state and oxygenation during the procedure. Forty consecutive patients were allocated randomly to two groups. Patients in group I (n = 19) received midazolam 81 (SEM 32) micrograms kg-1; those in group II (n = 21) received propofol 950 (400) micrograms kg-1. Both agents were administered as single injections to similar end-points of sedation. Psychomotor function was assessed using the digit symbol substitution test (DSST). Amnesia was measured with a visual memory test and subjective questionnaire. Patients in group I had a lower DSST score than those in group II (P less than 0.01), indicating a hangover effect from midazolam. Amnesia was similar in the two groups up to the time of removal of the endoscope. More patients in group II remembered removal of the endoscope (P less than 0.001). Oxygen desaturation from baseline was similar in both groups (P less than 0.01). An increase in heart rate and decrease in mean arterial pressure were noted in both groups. Propofol provided more rapid recovery compared with midazolam, but was associated with pain on injection, a short amnesia span, and reduced patient acceptance.

Lung cavities in patients with coeliac disease.

The clinical, radiological and pathological features of 7 patients with coeliac disease (CD) who developed lung abscesses or cavities are described. These patients were seen during a 20-year period during which time approximately 600 coeliacs were seen and 50 died. Six of the coeliac patients with lung abscess died. The patients were middle aged. Staphylococcal infection, Klebsiella pneumoniae, bronchial carcinoma and previous pulmonary tuberculosis accounted for the cavities in 4 patients. In the 3 other patients a definite cause could not be identified. Hyposplenism and malnutrition were common. Next to malignancy pulmonary abscess was the commonest cause of death in the coeliac population. The development of respiratory symptoms should be regarded as a potentially serious and a life-threatening event in the middle-aged coeliac patients. Lung abscess should be added to the list of respiratory diseases associated with coeliac disease.

Mutual support groups to reduce alcohol consumption by pregnant women: marketing implications.

This paper reports on a study of social support and alcohol consumption of 153 women during pregnancy. The majority of women changed their alcohol intake patterns during pregnancy because of concern for the health of the fetus. Most women decreased the amount and frequency of drinking and changed their beverage of choice. Social support was found to be significantly related to reduction in alcohol use during pregnancy. Social support came from relationships with specific individuals and groups of individuals. Health care providers may be able to extend the range of their work by designing specific prevention strategies targeted toward the development and implementation of mutual support groups for pregnant women. The marketing discipline has identified certain characteristics of the mutual benefit association, an organization which exists exclusively for the benefit of its members. The authors propose that the mutual support group, often used to promote health-related behaviors, is a special case of the mutual benefit association; further, that appropriate application of established marketing principles and practices will be effective in promulgating the mutual support group. The authors offer a marketing strategy for the mutual support of pregnant women, a strategy which should be effective in further reducing the alcohol intake of pregnant women.

Physician satisfaction with capitation patients in an academic family medicine clinic.

Physician work satisfaction may play an important role in the management and quality of health care, yet cost-containment measures may compromise levels of physician satisfaction. This article reports an evaluation of physician attitudes toward aspects of capitation plans that may place the physician in conflict with the physician's traditional role. The literature was reviewed in an effort to generate a list of constructs that would be relevant to physician work satisfaction. By using constructs that focus on both physician work satisfaction and capitation, a survey instrument was developed and serially administered to physicians involved directly in a capitation program. Among the five dimensions studied, providers rated capitation patients more favorably in only one area: interpersonal relationships. Providers indicated a preference for noncapitation patients in the dimensions of autonomy, intellectual stimulation, time restraints, and structural variables. Furthermore, physicians' satisfaction levels with capitation patients tended to decrease the longer they cared for them. These findings are consistent with expectations, and lend support to the hypothesis that organizational constraints may have an adverse effect on physician attitudes toward selected aspects of caring for capitation patients.

A study of the prevention of hot tapwater burns.

