Computerized literature searching in the ambulatory setting using PaperChase.

PaperChase, a self-service computerized literature search (SSCLS) service, was compared to conventional resources for accessing recent medical information by assessing user attitudes, search costs, and number of searches performed. The study was designed as a randomized controlled trial using survey instruments before and after the intervention. Accounting of PaperChase searches was monitored electronically, and costs of librarian searches were provided by the hospital library. Participants included 57 physicians in several specialties who were members of a group practice located in a suburban ambulatory care center. Responses were received from 67%. The experimental group received free, unlimited access to PaperChase over a one-year period, while the control group used conventional resources (manually self-performed searches and computerized MEDLINE searches performed free-of-charge by hospital librarians). The study disclosed no change in attitude of either those employing computers or SSCLS. Attitude scores in the experimental group showed statistically significant worsening in preference for SSCLS over textbook use and the estimation of SSCLS utility in the outpatient setting. The cost of PaperChase compared favorably to literature searches done by librarians. The self-reported numbers of literature searches of all types increased in the experimental group. PaperChase searches changed physicians' perceptions of patient treatment and outcome in some cases. While computerized literature searches may have a role in the outpatient setting, other resources remain important. Although only certain physicians are interested in using this method, this study shows that PaperChase can be a cost-effective alternative to MEDLINE searches performed by hospital librarians.

Hypodipsia and hypernatremia in congenital hydrocephalus.

The authors describe a case of hypodipsia and severe hypernatremia most probably secondary to hydrocephalus in a 22-year-old man in the absence of abnormalities of ADH secretion or metabolism. The patient became hypernatremic only in situations when the decreased spontaneous fluid intake was insufficient to replace that lost caused by sweating or vomiting. Adequate hydration returned the sodium value to normal.

Effect of in vitro cultivation and Mycoplasma pneumoniae infection on intracellular cyclic AMP levels in hamster tracheal organ cultures.

Exogenous cyclic AMP and dibutyryl cyclic AMP decreased the relative ciliary activity values of tracheal organ cultures. In contrast, theophylline and cholera toxin were not ciliostatic. The use of a radioimmunoassay for cyclic AMP indicated that all of the tested substances increased intracellular cyclic AMP levels to some extent (from 3-fold for cholera toxin to almost 40-fold for dibutyryl cyclic AMP). Physical inactivation of explants by either freeze-thaw or heat destroyed all ciliary activity and greatly decreased intracellular cyclic AMP levels. Cyclic AMP levels of explants remained relatively constant during in vitro cultivation. Three strains of Mycoplasma pneumoniae were found to contain extremely low amounts of cyclic AMP. Infection of tracheal explants produced a significant decrease in relative ciliary activity, but only a slight decline in organ-culture cyclic AMP levels.