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Research is yet to fully examine the utility and effectiveness of telehealth in primary care resident ambulatory training. This study examined the attitudes of preceptors, residents, and nurses on (1) the impact of telehealth on healthcare; (2) the impact of telehealth on the work activity of resident clinics; (3) the impact of telehealth on resident training in the outpatient setting; and (4) the impact of telehealth on relationships. There were three focus groups, one each of preceptors (N = 5), residents (N = 10), nurses (N = 7). Eight focus group themes evolved regarding the use of telehealth in the resident clinic: (1) impact on patient/provider relationships; (2) consistent with the values of those using telehealth; (3) logistics; (4) reduces patient transfers; (5) appropriate level of care; (6) reimbursement concerns; (7) psychological risk; and (8) impact on resident/attending relationships. Though as yet not generalizable, results of this pilot study suggest that there is general acceptability of telehealth in ambulatory resident training settings, but there is concern about the impact that telehealth may have on relationships, logistics, finances, and the need to see patients face-to-face when there is greater complexity.

25 hypertensive subjects underwent a double-blind, randomized study to compare the effects of ticrynafen (TCNF) with hydrochlorothiazide (HCTZ) on blood pressure (BP), renal function, serum uric acid (UA) and electrolytes, and body fluid spaces. BP was similarly lowered by TCNF and HCTZ. Neither TCNF nor HCTZ had a significant effect on true or regular creatinine, inulin, or PAH clearances. TCNF lowered UA, whereas HCTZ elevated UA. Both produced similar electrolyte disturbances. Neither TCNF nor HCTZ, according to our methods, had a significant effect on plasma volume, extracellular fluid, or total body water. The primary advantage of TCNF compared with HCTZ is its profound hypouricemic effect.

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1. Erythrocyte mass, plasma volume (PV), extracellular fluid volume (ECFV) and total body water were simultaneously measured in 30 normotensive and 30 normal-renin hypertensive Caucasian male subjects for accurate determination of the presence or absence of a disorder(s) in body-fluid composition in hypertension. 2. The results indicate that plasma volume and total blood volume are lower in hypertensive subjects than in normotensive control subjects. The PV comprised 19% of the ECFV in both control and hypertensive subjects. 3. ECFV was lower in hypertensive subjects than in normotensive control subjects; the PV and interstitial fluid components of the ECFV were reduced by similar proportions. The ECFV, furthermore, comprised a smaller portion of the total body water in hypertensive subjects than that in control subjects. 4. We conclude that in the hypertensive state there is a reduction in the ECFV, but that there is no change in the partition of the ECFV between the plasma and interstitial components.

Ticrynafen (TCNF), a nonthiazide diuretic, has been reported to be nonhyperlipidemic. To define the effects of these drugs on plasma lipoproteins, experiments were performed in hypertensive subjects after placebo therapy, 4 wk after therapy with either hydrochlorothiazide (HCTZ) or TCNF, 3 mo after diuretic with propranolol, and 1 mo after therapy with propranolol alone. Plasma lipoproteins were separated by ultracentrifugation and the lipid fractions isolated by extraction and silicic acid thin-layer chromatography. Plasma low-density lipoprotein (LDL) total cholesterol fell and high-density lipoprotein (HDL) total cholesterol rose in subjects receiving TCNF. TCNF had no effect on plasma low-density lipoprotein (VLDL) triglyceride or phospholipid. There was no significant changes in LDL or HDL total cholesterol in subjects on HCTZ. HCTZ tended to increase plasma VLDL triglyceride and phospholipid. The addition of propranolol to either diuretic had no effect on LDL or HDL total cholesterol but increased VLDL triglyceride, especially in subjects on HCTZ. Propranolol alone had no effect on any of the lipids measured.