PubMed Health⌕ Search

Biomedical subjects

Daniel K Benjamin

Publications and source records attributed to Daniel K Benjamin.

46 records · Page 3Linked to original sources
PubMed2004

In vitro interactions between antifungals and immunosuppressants against Aspergillus fumigatus isolates from transplant and nontransplant patients.

We performed in vitro antifungal checkerboard testing on 12 Aspergillus fumigatus clinical isolates (6 transplant recipients and 6 nontransplant patients) with three antifungal agents (amphotericin B, voriconazole, and caspofungin) and three immunosuppressants (FK506, cyclosporine, and rapamycin). We were not able to detect a difference in calcineurin inhibitor antifungal activity against isolates from transplant recipients and nontransplant patients.

Amphotericin B↗
PubMed2003

A comparison of height and weight velocity as a part of the composite endpoint in pediatric HIV.

BACKGROUND: HIV adversely affects growth in children. Pediatric AIDS Clinical Trial Group (PACTG) protocols often use weight velocity [changes in weight z-score for age (WAZ)] as a part of the composite endpoint for phase II and III clinical trials. However, WAZ and height velocity (HAZ) have not been critically compared for their utility as part of the composite endpoint. METHODS: HAZ and WAZ were compared to predict laboratory and clinical progression of HIV in a retrospective cohort study of HIV-infected children with data from PACTG Protocol 300. RESULTS: In both bivariable and multivariable analyses, changes in HAZ were more closely linked to subsequent progression than WAZ. Children with improved HAZ were somewhat less likely to exhibit virological failure [odds ratio (OR), 0.76; 95% confidence interval (CI) 0.51-1.14], than children with improved WAZ (OR, 1.45; 95% CI, 0.99,2.11). Children who had improved HAZ were less likely to exhibit immunological failure (OR, 0.7; 95% CI, 0.49-1.00), than children with improved WAZ (OR, 1.13; 95% CI, 0.82-1.57). Children who had improved HAZ were less likely to have other forms of clinical progression of HIV (OR, 0.55; 95% CI, 0.31-0.99), than children who had improved WAZ (OR, 1.0; 95% CI, 1.58-1.94). CONCLUSIONS: Increases in HAZ were associated with reduced risk of subsequent clinical progression and subsequent immune reconstitution and weakly associated with declines in HIV RNA. Changes in WAZ were not associated with laboratory outcomes relevant to pediatric HIV infection. Height velocity should be considered as a component of a composite clinical endpoint in future PACTG trials.

Adolescent↗
PubMed2003

Candida bloodstream infection in neonates.

Neonatal candidemia is poorly understood and is a leading cause of nosocomial infectious mortality in the nursery. Prevention of candidemia has been difficult, although a combined approach of antifungal prophylaxis and targeted empirical therapy may eventually reduce morbidity and mortality. Multicenter prospective testing of an integrated approach to early diagnosis of neonatal candidemia using newer molecular techniques is also needed. Candidemia in the infant is cause for prompt removal (or replacement) of central vascular catheters and institution of antifungal therapy. End-organ evaluation is also probably warranted to guide treatment and facilitate prognostication. Given the continuing progress in clinical research infrastructure and development of new diagnostic tests and antifungal agents, substantial improvement in the prevention, diagnosis, and management of neonatal candidemia is plausible over the next decade.

Candida↗
PubMed2003

Empirical therapy for neonatal candidemia in very low birth weight infants.

OBJECTIVE: Neonatal candidemia is often fatal. Empirical antifungal therapy is associated with improved survival in neonates and patients with fever and neutropenia. Although guidelines for empirical therapy exist for patients with fever and neutropenia, these do not exist for neonates. METHODS: A multicenter, retrospective, cohort study was conducted of neonatal intensive care unit patients (N = 6172) who had a blood culture (N = 21,233) after day of life 3 and whose birth weight was or=28 weeks. We developed a candidemia score on the basis of the ORs from the multivariable model. Children with a candidemia score >or=2 points were classified as having a "positive" score, and a score of >or=2 points had a sensitivity of 85% and a specificity of 47%. CONCLUSIONS: We developed a clinical predictive model for neonatal candidemia with high sensitivity and moderate specificity for candidemia. On the basis of our model, when a physician obtains a blood culture, the physician should consider providing antifungal therapy to neonates who are <25 weeks' estimated gestational age and to neonates who have thrombocytopenia at the time of blood culture. In addition, if a physician obtains a blood culture from a child who is 25 to 27 weeks' estimated gestational age and is not thrombocytopenic but has a history of third-generation cephalosporin or carbapenem exposure in the 7 days before the blood culture, then the physician should consider administration of empirical antifungal therapy.

Antifungal Agents↗
PubMed2003

Neonatal candidemia and end-organ damage: a critical appraisal of the literature using meta-analytic techniques.

