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Biomedical subjects

D J Conti

Publications and source records attributed to D J Conti.

At least 37 records · Page 2Linked to original sources
PubMed1995

Preemptive ganciclovir therapy in cytomegalovirus-seropositive renal transplants recipients.

OBJECTIVE: To evaluate the efficacy, safety, and cost of preemptive ganciclovir therapy in cytomegalovirus (CMV)-seropositive renal transplant recipients treated with antilymphocyte antibody (ALA) preparations. DESIGN AND SETTING: A prospective, randomized trial at a 650-bed tertiary medical center hospital. PATIENTS: Forty consecutive CMV-seropositive renal allograft recipients who underwent transplantation between January 1992 and January 1994 and were treated with ALA for induction immunosuppression or acute rejection therapy. MAIN OUTCOME MEASURES: The incidence and severity of CMV disease, length of hospitalization, and patient and allograft survival. INTERVENTION: Cytomegalovirus infection prophylaxis by use of intravenous ganciclovir during ALA therapy was administered to 22 patients (group 1) and the results were compared with those obtained in 18 control patients who did not receive prophylaxis for CMV disease (group 2). RESULTS: Preemptive ganciclovir therapy significantly reduced the incidence of CMV disease (P < .05) in CMV-seropositive renal transplant patients who were treated with ALA and was well tolerated. In addition, the cost of prophylactic therapy was offset by the decreased length of hospitalization observed in patients in group 1. CONCLUSION: Preemptive ganciclovir therapy provides a cost-effective approach toward significantly improving the outcome of renal transplantation in CMV-seropositive patients treated with ALA.

Adult↗
PubMed1994

Prophylaxis of primary cytomegalovirus disease in renal transplant recipients. A trial of ganciclovir vs immunoglobulin.

OBJECTIVE: To compare the efficacy, safety, and cost of prophylactic low-dose ganciclovir with that of immunoglobulin in renal transplant recipients at risk for primary cytomegalovirus (CMV) disease. DESIGN AND SETTING: A prospective, randomized trial at a 650-bed tertiary medical center hospital. PATIENTS: Fifty-one consecutive CMV-seronegative patients who received renal allografts from seropositive donors between March 1990 and April 1992. MAIN OUTCOME MEASURES: Patient and allograft survival, and the incidence and severity of CMV disease. INTERVENTION: Cytomegalovirus prophylaxis with seven doses of intravenous immunoglobulin for 6-week periods (group 1, n = 27) or low-dose intravenous ganciclovir for 3 weeks (group 2, n = 24). Results were compared with those obtained in 23 CMV-seronegative historical controls who received renal allografts from CMV-seropositive donors between 1987 and 1989, and who did not receive prophylaxis for CMV (group 3). RESULTS: Both prophylactic regimens significantly reduced the incidence of invasive CMV infection (P < .05) and were well tolerated. However, the cost of ganciclovir ($350 per patient) was substantially less than that of immunoglobulin ($4000 per patient). CONCLUSIONS: These data suggest that prophylactic ganciclovir therapy provides a cost-effective approach toward significantly improving the outcome of renal transplantation in recipients at risk for primary CMV disease.

Adult↗
PubMed1994

The economic impact of depression in a workplace.

Epidemiological studies hold that depressive disorders are among the most common forms of mental illness in the population and should produce a substantial economic impact upon corporate America. However, only a few studies have examined the economic impact of depression in the workplace. A study of the medical and disability costs of depressive disorders was conducted at the First Chicago Corporation. In this analysis, short-term disability data, medical plan costs and Employee Assistance Program referral data for depressive disorders were compared with selected common chronic medical conditions. The average length of disability and the disability relapse rate was greater for depressive disorders than for the comparison medical groups. Depressive disorders were also found to have the largest medical plan costs of all behavioral health diagnoses. Finally, depressive disorders proved to be the most common Axis-I-level diagnosis encountered in the Employee Assistance Program. These findings have important implications for medical benefit plan design, disability plan management, and occupational health professionals' training. The observed higher prevalence of these disorders in women force their recognition as a women's health issue.

Absenteeism↗
PubMed1994

Placement of a double lumen silastic catheter for hemodialysis access through the cephalic vein.

The cephalic vein within the deltopectoral groove provides adequate access to the central venous system for the PermCath hemodialysis catheter. Unlike EJV techniques, which are successful in few instances, the cephalic vein approach was successful in approximately 75 percent of instances. In addition, the rate of complications secondary to bleeding or catheter kinking are decreased with the cephalic vein technique as compared with insertion through the EJV or IJV. We conclude that the cephalic vein is a dependable and functional approach to the central venous system for the PermCath hemodialysis catheter.

Adult↗
PubMed1991

Value-managed mental health benefits.

The First National Bank of Chicago's comprehensive program for mental health services has been shown to be an effective response to the rising demand and cost of mental health care. By assertively managing a benefit plan rather than capriciously cutting it, employees are afforded quality care while the corporation is able to handle the costs of a worthwhile benefit. The plan represented a collaboration of the Benefits and Medical Units, which brought together philosophies of benefit plan management and research regarding primary prevention and early intervention. Employees are afforded education and early intervention while at the work site and appropriate referrals to cost-efficient providers outside the bank. Should they need time away from the work site for treatment, this along with their reentry is also managed to increase the probability of successful recovery. In this way continuity of care is assured so that recurrent disability (eg, rehospitalization, further STD) may be reduced. The 4-year follow-up investigation of the program reveals management of overall mental health care costs, reduction in inpatient psychiatric hospitalization costs, and reduction in the average length of psychiatric short-term disability episodes for employees.

Chicago↗
PubMed1989

The effect of pre-bed care on alcoholic patients' behavior during inpatient treatment.

Sixty-five alcoholic patients admitted to an inpatient rehabilitation unit were studied regarding the effect of an outpatient pre-bed care participation program on subsequent behavior. There were no differences in on-ward behavior between the pre-bed care and direct admission patients. However, the pre-bed care patients were less likely to leave the inpatient unit AMA and more likely to still be active in aftercare treatment 6 months after discharge.

Adaptation, Psychological↗
PubMed1988

Infection of the central nervous system in organ transplant recipients.

Infections of the central nervous system are an important cause of morbidity and mortality in recipients of organ transplants. Three organisms--Listeria monocytogenes, Aspergillus fumigatus, and Cryptococcus neoformans--account for the great majority of such infections. The incidence of these infections is directly related to the patient's net state of immunosuppression and to the epidemiologic exposures he encounters. There is an expected timetable of when particular infections are likely to occur post-transplant. The most important factor in effecting patient survival is the rapidity with which diagnosis is made. Because of the nature of the infecting organisms and the impaired inflammatory response, the clinical presentation of CNS infection is often insidious, making early diagnosis difficult. However, an aggressive approach based upon lumbar puncture and CT scanning for patients with headache and fever or altered states of consciousness can be very rewarding. In addition, the use of such ancillary clues as the results of skin and lung biopsies can be an important clue to disseminated infection, particularly involving the CNS. The recent deployment of the MRI scan in immunosuppressed patients with unexplained CNS symptoms holds particular promise for early diagnosis.

Aspergillosis↗