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Many Canadian medical families have been approached by US headhunters anxious to recruit family physicians to practise in the US. Lynne Sears Williams and her husband, Calgary family physician Jim Williams, went to Texas to see what opportunities awaited. In this article she describes the high and low points of recruitment efforts south of the border.
This is the second in a two-part series dealing with disciplinary actions by the Board of Nurse Examiners of the State of Texas. Part I discussed the grounds for Board of Nurse Examiners to take disciplinary action against a registered nurse's license. Part II describes the disciplinary process.
Ask most folks if they would trade the crime, high taxes, traffic nightmares, and general hassle of big cities for the pastoral setting of small-town life, and their first question may be what time the moving van arrives. Life in a small town can be peaceful, quiet, and relaxing: just the tonic for the headaches of modern urban life. Then reality in the form of illness intrudes, and the services of a doctor are needed. Unfortunately, in many rural areas of Texas, one may not be available.
Domadracunculus janovyi n gen., n. sp. (Apicomplexa: Actinocephalidae) is described from trophozoites, gamonts, and oocysts collected from adult Ischnura verticalis (Odonata: Zygoptera) in Brazos County, Texas. Oocysts of the new species are axially asymmetric, smooth, and crescentic, features that unite the taxon with the Menosporinae. The new genus is distinguished from existing menosporid genera by an epimerite in the form of a distinctly pleated cup or sucker, without the anterior digitations of Hoplorhynchus or the crown of hooks diagnostic of Menospora.
In October and November 1994, three persons (one each in Alabama, Tennessee, and Texas) died from rabies. This report summarizes the investigations of these cases by state and local health departments and CDC.
Malaria was endemic in the United States until the late 1940s; since then, most cases of malaria reported in the United States has been acquired during international travel or has occurred in persons who had resided in countries where malaria is endemic. This report summarizes the investigation of three persons who acquired Plasmodium vivax infection in Houston, Texas, by presumed mosquitoborne transmission during 1994.
Exposure to environmental tobacco smoke (ETS), which is associated with adverse health effects among nonsmokers (1), is a health hazard of particular concern for patrons and employees in restaurants (2). To protect nonsmokers, many local governments have enacted ordinances requiring restaurants to be smoke-free. However, the potential economic impact of these laws on restaurants is an important concern for restaurant owners. On June 1, 1993, the city of West Lake Hills (a suburb of Austin), Texas (1995 population: 3000), implemented an ordinance requiring a 100% smoke-free environment in all commercial establishments to which the public has access, including all restaurants and restaurants with bar areas. This report summarizes an assessment of sales in restaurants during June 1993-December 1994 compared with January 1992-May 1993.
The association between various management factors and development of colic was studied in 821 horses treated for colic and 821 control horses treated for noncolic emergencies by practicing veterinarians in Texas between Oct 1, 1991 and Dec 31, 1992. History of previous colic and history of previous abdominal surgery were found to be significantly associated with colic. Change in stabling conditions during the 2 weeks prior to the time of examination, recent change in diet, and recent change in level of activity significantly increased the risk for development of colic. Changes in activity level, diet, and stabling conditions were identified as potentially alterable risk factors for colic. Logistic regression was used to adjust for the effects of all variables found to be significantly associated with colic by means of univariate analysis, and only history of previous colic, history of previous abdominal surgery, and history of recent change in diet remained significantly associated with colic. Results of this study indicate that a proportion of colic cases might be prevented by minimizing changes in management practices.
Tick-borne relapsing fever (TBRF), a disease of humans and other animals, has been recognized in North America since early in this century. Caused by Borrelia spirochetes, TBRF is transmitted by softshelled Ornithodoros ticks, which may also act as reservoirs for the etiologic agents. Initial symptoms include sudden onset of fever, chills, headache, arthralgias, and myalgias. Persons with TBRF may suffer several febrile episodes or relapses unless they are diagnosed and treated promptly because TBRF spirochetes are able to alter their outer surface proteins and, thus, escape the infected host's immune response. Laboratory diagnosis is made by detecting spirochetes in peripheral blood specimens or by inoculating laboratory mice with blood collected during febrile episodes. In the 1930s and '40s, TBRF was reported commonly in Texas. More recently, fewer cases have been reported, although 13 cases were confirmed between 1990 and the first half of 1994.
Ingestion of Jimson weed (Datura stramonium), which contains the anticholinergics atropine and scopolamine, can cause serious illness or death. Sporadic incidents of intentional misuse have been reported throughout the United States, and clusters of poisonings have occurred among adolescents unaware of its potential adverse effects. This report describes incidents of Jimson weed poisoning that occurred in Texas, New York, and California during June-November 1994.
In the United States, an estimated 95% of elevated blood lead levels (BLLs) in adults are attributable to occupational exposure (1). This report summarizes the findings of an investigation by the Galveston County (Texas) Health District (GCHD) of occupational lead poisoning associated with sandblasting during February-March 1994.
