Biomedical subjects
E Larson
Publications and source records attributed to E Larson.
A case of resistant tuberculosis.
We report a case of multiple drug-resistant pulmonary tuberculosis, in which treatment with two second line chemotherapy regimens was inadequate. Despite in-vitro sensitivity to ciprofloxacin the patient remained sputum positive with Mycobacterium tuberculosis after 11 months.
Low-dose alternate-day pyrimethamine for maintenance therapy in cerebral toxoplasmosis complicating AIDS.
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Clinical and laboratory findings in the Paul-Bunnell negative glandular fever-fatigue syndrome.
Forty-one patients with recurrent fatigue were studied for evidence of symptom clustering, abnormal laboratory findings and infection with novel viruses. Symptom enquiry and investigations were repeated 4 months later. Four patients were found to have diseases compatible with their symptoms. In those remaining, an initial acute onset of symptoms was associated with an intermittent course, tender glands and a raised number of T suppressor lymphocytes. Raised numbers of T suppressor lymphocytes at follow-up correlated with resolution of symptoms. Antibodies to human herpesvirus 6 (HHV-6) were found in 75% of the patients as compared to 53% of a control group and more patients than controls were strongly seropositive. Some patients with chronic fatigue have a pattern of illness which suggests glandular fever, although acute infection with Epstein-Barr virus (EBV) is not demonstrated. Primary or reactivation infection with HHV-6 may have a role in this syndrome.
Occurrence of infectious symptoms in children in day care homes.
Transmission of enteric pathogens is facilitated in child day care centers, including family day care homes, by frequent and intimate exposure among susceptible hosts, with diaper changing as the highest-risk procedure for such transmission. The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period. Each of 24 family day care homes was randomly assigned to an intervention or control group. The intervention included four components: (1) a handwashing educational program and (2) use of vinyl gloves, (3) use of disposable diaper changing pads, and (4) use of an alcohol-based hand rinse by the day care provider. Symptoms of enteric disease (diarrhea and vomiting) were significantly reduced in intervention family day care homes (p less than or equal to 0.05), whereas respiratory symptoms were not significantly different between intervention and control family day care homes (p = 0.35). Diarrhea was reported in 1 of every 100 child care days, representing one diarrhea episode per month in a typical family day care home.
Preventing and treating human immunodeficiency virus infection in the homeless.
The problem of human immunodeficiency virus infection in the homeless has received little attention in the literature but is a cause for serious concern. Nineteen health care agencies were studied to explore the types and outcomes of programs targeting this population, and factors associated with prevention and treatment strategies. The results showed that a variety of services were provided, but that little formal evaluation had been conducted. Factors identified were population variability, altered health status, daily survival, provider role conflicts and attributes, and a so-called nonsystem of care. The numerous gaps in knowledge about human immunodeficiency virus infection in the homeless inform future psychiatric nursing care and research.
Encephalitis due to Epstein-Barr virus.
Acute encephalitis due to Epstein-Barr virus is described. The initial diagnosis was based on clinical features and a positive Monospot test. Early treatment with intravenous acyclovir was given; steroids were not used. The patient made a rapid and complete recovery from a comatose state. The effectiveness of acyclovir in this condition remains unproven but early treatment is recommended in severely ill patients whose prognosis is uncertain.
Handwashing: are experimental models a substitute for clinical trials? Two viewpoints.
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Leakage of virus through used vinyl and latex examination gloves.
A total of 480 examination gloves (240 vinyl and 240 latex) were stressed by using manipulations designed to mimic patient care. At the highest use level, 38 (63%) of 60 vinyl gloves leaked bacteriophage phi X174 compared with 4 (7%) of 60 latex gloves. At lower use levels, there was no statistically significant difference in leakage.
Infection control programmed instruction: an alternative to classroom instruction in baccalaureate nursing education.
The purpose of this study was to determine whether self-managed learning in the form of a programmed unit of instruction (PUI) in the basic principles of infection control is an acceptable alternative to a standard lecture format for teaching infection control to nursing students. A sample of 108 subjects was selected from third-year baccalaureate nursing students at two universities. The subjects were randomly assigned to two groups. The experimental group was given the pretest, the PUI (treatment), the post-test, and a Likert scale opinionnaire of the PUI. The control group was pretested and presented the same content in a lecture format, then post-tested. A pretest-post-test control group design was used for data analysis and a one-way analysis of covariance was performed on the post-test means of the groups. Analysis of covariance (ANCOVA) was applied to the post-test means of the groups, with pretest scores and educational setting as covariates. Results indicate that nursing students who complete an infection control PUI score higher on post-tests than those who attend a lecture (p less than .001), regardless of pretest scores and educational setting. Subjects using the PUI also preferred this format and found the content manageable.
Coping with AIDS and HIV.
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Multimodality approach to a massive carcinoma of the vulva.
The presentation, combination therapy and clinical course of a patient with a massive vulvar carcinoma are described. Therapeutic aspects in the treatment of such advanced malignancies are considered. A multimodality approach to locally advanced, unresectable vulvar carcinomas may benefit this group of patients.
Searching the literature: a professional imperative.
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Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel.
Four handwashing products (containing either 2% chlorhexidine gluconate, 0.6% parachlorometaxylenol, 0.3% triclosan, or a nonantimicrobial control) at two handwashing frequencies (6 or 18 times/day) were compared with regard to their effectiveness in reducing colonizing hand flora. Eighty adult volunteers were assigned by block randomization to one of the four products and one of the two frequency schedules (n = 10/group) and washed their hands under supervision for 5 consecutive days. There were no significant differences between products in mean log10 colony-forming units after the initial wash (p = 0.61), nor were there significant differences in products after 5 days among subjects washing six times per day. For those who washed 18 times per day, however, the effectiveness of all three antimicrobial soaps was significantly better than that of the control soap (p less than 0.05). Chlorhexidine gluconate produced significantly greater reductions than triclosan or parachlorometaxylenol (p less than 0.05), which were not significantly different from each other. On the basis of these findings an antimicrobial soap is recommended when handwashing frequency is high and a long-term reduction in colonizing flora is desirable. When handwashing frequency is low (6 times/day), there seems to be less advantage of one product over another, although the use of chlorhexidine gluconate resulted in greater reductions at both high and low handwashing frequencies.
The infection control community's response to the Agenda for Change.
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Regulation of topical antimicrobials: history, status and future perspective.
Antimicrobial agents used as disinfectants and antiseptics are increasing in epidemiologic importance. The regulation of topical antiseptics has ranged from nonexistent, lax and confusing to inclusion in the Food and Drug Administration (FDA) over-the-counter (OTC) review of drug ingredients. This article simplifies the complex history, current status and future possibilities for the hospital use of topical antiseptic products.
An early historical perspective on the FDA's regulation of OTC drugs.
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Attribution of control in psychiatric residents.
At quarterly intervals in 1986-87, attribution of control and subjective symptom ratings were assessed among the 42 general psychiatry residents in the University of Cincinnati's training program. Within each of the four groups of residents (that is, the residents in each postgraduate year), ratings remained stable over time. Between-group differences were significant for ratings of internal locus of control, but the external locus of control ratings showed no corresponding fluctuation. The internal locus of control scores were inversely correlated with psychological distress as reported in the Brief Symptom Inventory.