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Biomedical subjects

B M Farr

Publications and source records attributed to B M Farr.

At least 73 records · Page 4Linked to original sources
PubMed1990

A randomized controlled trial of glucocorticoid prophylaxis against experimental rhinovirus infection.

The effects of combined intranasal and systemic glucocorticoid steroids on the local inflammatory response, and symptoms due to experimental rhinovirus infection were studied in 45 adults randomized to prophylaxis with either placebo or steroids. Intranasal beclomethasone (168 micrograms twice a day) was begun 4 days before viral challenge and continued 5 days after challenge. Oral prednisone (30 mg twice daily) was given for 3 days beginning 1 day before challenge. During the first 48 h after viral inoculation, nasal obstruction, nasal mucus weights, and kinin concentrations in nasal lavages were lower in steroid recipients, but subsequent increases in these variables in the steroid group resulted in no significant cumulative differences between treatment groups. These data suggest that steroid prophylaxis may suppress nasal inflammation and cold symptoms during the first 2 days in experimental rhinovirus colds.

Administration, Intranasal↗
PubMed1989

Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. A randomized, controlled trial.

We performed a randomized controlled trial of an attachable subcutaneous cuff for the prevention of central vascular catheter-related infection among patients receiving intensive care. Catheters were placed percutaneously into new sites with or without a cuff and were dressed with polyantibiotic ointment containing polymyxin, neomycin, and bacitracin. Microbial colonization developed in 34.5% of 29 control and 7.7% of 26 cuffed catheters. Catheter-related bloodstream infection occurred with 13.8% of control vs 0% of cuffed catheters. The cuff was not associated with adverse effects. An unexpectedly large proportion (75%) of catheter infections were due to Candida albicans. This may have been due, in part, to the use of polyantibiotic ointment, as suggested by a pooled analysis of previous trials that demonstrated increased Candida colonization of catheters with the ointment, which is not fungicidal. These data suggest that the cuff can reduce the incidence of catheter-related infection among high-risk patients receiving catheter site care with an antibacterial ointment.

Adult↗
PubMed1989

Survey of patients' knowledge of nosocomial infections.

A survey of discharged patients revealed that 62% of respondents were aware of the risk of nosocomial infection before they received the survey. Of the respondents 12.4% said they had suffered from a nosocomial infection; 70% were concerned about their risk of acquiring a nosocomial infection in the future; 83% believed nosocomial infections were preventable; 69% said the risk of acquiring a nosocomial infection was never explained to them during hospitalization; and 62% were dissatisfied with the information that hospitals and the medical community provided concerning the risk of nosocomial infections. Fifty-seven percent were willing to pay an extra $7.14 mean per diem charge to enhance the hospital's infection control program if this payment would lower their risk of infection. This survey suggests that the subset of responding patients want to know more about the risk of nosocomial infections, and they are willing to pay for more resources to be channeled into effective infection control programs.

Adult↗
PubMed1989

Morbidity and mortality associated with multiple episodes of nosocomial bloodstream infection: a cohort study.

A retrospective cohort study of patients with multiple nosocomial bloodstream infections (BSIs) compared with patients suffering only one BSI was conducted to assess morbidity and mortality. Three hundred forty-one patients with BSIs were identified, including 33 with multiple BSIs (9.7%). No significant differences existed between patients experiencing one BSI compared to those experiencing multiple BSIs in age, sex, race, severity of underlying disease, hypothermia, hypoxemia, oliguria, metabolic acidosis, or hypotension. Sixteen of 33 (49%) with multiple BSIs died compared with 124 of 308 (40%) with only one BSI (P = 0.36), leading to a relative risk of 1.23 for death and an attributable mortality of 9% in those with multiple BSIs.

Cohort Studies↗
PubMed1989

A study of the rate of postexposure human immunodeficiency virus testing in a hospital requiring written informed consent.