A 4-year retrospective study of hot tapwater scalds admitted to Mount Vernon Hospital Burns Unit suggested that the three high-risk groups are young children, the elderly and the mentally and physically handicapped. A household survey was conducted of 60 homes inhabited by people over 70 years of age and 60 homes inhabited by families with toddlers to identify what measures could be taken to prevent hot tapwater scalds. The survey showed that over half of the old people did not have adequate bathing aids and that one-third of all the homes visited had a hot tapwater temperature greater than 60 degrees C, which is the temperature recommended by British Building Services Engineers. The survey also revealed that 50 per cent of the immersion heaters and 25 per cent of the gas boiler central heating systems produced an excessively high hot tapwater temperature. The study thus indicated that both the wider provision of bathing aids to the elderly and a nationwide programme to update old inefficient immersion heater and gas boiler central heating systems would reduce the risk of hot tapwater scalds. The installation of a 'thermoscopic' mixing valve, pre-set and locked at 43 degrees C, at bath and shower outlets can totally eliminate the risk of hot tapwater scalds. At present it is not a feasible option to install these valves in every household, but there is a strong case for installing them in hospitals and residential homes for paediatric, geriatric and mentally/physically handicapped patients.

A follow-up comparison of patient satisfaction among prepaid and fee-for-service patients.

This study reports the results of a follow-up patient satisfaction survey that sampled patients enrolled in a capitation program and compared their satisfaction levels with otherwise similar patients in a fee-for-service program two years after the programs began. On a scale of 1 (very dissatisfied) to 5 (very satisfied), the mean general satisfaction level for 158 prepaid patients was 3.17 +/- 0.70, and 3.42 +/- 0.61 for 87 fee-for-service patients (P less than .05). This finding contrasts with no differences seen in a previous study of the same populations at six months after the programs began (mean general satisfaction levels of 3.26 and 3.36 for the prepaid and fee-for-service patients, respectively). A statistically significant difference also existed in the subdimension "technical aspects of quality of care": 3.38 +/- 0.65 for prepaid patients, and 3.61 +/- 0.53 for fee-for-service service patients (P less than .05). Levels of satisfaction within other individual constructs were similar for both groups and tended to remain the same over two years, although satisfaction with access to care decreased among prepaid patients, and satisfaction with continuity of care increased among fee-for-service patients. These data support the hypothesis that overall satisfaction levels and certain aspects of patient satisfaction may be compromised by a capitation program.

A comparison of patient satisfaction among prepaid and fee-for-service patients.

This study compares levels of patient satisfaction (a valid, indirect measurement of quality of care) between prepaid and fee-for-service patients. A chart audit approach was used to determine whether prepaid and fee-for-service patients seen in an academic family health center at the end of the first six months of a new cost-containment program were comparable in terms of demographic characteristics and indirect measures of health and health behavior. Next, using a 26-item patient satisfaction questionnaire, 436 patients from a single group of providers in the same family health center seen six months after the programs began were randomly surveyed. Sociodemographic and health-related characteristics of prepaid and fee-for-service patients were similar for both groups in the chart audit. There was no statistically significant difference between the overall satisfaction levels of prepaid and fee-for-service patients. Individual constructs that comprise general satisfaction were also statistically similar except for an unexpected finding of dissimilar levels of satisfaction with "physician conduct/humaneness" (P less than .05). Assessed from at least one standpoint, cost containment does not seem to affect overall quality of care, but further investigation is needed, especially in the realm of "physician conduct/humaneness."

New concepts of confidentiality in family practice.

Medical confidentiality protects the physician-patient relationship and ensures privacy so that intimate information can be exchanged to improve, preserve, and protect the health of the patient. The ethical and legal basis of confidentiality forms a conditional rather than absolute privilege, however, and numerous exceptions currently exist whereby third parties with a legitimate interest have access to patient information. Family medicine may now be another exception because its conceptual framework abandons the old model of treating just the individual and employs a more advanced model of treating both the individual and the family. Using the argument that the treatment of a diseased individual really means treatment of the diseased family, traditional limitations on the scope of confidentiality need expansion. Critical information may necessarily have to be sought outside these limits for diagnostic purposes as well as successful treatment of family disease. At the initial visit, therefore, patients need to be informed that limited portions of confidential information may need to be shared with other members of the family, but that only information necessary and relevant to the treatment of the problem will be shared.