Biomedical subjects

David Fleming

Publications and source records attributed to David Fleming.

8 recordsLinked to original sources

PubMed2004

Improving fairness in coverage decisions: performance expectations for quality improvement.

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.

Advisory Committees↗

PubMed2003

The use of stimulated granulocyte transfusions to prevent recurrence of past severe infections after allogeneic stem cell transplantation.

The predictable neutropenia that follows allogeneic stem cell transplantation (ASCT) may be associated with recurrence of previous life-threatening infection. We describe nine patients with either previous invasive aspergillosis (IA) or considered to be at high risk of developing IA who underwent ASCT with prophylactic granulocyte transfusions. The study group, when compared with a control group, had a significant reduction in the incidence and duration of fevers (P < 0.05) and maximum C-reactive protein (P < 0.05). There were significantly fewer days of neutropenia (P < 0.05). There was also radiological improvement of pulmonary infiltrates in four out of seven assessable patients. No serious toxicity was encountered in donors or recipients. We conclude that prophylactic granulocyte donations can be given safely, and that they significantly reduce the number of days of neutropenia. Further investigation is warranted to determine whether granulocyte donations can prevent the recurrence of IA in patients at risk of fungal infection.

Adult↗

PubMed2002

Sexual behaviors in an urban bathhouse 15 years into the HIV epidemic.

OBJECTIVE: To characterize the population and sexual behaviors of men currently attending gay bathhouses. METHODS: Men entering a bathhouse in Portland, Oregon, were asked to complete a one-page questionnaire. Data collection ended when 1000 surveys were obtained. Questionnaires assessed demographics, self-reported HIV status, drug and alcohol use, and sexual behavior in the preceding 30 days. RESULTS: The estimated response rate was 80%-90%. Of 1000 respondents, 829 (83%) reported having anal or oral sex at a bathhouse in the previous 30 days, 715 (86%) engaged in oral sex, 420 (51%) in anal sex, and 89 (11%) in high-risk (unprotected anal) sex. In multivariate analysis, characteristics associated with men reporting high-risk sex compared with men reporting other sexual activities at the bathhouse were HIV infection (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.02-4.0); >or= 5 sexual partners in previous 30 days (OR, 3.2; 95% CI, 2.0-5.3); having anonymous sex at other sites (OR, 2.1; 95% CI, 1.2-3.8). CONCLUSIONS: Although most bathhouse patrons engaged in lower risk activities, those reporting unprotected anal sex were more likely to report HIV infection and to have multiple sexual partners. Well into the HIV epidemic, bathhouses remain venues for ongoing spread of HIV and opportunities for intervention.

Adult↗

PubMed2002

Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings.

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.

Adult↗

PubMed2002

A Nationwide Learning-Style Assessment of Undergraduate Athletic Training Students in CAAHEP-Accredited Athletic Training Programs.

OBJECTIVE: To identify the learning styles and preferred environmental characteristics of undergraduate athletic training students in Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs and to determine if learning-style differences existed among geographic regions of the country. DESIGN AND SETTING: Fifty CAAHEP-accredited athletic training programs were randomly selected in proportion to the number of programs in each geographic region. Ten students from each school were selected to complete the Kolb Learning Style Inventory (LSI) and the Productivity Environmental Preference Survey (PEPS). SUBJECTS: A total of 193 undergraduate athletic training students (84 men, 109 women) with a mean age of 22.3 +/- 2.8 years completed the PEPS, while 188 students completed the LSI. MEASUREMENTS: We used chi-square analyses to determine if differences existed in learning-style type and if these differences were based on geographic location. We calculated analysis of variance to determine if there were any geographic differences in the mean overall combination scores of the LSI. Descriptive statistics were used to evaluate the PEPS. RESULTS: The overall return rate was 38%. The chi-square analyses revealed no significant difference in learning-style type for athletic training students, regardless of the geographic region. The LSI yielded a relatively even distribution of learning styles: 29.3% of the students were accommodators, 19.7% were divergers, 21.8% were convergers, and 29.3% were assimilators. The overall mean combination scores were 4.9 (abstract-concrete) and 4.9 (active-reflective), and analysis of variance indicated no significant difference in the mean combination scores among the geographic regions. The PEPS revealed that undergraduate athletic training students demonstrated a strong preference for learning in the afternoon. CONCLUSIONS: Undergraduate athletic training students demonstrated great diversity in learning style. Educators must strongly consider this diversity and incorporate teaching methods that will benefit all types of learners.

Journal Article↗

PubMedDate not supplied

Pathology, prognosis, and prevention of heart failure.

Optimal management of patients with heart failure (HF) should be guided by thorough evaluation and use of functional classification and disease staging systems. Though the understanding of precise underlying pathophysiological mechanisms has increased dramatically in recent years, it is essential to continue the search for greater efficacy in preventing, controlling, and reversing this pathological state. Recent developments in the diagnosis and treatment of heart failure have improved prognosis in terms of both survival and morbidity due to re-hospitalization. The underutilization of medical and preventive therapies in patients with heart failure is a major public health issue, despite the recommendations of various evidence-based guide lines. Patient education and disease management programs have been shown to optimize HF-management by bridging the gap between evidence-based medicine and clinical practice, thereby, reducing hospitalization rate. This paper, the first in a series of three papers, will identify the pathology, prognosis and prevention of heart failure, while the paper to follow will discuss modern methods of interventional management.

Heart Failure↗

PubMedDate not supplied

Evidence-based drug treatment of heart failure.

Modern management strategies have revolutionized the treatment of patients with acute and chronic heart failure (HF). Physicians should identify the risks and benefits of each drug or interventional option being considered for the treatment of HF. Inhibition of the neurohormonal axis with angiotensin converting enzyme (ACE) inhibitors and beta-blockers has significantly improved morbidity and mortality of patients with chronic HF. An aggressive approach targeted at improving hemodynamics and end-organ function is warranted during acute exacerbations or decompensated heart failure. Immediate recognition and management of potentially reversible causes and simultaneous initiation of supportive therapy to augment the cardiac output are key elements to the successful treatment of acute heart failure.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Modern surgical and interventional options for the management of heart failure.

Current standard drug therapy provides only palliative and symptomatic relief for patients with severe heart failure, but there is now a wide array of device applications that holds great promise for reducing the mortality and disability that result from heart failure. Patients with severe chronic and refractory heart failure should be considered for heart transplantation or mechanical circulatory supportwith a ventricular assist device. Newer surgical and interventional treatments are in continuous evolution.

Cardiac Pacing, Artificial↗