Multiple authorities have recommended that human immunodeficiency virus (HIV) testing should be performed only with consent of the patient. After institution of a policy requiring written consent for testing patients and employees after blood/body fluid exposures, we prospectively studied incidents in which employees were exposed to the blood or body secretions of patients to determine the rate at which HIV testing could be performed under these circumstances. Two hundred four employees suffered an exposure. In 184/204 (90%) of incidents, the index patient was known. HIV testing was performed for 125/184 patients (68%). Patient consent was refused in one case, but consent could not be obtained from an additional 58/184 (32%) patients because of various logistical reasons. We conclude that a policy requiring informed consent for HIV testing of a patient after exposure of an employee to blood or body fluids of the patient results in an unacceptably low rate of testing and that an alternative approach must be developed.

AIDS Serodiagnosis↗
PubMed1989

Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee.

The selection of initial antimicrobial treatment in a patient with community acquired pneumonia is an important clinical decision. Because this decision is usually made before the results of specific microbiological tests are available, we attempted to determine how well the presenting clinical features would allow prediction of microbial aetiology in 441 adults admitted to hospital with pneumonia. Five of 90 variable available on admission were selected for inclusion in a multivariate discriminant function analysis because of their strong association with one or more of the major aetiological subsets (Mycoplasma pneumoniae, Streptococcus pneumoniae, "other," and undetermined). These variables were age, number of days ill before admission, presence or absence of bloody sputum and of lobar infiltration on chest radiograph, and white blood cell count. The microbial aetiology was correctly predicted by this discriminant function analysis in only 42% of cases, which gives a quantitative estimate of the degree of difficulty encountered in determining the microbial aetiology at the time of admission for pneumonia. When a similar discriminant function analysis was applied to the third of patients in whom the microbial aetiology was never determined, most of these cases were predicted to be due to Streptococcus pneumoniae.

Adolescent↗
PubMed1988

Evaluation of ultraviolet light for disinfection of hospital water contaminated with Legionella.

An epidemic of nosocomial Legionella micdadei pneumonia occurred among renal transplant patients in the University of Virginia hospital between 1978 and 1982. Although no further cases were diagnosed after 1982, filters and ultraviolet light (UVL) fittings were installed in 1985 as an attempt to disinfect water piped to rooms of transplant patients, because of concern about persistence of L micdadei in hospital water. Water samples were obtained from eight UVL-treated rooms and eight control rooms. 26 of 95 control samples were culture positive for L micdadei compared with 0 of 71 samples of filtered, UVL-treated water (p less than 0.0001, Fisher's exact test). After the UVL fitting and filter had been bypassed because of a leak, 9 of 33 samples from the UVL rooms were positive (p less than 0.0001). These data suggest that UVL treatment may be useful in continuous disinfection of water in the hospital rooms of high-risk patients.

Cross Infection↗
PubMed1988

Cohort study of human immunodeficiency virus (HIV) antibody testing among patients receiving long-term dialysis at a university hospital.

In a longitudinal study to determine the seroprevalence of antibody to the human immunodeficiency virus (HIV) and the natural history of a positive enzyme immunoassay (EIA) result we followed a cohort of 98 patients receiving long-term dialysis. Eight patients (8.2%) in the cohort had a positive EIA and a negative Western blot test result. The EIA-positive results of all patients seroconverted to negative during follow-up. No illness suggestive of HIV infection developed in any of the patients. Significantly associated with a false positive EIA were prior renal transplantation, transfusions during the months just before the positive EIA result, and a greater number of lifetime transfusions before the positive test result. We confirm that routine HIV screening of patients receiving long-term dialysis is associated with a high rate of false positive EIA results and conclude that such testing is unnecessary in the absence of established risk factors for HIV infection.

AIDS Serodiagnosis↗
PubMed1988

Primary cytomegalovirus infection in pediatric nurses: a meta-analysis.

A meta-analysis of six controlled studies was performed to evaluate the risk of cytomegalovirus (CMV) infection among pediatric nurses. The pooled risk ratio for CMV infection in pediatric nurses using cumulative incidence data was statistically significant (risk ratio [RR] 2.7; 95% confidence interval [CI] 1.33 - 5.52), but person-year analysis taking account of follow-up periods demonstrated a trend toward increased risk that failed to reach statistical significance (RR 1.8; 95% CI 0.88 - 3.55). Despite pooling, there was low statistical power for comparing person-year rates. The studies included in this analysis failed to provide data on several potential confounding variables. We conclude that studies published prior to the widespread adoption of universal precautions suggest that pediatric nurses may have been at increased risk for CMV infection due to occupational exposure, but inadequate design and sample size of the studies prevent a definitive conclusion. Well-designed, controlled studies are still needed to define the occupational risk of CMV infection.

