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Biomedical subjects

J C Wade

Publications and source records attributed to J C Wade.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of new anti-infective drugs for the treatment of febrile episodes in neutropenic patients. Infectious Diseases Society of America and the Food and Drug Administration.

The use of empirical antimicrobial therapy has significantly reduced the morbidity and mortality associated with untreated infections in febrile neutropenic patients. This guideline describes clinical trials of the safety and efficacy of new antimicrobial drugs in this population of patients. Fever and neutropenia should be precisely defined in each protocol. Patients should be randomized to treatment with a new or active-control drug regimen, stratified on the basis of type of cancer and age, and treated until resolution--as defined in the protocol--is attained. Outcome should be assessed both for cases with a defined microbial etiology and for those without. Final microbiological outcome is important for cases with identified pathogens, but clinical outcome is paramount.

Anti-Infective Agents↗
PubMed1992

Socialization groups: using The Book of Questions as a catalyst for interaction.

This article describes the use of The Book of Questions (Stock, 1987) as a tool for assessment and as a catalyst for social interaction in an acute short-term inpatient psychiatric unit. Examples of questions and how they can be used to provide information for the evaluation of personality style and social and interpersonal skills are provided. Group objectives, membership criteria and format, and leadership techniques are discussed. Analysis of the group activity and patients' responses to the group indicates that a group structured around The Book of Questions facilitates social interaction and is easily transferable to social activities outside of the structured therapeutic group setting and hospital environment.

Communication↗
PubMed1991

Herpes simplex virus infection in the immunocompromised cancer patient.

The development of infection remains a significant source of morbidity and mortality in the oncology patient. This patient population is at increased risk for infection because of alterations in cell-mediated immunity generated by the underlying neoplastic process and/or immunosuppressive therapy. Viral infection, particularly that attributable to herpes simplex virus (HSV), is being seen with increased frequency in the oncology patient. Because effective therapy is available with the early use of antiviral agents, it is important to be aware of the potential for viral infection and to recognize the signs and symptoms that are evident early in its course. An overview of HSV infection is provided here, including discussion of the virus itself, its pathogenesis, its clinical spectrum, and current prophylactic and therapeutic approaches.

Herpes Simplex↗
PubMed1990

Effect of granulocytopenia on oral microbial relationships in patients with acute leukemia.

Risk for acute infection increases as granulocyte levels decrease secondary to myelosuppressive chemotherapy in patients with acute nonlymphocytic leukemia (ANLL). Acute exacerbations of concomitant inflammatory periodontal diseases can result in systemic infections in these patients. However, host-oral bacterial relationships in the periodontium in patients with ANLL are not well understood. Twenty-one adult patients with ANLL with periodontal disease ranging from gingivitis to severe periodontitis were studied. Supragingival and subgingival plaque specimens were collected before chemotherapy (prechemotherapy), and at a defined midpoint of myelosuppression (midchemotherapy; day 14). All specimens were extensively cultured both aerobically and anaerobically. Data were submitted to a partial correlational analysis, controlling for covariation relation to oral hygiene intervention and antibiotic administration. Levels of total yeast exhibited a significant association with Staphylococcus sp. at supragingival sites midchemotherapy (r = 0.68, p less than or equal to 0.05). Levels of total yeast also correlated positively with Pseudomonas aeruginosa at subgingival sites both prechemotherapy (r = 0.70, p less than or equal to 0.01) and midchemotherapy (r = 0.61, p less than or equal to 0.05). Significant correlations of levels of Veillonella sp. with Neisseria sp. and gram-negative enteric bacilli were observed in both supragingival (r = 0.95, 0.77, p values less than or equal to 0.01) and subgingival (r = 0.69, 0.61, p values less than or equal to 0.05) plaque specimens midchemotherapy but not prechemotherapy. These data suggest that potentially pathogenic bacteria occur in plaque simultaneous with granulocytopenia in these patients. Multiple mechanisms, including intergeneric coaggregation and other symbiotic relationships, may influence infectivity of the mixed plaque flora and thus contribute to the oral ecology observed in these patients.

Adult↗
PubMed1990

In vitro activity of ciprofloxacin in combination with ceftazidime, aztreonam, and azlocillin against multiresistant isolates of Pseudomonas aeruginosa.

The combinations of ciprofloxacin plus ceftazidime, ciprofloxacin plus aztreonam, and ciprofloxacin plus azlocillin were evaluated for the presence of synergy against multiresistant isolates of Pseudomonas aeruginosa. The frequency of synergy was dependent on antibiotic susceptibilities. If the organism was resistant to ciprofloxacin, synergy was observed in more than 50% of the isolates; however, if the organism was resistant to the beta-lactam (with the exception of ceftazidime), synergy was generally observed in less than 10% of the isolates. Antagonism was not observed with any of the combinations. These results may be helpful in making clinical decisions in treating P. aeruginosa infections.

Azlocillin↗
PubMed1989

Venous access devices utilized in association with intensive cancer chemotherapy.

