PubMed Health⌕ Search

Biomedical subjects

J C Levy

Publications and source records attributed to J C Levy.

At least 91 records · Page 5Linked to original sources
PubMed1985

Renal disposition of gentamicin, dibekacin, tobramycin, netilmicin, and amikacin in humans.

The tubular disposition of five aminoglycosides was studied in humans to establish a possible relationship between tubular reabsorption and the nephrotoxicity that has been described in the literature. Thirty-three healthy male volunteers received a continuous intravenous infusion of isotonic saline with inulin, followed 1 h later by inulin plus gentamicin, dibekacin, tobramycin, netilmicin, or amikacin (1 mg/kg per h) or amikacin (4 mg/kg per h) over a period of 2 h. Brain-stem-evoked response audiometry was performed both before and at the end of each infusion. The latency of wave V remained constant whichever antibiotic was considered. The glomerular filtration rate did not vary significantly during the infusion of each drug. The percent fractional excretion was 79 +/- 6, 81 +/- 22, 85 +/- 5, and 99 +/- 9 for gentamicin, dibekacin, tobramycin, and netilmicin, respectively, and 83 +/- 4 and 124 +/- 13 for amikacin at concentrations of 1 and 4 mg/kg per h, respectively. Net balance and renal clearance were similar for the five aminoglycosides when administered at a rate of 1 mg/kg per h. With gentamicin only, fractional excretion was correlated with the urinary flow rate. We can conclude that (i) gentamicin, generally considered the most nephrotoxic agent, had the highest degree of net reabsorption; (ii) netilmicin exhibited a net zero tubular balance; (iii) amikacin had different patterns of tubular disposition according to the dose, i.e., reabsorption at 1 mg/kg per h and secretion at 4 mg/kg per h, raising the hypothesis of a saturable process of reabsorption; and (iv) these differences in tubular reabsorption could account at least in part for the known different nephrotoxic potentials of these five aminoglycosides in humans.

Adult↗
PubMed1982

Failure to thrive: diagnostic yield of hospitalisation.

Review of hospital records of 122 infants, aged between 1 and 25 months, admitted to a teaching hospital with the diagnosis of failure to thrive but without an underlying disease apparent at admission, showed that about one-third of them had no diagnosis after evaluation. Thirty-two per cent were thought to have a social or environmental explantation for poor growth, and 31% were given a specific organic or physiological diagnosis. Of the last group, 2 out 3 were diagnosed as having either gastro-oesophageal reflux or non-specific chronic diarrhoea. Vomiting was often associated with organic or structural disease. On average about 40 laboratory tests and x-ray films were performed per infant, but only 0.8% of all tests showed an abnormality which contributed to the diagnosis of the cause of failure to thrive. Our results stress the importance of social and environmental factors as basic causes of failure to thrive, and suggest that admission to hospital and laboratory testing is unlikely to lead to a specific organic diagnose in a child whose failure to thrive is unexplained after careful history taking and a physical examination.

Child, Preschool↗
PubMed1980

Patient and provider factors associated with selected measures of quality of care.

Studies assessing quality of general pediatric care are handicapped by (1) lack of explicit criteria, (2) the broad spectrum of medical needs presented, and (3) the need to distinguish between influence of patient and provider factors. In this study, part of a comprehensive study of utilization of pediatric services at five sites (three neighborhood health centers, an emergency room, and a hospital-based primary care program), we selected three measures sampling different aspects of quality of care, including (1) immunization status, (2) screening procedures, and (3) ongoing care for ten tracer conditons. Adequacy of follow-up of the tracer conditions was assessed along two dimensions: (1) whether a return appointment was scheduled, and (2) whether the patient kept the appointment ("compliance"). Results indicate that attainment of fully immunized status varies inversely with age, while for the tracer conditions, arrangement of follow-up (provider factor) was associated with site, and compliance (patient factor) was associated with both site and pattern of use. Accomplishment of follow-up was better for patients diagnosed in a primary care facility than in the emergency room and for patients with close ties to a primary care facility than for those with limited or no involvement with primary care. These findings support the value of continuity of care in a setting designed to deliver comprehensive care.

Child↗
PubMed1980

Use of primary care facilities by patients attending specialty clinics.