Cytomegalovirus Infections↗
PubMed1988

Two randomized controlled trials of virucidal nasal tissues in the prevention of natural upper respiratory infections.

Two six-month randomized, controlled double-blind trials of the efficacy of virucidal nasal tissues in the prevention of natural colds were conducted in Charlottesville, Virginia, between 1983 and 1986. Tissues impregnated with malic and citric acids and sodium lauryl sulfate were used in both trials. Placebo tissues contained saccharin in the first trial and a mixture including succinic acid in the second. A total of 186 families were evaluable after completion of trial I, and 98 families were evaluable in trial II. The antiviral tissues were associated with 14 and 5% relative reductions in the overall rate of colds in the first and second trials, respectively. In the first study, this appeared to be due to an appropriate fall in secondary illnesses with a relative reduction in the ratio of secondary to primary illnesses of 32%. In trial II, however, the small and statistically insignificant reduction was primarily due to a drop in the rate of primary illness (which cannot be attributed to tissue efficacy), and the ratio of secondary to primary illness was actually 5% higher in the group with active tissues than in the placebo group. We conclude that when rigorously used in a study protocol, virucidal tissues may offer a modest reduction of secondary colds in the home, but for reasons currently unknown, do not have a major effect on the overall rate of colds.

Antiviral Agents↗
PubMed1987

The problems of taste in placebo matching: an evaluation of zinc gluconate for the common cold.

A recently published randomized, controlled, double-blind, study has reported efficacy of zinc gluconate lozenge treatment of the common cold. Because of a higher rate of side effects in the zinc group and the lack of any confirmatory evidence of blinding efficacy, we are concerned about the possible contribution of bias to the study result. Unflavored zinc gluconate tablets can be easily distinguished from the relatively tasteless, unflavored calcium lactate tablets, which were used as placebo in the cited study, increasing our concern about bias. In order to be able to test zinc lozenges in a second trial of common cold therapy, we developed a matching placebo containing denatonium benzoate (a bitter substance used to prevent thumb sucking in children) and then undertook a formal evaluation of blinding efficacy. This article reports the results of this evaluation, encompassing two randomized, controlled taste trials; the first trial of the placebo matching showed zinc recipients to exhibit a higher rate of side effects and also a significantly higher proportion of subjects believing they were on "active" treatment. Alterations in dosage before the second taste trial yielded comparability of the placebo and zinc lozenges. This study illustrates the pitfalls which may sometimes be encountered in performing and publishing studies in which placebos are either not tested at all or tested in too small a subject population to detect a significant subjective difference between the placebo and the active medication.

Clinical Trials as Topic↗
PubMed1987

Two randomized controlled trials of zinc gluconate lozenge therapy of experimentally induced rhinovirus colds.

The therapeutic efficacy of zinc gluconate lozenge therapy in experimentally induced rhinovirus infection was assessed in two randomized controlled trials in susceptible adult volunteers. In trial 1, lozenges containing either zinc gluconate (23 mg of elemental zinc) or placebo were given 36 h after nasal inoculation of rhinovirus type 39 and administered eight times per day for 5 days. All of the volunteers had early cold symptoms at the time that treatment was begun. In trial 2, the same lozenge regimen was used, beginning 2 h after nasal inoculation with rhinovirus type 13, and continued for 7 days. Zinc therapy did not reduce the severity or duration of cold symptoms or the frequency or duration of viral shedding in either trial. Viral titers were measured in trial 2 and were shown to be unaffected by zinc therapy. Nasal mucus weights and the numbers of paper tissues used were slightly higher in zinc recipients. A statistically significant increase in levels of zinc in serum was documented in zinc recipients after 5 days of therapy. These data suggest that zinc gluconate lozenge therapy is not therapeutically useful in the treatment of rhinovirus colds.

Administration, Oral↗
PubMed1984

Intranasal interferon-alpha 2 for prevention of natural rhinovirus colds.

