Insights into asthma prevalence in Oregon.

Asthma is one of the most common chronic diseases. The prevalence of asthma appears to be increasing. National data have suggested that Oregon's asthma mortality rate has been twice as high as the national average. The prevalence and impact of asthma are not systematically assessed or tracked within Oregon. We estimated the current asthma prevalence and mortality using data from statewide hospital discharge data, the 1995 Behavioral Risk Factor Surveillance Survey, and school registration data from the Portland area. A conservative estimate of Oregon's current asthma prevalence is 6-7% and lifetime asthma prevalence is estimated at 6-11% for both adults and children. It appears that current asthma prevalence increases during adolescence. The Willamette Valley, an area known for high pollen counts, does not have a higher rate of hospital discharges per capita than other areas within the state. Oregon's apparent higher asthma mortality may be the result of the Oregon State Health Division's aggressive policies toward accurate reporting on death certificates. Oregon's age distribution may also contribute to the apparent higher asthma mortality rate.

Challenges to identifying actual diabetes case-mix complexity and total treatment charges.

Patient management programs are being used to improve the quality of care and decrease charges for both high-cost and potential high-cost claimants. Adequate information is key to program development, planning, and implementation. Claims-based data are a ready source of valuable information, but without proper processing, true case-mix complexity and total charges for patients will not be identified.

Automated application of clinical practice guidelines for asthma management.

Clinical practice guidelines will be more beneficial when they are integrated with the electronic medical record. We applied natural language processing (NLP) techniques to extract clinical findings from outpatient progress notes in an attempt to: 1) select outpatient chart notes appropriate for evaluation against the National Heart, Lung, and Blood/National Asthma Education Program clinical practice guidelines for the diagnosis and management of asthma, 2) determine patient need for inhaled anti-inflammatory agents, and 3) quantify the severity of asthma. Our results were compared to judgements by an expert panel of practitioners. We were able to correctly identify the need for inhaled anti-inflammatory agents 76% of the time. The success of this pilot project could have broad implications for the application of clinical practice guidelines.

Diagnostic efficacy of a nasotracheal protected specimen brush in patients with suspected bacterial pneumonia.

The diagnostic yield and safety of a novel nasotracheal protected specimen brush (PSB) were evaluated in 15 nonintubated adult patients with suspected bacterial pneumonia. A double-catheter PSB was passed directly through the anesthetized nose and into the trachea without bronchoscopy or fluoroscopy. Endotracheal brushing was performed in less than 10 sec, and the brush was immediately processed for Gram staining and quantitative aerobic and anaerobic cultures. According to clinical follow-up and response to therapy, 11 episodes of bacterial pneumonia and five cases of nonbacterial lung disease were established. The PSB Gram stain confirmed lower respiratory sampling in all cases. The PSB cultures indicated respiratory pathogens in 9/11 (82%) cases of pneumonia, with greater than 10(3) colony-forming units (cfu)/ml in all but two specimens. All patients with pneumonia responded to specific antibiotics. All patients with nonbacterial disorders had PSB cultures of less than 10(3) CFU/ml, and their pulmonary processes improved without antibiotic therapy. The procedure was well tolerated, although two patients had transient bronchospasm or apnea. Experience with the nasotracheal PSB is limited, but the procedure appears to be a reliable and relatively safe alternative diagnostic method in selected patients with suspected bacterial pneumonia. Quantitative cultures are necessary to improve its diagnostic accuracy.

Sensory blockade of smoking satisfaction.

Cigarette smokers were presented with controlled doses of cigarette smoke to determine whether the resulting reduction in cigarette craving depended upon perceiving the sensory qualities of the smoke. Cigarette craving was assessed before and after inhaling controlled doses of smoke in two conditions: (1) Local anesthesia of the upper and lower respiratory airways, induced by mouth rinsing, gargling and inhalation of a mist containing the topical anesthetic lidocaine; and (2) no-anesthesia control, in which all solutions were saline. A sham smoking procedure was presented in both conditions. Craving and ad lib smoking behavior were also assessed 30 minutes after controlled smoking. The results indicated that smoke, as opposed to sham puffs, significantly reduced reports of cigarette craving, and local anesthesia significantly blocked this immediate reduction in craving produced by smoke inhalation. Puffs were also rated as less desirable in the anesthesia condition. Thirty minutes after smoking, craving was no different in the anesthesia and saline control conditions. However, craving as well as smoking intake in both conditions was less when smoke had been given previously than in the sham smoking control. These results suggest that sensory cues accompanying inhalation of cigarette smoke are important determinants of immediate smoking satisfaction. However, the sustained effects of smoke intake on subsequent smoking behavior (30 min later) may be mediated by processes other than sensory stimulation of the respiratory tract, such as plasma nicotine levels.

Subjective response to cigarette smoking following airway anesthetization.

Subjective response to cigarette smoking was assessed after partial blockade of upper and lower airway sensations by the topical application of lidocaine. Pack-a-day smokers were given one cigarette after each of four conditions: (1) mouth anesthesia, obtained by rinsing the mouth with 2% lidocaine; (2) mouth and pharyngeal anesthesia, in which subjects rinsed their mouths and gargled with 2% lidocaine; (3) upper and lower airway anesthesia, in which subjects rinsed their mouths and gargled with a 2% lidocaine solution, and inhaled a mist containing 4% lidocaine (60 breaths); and (4) saline control, in which all solutions (rinse, gargle and inhalation) were saline. A significant linear decline in cigarette craving occurred with increasing anesthesia, and desirability ratings over the first several puffs were also reduced by anesthesia. These results suggest that sensory cues are important factors in smoking satisfaction, and their influence can be analyzed with the use of local anesthetics.

Stearoyl paratoluenesulfonate. A powerful acylating agent for lipid synthesis.

The utility of the mixed carboxylic-sulfonic acid anhydride stearoyl p-toluenesulfonate as a powerful, mild acylating agent for lipid synthesis is shown by the synthesis of rac 1,2-distearoyl-3-iodopropane, lecithin and a spin-labeled choline derivative from the corresponding alcohols. The method constitutes a significant improvement of earlier acylating methods.