Aging in colonial Philadelphia.
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Geriatrics↗
Biomedical subjects
J Freeman
Publications and source records attributed to J Freeman.
The influence of trainers on trainees in general practice.
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Adult↗
Drug therapy for Plasmodium falciparum malaria resistant to pyrimethamine-sulfadoxine (Fansidar). A study of alternate regimens in Eastern Thailand, 1980.
A trial of drug regimens for treating Plasmodium falciparum malaria was conducted in a refugee camp in eastern Thailand where extensive 'Fansidar' (pyrimethamine-sulfadoxine) resistance had been demonstrated. The efficacy of quinine alone was compared to that of quinine combined with either fansidar or tetracycline. Quinine alone cleared the parasitaemia in 57 of 59 patients but failed to cure approximately one-third of these patients after 7 or 10 days of therapy. The addition of fansidar to quinine therapy did not significantly improve the overall cure rate. Tetracycline given for 10 days in combination with quinine cured all patients, suggesting that tetracycline should be considered in treating patients with falciparum malaria contracted in the area of the Thai-Kampuchean border.
Child↗
Differential risk of nosocomial infection.
Our ability to interpret apparent differences in findings among surveys of nosocomial infection is limited by differences in the methods used, and differences among the study populations themselves. Methodologic areas in which there are substantial differences include definitions of rates of infection, criteria for infection and methods of case-finding. The studies themselves differ with respect to the characteristics of hospital populations, their underlying diseases, clinical procedures, patterns of lengths of hospital stay and efforts at prevention of infection. There are three separate concerns for constructing and interpreting comparisons: the choice of comparison or reference subjects, the control of confounding variables and the adjustment for variations in hospital stay. In order for studies to be credible, they must be accompanied by convincing evidence that the confounding effects of variables extraneous to the study have been identified and appropriately controlled in the analysis. It has been found that the day-specific incidence of nosocomial infection rises from near zero on the first hospital day to maximal during the fourth through the seventh weeks of hospital stay. Thus, the risk of nosocomial infection for a specific patient also depends on the hospital day. It may be possible to make better use of limited infection control resources by concentrating efforts to prevent infections on the patients who are at greater risk, during the time when the day-specific incidence is highest.
Bacterial Infections↗
Nosocomial infections in a neonatal intensive care unit.
Based on five years of surveillance in a neonatal intensive care unit (NICU), host and therapeutic risk factors for nosocomial infection were determined and the impact of staffing and environment on the rate of nosocomial infection was evaluated. From January 1974 to February 1977, infants occupied a crowded, hectic NICU that lacked basic infection control features, and 5.2% of the infants had at least one major nosocomial infection. The risk of nosocomial infection was associated with low birth weight, patent ductus arteriosus, surgery, and multiple supportive measures. After a new NICU opened in February 1977, 0.9% of the patients had major nosocomial infections (relative risk [old nursery/new nursery] = 5.06; P less than 10(-5); 95% confidence interval, 2.62-9.73). Improvements included 50% more nurses, increased space per infant, convenient sinks, and isolation facilities. Host and therapeutic risk factors for nosocomial infections were comparable in the old and new nurseries. The decrease in the rate of nosocomial infections therefore appeared to be due to improved staffing and environment.
Birth Weight↗
Day-specific incidence of nosocomial infection estimated from a prevalence survey.
The authors present a method for estimating hospital day-specific incidence of nosocomial infection from a prevalence survey. At Boston City Hospital this incidence was found to rise from zero on the first hospital day to become maximal during the fourth through the seventh weeks of hospital stay, and then to fall gradually. The risk in the second week of hospitalization was over four times that in the first week. The pattern of an initial rise and subsequent fall in day-specific incidence with increasing hospital stays was found to be more marked in patients with discharge diagnoses associated with greater susceptibility to infection and was similar among patients with both short and long total durations of hospital stay. As day-specific incidence varies by hospital day, and proportion of admissions remaining in hospital to any specified day varies by hospital population, both these sources of variation must be taken into account to interpret comparisons among hospital populations.
Boston↗
Disclosure of information to patients in medical care.
It is generally agreed that patients have a right to be adequately informed. However, little is known about the extent to which doctors and patients agree about information that should be disclosed. We studied what patients want to know, as contrasted with what physicians report actually disclosing, in a population of physicians who treat seizures and patients or parents of patients who have this disorder. In general, it was found that patients or parents of patients who have this disorder. In general, it was found that patients prefer far more detailed disclosures than physicians routinely offer and that the two groups have widely different beliefs about the consequences of detailed disclosures. Patients and parents preferred extensive disclosures, particularly regarding risks and alternative therapy. Physicians were likely to disclose only risks with a relatively high probability of occurrence and they provided little information about alternative therapies. Patients and parents were also much more likely than physicians to believe that the final decision concerning therapy should rest with the patient. The data suggest that a better empirical understanding of the consequences of detailed disclosures may help resolve differences of opinion regarding how much information should be provided to patients.
Adolescent↗
Disclosure standards and informed consent.
There is currently substantial disagreement about the kind of information that must be disclosed in obtaining an informed consent. This study examined physicians' interpretations of the demands of two alternative legal standards for disclosure, as well as a third standard intended to capture their normative sense of what should be disclosed to patients. Other factors which might affect disclosure practices of physicians were also studied. The findings raise questions about the extent to which a legal standard for disclosure can have an impact on medical practice; the data suggest that doctors currently disclose what they think patients want to be told. However, it appears that physicians substantially underestimate the amount of information patients wish to receive.
Disclosure↗
Failures in surgery for stapedial otosclerosis.