The prophylactic activity of intranasal human interferon-alpha 2 (HuIFN-alpha 2) against natural rhinovirus colds was determined in a randomized, double-blind, placebo-controlled trial. A total of 304 working adults self-administered sprays of HuIFN-alpha 2 (10(7) IU/day) or a placebo once daily. During 22 days of treatment, 13 (8.5%) placebo recipients but no HuIFN-alpha 2 recipients had respiratory illnesses documented secondary to rhinovirus infection (P = 0.0002). The occurrence of illness with symptoms of tracheobronchitis was lower in HuIFN-alpha 2 recipients (one eposide) than in placebo recipients (eight episodes, P = 0.04). In contrast, the frequency of nasal symptoms and the overall rate of respiratory illness were significantly higher in HuIFN-alpha 2 recipients during weeks 2 and 3 of treatment. Symptoms (obstruction, discomfort, blood-tinged nasal mucus) or signs (punctate bleeding sites, erosions, superficial ulcerations) of nasal irritation occurred in 40 HuIFN-alpha 2 recipients during week 3 (P less than 0.0001 versus placebo recipients). Although the results of the current study were partially confounded by the nasal side effects of prolonged administration, they showed that intranasal HuIFN-alpha 2 was efficacious in preventing rhinovirus colds under natural conditions.

Administration, Intranasal↗
PubMed1977

A single-injection method for measuring glomerular filtration rate.

A method for estimating glomerular filtration rate (GFR) has been developed that is based on an analysis of the total area under the plasma radioactivity-time curve after a single intravenous injection of [125I]iothalamate. Glomerular filtration rates obtained by this method (method A) and those obtained with two widely used single-injection techniques, the slope-intercept method (method B), and the two-compartment method (method C), were compared with GFRs obtained by standard inulin clearance techniques in 14 dogs. Method B consistently over. estimated inulin clearances more than 30%. Method C also overestimated inulin clearance considerably in dogs with an increased extracellular fluid volume, but was fairly reliable in normal dogs. Glomerular filtration rates obtained by the new method (method A) were in excellent agreement with inulin clearances in all dogs, regardless of the state of body hydration. The mean inulin clearance for all 14 experiments was 72.7+/-6.0 SE ml/min, while GFRs obtained by method A averaged 75.1+/-6.0 ml/min. The data from this study suggest that method A is a reliable means for estimating GFR that is especially useful in chronic experiments.

Animals↗
PubMedDate not supplied

Recent development of rigors during infusion of urokinase: is it related to an endotoxin?

PURPOSE: This study was undertaken to determine the prevalence of rigors associated with the use of urokinase (UK) and to assay for the presence of an endotoxin in the UK solution. PATIENTS AND METHODS: Records of 75 patients who underwent 86 UK infusions between January 1988 and July 1992 were reviewed to evaluate for the development of UK-associated rigors. A modified chromogenic limulus amebocyte lysate (LAL) test was performed to determine the presence of endotoxin in four samples of UK from lots associated with rigors, one sample of UK not associated with rigors, sterile water, nonionic contrast medium, and ionic contrast medium. RESULTS: Between January 1, 1988, and July 10, 1990, 43 patients underwent 46 UK treatments (group 1) with no documented rigors (0% prevalence). In 45 of these 46 treatments, a standard, non-pulse-spray bolus of 75,000-500,000 IU of UK (mean dose, 182,222 IU) was used. Between July 11, 1990, and July 6, 1992, 38 patients underwent 40 UK treatments (group 2). In 33 of these 40 treatments, a standard bolus was given. Five patients received a pulse-spray bolus. The mean bolus was 213,768 IU (range, 100,000-500,000 IU). Eleven group 2 patients developed rigors (28% prevalence; P = .0005 vs group 1). The chromogenic LAL tests demonstrated no endotoxin in sterile water, nonionic contrast media, or ionic contrast media. Endotoxin was detected in small concentrations in the four samples of UK associated with rigors and in the UK sample not associated with rigors. CONCLUSION: The increase in the prevalence of rigors associated with the use of UK does not appear to be related to an endotoxin in UK, since the concentration of endotoxin detected is well below the threshold pyrogenic dose in humans.

Contrast Media↗