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James C Garrelts

Publications and source records attributed to James C Garrelts.

5 recordsLinked to original sources
PubMed2006

Effectiveness of half-dose versus full-dose influenza vaccine in health care workers.

PURPOSE: A prospective, randomized, double-blind study comparing the effectiveness of half-dose versus full-dose trivalent inactivated influenza vaccine (TIV) in health care workers was conducted. METHODS: The study was conducted at a 760-bed tertiary care community hospital. Study participants (n = 444) were hospital staff or employees over 18 years of age who were enrolled during a two-week period in October and November 2004. Participants were assigned to either full-dose (n = 222) or half-dose (n = 222) TIV. The participants completed a standardized questionnaire monthly from November 2004 through March 2005. The primary outcome was the incidence of influenza between the two groups; the secondary outcomes were self-reported days of work missed as a result of influenza and the proportion of participants in each group self-reporting signs and symptoms of influenza. Laboratory confirmation of influenza diagnosis was sought in participants reporting a clinical diagnosis by their physicians. Differences in the groups were analyzed with Fisher's exact test, with a < 0.05 considered significant. RESULTS: There was no difference between the full-dose and half-dose groups in the diagnosis of influenza (4% versus 7%, p = 0.198). Laboratory confirmation of an influenza diagnosis occurred in one participant who received full-dose TIV. CONCLUSION: Half-dose TIV demonstrated a similar effectiveness to full-dose TIV, measured by the number of diagnoses of influenza and symptom survey of participating health care workers. Administration of half-dose TIV is an acceptable strategy for maximizing the number of vaccinations in health care workers, but additional studies are needed to confirm the comparable immunogenicity and effectiveness between the two doses.

Adolescent↗
PubMed2005

Venous thromboembolism prevention in acutely ill nonsurgical patients.

OBJECTIVE: To review recent advances in the prevention of venous thromboembolism (VTE) in acutely ill nonsurgical inpatients. DATA SOURCES: A MEDLINE search (1966-March 2005) was done to identify relevant articles relating to prevention of VTE in acutely ill nonsurgical inpatients. STUDY SELECTION AND DATA EXTRACTION: Four major prophylaxis trials, one registry, one guideline, and supporting articles representative of the subject matter from the last few years were included. DATA SYNTHESIS: Enoxaparin, dalteparin, fondaparinux, and unfractionated heparin 5000 units every 8 hours are effective in reducing the risk of VTE in acutely ill medical patients, but such prophylaxis is currently underused. Barriers to be overcome include recognition of the importance of VTE in this population, definition of the optimal strategy to assess risks, optimal timing of the risk assessment, optimal prophylactic regimen for a given level of risk or disease state, and optimal duration of prophylaxis. We recommend that acutely ill medical inpatients should be risk-stratified early in their hospitalization. At this time, the specific risk-assessment protocol should be derived from the trial(s) of the available formulary agent(s). Decisions about providing prophylaxis must also be made considering anticoagulant contraindications and renal function. Mechanical methods of prophylaxis should be considered as monotherapy only if an anticoagulant contraindication exists. The optimal duration of prophylaxis is not known, but 14 days was used in recent studies. CONCLUSIONS: Prophylaxis of VTE in acutely ill medical inpatients is underused. Data provide some guidance for increasing awareness and optimizing patient care.

Acute Disease↗
PubMed2004

Impact of fluconazole administration on outcomes in critically ill patients.

BACKGROUND: Serious infections caused by Candida spp. are an increasingly important cause of morbidity and mortality in critically ill patients. It is unclear which patients will benefit from therapy and at what point to institute treatment. OBJECTIVE: To evaluate the impact of administration of fluconazole therapy in critically ill trauma patients on mortality, length of hospital stay, incidence of deep-seated fungal infection, and positive fungal cultures from any site. METHODS: We conducted a retrospective, matched case-control study of 116 critically ill surgical trauma patients who did or did not receive fluconazole. Patients were followed until hospital discharge or death. A consecutive sample of 58 patients who received fluconazole was selected. A parallel group of patients was evaluated, from which 58 were matched with fluconazole-treated patients based on age (+/- 5 y), gender, and APACHE II score (+/- 3). RESULTS: The groups of patients were well matched, with the exception of central venous catheter placement and broad-spectrum antibiotic use. We found no difference between groups in hospital mortality (21% vs 26%; p = 0.661) or incidence of deep-seated fungal infection (0% vs 2%; p = NS). However, patients receiving fluconazole had a significantly longer stay in both the intensive care unit (ICU) (18 +/- 13 vs 7 +/- 11 days; p < 0.001) and hospital (25 +/- 15 vs 9 +/- 11 days; p < 0.001). Fluconazole patients were significantly more likely to have Candida cultured from sites associated with colonization (43% vs 2%; p < 0.001), possibly explaining why they received fluconazole. CONCLUSIONS: We were unable to detect a benefit from use of fluconazole in our surgical trauma patient population. Isolation of Candida from the mouth or throat alone, in the absence of correlating clinical signs of infection, should not lead to initiation of fluconazole therapy. Fluconazole use should be reserved for carefully selected patients in the trauma ICU setting.

Adult↗