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Biomedical subjects

J Freeman

Publications and source records attributed to J Freeman.

At least 253 records · Page 14Linked to original sources
PubMed1986

Treatment of fecal incontinence in children with spina bifida: comparison of biofeedback and behavior modification.

Two experiments compared the effects of biofeedback training to behavior modification in the treatment of 33 children aged 5 to 16 who had fecal incontinence secondary to myelomeningocele. Biofeedback involved providing visual feedback and rewards for successively stronger sphincter contractions during training sessions and requiring 50 sphincter contraction exercises daily. Behavior modification involved attempting to defecate immediately after the evening meal each day, receiving a reward for defecating in the toilet without an enema or suppository, and receiving an enema if unsuccessful for two consecutive days. In experiment I, eight children were offered biofeedback alone in an attempt to replicate previous studies. Biofeedback alone was found insufficient; addition of behavior modification was necessary. Experiment II systematically investigated the relative contribution of these two treatments. Overall, patients who received only behavior modification for three months showed as much clinical improvement as patients who received behavior modification plus biofeedback. This suggests that previous reports, because they have not controlled for nonspecific treatment effects, have overestimated the value of biofeedback in this population. However, a subgroup of patients (27%) were identified for whom biofeedback provided additional, specific benefit. These were children who had spinal cord lesions below L-2 and who initially had two or more bowel movements daily. The combination of behavior modification and biofeedback resulted in a greater than 50% reduction in the frequency of incontinence for 64% of patients, and results were well maintained at follow-up one year later.

Adolescent↗
PubMed1985

Risk of illness after exposure to a pediatric office.

To determine whether well children visiting a pediatrician's office are at risk of acquiring common communicable diseases, we conducted a prospective cohort study during the winter of 1983-1984. The occurrence of respiratory or gastrointestinal illness or fever in young children in the week after a visit to a pediatric office (office group) was compared with the occurrence of these illnesses in a similar group of children (home group) not exposed to the office during the study period. One home comparison subject was matched by age and sex to each of 127 children three years of age and under who were seen for well-child care in a private pediatric office with a common waiting room. The adjusted relative risk of the development of illness during the study week for the office group as compared with the home group was 0.95 (95 per cent confidence interval, 0.66 to 1.37), indicating no effect. We conclude that exposure to a pediatric office is not an important cause of the common infections in young children that have incubation periods of a week or less.

Child Health Services↗
PubMed1985

Topical antimicrobial toxicity.

Three topical antibiotics and four antiseptics (1% povidone-iodine, 0.25% acetic acid, 3% hydrogen peroxide, and 0.5% sodium hypochlorite) were directly applied to cultured human fibroblasts to quantitatively assess their cytotoxicity. The four antiseptics were found to be cytotoxic; all of the cytotoxic agents except hydrogen peroxide were subsequently found to adversely affect wound healing in an animal model. Comparison of bactericidal and cytotoxic effects of serial dilutions of these four topical agents indicated the cellular toxicity of hydrogen peroxide and acetic acid exceeded their bactericidal potency. Bactericidal noncytotoxic dilutions of povidone-iodine and sodium hypochlorite were identified. These experiments provide evidence that 1% povidone-iodine, 3% hydrogen peroxide, 0.5% sodium hypochlorite, and 0.25% acetic acid are unsuitable for use in wound care. This sequence of experiments could be used to identify bactericidal, noncytotoxic agents prior to their clinical use.

Acetates↗
PubMed1985

A new transtracheal catheter for ventilation and resuscitation.

We describe a new catheter for emergency ventilation of patients difficult to intubate. This catheter can be inserted through the crico-thyroid membrane or the first or second intertracheal ringspace with ease in an almost atraumatic fashion. The outside part of the device, with its dual attachment system, can be connected to conventional resuscitation equipment by its 15 mm male end or to a high-pressure oxygen source by its luer-lock fitting. A double angulation maintains the intratracheal portion of the catheter in the axis of the trachea and the external part in close contact with the larynx. A Velcro band attached to two lateral flanges keeps the catheter in place. The results of transtracheal catheterization of 48 patients by means of this new device are discussed.

