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Biomedical subjects

J F Keith

Publications and source records attributed to J F Keith.

15 recordsLinked to original sources
PubMed1995

Sensitivity and specificity of rapid diagnostic tests for detection of group B streptococcal antigen in bacteremic neonates.

Latex particle agglutination (LPA) testing for antigen to group B streptococcus (GBS) has been useful in the diagnosis of GBS sepsis in newborns. However, recent reports have demonstrated that the sensitivity of LPA assays may be as low as 27 to 54%. The purposes of the present study were to directly compare the abilities of four urine antigen assays to detect GBS antigen with clinical urine samples from neonates with GBS bacteremia and to evaluate the effect of the urine concentration on the sensitivities and specificities of these assays. Urine samples were collected serially from neonates with blood cultures positive for GBS or on admission from healthy full-term infants. One milliliter of urine was removed, and the remainder was concentrated to a volume of 1 ml. Unconcentrated samples were serially diluted with normal saline and were assayed to determine the highest dilution which would produce a positive test result. The Wellcogen, Bactigen, and Directigen LPA tests and ICON immunoassay were directly compared by using concentrated and unconcentrated urine specimens and urine specimens with known titers. A total of 94 urine specimens, including 61 concentrated and 75 unconcentrated specimens, from bacteremic infants were available for sensitivity testing, and 220 urine specimens from uninfected infants were available for specificity testing. There were significant differences in sensitivity among the four assays when they were performed on concentrated urine specimens, as follows: Directigen, 98%; Bactigen, 92%; ICON, 89%; Wellcogen, 68%. When the assays were performed on unconcentrated urine specimens, the Directigen (84%) and Bactigen (76%) assays were each significantly more sensitive than the ICON (59%) or Wellcogen (43%) assay. All four assays were significantly more sensitive in detecting GBS antigen in concentrated than in unconcentrated urine. The Directigen assay detected antigen in higher dilutions (geometric mean titer, 1:5) than the ICON (1:3), Bactigen (1.2), or Wellcogen (1:1) assay. The specificity was 99.5% for all four assays when concentrated urine was used and for the Bactigen, Directigen, and ICON assays when unconcentrated urine was used; the Wellcogen assay was 100% specific when unconcentrated urine was used. We conclude that there are significant differences in sensitivity but not specificity among the commercially available assays for the detection of GBS antigenuria when concentrated and unconcentrated urine specimens are tested. These differences in sensitivity may affect the abilities of clinicians to accurately diagnose GBS sepsis before culture results are available.

Antigens, Bacterial↗
PubMed1995

Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very low birth weight preterm infants.

DESIGN AND METHODS: We hypothesized that treatment with recombinant human erythropoietin (r-HuEPO) would stimulate erythropoiesis and would thereby reduce the need for erythrocyte transfusions in preterm infants. We treated 157 preterm infants born at 26.9 +/- 1.6 weeks of gestation who weighed 924 +/- 183 g at birth with either subcutaneous r-HuEPO (100 U/kg/d, 5 days per week) or placebo for 6 weeks in a randomized, double-blind, controlled clinical trial. All patients received oral iron and were managed according to uniform conservative transfusion guidelines. RESULTS: Treatment with r-HuEPO was associated with fewer erythrocyte transfusions (1.1 +/- 1.5 per infant in the r-HuEPO group versus 1.6 +/- 1.7 per infant in the placebo group; P = .046) and with a reduction in the volume of packed erythrocytes transfused (16.5 +/- 23.0 mL versus 23.9 +/- 25.7 mL per infant; P = .023). Overall, 43% of the infants in the r-HuEPO group and 31% of placebo-treated infants were transfusion-free during the study (P = .18). The volume of blood removed for laboratory tests and the need for respiratory support at the start of treatment had major effects on transfusion requirements independent of r-HuEPO. Reticulocyte counts were higher during treatment in the r-HuEPO group (P = .0001), and r-HuEPO-treated infants had higher hematocrit values at the end of the study (32% versus 27.3% in the placebo group; P = .0001). We found no differences in the incidence of major complications of prematurity between the treatment groups. CONCLUSION: We conclude that treatment with r-HuEPO at a weekly dose of 500 U/kg stimulates erythropoiesis, moderates the course of anemia, is associated with a reduction in erythrocyte transfusions, and appears safe in very low birth weight preterm infants who are receiving iron supplements. Conservative transfusion criteria, minimization of phlebotomy losses, and treatment with r-HuEPO are complementary strategies to reduce erythrocyte transfusions in these infants.

Anemia↗
PubMed1985

Extending the extenders. Compromise for the geriatric specialization-manpower debate.

This pilot study reports on issues germane to the geriatric specialization-manpower debate. The study found that a large amount of the functional responsibility required by older adults in an urban clinic setting could be delegated to physician extenders. Other findings included shorter hospitalizations, increased feelings of well-being, and high patient satisfaction with physician extended care. The implications are that rather than develop a new physician specialty, more geriatric manpower needs could be met by delegating responsibility to appropriately trained and supervised physician extenders.

Aged↗
PubMed1983

Cardiomyopathy associated with tricyclic antidepressants.

Nine other cases of cardiomyopathy in patients taking tricyclic antidepressants have been reported. The patient we have described had been taking tricyclic antidepressants for years before cardiomyopathy developed. While a cause-and-effect relationship between tricyclic antidepressants and cardiomyopathy cannot be proven, physicians should keep in mind the association and discontinue the medication if cardiomyopathy develops. Further, tricyclic antidepressants should be used with great caution in patients with cardiomyopathy because of possible risk of ventricular fibrillation.

Animals↗
PubMedDate not supplied

Into the next century. A strategic plan for the North Carolina Physicians Health Program.

The staff and Board of Directors of NCPHP have developed a strategic plan to carry the Program into the next century. The goals of the plan are: 1) to reduce the risk of impairment among medical health care professionals through the application of primary prevention principles, 2) to provide improved outreach/intervention strategies for impaired professionals, and 3) to provide state-of-the-art treatment/rehabilitation services for impaired professionals and their families. Of course, appropriate staffing and fiscal resources will be a critical part of this process.

Humans↗