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Biomedical subjects

Elizabeth DeLong

Publications and source records attributed to Elizabeth DeLong.

4 recordsLinked to original sources
PubMed2004

Mortality following blood culture in premature infants: increased with Gram-negative bacteremia and candidemia, but not Gram-positive bacteremia.

OBJECTIVE: To describe survival following nosocomial bloodstream infections and quantify excess mortality associated with positive blood culture. STUDY DESIGN: Multicenter cohort study of premature infants. RESULTS: First blood culture was negative for 4648/5497 (78%) of the neonates--390/4648 (8%) died prior to discharge. Mortality prior to discharge was 19% in the 161 infants with Gram-negative rod (GNR) bacteremia, 8% in the 854 neonates with coagulase negative staphylococcus (CONS), 6% in the 169 infants infected with other Gram-positive bacteria (GP-o), and 26% in the 115 neonates with candidemia. The excess 7-day mortality was 0% for Gram-positive organisms and 83% for GNR bacteremia and candidemia. Using negative blood culture as referent, GNR [hazard ratio (HR)=2.61] and candidemia (HR=2.27) were associated with increased mortality; CONS (HR=1.08) and GP-o (HR=0.97) were not. CONCLUSIONS: Nosocomial GNR bacteremia and candidemia were associated with increased mortality but Gram-positive bacteremia was not.

Bacteremia↗
PubMed2003

Evaluation of the dofetilide risk-management program.

BACKGROUND: Dose-dependent torsades de pointes has been shown to occur with dofetilide (Tikosyn) and sotalol HCl (Betapace AF); thus, detailed dosing and monitoring recommendations to minimize this risk are included in the product labeling for both drugs. Only dofetilide, however, has a mandated risk-management program that restricts distribution of the drug and requires prescriber education on the drug. We investigated whether this program improved adherence to dosing and monitoring recommendations for dofetilide as compared with sotalol. METHODS: Charts for 47 patients taking dofetilide and 117 patients taking sotalol were reviewed. RESULTS: The recommended starting dose was prescribed more frequently in the dofetilide group than in the sotalol group (79% vs 35%, P <.001). A higher number of patients in the dofetilide group compared with the sotalol group received the recommended baseline tests for potassium (100% vs 82%, P <.001), magnesium (89% vs 38%, P <.001), serum creatinine (100% vs 82%, P <.001), and electrocardiography (94% vs 67%, P <.001). A significantly greater proportion of patients in the dofetilide group received recommended electrocardiograms obtained after the first dose (94% for dofetilide vs 43% for sotalol, P <.001) and subsequent doses (80% for dofetilide vs 3.5% for sotalol, P <.001). CONCLUSION: Better adherence to several dosing and monitoring recommendations in the dofetilide group may be caused by the presence of the risk-management program. However, low usage of dofetilide during the study period may signify an unintended, negative consequence of the risk-management program.

Arrhythmias, Cardiac↗
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↗