OBJECTIVE: To assess the effectiveness of a cholesterol-lowering intervention designed to facilitate the management of hypercholesterolemia by primary care clinicians. DESIGN: Randomized controlled trial, with randomization of clinician-patient groups. SETTING: Twenty-one community and rural health centers in North Carolina and Virginia. PARTICIPANTS: Primary care clinicians (n = 42, 71% physicians) and the patients they enrolled with high cholesterol (n = 372). Twenty-two clinicians were randomized to give the special intervention (184 patients) and 20 to give usual care (188 patients). Two thirds of participating patients were women, 40% were African American, and 11% were Native American. INTERVENTION: A 90-minute tutorial to train clinicians how to use a structured assessment and treatment program (Food for Heart Program) consisting of a brief dietary assessment and three 5- to 10-minute dietary counseling sessions given by the primary care clinician, referral to a local dietitian if the low-density lipoprotein cholesterol (LDL-C) remained elevated at 4-month follow-up, and a prompt for the clinician to consider lipid-lowering medication based on the LDL-C at 7-month follow-up. MAIN OUTCOME MEASURES: Changes in total and LDL cholesterol at 4-month follow-up and averaged over a 1-year follow-up period (4-, 7-, and 12-month follow-up). RESULTS: At 4-month follow-up, total cholesterol decreased 0.33 mmol/L (12.6 mg/dL) in the intervention group and 0.21 mmol/L (8.3 mg/dL) in the control group: the difference was 0.11 mmol/L (4.2 mg/dL) (90% confidence interval [CI], -0.02 to 0.24 mmol/L [-0.7 to 9.1 mg/dL]). The average reduction during the 1-year follow-up period was 0.09 mmol/L (3.6 mg/dL) greater in the intervention group (90% CI, -0.01 to 0.19 mmol/L [-0.3 to 7.5 mg/dL]). Eight percent of intervention patients were taking lipid-lowering medication at follow-up visits compared with 15% of control patients. In a subgroup analysis restricted to the 89% of returnees who were not taking lipid-lowering medication, the reduction in total cholesterol at 4-month follow-up was 0.14 mmol/L (5.5 mg/dL) greater in the intervention group (95% CI, 0.01 to 0.28 mmol/L [0.3 to 10.7 mg/dL]); averaged over 1 year, it was 0.14 mmol/L (5.3 mg/dL) greater (95% CI, 0.03 to 0.24 mmol/L [1.2 to 9.4 mg/dL]). Changes in LDL-C were similar. CONCLUSIONS: Total cholesterol and LDL-C decreased more in the intervention group than in the control group. Overall, the difference in lipid reduction between groups was modest and of borderline statistical significance; among participants who did not take lipid-lowering medication during follow-up, the difference in lipid reduction between groups was larger. We conclude that primary care clinicians can be trained to give a cholesterol-lowering intervention to low-income patients that results in modest, short-term reductions in total cholesterol and LDL-C.

Cholesterol, LDL↗

PubMedDate not supplied

Characterization of neurotensin(6-13) from an hepatic fibrolamellar carcinoma.

Neurotensin(6-13) has been isolated and sequenced as the major form of neurotensin-like immunoreactivity (NTLI) in a human hepatic fibrolamellar carcinoma. Circulating NTLI in the patient, especially C-terminal, was very high. In additional studies, NT(6-13) was synthesized and compared with the purified tumor NTLI by HPLC analysis and by testing stability in plasma in vitro. These methods confirmed that the tumor NTLI was identical to NT(6-13). Since the metabolic clearance rate of synthetic NT(6-13) in sheep was 30-fold higher than NT(1-13), it suggests that the elevated plasma levels are the result of impaired clearance and/or markedly elevated production.

Adult↗

PubMedDate not supplied

Effects of ambient particle pollution on daily mortality in Melbourne, 1991-1996.

This paper presents the results of a study in Melbourne, Australia, of the short-term effects of ambient fine particle pollution on daily mortality occurring between 1991 and 1996. The methodological approach used Poisson regression and Generalized Additive Models (GAM) with LOESS smoothing to control for temporal and meteorological effects. The association between particles and increases in daily mortality was examined using nephelometry data (bsp, mean 24 h average = 0.26 x 10(-4) m(-1), mean 1 h maximum = 0.60 x 10(-4) m(-1)), PM2.5 (24 h mean = 9.42 microg/m3) and PM10 (24 h mean = 19 microg/m3). Both the PM10 and PM2.5 data were estimated from nephelometry data using previously derived relationships for the Melbourne airshed. Significant positive associations between the particle measures considered and all cause and respiratory mortality were found in the warm season (November-March). A 1 x 10(-4) m(-1) increase in maximum 1-h bsp levels was associated with a 2.19% (95% CI = 0.01-4.43%) increase in risk of death for all cause mortality and a 10.40% (95% CI = 2.44-18.97%) increase in risk for respiratory mortality in the warm season. A 1 microg/m3 increase in 24-h PM2.5 in the warm season was associated with a 0.38% (95% CI = 0.06-0.70%) increase in risk of death for all cause mortality and a 1.18% (95% CI = 0.05-2.32%) increase in risk for respiratory mortality. For PM10, a 1 microg/m3 increase was associated with an increased risk of 0.18% (95% CI = 0.03-0.33%) for all cause mortality and 0.59% (95% CI = 0.06-1.13%) for respiratory mortality. Significant associations were also found in the 65+ age group in the warm season. However, for these warm periods, the effects of ozone (average 1 h maximum = 127 ppb) and nitrogen dioxide (average 1 h maximum = 70.7 ppb) were also significant and, due to high correlations between these pollutants, it was not possible to separate the particle effects from those of O3 and NO2. Sulfur dioxide was not examined as concentrations of this pollutant in Melbourne are very low (max 1 h = 15-24 ppb, annual average 0.8 ppb). Comparison with other Australian studies in Sydney and Brisbane indicates different results for particle pollution.

Adult↗

PubMedDate not supplied

Traceability and calibration in temperature measurement: a clinical necessity.

Patient temperature is a fundamental physiological measurement used primarily for observation and diagnosis, for example during surgery, intensive care, recuperation, or treatment. A variety of thermometers are used clinically and these can be separated into two categories, either contact (oral thermometers, rectal thermometers and temporal strips), or non-contact (ear thermometers, temporal thermometers and thermal imagers). To have the maximum confidence in the clinical performance of the temperature measurement instrument it is strongly desirable that the device be traceably calibrated to the International Temperature Scale of 1990 (ITS-90). Lack of traceable calibrations accredited to ISO17025 can lead to unreliability in temperature measurement and in some cases can have a deleterious effect on patient care. The National Physical Laboratory (NPL) maintains and disseminates the ITS-90 for contact and non-contact thermometry in the UK. The importance of accredited traceable calibrations and an outline of contact and non-contact thermometry standards are given here.

Calibration↗

PubMedDate not supplied

How close is North Carolina to meeting Medicare's clinical priorities?

The analyses upon which this publication is based were performed under Contract No. 500-99-NC03, entitled "Utilization and Quality Control Peer Review Organization for the State of North Carolina," sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied