A total of 9,955 isolates of Staphylococcus aureus (SA) from an urban hospital and clinic and from rural office settings obtained during 1971 through 1978 were compared for susceptibility to penicillin G. Clear downward trends in susceptibility of SA were noted for all urban settings during the 1970s. In 1978, penicillin G susceptibility of SA in an urban community practice (16.3 percent) was actually less than that in the urban hospitals in the same city (17.1 percent). Penicillin G susceptibility of SA from two rural sources was likewise very low (20.9 percent and 28.7 percent). Therefore, Staphylococcus aureus must be considered resistant to penicillin G until proven otherwise, irrespective of the source of the isolate.

Evaluation Studies as Topic↗

PubMed1971

Amounts and turnover rates of brain proteins in morphine-tolerant mice.

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Animals↗

PubMedDate not supplied

Biomechanical and computer analysis of radial head prostheses.

Radial head fractures can lead to significant upper extremity disability. A comminuted radial head fracture with a medial collateral ligament tear presents a clinical conundrum. The radiocapitellar (RC) joint should be maintained, yet the head frequently cannot be reduced and stabilized. The silicone rubber implant currently available is not biomechanically or clinically satisfactory, and thus there is a need for a more suitable prosthetic replacement for the radial head. We have attempted to design such a prosthesis and have examined prosthetic design with various materials that would best transmit force of the RC joint. Design configurations based on our cadaveric and radiographic measurements were tested with structural finite element method computer analyses. Materials examined included titanium alloy, cobalt-chrome alloy, alumina ceramic, and ultrahigh molecular weight polyethylene (UHMWPE). Metals and ceramic transmitted force at the distal bone and implant interface and strain shielded the proximal radial cortex while UHMWPE distributed load uniformly through the cortex and along the entire bone and implant interface. In addition, load transmission comparisons were made with the intact radial head, with a silicone prosthesis, and with 6 and 10 mm thick UHMWPE prostheses in cadaveric specimens. UHMWPE prostheses transmit more force to the RC joint than the silicone prosthesis and with leads closer to physiologic levels at all flexion angles. UHMWPE prostheses not only transmit much more force than silicone, but because of substantially less deformation under load, also provide more stability to the joint.

Biomechanical Phenomena↗

PubMedDate not supplied

Delivery of preventive services.

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Adult↗

PubMedDate not supplied

Mammography.

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Breast Neoplasms↗

PubMedDate not supplied

Mammography.

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Family Practice↗

PubMedDate not supplied

Feasibility of sigmoidoscopic screening for bowel cancer in a primary care setting.

Sigmoidoscopic screening for bowel cancer is controversial because of its debatable efficacy, lack of patient and physician acceptance of the procedure, and uncertainty about its practicality with the large numbers of patients in primary care settings. This study addressed patient acceptance and practicality. During an 18-month period, 75 percent of all patients aged 50 years and greater who were seen for health maintenance accepted sigmoidoscopy. The procedure was integrated into office routines without disrupting other patient care. While compliance with fecal occult blood testing was high (88 percent), sensitivity of this test for neoplastic polyps within reach of the proctosigmoidoscope was low (11 percent). These results suggest that acceptance of sigmoidoscopy by patients seen in family physicians' offices could be greater than has been anticipated.

Aged↗

PubMedDate not supplied

Systematic cholesterol screening during acute care visits.

BACKGROUND: Physicians rarely offer clinical preventive services to patients during acute care visits, but only a minority of patients schedule health maintenance visits. Consequently, many eligible patients never receive appropriate preventive care. Successful strategies are needed to deliver preventive services during acute care visits. METHODS: This study tested the feasibility and effectiveness of a simple, physician-initiated protocol for management of hypercholesterolemia in one nonacademic community primary care (family practice) practice. Cholesterol testing was offered to all adult patients (aged 18 years or older) encountered by the clinician during acute care visits, as well as during scheduled health maintenance visits. Mailed notification of cholesterol risk status with a recommendation to follow a prudent (Step I) diet was the main intervention. Some high-risk patients additionally received formal dietary counseling and lipid-lowering medication as clinically warranted. RESULTS: A total of 1334 patients (95 percent of the eligible clinical population) accepted cholesterol testing, and 158 (11.8 percent) had high cholesterol (> or = 240 mg/dL). For the 114 patients (72.2 percent) with high cholesterol (mean 275.1 mg/dL) who returned for follow-up, cholesterol change 1 year after screening was -9.2 percent (P < 0.001, compared with base line). This decrease could not be explained by expected temporal trends or regression to the mean. Assuming unchanged cholesterol values for patients not followed up, decrease for the entire clinical population with high cholesterol was -6.8 percent (95 percent confidence interval -4.9 to -8.6 percent). CONCLUSIONS: Systematic cholesterol screening during acute care visits is a feasible and effective adjunct to screening during health maintenance visits in this practice. Because most people eventually visit a primary care physician, offering clinical preventive services during acute care visits might be an effective method for reaching the entire clinical population.

Adolescent↗