Consistent and reliable venous access is a major component of the management of patients with cancer undergoing chemotherapy. Venous access devices such as the long-term right atrial catheter and the subcutaneous port have become a major aspect of the supportive care of such individuals, with resultant advantages which have improved their quality of life. Yet, the occurrence of infectious and non-infectious complications restricts the usefulness of these devices and warrants a standardized approach to device placement, patient education and the management of such complications. Infectious complications, including exit site and tunnel infections, as well as bacteremias requiring catheter removal occur at a rate of approximately two episodes for every 1000 catheter days, while non-infectious complications occur more frequently. Uniform patient education and catheter care, as well as placement by a single consistent surgeon will decrease the frequency of complications, improve the longevity and function of these venous access devices, while minimizing the associated morbidity.

Antineoplastic Agents↗
PubMed1989

Choosing an appropriate implantable device for long-term venous access.

A variety of devices is now available for venous access in patients requiring long-term infusions of chemotherapeutic agents, hyperalimentation solutions, blood products or antibiotics. All have advantages and disadvantages which may make the selection of one type of device appropriate under a given set of circumstances but inappropriate in another. Experience has shown that patients needing intensive therapy for hematologic malignancies are best served by lines that require minimal dissection for insertion, such as the Hickman catheter. Patients who are unlikely to hemorrhage at the time of insertion and who need only intermittent therapy can take advantage of the greater convenience and cosmetic appearance of a totally implantable port. Peripheral vein cannulation by means of fine silicone rubber catheters can be performed by trained intravenous nurses to provide access of intermediate duration without the expense and inconvenience of surgical insertion in an operating room.

Catheterization, Central Venous↗
PubMed1989

A prospective evaluation of optimal sampling theory in the determination of the steady-state pharmacokinetics of piperacillin in febrile neutropenic cancer patients.

We examined the use of optimal sampling theory in the determination of the pharmacokinetics of piperacillin in febrile, neutropenic cancer patients. Patients were studied prospectively as part of a randomized, double-blind clinical trial of piperacillin and amikacin versus imipenem and placebo. The results from the analysis of 5 optimal samples were compared with those derived from 15 concentration determinations (10 samples, with the 5 optimal samples assayed in duplicate). The use of a standard least-squares estimator as opposed to a bayesian estimator, with normal prior distributions placed on beta and serum clearance, was also examined. Finally, the use of duplicate determinations in improving the precision of parameter estimation was studied. Plasma concentrations obtained at time points determined by optimal sampling theory, when analyzed with a bayesian estimator, produced estimates of pharmacokinetic parameter values that were in good agreement with those derived from the 15-determination set. Duplicate assay did not improve the precision of parameter estimation. Estimation of plasma clearance was quite robust, irrespective of the estimator used, probably because this evaluation was performed at steady state. Optimal sampling theory is a promising technique that can be employed to determine patient-specific estimates of pharmacokinetic parameter values in target populations.

Adolescent↗
PubMed1989

The use of a DNA probe for epidemiological studies of candidiasis in immunocompromised hosts.

Reproducible typing procedures to differentiate isolates of Candida albicans are limited. C. albicans isolates were obtained from immunocompromised patients by using DNA restriction enzyme fragment analysis and hybridization with both a radiolabeled mitochondrial DNA probe and a nonradioactive (biotinylated) DNA probe. There were 110 pathogenic and nonpathogenic C. albicans isolates from 63 immunocompromised patients. EcoRI restriction fragment analysis with the biotinylated probe revealed different "fingerprint" patterns for 60 of 63 patients. Analysis of 57 isolates from 20 patients showed no intrapatient variation regardless of the isolation site. DNA probe "fingerprint" patterns were analyzed for eight patients on serially recovered (range, 2-18 mo) C. albicans isolates. The unique patient profiles persisted over time. The application of this biotinylated C. albicans DNA probe provides a more sensitive means than simple gel restriction fragment analysis to define the epidemiology of C. albicans infection. The use of this biotin-labeled nonradioactive probe has potential application in clinical evaluations of outbreaks of nosocomial candidiasis.

Biotin↗
PubMed1988

Bacillus infections in patients with cancer.

Eighteen febrile patients experienced 24 episodes of Bacillus bacteremias from January 1978 to June 1986. Bacillus species isolated included Bacillus cereus (eight cases), Bacillus circulans (three), Bacillus subtilis (two), Bacillus pumilus (two), Bacillus licheniformis (one), Bacillus sphaericus (one), Bacillus coagulans (one), and six that could not be speciated. Fifteen patients had lymphoma or leukemia and three had breast cancer. Nine patients were neutropenic (polymorphonuclear neutrophil count, less than 1.0 x 10(9)/L), seven patients had a Hickman catheter in place, and 14 had recently received chemotherapy. Twelve of the bacteremic episodes were clinically significant, and four of these 12 involved Hickman catheters. Catheter removal was ultimately necessary in all four patients. Scanning and transmission electron microscopy was performed on one of the removed Hickman catheters and showed Bacillus organisms embedded in a biofilm composed of gram-positive cocci and glycocalyx. Bacillus species were uniformly susceptible to vancomycin, imipenem, and aminoglycosides, with penicillin susceptibilities being variable. Bacillus appears to be another gram-positive organism now being recognized as a bacterial pathogen for compromised hosts. When such infections involve long-term indwelling venous access devices, treatment should include immediate catheter removal as well as antibiotic therapy.

Adolescent↗