The causes for failure in surgery for stapedial otosclerosis are many. Most of these occur in the early postoperative period. Failures occurring later are due to either a breakdown of the reconstructed transformer system or to a labyrinthitis due to failure of the vestibular seal. The role of cochlear otospongiosis in producing late failures has not been sufficiently emphasized. This clinical review of 105 surgical failures examined consecutively during the years of 1975 through 1979 will demonstrate the importance of cochlear otospongiosis in this consideration. The fate of the unoperated-on ear in unilateral surgical failures will be demonstrated. Control of the progressive sensorineural hearing loss in these instances can be gained by the use of sodium fluoride therapy.
Adolescent↗
Current concepts of Total Parenteral Nutrition.
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Canada↗
Influence of H-2 complex on acquired resistance to Leishmania donovani infection in mice.
Innate susceptibility to Leishmania donovani infection in mice (measured over 2--4 weeks) is under the control of a single autosomal gene (Lsh) segregating for incompletely dominant resistant (r) and recessive susceptible (s) alleles. This locus maps away from the known histocompatibility loci to a position between the centromere and Id-1 on the chromosome 1 of the mouse. Amongst homozygous recessive Lsh strains of mice two patterns of recovery are observed when the course of infection is followed over a longer term. In some strains a dramatic fall in parasite numbers with histological liver damage occurs while other strains maintain immense parasite loads for up to two years involving mononuclear phagocytes throughout the body. We now present evidence which suggests that this difference in long-term response is largely controlled by a gene(s) within, or closely adjacent to, the major histocompatibility complex (H-2) of the mouse.
Animals↗
Prevalence, incidence and duration.
Prevalence, incidence and duration of a condition or illness in a steady-state population are interrelated in such a way that two of these quantities may be used to obtain the third. Data may be collected in the most expedient manner, either as prevalence or incidence series of cases, and the results expressed as both incidence and prevalence. Information about the distribution of total durations of the condition in an incidence series of cases, or about the distribution of total durations or durations-to-date in a prevalence series is necessary in order to use these relations between prevalence and incidence of a condition or illness. The duration of a condition may be taken as one measure of the effect of the condition or illness on a population, and a "treatment effect" measured by comparing two populations may be termed the etiologic duration. Exact methods are presented for interconverting the distribution of total durations of condition among prevalence and incidence series of cases arising from the same steady-state population. Both prevalence and incidence series of cases may naturally arise in the same epidemiologic study, such as the initiation and conduct of a periodic screening program, and under certain conditions the size and even the direction of the etiologic duration may differ as measured in corresponding prevalence and incidence series of cases.
Cross-Sectional Studies↗
Otosclerosis and vestibular dysfunction.
Vestibular dysfunction associated with otosclerosis has been observed for many years. In a recent clinical study of patients exhibiting progressive sensorineural hearing loss of unknown origin, it was demonstrated that approximately 50% of the cases had cochlear otosclerosis/otospongiosis as the most probable cause for the hypacusis. Of these, approximatley 55% had vestibular symptoms. In the present study, the effect of sodium fluoride therapy in this group of patients is analyzed. It will be demonstrated that such therapy is beneficial not only in controlling the progressive sensorineural hearing loss but also the symptoms of vestibular dysfunction in patients with cochlear otosclerosis (otospongiosis).
Adult↗
Comparative approach to health maintenance: definition, need, and rationale.
A comparative approach has been employed in many phases of medicine, eg, epidemiology, surgery, nutrition, cancer. It has been used widely in teaching, research, and surveillance, but little attention has been paid to its application in delivery systems. Geographic and financial circumstances often create situations in which it is extremely difficult to enter the health care system or even to know when such entry is indicated. Because the comparative approach has been successful in other phases of medicine, it deserves consideration in the health maintenance phase. The comparative approach has three major components: (1) Reliance on broad principles of health maintenance, not on specifics; (2) emphasis on health maintenance, not on curative medicine; and (3) utilization of health care systems designed for nonhuman beings to bring man into the human health care system. The ways to utilize ethically and legally the expertise of other health professionals in providing entry to the health care system and in facilitating transfer of our technical knowledge to more of the general public should be explored.
Delivery of Health Care↗
Progressive sensorineural hearing loss and cochlear otosclerosis: a prospective study.
The association of otosclerosis with reduced bone conduction is well known but no experimental or valid clinical relationship has been established to confirm this relationship. The purpose of this presentation is to demonstrate a clinical relationship between otosclerosis and sensorineural hearing loss. Experimental proof will await the accumulation and study of temporal bones of those individuals who, in life, exhibited the clinical relationship to be developed in this dissertation.
Adolescent↗
Leiomyoma of small bowel: a case report.
Benign small bowel tumors are rare and usually present in late adult life. Because of its raity, a case of benign leiomyoma of the small bowel presenting with distal small bowel obstruction in childhood is reported, with a discussion of the principles of management.
Child↗
Adverse effects of nosocomial infection.
The effects of noscomial infection on duration of hospital stay and outcome of hospitalization were measured by matching two control patients to each of 85 patients found to have qctive nosocomial infection during a prevalence survey at Boston City Hospital in 1973. The control patients were selected from all patients discharged from this hospital during the same time period; they were matched by exact primary discharge diagnosis, similar operative procedure, and age. Patients with a single infection remained in hospital on average 13.0 days longer than their matched controls, and those with two such infections stayed on average 35.4 days longer. This effect of extra stay associated with nosocomial infection was consistent when data were stratified by primary discharge diagnosis, hospital service, site of infection, or outcome of hospitalization. The outcome of hospitalization for these infected patients was slightly, but not significantly, worse than for their matched controls.
Boston↗