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PURPOSE To determine the proportion of regional primary care physicians who would attend grand rounds on preventive services and their interest in and use of free follow-up enabling and reinforcing assistance to implement changes in their practice routines. METHOD From January to July 1992 grand rounds on early detection of cancer were offered by Dartmouth Medical School at 38 acute care community hospitals in New Hampshire and Vermont. The target audience of 679 family physicians and general internists was identified through state medical society and hospital attending lists. The hour-long grand rounds program described preventive service guidelines and an office system that promoted their implementation. Follow-up practice support with planning, office staff training, and materials were offered to augment the effects of the grand rounds. Attendance was determined by sign-in documents. In addition, all attendees were asked to complete a survey regarding practice and personal characteristics and interest in follow-up assistance. Statistical comparisons were made using chi square and Fisher's exact tests. RESULTS In all, 261 family medicine physicians and general internists (38.4%) attended. Certain categories of physicians were more likely to have attended: internists, those younger than 55 years, and physicians on the staffs of hospitals located in small towns. Assistance was requested by 70.1% of the attendees; many requested more than one type of assistance. Physicians from hospitals in smaller towns were more likely to show interest in follow-up assistance and use it when offered. CONCLUSION Many of the grand rounds attendees were receptive to follow-up assistance that could improve the preventive services they provided. Most hospitals offer grand rounds, and many organizations have interest in and resources for helping physicians provide high-quality care. Future research should establish the best linkage to the actual care provided in practices and explore the relevance of similar approaches to clinical areas beyond prevention.

To define the risks of disseminated bacille Calmette-Guérin (BCG) or disseminated Mycobacterium tuberculosis in adults with AIDS who were immunized with BCG in childhood.HIV-infected patients with CD4200 x 10(6)/l were enrolled from five study sites (New Hampshire, Boston, Finland, Trinidad and Kenya). Prior BCG immunization was determined and blood cultures for mycobacteria were obtained at study entry and at 6 months. Acid-fast bacilli were identified as Mycobacterium tuberculosis complex (MTBC) using DNA probes. MTBC isolates were then typed by both IS6110 restriction fragment length polymorphism and polymerase chain reaction/restriction enzyme analysis.Most patients in New Hampshire and Finland were outpatients; most patients in Trinidad were inpatients with terminal illness; and most patients in Kenya were outpatients, although 44 were inpatients with terminal illness.A total of 566 patients were enrolled, including 155 with childhood BCG immunization; 318 patients had a single study visit and culture, and 248 patients had two study visits and cultures.Isolation and identification of mycobacteria from blood cultures.Blood cultures were positive for MTBC in 21 patients; none were positive for M. bovis BCG, and 21 were M. tuberculosis-positive. In Trinidad, seven (87%) out of eight isolates of M. tuberculosis were indistinguishable by IS6110 typing; BCG immunization was associated with a decreased risk of bacteremic infection with M. tuberculosis (P = 0.05).The risk of disseminated BCG among adult AIDS patients with childhood BCG immunization is very low. Childhood BCG immunization is associated with protection against bacteremia with M. tuberculosis among adults with advanced AIDS in Trinidad.