Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.

OBJECTIVE: To compare patient outcomes 1 year before and 1 year after enrollment in a comprehensive diabetes lower-extremity amputation prevention program. RESEARCH DESIGN AND METHODS: Outcome data were obtained on 197 patients enrolled in the Louisiana State University Health Sciences Center Diabetes Foot Program, which provides foot care to a predominantly low-income African-American population in Louisiana. Data were obtained using a structured interview administered by a registered nurse. Recordings were made of number of days with an open foot ulcer, number of times hospitalized for a foot problem, number of days spent in the hospital for a foot problem, number of visits to the emergency room for a foot problem, number of times an antibiotic was prescribed for a foot problem, number of all foot operations, number of lower-extremity amputations, and number of missed workdays for a foot problem. Data were obtained on all patients at the initial visit and at the 1-year follow-up. RESULTS: Analysis of data showed a reduction in foot-related ulcer days (-49%), hospitalizations, (-89%), hospital days (-90%), emergency room visits (-81%), antibiotic prescriptions, (-57%), foot operations (-87%), lower-extremity amputations (-79%), and missed workdays (-70%) after 1 year of comprehensive foot care compared with the 1-year period before treatment. CONCLUSIONS: This single cohort outcome study showed a large reduction in foot-related complications after the first year of comprehensive preventive foot care.

Alcoholism among indigent inpatients: identification and intervention by internal medicine residents.

BACKGROUND: This study examined alcoholism identification and interventions by internal medicine residents, determined the prevalence of alcoholism among indigent inpatients, and examined some variables related to alcoholism in this population. METHODS: The alcohol abuse and dependence section of the Diagnostic Interview Schedule was administered to 197 inpatients, and chart audits were done. RESULTS: The obtained prevalence of alcoholism was 17%. Residents identified current alcohol abuse among 71% of current alcoholics, 17% of past alcoholics, and 3% of nonalcoholics. Sixty-two percent of alcoholics identified by the residents did not receive advice or referral, 13% received advice, 17% were referred to Alcoholics Anonymous, and 8% were referred to an inpatient facility. CONCLUSIONS: Our results suggest that although residents' identification of alcoholism is satisfactory, it is necessary to improve their rates of intervention. The profile of the alcoholic inpatients in this study includes demographics, presence of chronic illnesses, and utilization of medical services as compared with nonalcoholics.

Blastomycosis: pulmonary and pleural manifestations.

Seven diverse cases of pulmonary blastomycosis were recently diagnosed at this institution. It is our purpose to review the unique features in the spectrum of this systemic illness as illustrated by these cases. The wide range of radiographic findings included parenchymal disease, mass-like lesions, and pleural effusions. One patient had endobronchial blastomycosis. Although significant pleural effusions have been uncommonly reported, we note this finding in two of our seven cases. Both of these patients had thoracentesis, which yielded markedly elevated pleural fluid total protein. These seven cases emphasize the marked variability of pulmonary and pleural blastomycosis.