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Published clinical trials support the use of 0.2 to 0.4 percent nitroglycerin ointment for the treatment of an anal fissure, although no product is yet available in the United States. In 2004, 84,000 prescriptions were written for compounded nitroglycerin ointment. This study was designed to evaluate the quality of extemporaneously compounded nitroglycerin ointment. Prescriptions for 0.3 percent nitroglycerin ointment were filled at retail pharmacies and shipped to analytical laboratory for analysis by their validated method. Five of 24 (20.8 percent) samples did not meet the United States Pharmacopoeia requirement for content uniformity of 90 to 110 percent and< 6 percent relative standard deviation. Seven of 24 samples (29.2 percent) were subpotent based on the United States Pharmacopoeia requirement of 90 to 115 percent of label claim, and 1 sample was suprapotent. When considered for potency and/or content uniformity, 11 of 24 (45.8 percent) were misbranded and poor quality. Forty-six percent of the nitroglycerin ointment products compounded by 24 pharmacies did not meet the United States Pharmacopoeia specifications for potency and/or content uniformity when filling a prescription for 0.3 percent nitroglycerin ointment. These results raise significant issues regarding whether patients are put at undue risk relative to the relief of anal fissure pain. The pain associated with chronic anal fissure is severe, often debilitating, and may affect the patient’s ability to work. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. health care industry's rhetoric regarding health insurance, including its use of the idea of choice and empowerment in health insurance advertisements. An overview of the health insurance company Empire Blue Cross Blue Shield's (BCBS's) rhetoric of choice in their advertisements, including its impact on brand identity, is provided.

During late summer of 1996 and 1997 we examined ozone-induced foliarinjury in a plantation of 111 black cherry trees (ramets) comprising15 clones originating from wild ortets growing in the Allegheny National Forest, Pennsylvania, and the Monongahela National Forest, West Virginia. The experimental plantation was a clonal seed orchard in Centre County, Pennsylvania, started in 1971 using ortet buds grafted onto seedling rootstocks of mixed origin. Clones differed significantly in severity of foliar injury symptoms (F=31.83, p<0.001). One clone(R-12) had significantly more foliar injury with >50% leaf area affected than other clones during both years. In contrast, clone R-14, which is from the same area in northcentral Pennsylvania as R-12, exhibited significantly less injury (LAA<6%). Although ambient O3 concentrations were similar in both years, foliar injury was significantly greater (15.7%) in 1996 than in 1997 (9.9%). This is probably explained by lower stomatal conductance in 1997 caused by drier andhotter weather patterns in June and July of that year. Despite very different weather patterns and overall levels of injury in 1996 and 1997, mean clonal injury was significantly correlated between both years of assessment (r=0.92, p<0.001). Within tree crowns, foliage in lower and inner crown positions was significantly more injured than foliage in upper and exterior crown positions. There was no evidence of geographically based population differences in sensitivity to foliar O3 injury. On the contrary, results demonstrate that wild genotypes of proximal geographic origin may differ greatly in sensitivity. [ABSTRACT FROM AUTHOR]

An evidence gap exists in comparing the effectiveness of angiotensin receptor II blockers (ARBs) for hypertension with that of angiotensin-converting enzyme inhibitors (ACEIs). We identified elderly hypertensive patients in whom ACEI/ARB therapy had been initiated after hospitalization for coronary artery disease (CAD), heart failure (HF), or stroke and who were eligible for Medicare and state pharmacy assistance programs. Of 18,801 initiators of ACEIs and 2,641 initiators of ARBs, 2,535 died during the follow-up. We observed substantial differences in characteristics between ARB and ACEI initiators, suggesting that ARB users were more health seeking. The incidence of death and sudden cardiac death (SCD) in ACEI initiators was 77 and 22 per 1,000 person-years, respectively. The relative risk for SCD comparing ARB initiators to ACEI initiators was 0.69 (95% confidence interval (CI) 0.50-0.96); when the analysis was restricted to patients with low ejection fraction (EF), the relative risk was 1.1. The reduced risk of SCD can be explained, at least partly, by (i) residual confounding because ARB users were healthier on unobserved domains and (ii) lack of data on EF.

