Is e-mail communication effective in changing ordering patterns in the emergency department? A case study of computed tomography for pulmonary embolus.

RATIONALE AND OBJECTIVES: We sought to evaluate the effectiveness of e-mail communication to reduce the utilization of computed tomography for pulmonary thromboembolism (PE) in young patients (aged 40 and under) in our institution. MATERIALS AND METHODS: An e-mail was sent to all of our institution's emergency department (ED) physicians in response to a series of negative PE studies in young females. The periods 90 days before and 90 days after were evaluated to assess the total number of PE studies performed in patients aged 40 and younger, the rate of positivity, and the utilization of D-dimer and ventilation/perfusion scans during each period. RESULTS: Over the 180-day period, a total of 65 PE studies were ordered in patients aged 40 and younger in the ED. Studies were positive for PE in 1 of 33 (3%) before the e-mail and 4 of 32 (12.5%) after (P = .343). There was no difference in the number of D-dimer studies ordered during each period for patients studied with computed tomography. Ventilation/perfusion scanning was not performed on any ED patients younger than 40 during the 180-day period. CONCLUSIONS: One-time e-mail communication was not effective in changing ED ordering habits of PE studies. Scant information exists in regard to effective clinician-to-clinician communication. Further evaluation for successful mechanisms to promote health practice reform and quality improvement is necessary.

Proteolytic release of membrane-bound endo-(1,4)-beta-glucanase activity associated with cell wall softening in Achlya ambisexualis.

Branching and other cell wall softening events in fungi and oomycetes are thought to involve the activity of secreted enzymes, which are packaged in membrane vesicles and delivered to sites of cell expansion, there to work in a carefully regulated manner upon the structure of the wall. Here we demonstrate a latent endo-(1,4)-beta-glucanase activity in a mixed membrane fraction of the oomycete Achlya ambisexualis, which can be released by cysteine proteases with an increase of apparent activity. In addition, a similar endogenous process is strongly inhibited by the cysteine protease inhibitor iodoacetamide, while inhibitors of other types of proteases have a much smaller effect. Detergent treatment of membranes releases two glucanases detectable by electrophoretic activity staining, with apparent molecular masses of about 164 and 35 kDa. Proteolysis produces several activity bands, with major species having apparent molecular masses of about 149, 133, 48, 35, and 25 kDa. The ca. 35- and 25-kDa bands migrate in parallel with glucanases secreted during wall softening in vivo. We propose that the initiation of wall softening in Achlya involves the proteolytic processing and solubilization of at least some secreted endoglucanases. We also propose that the solubilization component of this process functions not just to provide the enzymes with access to wall matrix substrates but also may provide a mechanism for the eventual termination of their biological function.