How an academic health center and a community health center found common ground.

Despite their divergent missions, academic health centers (AHCs) and community health centers (CHCs) are natural partners. This is becoming more obvious as national attention is focused on greatly increasing the number of primary care providers. AHCs are responding to this pressure and now need more sites to train primary care physicians, and CHCs need more primary care physicians (the AHCs' graduates) as staff. Thus these two types of institutions have a common interest. Other major themes of health care reform are also likely to drive AHCs and CHCs together, such as providing access to the uninsured, placing more emphasis on prevention and public health, and coordinating care in managed care systems to improve outcomes and control costs. Yet partnerships between these two kinds of institutions are still rare. This article describes a successful joint program begun in 1991 between the Lincoln Heights Health Center, which serves a poor, predominantly black community, and the University of Cincinnati Medical Center. All the program's activities are monitored by a policy committee made up of representatives from both institutions. For the first five years, the main hospital of the medical center is supporting the relationship with a $350,000 grant. Both parties retain their independent governance, yet collaborate closely and feel the relationship yields high value to each party and the community. For example, medical education in out-of-hospital settings has increased greatly, as have referrals to the AHC. The CHC has been able to recruit and retain high-quality physicians; its balance sheet has been favorably affected also.(ABSTRACT TRUNCATED AT 250 WORDS)

Development, effects, and educational outcomes of reporting from a clinical database.

To develop clinically applicable and educationally useful reports from a clinical database, the authors explored the development of such databases at a medical center. The patient-centered database (PCD) integrates disparate data resources in the service of academic clinicians, postgraduate trainees, and students. From the PCD, daily and monthly reports are generated, which include 1) census update reports, serving as an educational format for a daily case-based morning report discussion and routine rounds; 2) reports of daily admissions and patient census stratified by appropriate housestaff providing the clinical care; and 3) quality assurance measures such as monitoring of length of stay of each patient regardless of the initial housestaff service to which the patient is initially admitted. The results of expanding the number of report beneficiaries, outcomes from a five-month test period, and possibilities for further development and implementation are considered.

Predisposing factors in Pneumocystis carinii pneumonia: effects of tetracycline, protein malnutrition, and corticosteroids on hosts.

Components of the immunosuppressive regimen used to reactivate latent Pneumocystis carinii infection were analyzed for their effects on the growth, nutrition, and lymphoid system of hosts. Rats that were administered either tetracycline or a low-protein (8%) diet alone for 7 weeks developed few abnormalities, but animals on the combined regimen developed lower body and lymphoid organ weights, lower serum albumin levels, and fewer circulating lymphocytes. Rats that were administered corticosteroids and tetracycline experienced severe wasting, debilitation, and generalized lymphocyte depletion; the low-protein diet increased the magnitude of these changes. Alterations in the frequency of occurrence of specific lymphocyte subsets occurred only in rats given corticosteroids and consisted mainly of a greater decline in peripheral blood T helper cells than in T suppressor cells. The data suggest that long-term tetracycline administration and a low-protein diet have a variety of adverse effects on the host which enhance the immunosuppressive properties of corticosteroids.

Lymphocyte changes during chronic administration of and withdrawal from corticosteroids: relation to Pneumocystis carinii pneumonia.

Corticosteroids were administered for up to 8 wk in adult Lewis rats to provoke Pneumocystis carinii pneumonia, and lymphocyte subsets were analyzed at different body sites with monoclonal antibodies by flow microfluorometry in a fluorescence activated cell sorter. The rats became chronically ill, debilitated, and exhibited marked involution of all lymphoid tissues. The lymphocytopenia was characterized in peripheral blood by a large fall in the frequency of T helper cells, and in the lungs by a fall in T helper (Th) cells and a rise in T suppressor (Ts) cells; at both sites there was reversal of the Th to Ts ratio. These changes were not found in the thymus, spleen, or bone marrow. When corticosteroids were withdrawn, the rats gained weight, cleared P. carinii from the lungs, and regenerated their lymphoid tissues. The lymphocyte subpopulations exhibited variation in their frequencies at different body sites, but gradually returned to baseline levels. Thus, in this model chronic corticosteroid administration results in profound generalized lymphocyte depletion and changes in the proportions of circulating and pulmonary T cell subsets. These abnormalities may be an important immunologic mechanism in the development of P. carinii pneumonia.