Clinical pharmacists have been involved in treating people with HIV and AIDS since the epidemic began. Their roles have evolved from inpatient infectious diseases training clinical pharmacists offering treatment regimens for the serious opportunistic infections seen in the hospital, to clinical pharmacists who received specialized training in the treatment of people with HIV in the ambulatory care setting. Their roles and benefits have been documented in the literature, but not to a large extent. Improvements in adherence and cost savings have been seen, but significant improvements in clinical outcomes (changes in viral load and CD4 cell counts) are quite complex and often difficult to identify in the small studies that have been published. This manuscript will review the published data on this topic, and provide examples of clinically trained pharmacists in the US who focus on the treatment of people with HIV infection. The pharmacists discussed here practice in a variety of settings (privately managed free-clinics and government managed clinics), take care of a variety of types of patients (children, adults, military veterans, lower socio-economic groups, etc.), and are employed by a variety of institutions (academic, pharmaceutical company, large healthcare systems and small healthcare systems). These pharmacists were chosen to be representative of the wide variety of individuals, positions and roles of clinical pharmacists involved in the treatment of HIV in the US., (Copyright © 2009 SEFH. Published by Elsevier Espana. All rights reserved.)

Telemedicine has been shown to have a considerable impact in medical education, conferencing and consultation. As a result, the People's Republic of China has been keen to develop telemedicine. In her attempts to further the development of telemedicine, China has looked to the progress of medical services in Western countries such as Europe and North America. The United States of America, however, has exceeded the rest in exchange of health-care information and telemedicine technologies with China. Although China has been enthusiastic about the exchange, telemedicine in China requires development in the technical infrastructure and professional infrastructure.

Bovine mastitis caused by Staphylococcus aureus is responsible for major economic losses to the dairy industry, and more-effective therapeutic or preventive approaches are sorely needed. The predominance of staphylococcal capsular polysaccharide types 5 and 8 among human isolates from many sources is well documented, but there seems to be a greater variation in the distribution of capsular serotypes among isolates from cows. A total of 636 isolates of S. aureus from cases of bovine mastitis in Sweden, Denmark, Finland, Iceland, Ireland, and the United States were investigated for production of capsular polysaccharide types 5 and 8. Approximately half of all the European isolates tested were of serotype 8, although variation among countries and among isolates of clinical and subclinical origin was observed. Sweden had the highest frequency (87%) of serotypeable isolates, and Finland had the lowest (48%). Capsule types 5 and 8 accounted for only 42% of the U.S. isolates tested. A few isolates showed weak reactivity with CP5 antiserum in a colony blot assay, and an enzyme-linked immunosorbent assay inhibition method confirmed that the levels of capsule produced by these strains were <10% of those produced by control strains. Fifty isolates that failed to react with capsular antisera all possessed the genes for production of capsular polysaccharide type 5 or 8. These results underscore the variability in capsule production by bovine isolates of S. aureus from different geographic regions. This information is important for the rational design of a capsule-based vaccine to prevent S. aureus bovine mastitis.

The objective of this paper is to investigate chronologically the life of Sigerist as follows: (i) how Henry Sigerist (1891-1957) became interested in medical history, (ii) how he succeeded Karl Sudhoff (1853-1938) as professor of the history of medicine in the University of Leipzig, (iii) why he came to the Johns Hopkins in 1932, (iv) what he did for health care reform in the U.S. and Canada, (v) why he returned to his motherland in 1947, and (vi) how health professions have been globally influenced by his life. Based on the solid academic scholarship of medical history and sociology, Sigerest was energetically engaged in health care reform. What distinguished his social activism from other health care reformers is that wheras most health care reformers take the positivism-centered perspective to transform the existing health care system, Sigerist integrated historical vision with sociologically a pedagogic mission to pursue health care progress.

The purpose of this article is to analyze the two early health care reform groups: the American Association for Labor Legislation (AALL), the first organization to try to initiate compulsory health insurance in the U.S., and the Committee on the Costs of Medical Care (CCMC), a self-formed committee to study the economics of medical care. By viewing health policy from a historical perspective, we can find a variety of possible alternatives that would have been implemented in different place and time. Unlike positivistic studies on health policy whose only concern is with successful programs, the history of health policy is interested not only in success but also in failure of policy. Reformers from the late 1910s through early 1930s recognized health insurance as a medical issue not as a welfare issue. As long as health insurance belonged to medical domain, policy on health insurance remained separate from public policy. If so, who analyzed and decided the policy? This article argues that social reformers in this period should have tried to launch health insurance not from the front of medical care but in the field of public welfare. This shift in the direction of health care reform would inevitably have caused changes in the strategies accepted.