An evaluation of Open Airways for Schools: using college students as instructors.

Fifteen years ago, Open Airways for Schools (OAS) was found to be an effective asthma education program for elementary school children when taught by professionals. To determine whether OAS is effective when taught by college students and whether it could withstand potential cohort effects, 54 inner-city fourth and fifth graders were taught OAS. Paired t-tests revealed that OAS improved asthma knowledge, self-efficacy, self-management skills, social support, and perception of well-being (p < 0.05). Fifteen years later OAS continues to improve children's self-management skills. Facilitators with little prior experience who received brief training in asthma knowledge and group leadership skills can effectively teach OAS.

Intra-aortic balloon pumping in the community hospital setting.

A community-hospital IABP program provides potentially lifesaving treatment for patients with lethal cardiac problems. Similar to the rapidly growing number of other community hospitals with IABP programs, Landmark Hospital in Rhode Island has successfully implemented this modality of cardiac care, once limited to tertiary care facilities. Although the challenges the community hospital faces when establishing an IABP program and maintaining clinical competency are unique, IABP in the community hospital is a proven treatment modality that decreases mortality rates.

More Aggressive Drug Treatment of Rheumatoid Arthritis in a University-based Practice.

We sought to assess the impact of recent observations and recommendations on the treatment of rheumatoid arthritis in a university-based rheumatology practice over a recent 6-year period. Data was collected from information recorded in a database by physicians treating patients in outpatient rheumatology clinics. The treatment regimens of all patients with rheumatoid arthritis seen during the first half of 1987 and 1993 were compared. The populations were similar in age, race, and sex distribution, disease duration, and seropositivity. Nonsteroidal anti-inflammatory drug use decreased from 85% to 74%, while corticosteroid use increased from 31% to 44% of patients. Second-line agent use increased from 46% to 65% of patients, all of which could be accounted for by the increase in methotrexate use from 11% to 32%. The use of other second-line agents remained stable (hydroxychloroquine, auranofin, azathioprine), declined (intramuscular gold, penicillamine), or increased slightly (sulfasalazine). An increase in combination second-line drug therapy from 2% to 6% was noted. This study shows that between 1987 and 1993, our drug therapy for rheumatoid arthritis has become more aggressive: we have increased steroid use, decreased nonsteroidal use, and more frequently used second-line agents, particularly methotrexate.