Flow microfluorometry analysis of alterations in T-lymphocyte subsets during murine listeriosis.

C57BL/6 mice were infected intravenously with 6 X 10(3) Listeria monocytogenes organisms. As early as day 3 of infection, there was a marked reduction in the number of lymphocytes recovered from the peripheral blood, bone marrow, and thymuses of infected animals. Concomitantly, there was an increase in the number of splenic lymphocytes. By day 14, both the total and differential cell counts were similar in both infected and normal animals. Flow microfluorometric studies comparing the Thy-1.2, Lyt-1, Lyt-2, and surface immunoglobulin (SIg) phenotypes of lymphocytes from normal and infected mice were performed. Between days 3 and 5, there was a decrease in the percentage of Thy-1.2+ cells in the spleens of L. monocytogenes-infected animals. Conversely, the percentages of Lyt-1+, Lyt-2+, and SIg+ cells remained constant. At day 7 of infection, the percentage of Thy-1.2+ splenocytes was within normal limits, and at day 10, the percentage of Thy-1.2+ cells was elevated slightly. The absolute numbers of Thy-1.2+ cells were comparable in both infected and normal animals at early stages (days 3 to 5) of L. monocytogenes infection, but there was a marked elevation of Thy-1.2+ splenocytes at days 7 to 14 of infection. Lyt-1+, Lyt-2+, and SIg+ splenocytes increased in absolute numbers as early as day 3 of infection and were still elevated at day 14. Adrenalectomy before infection had no effect on the results obtained, suggesting that these changes were not mediated by endogenous steroids.

Immunoregulation in experimental disseminated histoplasmosis: flow microfluorometry (FMF) studies of the Thy and Lyt phenotypes of T lymphocytes from infected mice.

Previous studies have shown that mice infected i.v. with 6 X 10(5) yeast phase Histoplasma capsulatum (Hc) develop suppressed immune responses during weeks 1 to 4 of infection but that by weeks 8 to 12 of infection these responses return to normal. In this study total and differential cell counts showed that as early as the third day of infection there was a marked reduction in the number of lymphocytes recovered from the peripheral blood, bone marrow, and thymus of infected animals. Concomitantly, there was an increase in the number of splenic lymphocytes. By day 28 both the total and differential cell counts were similar in both infected and normal animals. Flow microfluorometric (FMF) studies comparing the Thy-1.2, Lyt-1, Lyt-2, and surface immunoglobulin (slg) phenotypes of lymphocytes from normal and infected mice were performed. Between days 5 and 7 the thymocytes from infected mice displayed a higher relative fluorescence intensity (RFI) of the Thy-1.2 marker than normal thymocytes, whereas at day 10, the RFI was less than that of normal thymic lymphocytes. Between days 7 and 10 of infection the RFI of the Lyt-2 marker was less on thymocytes from Hc-infected mice; however, there was no change in the Lyt-1 marker. Examination of these lymphocyte markers in blood, spleen, and mesenteric lymph nodes showed that there were decreases in the RFI of both the Thy-1.2 and Lyt-2 between days 5 and 10 of infection. No changes were observed in the Lyt-1 or slg markers. By day 28 there were no differences between the normal and infected mice with respect to any surface marker in any of the organs studied. In other experiments, the effect of adrenalectomy before infection on these surface markers was studied. Absolute numbers of Thy-1.2+, Lyt-1+, and Lyt-2+ cells were significantly increased in the spleen and significantly decreased in the thymus and peripheral blood of infected mice relative to normal controls. These studies suggest that there is a migration of cells from the thymus, blood, and bone marrow to the spleens of mice with disseminated Hc infection.