Biomedical subjects
Publications and source records attributed to C Jordan.
We argue that the scope of basic audiometric assessment must be broadened to include speech audiometric measures sensitive to central auditory dysfunction. Findings in twenty cases of retrocochlear disorder illustrate the fact that conventional criteria of audiometric normalcy are inadequate.
A case of severe suppurative endogenous panophthalmitis caused by Bacillus cereus resulted from intravenously administered medications. This is the first, to our knowledge, well-documented case of endogenous endophthalmitis associated with this organism. It is recommended that if on Gram's stain of the anterior chamber fluid, Gram-positive rods are seen, chloramphenicol should be administered in addition to penicillin because of the possibility of B cereus infection.
A simple mathematical model of the chest wall was constructed so that during tidal breathing the relative volume contributions of the rib cage and abdomen/diaphragm could be measured in man, using four mercury-in-rubber strain gauges around the trunk. From the dimensions of the trunk and the change in circumference determined by the four gauges, the separate contributions of rib cage and abdomen/diaphragm could be determined using a purpose-built analog computer. The system was evaluated in 13 laboratory personnel, and in 13 other subjects before and after anaesthesia. There was a linear relationship between tidal volumes computed and measured at the mouth, over the residual volume to (FRC + 1 litre) range, with an error of +/- 8%. The relative contribution of rib cage to tidal breathing showed a large scatter from 5 to 42% with a non-significant tendency to decrease with age.
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The respiratory effects of a new strong analgesic, meptazinol, were compared with a placebo and with equianalgesic doses of morphine and pentazocine in a double-blind crossover trial in seven healthy volunteers. No significant change in the ventilatory response to rebreathing carbon dioxide was observed after meptazinol 100 mg/70 kg or placebo. However, both morphine 10 mg/70 kg and pentazocine 60 mg/70 kg depresesd the slope of the ventilatory response (-30.0% and -31.6% respectively, P less than 0.02, averaged over the first 3.5-h period). End-tidal carbon dioxide tension (PE'CO2) while breathing room air increased significantly following all three drugs. However, the increase in PE'CO2 after meptazinol (0.22 kPa averaged over 3.5 h) was significantly less than that following morphine (0.40 kPa, P less than 0.05) and pentazocine (0.59 kPa, P less than 0.01). While breathing room air with a resistive inspiratory load of 8 kPa litre-1 s, PE'CO2 again increased significantly (P less than 0.05) following all three drugs. The increase in PE'CO2 after meptazinol was then the same as that after morphine (0.51 kPa averaged over 3.5 h). The increase following pentazocine (0.80 kPa) was significantly greater than that after both morphine and meptazinol (P less than 0.02).
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OBJECTIVE: To evaluate the efficacy of intravenous immunoglobulin (IVIG) for prevention of viral, opportunistic, and minor bacterial infections in children infected with human immunodeficiency virus (HIV). DESIGN: Randomized, double-blind, placebo-controlled, outpatient clinical trial comparing subjects treated with 400 mg of IVIG per kilogram of body weight every 28 days with those given albumin placebo. SETTING: Twenty-eight clinical centers in mainland United States and Puerto Rico. PATIENTS: Three hundred seventy-six children infected with human immunodeficiency virus with clinical or immunologic evidence of HIV disease, 313 of whom had entry CD4+ counts of at least 0.20 x 10(9)/L (greater than or equal to 200/mm3). MAIN OUTCOME MEASURES: The incidence of laboratory-proven and clinically diagnosed viral, opportunistic, and bacterial infections. MAIN RESULTS: Viral infections and minor bacterial infections contributed more frequently to morbidity in children with entry CD4+ counts of at least 0.20 x 10(9)/L (together over five times as frequent) than did serious bacterial infection, the primary outcome measure of the trial. Opportunistic infections occurred at a similar rate as laboratory-proven serious bacterial infections. In this group of children, IVIG was significantly associated with a decrease in the rate of viral infections and minor bacterial infections per 100 patient-years (36.0 vs 54.0 episodes of viral infection per 100 patient-years, IVIG vs placebo, P = .01; and 115.1 vs 159.7 episodes of minor bacterial infection per 100 patient-years, IVIG vs placebo, P = .02), as well as a decrease in the rate of serious bacterial infections per 100 patient-years (26.4 vs 48.2 episodes per 100 patient-years; P = .002). There was no apparent difference in the rate of opportunistic infections between treatment arms. CONCLUSIONS: Beneficial effect of IVIG was seen across multiple infectious outcome measures, with reductions in serious and minor viral and bacterial infections observed in children with entry CD4+ counts of at least 0.20 x 10(9)/L.
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Changing health care needs over the past 30 years have created new roles for professionals in advanced health care practice settings. As new roles continue to evolve, educational preparation and clinical experiences must be considered when determining the most appropriate health care provider for a particular specialization. Although similarities exist between the PA and PNP, the extent of pediatric didactic and clinical experiences is limited in most PA programs. Only one program is identified by the American Academy of PAs as a child health PA program. PNP education provides the nurse in an advanced practice role with an extensive background in normal growth and development, family counseling, health promotion, and management of common pediatric problems and chronic illnesses. The PNP is a registered nurse who is experienced in the care of children before pursuing an advanced degree as a PNP. In comparison, many PAs are not required to hold a professional degree before enrollment in a PA program. Although students entering PA programs may have experience in health-related fields before enrollment, few are specialized in the care of children. The PA program is designed to prepare the student to assist the physician with diagnosis and treatment in primary care with limited exposure to pediatrics. In comparison, the PNP spends the entire educational program of study gaining expertise in the care of children from infancy to adolescence. Because of advanced educational preparation, the PNP is in a unique position to contribute substantially to the total care of the child and family.