Catheterization↗
PubMed1985

Reduced pulmonary capillary blood volume as a long-term sequel of ARDS.

Lung function was evaluated in nine survivors of ARDS. All patients were asymptomatic at rest at the time of the study, ie, 5.5 to 19 months after extubation (mean 12.5). Six had mild to moderate exertional dyspnea. Chest x-ray films showed no gross parenchymal abnormalities. Spirometry and pulmonary mechanics were either normal or minimally altered, particularly in smokers. At submaximal exercise levels, effort was limited by tachycardia in eight patients; one subject showed ventilatory and cardiovascular limitations. It was concluded that spirometry and pulmonary mechanics are restored to normal within six months after extubation, and gas exchange abnormalities persist after ARDS and might be related to intrapulmonary shunts at rest, whereas during exercise a decreased pulmonary capillary blood volume might be the primary factor.

Adult↗
PubMed1985

Pharmacokinetics of low-dose 1-beta-D-arabinofuranosylcytosine given by continuous intravenous infusion over twenty-one days.

The pharmacokinetic parameters of low dose 1-beta-D-arabinofuranosylcytosine (ara-C) infusions were studied in 11 patients, 6 males and 5 females, with a mean age of 68.5 +/- 13.8 (SD) years. The drug was infused to 4 patients with pre-leukemia (refractory anemia with excess blasts), 5 patients with acute myelogenous leukemia, and 2 patients with secondary leukemia due to chemotherapy, at a dosage of 20 mg/m2/day over 21 days. The patients' blood and urine were analyzed for ara-C content by radioimmunoassay. Mean steady state plasma levels of 7.7 +/- 4.7 ng/ml (31.7 +/- 19.3 nM) (n = 189) and a range 0.6 (2.5 nM) (lower limit of assay) to 29.7 ng/ml (122.1 nM), with significant inter- and intra-patient variations, were reached within about 2.7 h. The plasma levels of ara-C decreased rapidly, with a t1/2 alpha of about 12 min following discontinuation of the infusion, followed by a very slow t 1/2 beta of about 19 h. Other parameters (mean values of 10 or 11 patients) were: area under the curve, 182.1 +/- 64.8 ng X day/ml; total body clearance, 188.7 +/- 54.8 liters/h; renal clearance, 3.1 +/- 1.4 liters/h; volume of distribution at steady state, 53,913 +/- 17,626 liters; and recovery of ara-C in urine, 1.43 +/- 0.69% (n = 226) of daily administered ara-C. A linear relationship was observed with administered dose when the mean plasma levels of our study were compared with the ones reported for conventional ara-C infusions. Plasma clearance was comparable to that observed in conventional dose, when the observed values were extrapolated to the dose administered in this study.

Aged↗
PubMed1984

[The Cardiac Arrest Team of the Vaud University Hospital].

A resuscitation team has been organized in the CHUV for the purpose of immediate intervention on the scene of cardiac arrest or any other life-threatening condition. The team composition is as follows: 1 anesthesiologist, 1 internist (usually cardiologist) and 1 surgeon. The team is responsible for elaborate resuscitation of in-patients from the general wards as well as out-patients coming for examination or for diagnostic and medicotechnical procedures. The team was almost never called from the intensive care units, from the operating theatres or from the emergency ward. Organization of the CHUV in this respect includes (a) grouping the facilities in larger areas where an alarm is signalled both optically and acoustically, (b) a special priority paging system with pocket radio-receptors (beeps) which can reach all members of the team within seconds, and (c) standardized resuscitation carts strategically located in the hospital. During a period of 7 months the team's work was judged satisfactory. It is called in once every 3 days on average.

