Issues in assessing satisfaction: findings of the arkansas medicaid family planning demonstration waiver evaluation.

Arkansas was one of the first states to expand family planning services under its state Medicaid plan through a Section 1115 Demonstration Waiver. In addition to an assessment of other outcome measures, evaluators used exit interviews, which had been designed to reduce courtesy bias, to assess client satisfaction with family planning services available under the waiver in public health units. Client satisfaction with family planning services can serve as a simple measure of one dimension of perceived quality of care. Findings indicate overall client satisfaction with family planning services. However, noted methodological issues may limit the generalizability of these findings. Potential corrective measures are suggested for improving client satisfaction with family planning services and for increasing the utility of survey instrument utilized in this effort.

A prospective, randomized comparison of Foley catheter insertion versus intracervical prostaglandin E2 gel for preinduction cervical ripening.

OBJECTIVE: The objective of this study was to compare intracervical prostaglandin E2 gel with insertion of a Foley bulb for efficacy in preinduction cervical ripening. STUDY DESIGN: Women who came to the hospital for induction of labor with a Bishop score

Acetaminophen and ibuprofen in the management of fever and mild to moderate pain in children.

Acetaminophen has become the non-narcotic of choice for children because of concerns regarding the connection between acetylsalicylic acid exposure and Reye's syndrome. Ibuprofen, recently granted over-the-counter status for children over two years of age, offers another choice for treatment. The efficacy and safety of both drugs have been studied in numerous clinical trials. This paper reviews the published evidence about the efficacy and safety of acetaminophen and ibuprofen with regard to treating fever and mild to moderate pain in children.

Social science education as a component of medical training.

The broad view of health espoused by the World Health Organization is now generally accepted by medical educators. Implicit in the new paradigm is a recognition of multiple determinants of health and of shifting divisions of professional responsibilities among providers. As a consequence, the importance of social and behavioural science education as a foundation to medical training is increasingly appreciated. At the same time medical programmes are under pressure to contend with the explosion of knowledge in basic biomedical and life sciences and with technological innovation. Curricula are being submerged in facts, causing medical schools to look for innovative teaching models that feature more flexible approaches to the diverse body of knowledge supporting professional practice. Independent learning methods are being explored and revised teaching programs are being organized around coordinating themes, such as aging, human development and environmental health. Future programmes must be designed to encourage multiprofessional approaches while fostering awareness of the important interplay between health care (both curative and preventive) and social/behavioural science. Within the curriculum students should be offered options that include sociology, child growth and development, gerontology, medical anthropology, psychology, medical geography, health economics, political science and related subthemes. More important than the inclusion of any specific discipline is the creation of an environment in which future physicians may be exposed to critical thinking across a wide range of themes that characterize the social and cultural context for medical practice. Such enquiry is also likely to drive a closer relationship between medical schools and their parent universities within which the social science expertize resides.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four-hour intragastric measurements in twenty healthy subjects: effect of enisoprost, a novel and potent antisecretory and antipeptic synthetic E1 prostaglandin.

Gastric aspiration was performed continuously overnight and at hourly intervals during the daytime in 20 healthy male volunteers. Medications used included enisoprost 100, 200 or 400 micrograms, misoprostol 200 micrograms and placebo, given at bedtime. Each dose of enisoprost markedly inhibited nocturnal mean acid output, hydrogen ion activity, pH and peptic activity. The duration of these effects was up to 10 h. Misoprostol, given at bedtime, also decreased acid secretion, but the effect was significantly less than that observed with any of the doses of enisoprost. A dose-response effect for enisoprost was found for the mean nocturnal hydrogen ion activity and pH, as well as for maximum pH attained. Although enisoprost, given at bedtime, had a marked inhibitory effect on acid and pepsin secretion for the overnight interval, this did not result in rebound hyperacidity or a rise in serum total gastrin concentration. The results of this study suggest that enisoprost should be tested by clinical trial for the treatment of peptic ulcer disease.

Controlled delivery of an antitumor drug: localized action of liposome encapsulated cytosine arabinoside administered via the respiratory system.

Cytosine arabinoside in free or liposome encapsulated form was administered to the lungs of rats via intratracheal instillation. The free drug rapidly left the lung (T 1/2 = 40 min), while the encapsulated drug remained in the lung for a prolonged period (T 1/2 = 8 hr). Free cytosine arabinoside effectively inhibited DNA synthesis (measured by [14C]thymidine incorporation) in the intestine and bone marrow as well as in the lung. By contrast, liposome-encapsulated drug effectively inhibited DNA synthesis in the lung, but similar doses failed to inhibit DNA synthesis in other tissues. The metabolism of free and encapsulated drug were similar in that the same products resulted, namely the inactive catabolite uracil-beta-D-arabinofuranoside and the phosphorylated anabolites of cytoside arabinoside. These results suggest that the action of an antitumor drug can be confined to a single organ through the use of a liposomal drug delivery system.