The health care patterns of 158 children attending a medical specialty clinic at least twice a year were studied. The families were interviewed about (1) use of a primary care source, (2) continued contact with the referring physician, and (3) perceived health needs. For almost one third of the children, no source of primary care was reported. This group contained a higher percentage of older children and children from the urban center than did the group as a whole. No differences were attributable to insurance coverage. Of patients referred by a primary care provider, 62% were still in contact with that provider, whereas only 20% referred from another hospital-based program were still in touch with that program. Of the children attending specialty clinics 60% had other perceived health needs. Thirty-eight percent of the families reported health problems that they had never discussed with any medical provider. This study indicates that a large proportion of children with frequent attendance at specialty clinics perceive the hospital as the source of all their care. Health planners and providers need to take this patient perception into account as they design and manage programs for chronically ill children.

Adolescent↗
PubMed1980

Vulnerable children: parents' perspectives and the use of medical care.

In a study of use of five general pediatric services, 750 parents were interviewed on site about their decisions on how and when to seek medical care for their children. Parents' fears that a particular child was "vulnerable"--ie, uniquely threatened by an episode of illness--was a recurrent concern (reported by 27%), explaining many of their medical visits. Medical record review indicated that in 40%, there was no clinical basis for these parent concerns. One important source of these unwarranted concerns was fear of recurrence of an earlier medical problem, long since resolved. In some families, the role of social and environmental issues in generating a high level of concern was evident. Vulnerable children made more visits per year and made many more of their visits to the emergency room, and their parents more often expressed dissatisfaction with care received. Recognition of reasons underlying parents' sense of the child's special status may do much to allay unnecessary fears and promote more appropriate use of health care facilities.

Adult↗
PubMed1979

Controlled clinical trial of pediatric telephone protocols.

A randomized clinical trial of pediatric protocols administered by health assistants demonstrated an alternate method of handling telephone complaints in a large emergency room. The new system advised a higher medical examination rate than the current system in the emergency room probably bacause the current system has deficits with respect to collecting necessary information and making explicit decisions. This higher rate of recommended visits demonstrated in the emergency room was not confirmed in the two pediatric primary-care settings in which the protocol system was also tested. In addition to this use, the telephone protocols may also be useful in training medical and nursing students, in handling telephone complaints similar to a poison control center, in triaging problems in a rural or emergency medical service, and in providing a record of the telephone call.

Age Factors↗
PubMed1979

Development and field testing of protocols for the management of pediatric telephone calls: protocols for pediatric telephone calls.

Although telephone calls comprise almost one fourth of all childhood patient-physician contacts, the content of telephone care is not emphasized in most educational and service programs. In response to the need to improve management of telephone calls to our pediatric emergency room, we developed 28 protocols to deal with the 25 most common complaints presented by phone. This paper describes the content of these protocols, the training of the health assistants who administered them, and the measures we took to assure their safety and general utility in pediatric practice settings. The study demonstrates the feasibility of an organized system for telephone care based on protocols which include: (1) basic data to be collected for each chief complaint category; (2) a range of appropriate dispositions; and (3) advice for home management when the patient does not require an immediate medical visit. Potential uses of these protocols for medical and nursing education and for clinical service needs are discussed.

Age Factors↗
PubMedDate not supplied

A genetic analysis of type 2 (non-insulin-dependent) diabetes mellitus in Punjabi Sikhs and British Caucasoid patients.

A genetic analysis of diabetic and non-diabetic Punjabi Sikhs (n = 164) was made for markers of non-insulin-dependent diabetes mellitus using insulin receptor, insulin, and HLA-D alpha chain gene probes. Additionally British Caucasoids (n = 163) were studied using the insulin receptor probe. Insulin receptor gene restriction fragment length polymorphisms were defined using Southern blot techniques and the restriction enzyme Bgl II and BAm Hl. In Punjabi Sikhs and British Caucasoids neither of the restriction fragment length polymorphisms distinguished non-insulin-dependent diabetes mellitus subjects from controls. In the Sikhs no association with non-insulin-dependent diabetes mellitus was seen with the hypervariable region of the insulin gene or with HLA-DR/DQ/DX alpha chain restriction fragment length polymorphisms. We therefore conclude that despite the high prevalence of non-insulin-dependent diabetes mellitus in Asians we were unable to find any genetic markers for this disease using the available cloned gene probes.

Diabetes Mellitus, Type 2↗