Health risk appraisal modifies cigarette smoking behavior among college students.

To assess whether Health Risk Appraisal (HRA), a computer-scored lifestyle analysis questionnaire, can result in significant changes in health behavior, a controlled clinical trial with one-year follow-up was conducted among entering freshmen at an urban state university. Three hundred fifty entering freshmen were each assigned to one of four groups: HRA with feedback, HRA without feedback, initial control, and final control. Twenty-two per cent of the nonsmokers in the no-feedback group, as compared with 5% in the feedback group, acquired the habit of cigarette smoking (p less than 0.001). Furthermore, 26% of the smokers in the feedback group, as compared with 6% in the no-feedback group, were able to quit smoking (p less than 0.05). Among those unable to quit smoking, 59% in the feedback group, as compared with 19% in the no-feedback group, were able to reduce their cigarette consumption by more than six cigarettes per day (p less than 0.01). Health Risk Appraisal, when accompanied by feedback counseling, was an effective health promotion tool to help prevent nonsmokers from acquiring the habit and to modify cigarette smoking behavior among college freshmen.

The impact of outpatient hospital pharmacists on patients receiving antihypertensive and anticoagulant therapy.

The effect of an outpatient clinical pharmacy program on selected therapeutic outcomes of 39 antihypertensive- and 16 warfarin-treated study patients in a hospital-based group medical practice was evaluated by retrospective medical record audit and compared to two control groups. Results revealed that a significantly greater number of drug discontinuations (p less than 0.05) and changes (p less than 0.005) were documented in the medical records of study patients. Hypertensive study patients who received the services of pharmacists had poorer blood pressure control at the beginning of the study (p less than 0.05) but were as equally well controlled as control patients by the conclusion of the study. Compared with control patients, warfarin-treated study patients were better controlled at the end of the study (p less than 0.05). The participation of pharmacists in the care of hypertensive and anticoagulated patients appears to result in acceptable therapeutic outcomes.

Treating sore throats in the emergency room. The importance of follow-up in decision making.

Evaluation and treatment of emergency room patients complaining of sore throats are complicated by an unknown probability of follow-up. Tompkins' analysis of cost-effective sore throat management strategies was modified by adding an expression for variable follow-up rate. The original analysis specified a culture range when the probability of streptococcal infection was between 0.05 and 0.20, while the expanded analysis demonstrates that this range decreases with decreasing follow-up. For follow-up rates of 0.70 or less, all patients would be in either the treatment or no treatment group. This analysis demonstrates the importance of follow-up in out-patient decision making, and illustrates the methodology for including follow-up (and similar factors) in our analyses.

Initial experiences with a pharmacy clinic in a hospital-based group medical practice.

Experiences in implementing a pharmacy clinic in a hospital-based primary-care group medical practice are described. A clinic was instituted through the joint support and active participation of the hospital administration and the departments of pharmacy and medicine. In the clinic, pharmacists monitored, assessed, and intervened in the drug therapy needs of patients who requested care or were referred by their primary-care physicians. Pharmacists provided services in 1751 patient visits during the first year of the clinic's operation. Clinic volume increased from two to 17 patients per session. Analysis of these patient visits showed that the pharmacists: (1) assessed physical signs in 60% of the patients, (2) ordered laboratory tests in 30%, (3) found a problem with the drug therapy in approximately one third of the patients, (4) detected new medical complaints in 4% of the patients, (5) initiated change in the drug regimen in 10% of the patient visits, and (6) referred almost 15% of the patients to new sources of care. In this clinic, pharmacists supplemented, not supplanted, the services of physicians for ambulatory patients.

The diagnosis of strep throat in adults in the emergency room.

Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

Focal neurologic symptoms in hypercalcemia.

An unusual clinical presentation of moderate hypercalcemia as a result of primary hyperparathyroidism is described. The patient complained of fatigue, depression, thirst, polyuria, and focal neurologic symptoms including amaurosis fugax, anomia, right upper-extremity dysesthesias, and a left cerebral transient ischemic attack. No structural central nervous system abnormality could be documented. Signs and symptoms disappeared when serum calcium levels were reduced from 13.2 to 9.8 mg/100 ml. They have not recurred in 30 months of follow-up. The association of focal neurologic disease and hypercalcemia is uncommon. Although the precise pathophysiologic mechanism is unclear, this patient's symptoms suggest a vascular etiology.

Hypertensive crisis and phencyclidine abuse.

This report of a case in Virginia suggests linkage between the abuse of a "street drug" by a young woman and an acute episode of hypertension resulting in coma and blindness. The authors warn of the potential dangers of phencyclidine and describe its mechanisms.