Organ-selective action of an antitumor drug: pharmacologic studies of liposome-encapsulated beta-cytosine arabinoside administered via the respiratory system of the rat.

beta-Cytosine arabinoside (Ara-C) in free and liposome encapsulated form was administered to Wistar rats by intratracheal institution. Free [3H]Ara-C administered in this manner rapidly left the lung and entered the systemic circulation. Liposome-encapsulated [3H]Ara-C persisted in the lung for a long period, with little redistribution to other tissues. Liposomes administered via the trachea became widely distributed throughout the lung air spaces, as evidenced by the histochemical localization of liposomes containing horse-radish peroxidase. Free Ara-C (5 mg/kg) administered into the trachea effectively suppressed macromolecular incorporation of [14C]thymidine ([14C]dThd) in the bone marrow and gut as well as in the lung. Liposome-encapsulated Ara-C (5 mg/kg) effectively suppressed macromolecular incorporation of [14C]dThd in the lung but had little effect on this process in the gut and bone marrow. Our results suggest that liposome-encapsulated Ara-C may be able to produce a local pharmacologic effect within the lung without producing adverse side effects in other tissues. This observation may be relevant to the chemotherapy of pulmonary metastases.

Scanning electron microscopical examination of gonococcal urethral exudate.

The relationship of gonococci and phagocytes in gonococcal urethral exudate was examined using a scanning electron microscope. Several stages in the phagocytic process were evident. These included pseudopodias, microvilli, and simple attachment of gonococci to phagocytic surfaces. Epithelial cells, also a part of the exudate, were examined in this study. Parallels are drawn between this and other phagocytic systems. The technique provides excellent preservation of phagocyte-bacterial interrelationships and offers a means of investigating the nature of the resistance of Neisseria gonorrhoeae to phagocytosis.

The effect of exercise on the venous blood ammonium concentration in man.

Mild muscular exercise did not cause any significant rise in the ammonium concentration of venous blood draining the exercising forearm of control subjects or patients with cirrhosis. However, in both cirrhotic and non-cirrhotic subjects moderate exercise produced significant increases in venous blood ammonium values and these occurred earlier and were more prolonged in cirrhotic patients. Severe exercise caused larger increases in venous blood ammonium concentration in all subjects but there were no significant differences between the mean ammonium concentrations of the cirrhotic and control groups either before or after exercise. All ammonium values returned to their pre-exercise levels within half an hour of resting. The exact mechanism of these phenomena is not fully understood but they are of practical importance in the study of blood ammonium metabolism in normal subjects and in patients with cirrhosis of the liver. The importance of making subjects rest for at least 30 minutes before obtaining blood for ammonium determination is emphasized in order to obviate misleadingly high readings due to muscular activity.

Venous blood ammonium levels in control subjects and in patients with disorders of the liver.

Venous blood ammonium levels were studied in 106 control subjects and 47 patients with varying degrees of liver disorder. The resting venous blood ammonium was normally distributed in both male and female control subjects and was not influenced by either the sex or the fasting state of the subject. In general it was also uninfluenced by age except that the level was found to be a little lower in subjects over 60 years of age probably due to their state of greater muscular inactivity. The mean resting ammonium level in controls was 80.0 mug/100 ml +/- 17.17 mug/100 ml and the range (mean +/- 2 SD) 46-114 mug/100 ml. Raised levels were obtained in 16.7% of patients with subclinical liver disorder, 62.5% with moderate liver disorder, and 85.5% with severe liver disorder, indicating a relationship between the severity of liver disorder and the resting venous blood ammonium level. As the majority of patients with severe liver disorder were known to have varices the raised ammonium levels are likely to have been related to the greater magnitude and incidence of portal systemic shunts in those with severe liver disease.

Semi-automated method for the differential determination of plasma catecholamines.

A method is described for the estimation of adrenaline and noradrenaline in a 5 to 10 ml plasma sample.A batch technique of adsorption and elution from alumina is used and the final estimation is carried out using an automated fluorimetric technique based on the trihydroxyindole method. Fluorescence is stabilized first by thioglycollic acid to give noradrenaline concentrations only and then by ascorbic acid to give the total catecholamine concentration. The results of a number of catecholamine analyses are given.