K Gilbert | PubMed Health

PubMed1998

Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia.

PURPOSE: To assess the patterns of antimicrobial use, costs of antimicrobial therapy, and medical outcomes by institution in patients with community-acquired pneumonia. PATIENTS AND METHODS: The route, dose, and frequency of administration of all antimicrobial agents prescribed within 30 days of presentation were recorded for 927 outpatients and 1328 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial costs were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral agents, plus the costs associated with preparation and administration of parenteral therapy. Thirty-day outcome measures were mortality, subsequent hospitalization for outpatients, and hospital readmission for inpatients. RESULTS: Significant variation (P <0.05) in prescribing practices occurred for 17 of the 23 antimicrobial agents used in outpatients across 5 treatment sites, and for 18 of the 20 parenteral agents used in inpatients across 4 treatment sites. The median duration of antimicrobial therapy for treatment site ranged from 11 to 13 days for outpatients (P=0.01), and from 13 to 15 days for inpatients (P=0.49). The overall median cost of antimicrobial therapy was $12.90 for outpatients, and ranged from $10.80 to $58.90 among treatment sites (P <0.0001). The overall median cost of antimicrobial therapy was $228.70 for inpatients, and ranged from $183.70 to $315.60 among sites (P <0.0001). Mortality and hospital readmission for inpatients were not significantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness severity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial costs. CONCLUSION: Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia. Although variation in antimicrobial prescribing practices across institutions results in significant differences in antimicrobial costs, patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.

Anti-Infective Agents↗

PubMed1998

Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement.

BACKGROUND: The purpose of this study was to validate a previously published point score system for predicting the likelihood of a postoperative blood transfusion following hip or knee replacement. STUDY DESIGN AND METHODS: Data were collected prospectively on 460 sequential patients undergoing elective hip and knee replacement at two academic hospitals. Blood transfusion frequency was determined for patients in each of the four risk strata, as defined by the point score system. The accuracy of the system was validated by calculating the area under the receiver operating characteristic (ROC) curve for each site. Data were then combined and inappropriate blood transfusions were eliminated, by using the American College of Physicians guidelines. The frequencies of blood transfusion within each strata were recalculated along with an ROC curve. RESULTS: The point score system accurately predicted the likelihood of blood transfusion at both hospitals, despite marked differences in overall transfusion frequencies. The calculated areas under the ROC curves were 0.78 and 0.79 for the two sites. The point score system also proved valid when only appropriate blood transfusions were considered, with a calculated area under the ROC curve of 0.74. CONCLUSION: The point score system can accurately predict the likelihood of postoperative blood transfusion following hip or knee replacement. Such a system can be used to target high-risk patients for preoperative autologous blood donation.

Aged↗

PubMed1998

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

PubMed1998

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

PubMed1998

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

PubMed1998

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Professional↗

PubMed1997

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Professional↗

PubMed1997

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

PubMed1997

A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty.

BACKGROUND: Given the high cost of autologous blood donation for elective surgery, it would be desirable to predict which patients are most likely to benefit from the procedure. The purpose of this study was to develop a point score system for predicting the likelihood of blood transfusion in hip and knee arthroplasty. STUDY DESIGN AND METHODS: A database of 599 patients undergoing elective surgery at a teaching hospital was used for the analysis. Variables were analyzed to determine their univariate association with postoperative blood transfusion. Significant factors were entered into a multiple logistic regression model, and a point score system was developed on the basis of the regression coefficients. Four strata of transfusion risk were constructed. RESULTS: Factors independently associated with blood transfusion included preoperative hemoglobin, type of arthroplasty, primary versus revision surgery, autologous donor status, and patient weight. Four factors were used to create a point score system with four strata. The likelihood of blood transfusion for patients in the four risk strata was 1.7, 11.0, 40.0, and 78.3 percent. The calculated area under the receiver operating characteristic curve was 0.86. CONCLUSION: The likelihood of a postoperative blood transfusion can be predicted by using this simple point score system. Autologous blood donation can subsequently be targeted to the high-risk patients.

Aged↗

PubMed1997

Environmental health hazards: the impact on a southern community.

