RESUMEN
BACKGROUND: Recent shifts in reimbursement toward capitation makes appointment availability a significant resource and stimulates us to understand primary care physician (hereafter referred to as "provider") behavior concerning appointment assignment. The results of prior studies suggest significant provider variability in this area. OBJECTIVE: To examine the influences on assigning patient revisit intervals in the ambulatory setting. METHODS: Survey regarding general care issues of hypothetical diabetic and hypertensive patients seen in an ambulatory setting was given to 62 providers in the Internal Medicine Program at the Tulane University Internal Medicine Residency Program and outpatient clinics, New Orleans, La. Measurements evaluated included survey responses for demographics (sex, year of birth, year of graduation from medical school, and level of training) and practice style (decision to change therapy, order tests, and recommended return appointment interval in weeks) variables. RESULTS: The response rate was 89% (56 providers). Most respondents were men (n = 39). Wide variation was noted in assignment of reappointment interval with mean return intervals for the scenarios ranging from 2.2 to 20.5 weeks. Significant influences on provider practice included patient stability (P<.001), the decision to change therapy (P = .001), and the decision to order tests (P = .001). All correlated with an earlier return appointment. Some providers exhibited test-ordering tendencies across scenarios. Sex was a significant provider independent variable and was not influenced by other study variables. Female providers assigned earlier reappointment intervals for their patients. CONCLUSIONS: Wide variation exists among practitioners with similar training background and practice setting. As expected, patient stability was a major determinant of assigned return interval. Test-ordering behaviors may consume appointments inappropriately and may be a productive area for efforts to reduce provider variability. The influence of the provider's sex on scheduling follow-up appointments warrants further investigation.
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Atención Ambulatoria/estadística & datos numéricos , Citas y Horarios , Capitación/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Femenino , Humanos , Louisiana , Masculino , Factores Sexuales , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Lymphocyte-predominant Hodgkin's disease (LPHD) is a subtype of Hodgkin's disease characterized by an indolent clinical course and by distinctive histological and immunological features. Coexistence of diffuse or nodular LPHD with large-cell non-Hodgkin's lymphoma (NHL) distant from the presenting site has rarely been reported. We studied three cases of simultaneous LPHD and large-cell NHL. Two cases involved men, aged 66 and 20 years, with neck and axillary masses, respectively. Biopsy of each mass revealed nodular LPHD. In one case the spleen contained areas of both LPHD and large-cell NHL, whereas only large-cell NHL was found in the spleen of the other patient. The patients are alive 49 months and 29 months after diagnosis. The third case was from a 4-year-old boy with a neck mass that revealed both diffuse LPHD and areas of large-cell NHL. Local recurrence prompted therapy, and the boy is in complete remission 31 months after diagnosis. Immunophenotyping in all three cases showed the Reed-Sternberg variant lymphocytic and histiocytic cells to be B-lymphocytes. The NHL cells in two cases were B-cells; in the child, the cells reacted only with leukocyte common antigen. Immunoglobulin heavy- and light-chain genes were rearranged in the NHL cells in the spleen of one case, and heavy-chain genes were rearranged in the lymph node of the child. It appears that when large-cell NHL and LPHD occur simultaneously, even when the large-cell NHL occurs at a site distant from the LPHD, the patient's clinical course is like the indolent course of LPHD rather than like the typically aggressive course of large-cell NHL. This clinical course, together with immunophenotyping and genotyping studies, suggests a developmental relationship between these two lymphomas when they occur simultaneously.
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Enfermedad de Hodgkin/complicaciones , Linfocitos/patología , Linfoma de Células B Grandes Difuso/complicaciones , Adulto , Anciano , Preescolar , Genotipo , Enfermedad de Hodgkin/genética , Enfermedad de Hodgkin/patología , Humanos , Inmunoglobulinas/metabolismo , Inmunohistoquímica , Inmunofenotipificación , Ganglios Linfáticos/patología , Linfoma de Células B Grandes Difuso/genética , Linfoma de Células B Grandes Difuso/patología , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/genética , Linfoma no Hodgkin/patología , MasculinoRESUMEN
I-131 MIBG scintigraphy was performed on a neonate who presented with a left neck mass and brachial palsy. Increased uptake of the tracer was apparent in the mass, initially suspected as being a neuroblastoma, but later diagnosed as infantile myofibromatosis. Since MIBG is principally taken up by neuroendocrine tumors, this finding suggests caution be used when interpreting studies in this age group.
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Neoplasias de Cabeza y Cuello/congénito , Radioisótopos de Yodo , Yodobencenos , Leiomioma/congénito , 3-Yodobencilguanidina , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Recién Nacido , Leiomioma/diagnóstico por imagen , CintigrafíaRESUMEN
Rochalimaea quintana, the etiological agent of trench fever, was tested by an agar dilution method for its susceptibility to the following 14 antibiotics: penicillin G, methicillin, ampicillin, cephalothin, vancomycin, doxycycline, tetracycline, erythromycin, chloramphenicol, streptomycin, kanamycin, rifampin, colistin, and amphotericin B. The MIC of each of these antibiotics was determined. The results showed that R. quintana is susceptible in vitro to these antibiotics, with the exception of vancomycin, kanamycin, streptomycin, colistin, and amphotericin B.