Graphic-output temperature data loggers for monitoring vaccine refrigeration: implications for pertussis.

We conducted the first US study using graphic-output temperature data loggers in quantifying cold chain failure. Fifty-four vaccine refrigerators of a county outpatient health system were studied. Forty-eight percent maintained temperatures of 2°C to 8°C and 24% had protracted periods of temperatures less than 0°C. The correlation between the percentage of refrigerators with freezing temperatures and the pertussis rate for each health region was r = 0.76. The findings suggest that improper vaccine storage may have contributed to recent increases in pertussis rates.

Use of gelatin sponges in Mohs micrographic surgery defects and staged melanoma excisions: a novel approach to secondary wound healing.

BACKGROUND/AIMS: surgical closure or reconstruction is commonly used to treat wounds generated by Mohs micrographic surgeries (MMS) and staged melanoma excisions, which may result in contractures and scarring. The authors' objective was to determine the value of using gelatin sponges to promote secondary intention healing for surgical defects after MMS and staged melanoma excisions. METHODS: sixty-four surgeries from 54 predominantly elderly patients (median age=76 years) were treated with gelatin sponges to promote healing by secondary intention in this prospective investigation. Patients rated their satisfaction with outcomes on a scale of 1 (highly dissatisfied) to 5 (highly satisfied). RESULTS: in all patients, the wounds healed within four to 16 weeks (median=five weeks). Forty-five patients were highly satisfied with their results (mean score=4.9). CONCLUSION: healing by secondary intention using gelatin sponges was associated with improved hemostasis, excellent cosmesis and a high level of patient satisfaction.

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

OBJECTIVE: To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy. DESIGN: Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons. SETTING: Academic medical center. PARTICIPANTS: Localized prostate cancer patients undergoing radiotherapy. INTERVENTIONS: The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise. MAIN OUTCOME MEASURES: Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups. RESULTS: No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04). CONCLUSIONS: An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.

Physician Role in Lack of Awareness and Control of Hypertension.

OBJECTIVES: To describe the systolic and diastolic blood pressure criteria used by community physicians to: 1) establish a diagnosis of hypertension; and 2) increase dosage or change drug therapy in treated hypertensives. METHODS: A multiethnic population sample of adults at or above 40 years old was surveyed, by random digit phone dialing in a major metropolitan area, regarding blood pressure measurement and hypertension awareness and treatment status. Respondents with and without known hypertension were asked to: 1) identify their health care providers; and 2) agree to sign and return a release form allowing the investigators to obtain copies of their medical records. Medical records received were abstracted in a standardized format. RESULTS: Medical records were obtained for 169 patients who collectively had 940 visits with 175 different providers during a consecutive 2-year period. Overall, 25% of these patients had 24-month average blood pressures of at or above 140/90 mm Hg without a diagnosis of hypertension being recorded by a physician. Over two-thirds of the undiagnosed had systolic blood pressure of 140-159 mm Hg, with diastolic pressure of less than 90 mm Hg. In persons on antihypertensive drugs (n equals 81), the average blood pressure was 147/86 mm Hg, and only 24% met the Joint National Committee-VI blood pressure goal of less than 140/90 mm Hg. A visit-level analysis indicated that when diastolic blood pressure was greater than 90 mm Hg, physicians intensified drug therapy 24% of the time, but intensification actions occurred in only 4% of visits when systolic pressure was less than 140 mm Hg and diastolic pressure was less than 90 mm Hg. Kaplan-Meier survival curves and multiple logistic regression modeling demonstrated that almost no action would be taken for persistently elevated systolic blood pressure over 20 consecutive visits. CONCLUSIONS: Community physicians do not give equal weight to systolic blood pressure of greater than 140 mm Hg as to diastolic pressure of greater than 90 mm Hg in diagnosing hypertension and intensifying treatment. This is a major determinant of the current level of unawareness of hypertension and uncontrolled, known hypertension found in national surveys. (c)2000 by Le Jacq Communications, Inc.

Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program.

The National High Blood Pressure Education Program Coordinating Committee published its first statement on the primary prevention of hypertension in 1993. This article updates the 1993 report, using new and further evidence from the scientific literature. Current recommendations for primary prevention of hypertension involve a population-based approach and an intensive targeted strategy focused on individuals at high risk for hypertension. These 2 strategies are complementary and emphasize 6 approaches with proven efficacy for prevention of hypertension: engage in moderate physical activity; maintain normal body weight; limit alcohol consumption; reduce sodium intake; maintain adequate intake of potassium; and consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat. Applying these approaches to the general population as a component of public health and clinical practice can help prevent blood pressure from increasing and can help decrease elevated blood pressure levels for those with high normal blood pressure or hypertension.