Computers↗
PubMed1984

Changing concepts in the management of otitic intracranial infection: use of computerized axial tomography in early detection and monitoring of cerebritis.

The pathogenesis and course of intracranial inflammatory disorders of otitic origin have been studied extensively in the past by clinical, surgical, and morbid means. The recent contribution by CT scanning cannot be overestimated as a modality for identification of the pathologic process. Its use for early detection and monitoring of a clinically suspected intracranial complication of otitic suppurative disease is documented for the first time in this report. Cerebritis or encephalitis as the early manifestation of impending brain dissolution can be identified and followed during specific antibiotic therapy. The proper timing for surgery to remove the otitic focus is enhanced. A review of the literature and a case report illustrate this contribution.

Adolescent↗
PubMed1983

Entry to general practice training.

Since 1979 general practitioner trainees in the North West Region of England have been assessed on knowledge and ability by several tests, including the multiple choice test. Trainers in the region require a score in the MCQ of 45% before taking a trainee into the practice. More British graduates have achieved this score than overseas graduates. The difference was statistically significant. Only applicants who show adequate factual recall should be appointed as trainees.

Education, Medical, Graduate↗
PubMed1983

[Reduction of pulmonary capillary volume following acute respiratory distress syndrome in adults].

Lung function after adult respiratory distress syndrome was evaluated in 8 survivors whose ages ranged from 20 to 54 years. At the time of the study, 5.5 to 19 months after extubation, all patients were asymptomatic at rest but 6 had mild to moderate exertional dyspnea. Physical examination was normal in 7 patients; lung volumes, flow rates and pulmonary mechanics were minimally altered, mainly in smokers. Chest X-rays showed no major abnormalities. On graded submaximal exercise test, performance was limited by tachycardia and not by ventilation. Resting arterial PO2 was low in 6 patients and increased only in one patient during submaximal exercise. The capillary blood volume was decreased in all patients. The mechanisms of hypoxia during exercise and decreased capillary blood volume, the latter apparently unrelated either to pulmonary microvascular obstruction or to fibrosis, remain unexplained. It is concluded that lung volumes and pulmonary mechanics are restored to normal within 6 months after ARDS, whereas gas exchanges persist after ARDS and are associated with a reduced pulmonary blood volume.

Acute Disease↗
PubMed1983

Nosocomial infection and death in a neonatal intensive care unit.

Based on five years of prospective surveillance in a neonatal intensive care unit (NICU), the association of nosocomial infection with death during hospitalization was studied. Low birth weight and patent ductus arteriosus (PDA) were the variables most strongly associated with nosocomial infection. After stratification for these variables, there was a persistent association between nosocomial infection and increased risk of death (relative risk = 1.96; 95% confidence interval, 1.09-4.44; P = 0.03). The relative risk of mortality with nosocomial infection was significantly modified (P = 0.02) by the presence of PDA (relative risk = 3.42; 95% confidence interval, 1.68-6.95 for infants without PDA; no effect for infants with PDA). Relocation of the NICU to an improved, better-staffed facility was associated with a significant decrease in the adjusted nosocomial infection rate (relative risk [old NICU/new NICU] = 9.73; 95% confidence interval, 4.30-22.0). This improvement was accompanied by a statistically insignificant reduction in the overall mortality because other causes of death, such as low birth weight and serious underlying disease, are much more common in this population and thus are more important determinants of outcome.

Boston↗
PubMed1983

Use of antibiotics and psychoactive preparations.

This is a report of selected aspects of a larger study of 70 general practitioners. The method involved a detailed study of performance over a period of three days using rating scales and check-lists to assess competence. A possible relationship between competence and rate of antibiotic prescribing was found. There was variation in the extent of psychiatric history-taking when psychoactive preparations were used. Advice about potential side effects was given in only a third of instances when a psychoactive preparation was prescribed for a new episode of illness.

Anti-Bacterial Agents↗