OBJECTIVE: Neonatal candidemia is an increasing cause of infant morbidity and mortality. We evaluated the current medical literature in an effort to critique the literature and to document the reported prevalences of end-organ damage after neonatal candidemia. METHODS: We analyzed all peer-reviewed articles of neonatal candidemia published in the English language; inclusion criteria included a cohort limited to all neonatal intensive care unit admissions or all episodes of candidemia in neonates. Articles that also incorporated older patients, did not define a numerator and a denominator for at least 1 form of end-organ damage, included patients from other reports, or did not include all episodes of candidemia in the source population were excluded from the analysis. RESULTS: Thirty-four articles reported episodes of candidemia and mortality; 21 articles reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 articles reported prevalence for >4 forms of end-organ damage from the following list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% (interquartile range [IQR]: 0%-17%), of meningitis was 15% (IQR: 3%-23%), of brain abscess or ventriculitis was 4% (IQR: 3%-21%), of endocarditis was 5% (IQR: 0%-13%), of positive renal ultrasound was 5% (IQR: 0%-14%), and of positive urine culture was 61% (IQR: 40%-76%). The medical literature concerning end-organ evaluation after episodes of neonatal candidemia is heterogeneous and consists largely of single-center retrospective studies. Year that the data were collected and prevalence of neonates infected with Candida albicans were associated with observed heterogeneity. CONCLUSIONS: Given the heterogeneity of the medical literature, precise estimates of the frequencies of end-organ damage are not possible and a prospective multicenter trial is warranted, but the data from the published literature suggest that the prevalence of neonates with end-organ damage not only is greater than 0 but also is high enough that until such a prospective trial is completed, end-organ studies should be considered before the conclusion of antifungal therapy.

Candida albicans↗
PubMed2002

Thirty-day postoperative death rate at an academic medical center.

OBJECTIVE: To improve understanding of perioperative deaths at an academic medical center. SUMMARY BACKGROUND DATA: Because published data have typically focused on specific patient populations, diagnoses, or procedures, there are few data regarding surgical deaths and complications in institutional or regional studies. Specifically, surgical adverse events and errors are generally not studied comprehensively. This limits the overall understanding of complications and deaths. METHODS: Data from all operations performed in the main operating suite of the University of Virginia Health Sciences Center from January 1 to June 30, 1999, were compared with state death records to gain a dataset of patients dying within 30 days of surgery. All clinical records from patients who died were screened for adverse events and subsequently reviewed by three surgeons who identified adverse events and errors and performed comparisons with survivors. RESULTS: One hundred nineteen deaths followed 7,379 operations performed on 6,296 patients, yielding a patient death rate of 1.9%. Patients dying within 30 days of surgery were older and had higher American Society of Anesthesiologists scores. Of 119 deaths, 86 (72.3%) were attributable to the patient's primary disease. Twenty-three patient deaths (19.3% of all deaths, 0.37% of all patients) could not be attributed to the patient's primary disease and thus were suspicious for an adverse event (AE) as the cause of the death. Of the 23 deaths suspicious for AE, 15 (12.6% of all deaths, and 65.2% of AE deaths) followed an error in care and thus were classified as potentially preventable, affecting 0.24% of the study population. CONCLUSIONS: Overall, the 30-day postoperative death rate was low in the total surgical population at an academic medical center. Errors and AEs were associated with 12.6% and 19.3% of deaths, respectively. Retrospective review inadequately characterized the nature of AEs and failed to determine causality. Prospective audits of outcomes will enhance our understanding of surgical AEs.

Academic Medical Centers↗
PubMed2002

Pediatric residents' clinical diagnostic accuracy of otitis media.

OBJECTIVE: Pediatric resident physicians' clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry. METHODS: Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used kappa statistics to calculate correlation of clinical findings and interpretation. RESULTS: A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a kappa statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (kappa statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (kappa statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a kappa statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a kappa statistic of 0.32 (fair agreement). CONCLUSIONS: Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.

Acoustic Impedance Tests↗
PubMed2002

Facial cellulitis in childhood: a changing spectrum.

BACKGROUND: Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of the vaccine. METHODS: Records of patients discharged with a diagnosis of facial cellulitis or infections of the oral cavity were reviewed. Fisher's exact test was used to compare rates of cellulitis during the two decades. RESULTS: Trauma was the most common antecedent to facial cellulitis in both eras. Buccal cellulitis accounted for 7/25 (28%) of cases before Hib vaccination and 0/19 cases since. Pneumococcal buccal cellulitis was not seen in either decade. CONCLUSIONS: Buccal cellulitis due to Hib is a disappearing disease. Eighty-nine percent of recent inpatient cases of childhood facial cellulitis were related to trauma, tooth problems, or severe sinusitis. Facial cellulitis due to S pneumoniae is rare.

Bacteremia↗
PubMedDate not supplied

Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills.

BACKGROUND: There is no gold standard readily available in several components of the routine physical exam: one example is the otoscopic exam, where the gold standard is confirmation by tympanocentesis. Resident education does not typically include routine assessment by the gold standard, making estimates of trainee performance extremely difficult. This is one reason why the otoscopic examination is difficult to teach. Available techniques can assess diagnostic exams when there is no gold standard-one of these is latent class analysis. METHODS: We use latent class analysis, a form of regression analysis, to compare the ability of pediatric residents to diagnose effusion with pediatric otolaryngologists and tympanometry. We briefly outline the technique of how to complete latent class analysis and provide an operational plan to use the method to assess resident performance. RESULTS: The sensitivity and specificity of pediatric resident otoscopic examination to diagnose the presence of effusion was 72% and 84%, respectively. Pediatric otolaryngologist sensitivity and specificity was 91% and 82%; tympanometry had a sensitivity of 70% and specificity 76%. Our estimates of the performance of otolaryngologists and tympanometry to diagnose effusion were the same as previously reported when these diagnosticians have been compared with the gold standard of tympanocentesis. CONCLUSIONS: Latent class analysis can help estimate otoscopic examination performance of residents. This technique can be incorporated into assessment in medical education.

Acoustic Impedance Tests↗