A survey was conducted to investigate medical liability claims filed against the University of Texas System (the U.T. System), physicians, and/or institutions concerning care of adult psychiatric patients. There were 34 such claims filed between 1978 and 1991 that had closed by December 1991. In many of these cases, medical record documentation was determined to be inadequate. Of the 34 claims filed, only seven were settled on behalf of U.T. personnel or U.T. institutions. Of these seven settlements, the mean monetary amount paid per case on behalf of U.T. System and non-U.T. System parties was $98,678.57. The two categories with the largest number of claims were 1) cases involving suicides, and 2) cases involving adverse reactions to medication. The largest award was $350,000, paid on behalf of U.T. physicians, a private physician, and non-U.T. institutions for alleged negligent failure to diagnose Cushing's disease. Of this amount, only $150,000 was paid on behalf of U.T. physicians. Risk management strategies should be implemented to address areas of liability in psychiatry residency programs.
To monitor the growth of the health-care sector in Texas, we made annual estimates of aggregate health spending in 1989 and 1990 and compared them with estimates from prior years and with national trends. Expenditures are grouped by total spending, spending by the state government, and distribution of payment. To achieve data that could be compared with national figures, we followed the methods used by the federal government to estimate national health spending. Results indicate a return to the rapid rates of growth experienced in the early 1980s. Possible explanations for some major trends in spending and in sources of payment are provided. Basic features of recent efforts to contain costs are addressed and related to the trends.
The authors present their experience, at the University of Texas Health Science Center at San Antonio, with foot surgery in patients with diabetes mellitus. It is important to note that the results that follow are a reflection of the authors' experience with foot surgery in these patients from 1980 to 1985. The authors report two separate groups of patients: those who underwent elective foot surgery and those who underwent ablative foot surgery for an infected diabetic foot with necrosis. Also reviewed is the etiology of diabetic foot deformities and ulcerations. It has been the authors' experience that elective prophylactic surgery in patients with diabetes and an intact vascular status produces good results. Patients with an infected diabetic foot, providing they demonstrate adequate vascular status, have a high percentage of healing with early surgical intervention.
An epizootic of encephalomyelitis attributable to western equine encephalitis virus was identified in emus (Dromaius novaehollandiae) from several flocks in western Texas in July 1992. Affected emus ranged from 3 months to 3 years old. Morbidity of emus in 8 flocks ranged from 15 to 50%, and 17 of 193 (8.8%) emus died. The diagnosis was confirmed by isolation and characterization of the causative virus and detection of antibody to the virus in emus that were currently ill and emus that had been ill but recovered. Clinical signs varied from mild to severe and included anorexia, lethargy with sternal recumbency, ataxia, muscle tremors, head tilt, unnatural positioning of the head on the back, acute onset of paralysis, and lateral recumbency with paddling. A few emus died without prior evidence of clinical disease. Post-mortem examination revealed 3 to 5 ml of clear pale-yellow pericardial fluid that contained a fibrin clot. Volume of the contents of the proventriculus and ventriculus were less than anticipated. Microscopic examination of numerous tissues revealed multifocal vasculitis with infiltration of plasmacytes, lymphocytes, and a few heterophilic leukocytes. The epizootic developed during a period of unseasonably heavy rainfall that resulted in higher numbers of mosquitoes than was typical for that season of year. A concurrent increase in the number of horses with encephalomyelitis attributable to western equine encephalities virus was not reported.
The search for policy options to contain health-care costs has sparked renewed national interest in reducing medical school enrollments. Concurrently, the goals of improving the specialty and geographic distribution of physicians have proved elusive both at the state and national levels. This study reexamines and reaffirms the conclusions of an earlier study that suggested enrollment reductions in Texas might decrease rather than increase the supply of primary care and rural physicians.
Antimicrobial resistance of bacterial pathogens usually varies from one geographic location to another. During the last 20 years, outbreaks of disease caused by multiresistant bacteria have occurred with higher frequency in developing countries. We investigated the antimicrobial resistance patterns of bacteria isolated in 1992 from two tertiary-care centers, in Riyadh and Texas. Of the 8841 strains used, 5318 were isolated from clinical specimens of patients at King Faisal Specialist Hospital and Research Centre, Riyadh, and 3523 were from Olin E. Teague Veterans Medical Center, Temple, Tex. Members of Enterobacteriaceae at the King Faisal hospital were significantly more resistant to frequently prescribed antimicrobials than were those at the Olin Teague center. Susceptibility to less frequently used agents like ciprofloxacin and ceftazidime was similar at both hospitals. Resistance patterns of Pseudomonas aeruginosa, Haemophilus influenzae, and coagulase-negative staphylococci were similar at both medical centers. The Olin Teague center encountered significantly more methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.
Mortality in youthful age groups in the United States is largely violent and increasingly due to homicide involving inner-city dwelling males. The majority of these deaths also involve decreased mental capacity as a result of drug and alcohol abuse. Most of the morbidity of youth is similarly related to high-risk behavior, also correlated with drug and alcohol abuse. Texas is no exception to national trends, as our review of statewide statistics confirms. It is important to recognize that the morbidity and mortality, and the developmental difficulties that lead to them, do not stop with the attainment of a mythical "age of majority," but in fact continue to at least age 25. The "forgotten age group," aged 18 to 25 years, is actually at highest risk, since those not in college have forfeited many of their social and financial supports. Most of these deaths should be preventable, if physicians will take creative leading roles in changing both their office practices and their levels of community involvement to deal with the epidemics of youthful death and dysfunction, and with the poverty and hopelessness of our urban ghettos that overwhelm all other risk factors.