Effect of clarithromycin treatment on Chlamydia pneumoniae in vascular tissue of patients with coronary artery disease: a randomized, double-blind, placebo-controlled trial.

Several small clinical trials have indicated that antibiotic treatment of Chlamydia pneumoniae infection is associated with a better outcome in patients with coronary artery disease (CAD). It has not been demonstrated whether antibiotic treatment eradicates C. pneumoniae from vascular tissue. The aim of the present study was to assess the effect of clarithromycin on the presence of C. pneumoniae in the vascular tissue of patients with CAD. Patients who had CAD and who were waiting for coronary artery bypass graft surgery were enrolled in a randomized, double-blind, placebo-controlled trial. Patients were treated with clarithromycin at 500 mg or placebo once daily from the day of inclusion in the study until surgery. Several vascular tissue specimens were obtained during surgery. The presence of C. pneumoniae in vascular tissue specimens was examined by immunohistochemical staining (IHC) and two PCR assays. Chlamydia immunoglobulin G (IgG) titers were determined by an enzyme-linked immunosorbent assay at the time of inclusion in the study and 8 weeks after surgery. A total of 76 patients were included, and 180 vascular tissue specimens were obtained (80 specimens from the group treated with clarithromycin and 100 specimens from the group treated with placebo). Thirty-five patients received clarithromycin (mean duration, 27 days; standard deviation [SD], 12.2 days), and 41 patients received placebo (mean duration, 27 days; SD, 13.9 days). IHC detected the C. pneumoniae major outer membrane protein antigen in 73.8% of the specimens from the group treated with clarithromycin and 77.0% of the specimens from the group treated with placebo (P was not significant). Chlamydia lipopolysaccharide antigen was found in only one specimen from the group that received placebo. C. pneumoniae DNA was not detected in any specimen. Baseline Chlamydia-specific IgG titers were equally distributed in both groups and were not significantly different after treatment. There was no indication of an active C. pneumoniae infection in vascular tissue. Chlamydia-specific IgG titers remained unchanged throughout the study in both the antibiotic- and the placebo-treated patients.

A descriptive study of emergency admissions to Farview State Hospital.

The prison population in the United States has grown steadily in the past 15 years. Farview State Hospital in Waymart, Pennsylvania annually provides service to approximately 350 to 400 inmates. This is less than 10 percent of the potential need for psychiatric treatment for the state. Emergency psychiatric admissions are a burden on the mental health system, as these inmates are given priority. This descriptive study identified profiles of emergency admissions for the period of July 1, 1990 to June 30, 1993. During this time, 86 emergency admissions occurred. Differences between state correctional and local county prison inmate admissions are described. The short stays of emergency admissions indicate that Farview is achieving its goal of stabilization of the mentally disordered inmate for return to the correctional facility. More research needs to be done to compare emergency and regular admissions for both diagnosis and length of stay.

Change in medical students' attitudes about primary care during the third year of medical school.

PURPOSE: This study explores how medical students' attitudes and career interests change over the third year, and it investigates the potential of an attitudinal instrument to predict specialty interest. METHOD: A total of 106 students in the classes of 1992-1994 at the Clinical Campus at Binghamton of the State University of New York Health Science Center at Syracuse College of Medicine were surveyed at the beginning and end of their third year about specialty interests and attitudes toward medical care practices. The students were divided into primary care, non-primary-care, and undecided groups based on end-of-year preferences. Statistical methods used were paired t-tests and one-way analysis of variance. RESULTS: Complete data were collected for 99 (93%) of the students: 23 (23%) in the primary care, 60 (61%) in the non-primary-care, and 16 (16%) in the undecided groups. Beginning-of-the-year differences were found among the groups on only four of 29 attitudinal items (p < .05). By the end of the year, the students in the non-primary-care group had changed on more items than those in the primary care and undecided groups. The students in the primary care and the non-primary-care groups diverged on statements relating to physician roles concerning control and treatment of patients. CONCLUSION: The results suggest that as students experience direct patient care, the attitudes of students preferring non-primary-care specialties diverge from those who prefer primary care specialties. Attitudinal changes relate primarily to the control of patient care and the role of specialists.

Effect of a year-long primary care clerkship on graduates' selection of family practice residencies.

This report compares the selection of family practice residencies from 1981 through 1989 by graduates trained at two campuses of the State University of New York (SUNY)-Health Science Center at Syracuse College of Medicine, at other New York State campuses, and at all U.S. medical schools. One of the SUNY-Syracuse cohorts comprised the students who had completed all their work at the Syracuse campus, while the other comprised those who had spent their third year at the campus in Binghamton, which has a year-long, half-day-a-week primary care clerkship that is not available at the Syracuse campus, which has no primary care clerkship. Comparison of the proportions of the graduates in the two SUNY-Syracuse cohorts who chose family practice residencies, and comparisons of the proportions of graduates from other New York state schools and from all U.S. schools who selected family practice residencies during the same nine-year period, indicate that the proportion of students trained during their third year at the Binghamton campus who selected family practice residencies was significantly greater (21%; p less than .001). Additional investigation is required to determine whether the year-long nature of the required clerkship affects graduates' choices more than does the primary care content of the clerkship.