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Background/Aims Clinical practice systems are an important component of a high functioning Patient-Centered Medical Home (PCMH). Here, the relationships between PCMH clinical practice systems and healthcare costs and utilization are examined using a retrospectively constructed longitudinal cohort receiving consistent primary care from the same medical group over a 5-year period.

Background: Medical homes are widely viewed as a partial answer to the problems of inadequate care quality and patient experiences plus excessive healthcare costs, even though there is very limited evidence about whether they can affect these issues. We evaluated the relationship between degree of medical home-ness and measures of quality and patient satisfaction among 21 primary care clinics certified as level III medical homes by the National Committee for Quality Assurance (NCQA). Methods: We used the research version of the NCQA certification survey to measure the degree to which each clinic exemplified the medical home, with scores (0–100) overall as well as for each of five domains from the Chronic Care Model. These scores were then tested for associations with clinic-specific performance measures, cost data, and patient satisfaction. Results: Despite common NCQA level III attainment, we found considerable variance in scores among these clinics. Total and domain mean scores ranged from 58.6 to 81.8 with SD of 15.0–41.2 on medical home measures. Mean composite diabetes outcome rates ranged from 16.4–41.9%. Clinic-level correlations were highest for Delivery System Redesign and Healthcare Organization domains, and among the five specific components of the composite diabetes measure, blood pressure

Objective Compare lipid response, side effect profile and toxicity of younger (

Two hundred one male and female subjects, aged 20 to 70 years, with elevated low-density lipoprotein cholesterol values (in the 75th to 95th percentiles), participated in a randomized, controlled, double-blind study using a new form of niacin (Enduracin), which employs a wax-matrix vehicle for sustained release. Four niacin treatment groups (daily doses of 2000, 1500,1250, and 1000 mg) were compared with placebo- and diet-treated controls to determine side-effect profile and optimal range of efficacy. The groups given 2000 and 1500 mg demonstrated significant reductions in values of low-density lipoprotein cholesterol (—26% and —19.3%, respectively), total cholesterol (—18.4% and —13.3%), and total cholesterol-high-density lipoprotein cholesterol ratio ( — 20.4% and —19.4%) when compared with diet- and placebo-treated controls. Smaller improvements were seen in high-density lipoprotein cholesterol and triglyceride levels. Blood chemistry monitoring indicated that reduction in low-density lipoprotein cholesterol level strongly correlated with an increase in baseline levels of some enzymes for niacintreated subjects. The improved side-effect profile of the wax-matrix form of niacin was particularly notable. The dropout rate due to side effects was only 3.4% and was coupled with good medication compliance. (Arch Intern Med.1991;151:1424-1432)

Caffeine withdrawal is an important but often overlooked cause of headache. In an ongoing investigation of caffeinism the authors used a questionnaire to determine whether there is a constellation of psychiatric characteristics associated with this type of headache. They found that persons who are susceptible to the syndrome generally report more symptoms of anxiety and depression and rate higher in tests evaluating those parameters; consume more antianxiety agents; feel they are less healthy; and have a significantly higher caffeine intake than persons without caffeine-withdrawal headaches.

Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms, felt that their physical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels, inhibits phosphodiesterase breakdown of cyclic AMP, and sensitizes receptor sites, association of caffeinism with both anxiety and depressive symptoms is possible.

Summary Antiserum to pure M-protein extracted from PR8 virions neutralized the infectivity and inhibited the haemagglutinating activity of various influenza A virions. It agglutinated concentrated suspensions of these virions and fixed complement in their presence. Antibodies to M-protein were readily absorbed by intact virions or by spikeless particles obtained after proteolytic treatment, giving clear evidence that M-protein is exposed at the surface of the virus envelope. The data suggest that when antibodies to M-protein occupy specific ligands exposed at the surface of the virion they interfere with sites critical for infectivity and haemagglutinating activity.

Access Grid (AG) is an Internet2-driven, high performance audio_visual conferencing technology used worldwide by academic and government organisations to enhance communication, human interaction and group collaboration. AG technology is particularly promising for improving academic multi-centre research collaborations. This manuscript describes how the AG technology was utilised by the electronic Primary Care Research Network (ePCRN) that is part of the National Institutes of Health (NIH) Roadmap initiative to improve primary care research and collaboration among practice- based research networks (PBRNs) in the USA. It discusses the design, installation and use of AG implementations, potential future applications, barriers to adoption, and suggested solutions.