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For the past two years a new system of caring for the ambulatory patient and for teaching medical students in the outpatient department has been in effect at the University of Oklahoma Hospitals. Traditionally, the emphasis in teaching internal medicine has been on the bed patient. The outpatient department has often been a crowded accessory that has been adapted neither to the comfort and welfare of the patient nor to the effective teaching of the student. Recent developments, especially in combating infections, have reduced the need for bed care in treating illness and have emphasized the plight of the ambulatory patient. The focus on the treatment of patients while they are in contact with their day-to-day environment has given rise to a growing awareness among physicians that social and psychological forces may be potential pathogenic factors in disease. A "comprehensive" point of view has developed that cuts across traditional boundaries

The attempt in one hospital to model a drug study after the NIMH nine-hospital collaborative study resulted in a useful modification in which relatively small numbers of newly admitted, acutely exacerbated chronic schizophrenic patients were studied for a period of four weeks. Statistically significant drug: placebo differences were easily detected on most psychiatric and behavioral variables, but not on the psychological performance tasks used. The overall design appears to be suitable for sequential analysis and might provide the basis for an early screening program for antipsychotic drugs in which very small numbers of subjects would be required for relatively short periods of observation. A possible differential drug response favoring thioridazine over chlorpromazine hydrochloride and fluphenazine hydrochloride on several variables was not statistically significant.

In this study 1,000 patients in an antepartum clinic were screened by collection of dual urine specimens, one immediately after awakening which was refrigerated until brought to the clinic and a second specimen which was collected during the clinic visit. Comparison of the 2 specimens demonstrated that useful quantitative bacteriology could be obtained by culturing a first morning voiding. Further comparison demonstrated that the incidence of >105bacteria per milliliter of urine was 7.8 per cent with the use of the first morning specimen and 6.1 per cent with the use of the clinic specimen. The incidence of urinary tract infection, as defined, in this population was 4.7 per cent, and in this study 96 per cent of these patients had >105bacteria per milliliter of urine in their first morning voiding, whereas only 83 per cent had >105bacteria per milliliter of urine in the clinic specimen.

The Griess test is a simple and inexpensive test which can be useful in detecting significant bacteriuria. The problem has been the high percentage of false negative values. In this study of 1,000 antepartum patients, 2 refinements of the Griess test were evaluated. One, the oral administration of potassium nitrate, did not increase the sensitivity of the Griess reaction. The second modification was to test the first morning urine specimen (which was refrigerated until brought to the clinic) and compare this with a urine specimen obtained in the clinic. This change allowed us to identify 96 per cent of patients with urinary tract infection (as defined), whereas only 55 per cent of these patients could be identified from the clinic specimen. Finally, once again the direct relationship between numbers of bacteria and a positive Griess reaction is demonstrated.

The Griess test was used as a screening procedure for bacteriuria in 1,983 pregnant out patients in an antepartum clinic. The prevalence of asymptomatic bacteriuria was found to be 6.6 per cent. The unmodified test was positive in 81 per cent of 94 patients with significant bacteriuria and was positive in 0.7 per cent of patients with sterile urine. However, 10 per cent of the positive Griess reactions are associated with sterile urine. The test was modified in 1,003 patients by in vivo or in vitro nitration of the urine. The results of the Griess test were not significantly altered by this procedure. The standard Griess test was compared with the STAT-Test in 500 patients. The STAT-Test gave positive results in 73 per cent of 40 patients with significant bacteriuria. Because of the simplicity and reliability of this test and the importance of diagnosing bacteriuria during pregnancy, it is strongly recommended as a routine part of antepartum care.

IT IS KNOWN that the administration of tetracycline results in visible yellow fluorescence of tumor tissue.1 The purpose of this paper is to communicate our experiences in the recovery of fluorescent material from the gastric contents in subjects with known bronchogenic carcinoma. METHOD Thirty male patients at the Veterans Administration Hospital, Oklahoma City, were studied. Fifteen of these patients had histologically proven bronchogenic carcinomas at different stages of the disease. The other 15 patients were diagnosed as having acute or chronic pulmonary diseases other than carcinoma.All study subjects received 1.0 gm of oxytetracycline in divided doses, orally, for five consecutive days, followed by a one day interval to allow for the disappearance of any residual tetracycline particles in the stomach and for the elimination of fluorescence from normal tissues. An overnight sputum specimen was obtained for exfoliative cytology. In the early morning of the seventh day, the stomach was