Primary care intervention programme to improve early detection of hearing loss in the elderly.

OBJECTIVE: To improve audiology screening in general practice, using an intervention programme aiming to empower older adults and their general practitioners. METHODS: We conducted a quasi-experimental community study comparing 206 patients and two control groups (the first being 101 people registered with the same general practitioner, and the second 87 people registered with another general practitioner). Outcome measures were: rates of hearing tests in the six months before interview, and screening recommendation by the general practitioner. RESULTS: Amongst patients, there was a significant increase in numbers undergoing a hearing test, from 19 per cent before the intervention to 49 per cent two years later, while in the two control groups there was little change. Twenty-two per cent of patients and 19 per cent of the first control group reported that their physicians suggested undergoing a hearing test; the second control group subjects (whose general practitioners received no specific educational intervention) showed no change. CONCLUSION: The two crucial factors for improving hearing screening uptake in the elderly are general practitioner education and patient empowerment.

Mandatory computer field for blood pressure measurement improves screening.

METHODS: We evaluated the effectiveness of a compulsory data field in a computerized medical record (CMR) in improving blood pressure (BP) screening. RESULTS: The proportion of study patients who had their BP measured increased from 40.6% to 58.5% (P < 0.001) after the intervention. After adjusting for age, gender and number of visits, patients were 73% more likely to have their BP recorded after the introduction of the compulsory field.

Grb7 expression and cellular migration in chronic lymphocytic leukemia: a comparative study of early and advanced stage disease.

Grb7, a noncatalytic intracellular adaptor protein involved in cell migration, is overexpressed in certain invasive and metastatic solid tumors. We found a highly significant difference in the level of expression of Grb7 between chronic lymphocytic leukemia (CLL) cells obtained from stage I and stage IV patients (P<0.001). Using semiquantitative RT-PCR, we detected high levels of Grb7 in 88% of stage IV patients vs only 18% in stage I patients. A corresponding increase was found in the in vitro migration of stage IV CLL cells in comparison to stage I cells. The statistically significant difference in the expression of Grb7 between stage IV and stage I patients was preserved even when tested specifically in the ZAP70-positive group (P<0.01). These findings show that Grb7 levels reflect the severity of the disease, and may be used, in conjunction with ZAP70, to predict disease progression.

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.

BACKGROUND: Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. METHODS: Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors. RESULTS: After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury. CONCLUSION: Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.

The presence of hrp genes on the pathogenicity-associated plasmid of the tumorigenic bacterium Erwinia herbicola pv. gypsophilae.

The pathogenicity-associated plasmid (pPATH) of Erwinia herbicola pv. gypsophilae (Ehg), which is present only in pathogenic strains, contains a gene cluster encoding indole-3-acetic acid and cytokinin biosynthesis. The transposon-reporter Tn3-Spice was used to generate nonpathogenic mutants on two overlapping cosmids, pLA150 and pLA352, of the pPATH. A cluster of such mutations, which spanned 16 kb, mapped approximately 15 kb from the gene cluster involved in phytohormone biosynthesis. Non-pathogenic mutants also failed to elicit the hypersensitive reaction (HR) on tobacco. Pathogenicity and HR were restored concomitantly to these mutants by in trans complementation with wild-type Ehg DNA. A 3.8-kb HindIII DNA fragment that complemented the hrp mutants was sequenced and six complete and two partial open reading frames (ORFs) were identified. Comparison of the deduced amino acid sequences of the eight ORFs showed striking homology and co-linearity with hrp genes of E. amylovora as well as with other plant and mammalian pathogenic bacterial genes encoding proteins of the type III secretion system. Limited DNA sequencing at various sites on the remaining 11-kb region of pLA352 also showed high identity to Hrp proteins of E. amylovora, E. stewartii, and Pseudomonas syringae. These results suggest that hrp genes are mandatory for gall formation by E. herbicola pv. gypsophilae.

The genes involved in cytokinin biosynthesis in Erwinia herbicola pv. gypsophilae: characterization and role in gall formation.

A locus conferring cytokinin production was previously isolated from the gall-forming bacterium Erwinia herbicola pv. gypsophilae. This locus resided in a cluster with the genes specifying indole-3-acetic acid production on the pathogenicity-associated plasmid pPATH (A. Lichter, S. Manulis, O. Sagee, Y. Gafni, J. Gray, R. Meilen, R. O. Morris, and I. Barash, Mol. Plant Microbe Interact., 8:114-121, 1995). Sequence analysis of this locus indicated the presence of a cytokinin biosynthesis gene (etz) homologous to other described cytokinin biosynthesis genes. A unique open reading frame (pre-etz) encoding 169 amino acids preceded etz and together with etz formed a region with a distinctive low G+C content. Northern (RNA) analysis indicated the presence of an etz-specific transcript of 1 kb and a common transcript for pre-etz and etz of 1.4 kb. The level of the 1-kb transcript was high in the late logarithmic phase and very low in the stationary phase. In contrast, the level of the 1.4-kb transcript was lower than that of the 1-kb transcript in the late logarithmic phase and predominant in the stationary phase. A marker exchange mutant of etz which did not produce cytokinins exhibited a reduction in gall size on Gypsophila cuttings and almost abolished disease symptoms in a whole-plant assay. Complementation of this marker exchange mutant with the intact etz gene on a multicopy plasmid resulted in overproduction of cytokinins and larger plant galls from which small shoots emerged. Insertional mutation in pre-etz resulted in a sharp decrease in both the level of the etz-specific transcript and cytokinin production. A frameshift mutation in pre-etz caused a similar reduction in the cytokinin level. A marker exchange mutation in pre-etz caused a reduction of symptoms but to lower degree than the etz mutation. In the former mutant, cytokinin production and pathogenicity could not be restored by complementation. Furthermore, attempts to complement the etz marker exchange mutant with a plasmid containing an intact etz gene and a frameshift mutation in the pre-etz gene were unsuccessful. These results suggest that the mutations in pre-etz were trans dominant.