The impact of environment on health is a growing area of concern for nurses. The purpose of this study is to describe and characterize residents living near an abandoned hazardous waste site, assess their past and present exposure risk, and describe health concerns and psychosocial effects. Data were obtained by a door-to-door outreach effort. Networking was also used to identify residents with health concerns. Extensive field notes were taken to record the responses of residents. A preliminary windshield survey was conducted to approximate the number of residents living in the geographic area, assess the residential community, analyze drainage pathways away from the site, and observe outdoor activity patterns. Community concerns from the residential population were collected and analyzed for recurrent themes. Significant off-site activity patterns included use of drainage ditches as play areas for children. Foraging on-site activities included picking berries, crawfishing, geophagy (clay eating), and rabbit hunting. Common health problems described by residents included skin rashes, respiratory-related complaints, reproductive difficulties, and headaches. The majority of residents were concerned about the incidence of cancer in the area. Identifying the concerns of residents and indicators of health problems helps nurses begin to understand the relationship between the environment and health.

Adolescent↗

PubMed1997

Complete genome sequence of Methanobacterium thermoautotrophicum deltaH: functional analysis and comparative genomics.

The complete 1,751,377-bp sequence of the genome of the thermophilic archaeon Methanobacterium thermoautotrophicum deltaH has been determined by a whole-genome shotgun sequencing approach. A total of 1,855 open reading frames (ORFs) have been identified that appear to encode polypeptides, 844 (46%) of which have been assigned putative functions based on their similarities to database sequences with assigned functions. A total of 514 (28%) of the ORF-encoded polypeptides are related to sequences with unknown functions, and 496 (27%) have little or no homology to sequences in public databases. Comparisons with Eucarya-, Bacteria-, and Archaea-specific databases reveal that 1,013 of the putative gene products (54%) are most similar to polypeptide sequences described previously for other organisms in the domain Archaea. Comparisons with the Methanococcus jannaschii genome data underline the extensive divergence that has occurred between these two methanogens; only 352 (19%) of M. thermoautotrophicum ORFs encode sequences that are >50% identical to M. jannaschii polypeptides, and there is little conservation in the relative locations of orthologous genes. When the M. thermoautotrophicum ORFs are compared to sequences from only the eucaryal and bacterial domains, 786 (42%) are more similar to bacterial sequences and 241 (13%) are more similar to eucaryal sequences. The bacterial domain-like gene products include the majority of those predicted to be involved in cofactor and small molecule biosyntheses, intermediary metabolism, transport, nitrogen fixation, regulatory functions, and interactions with the environment. Most proteins predicted to be involved in DNA metabolism, transcription, and translation are more similar to eucaryal sequences. Gene structure and organization have features that are typical of the Bacteria, including genes that encode polypeptides closely related to eucaryal proteins. There are 24 polypeptides that could form two-component sensor kinase-response regulator systems and homologs of the bacterial Hsp70-response proteins DnaK and DnaJ, which are notably absent in M. jannaschii. DNA replication initiation and chromosome packaging in M. thermoautotrophicum are predicted to have eucaryal features, based on the presence of two Cdc6 homologs and three histones; however, the presence of an ftsZ gene indicates a bacterial type of cell division initiation. The DNA polymerases include an X-family repair type and an unusual archaeal B type formed by two separate polypeptides. The DNA-dependent RNA polymerase (RNAP) subunits A', A", B', B" and H are encoded in a typical archaeal RNAP operon, although a second A' subunit-encoding gene is present at a remote location. There are two rRNA operons, and 39 tRNA genes are dispersed around the genome, although most of these occur in clusters. Three of the tRNA genes have introns, including the tRNAPro (GGG) gene, which contains a second intron at an unprecedented location. There is no selenocysteinyl-tRNA gene nor evidence for classically organized IS elements, prophages, or plasmids. The genome contains one intein and two extended repeats (3.6 and 8.6 kb) that are members of a family with 18 representatives in the M. jannaschii genome.

Anaerobiosis↗

PubMed1996

Cyclist road deaths in London 1985-1992: drivers, vehicles, manoeuvres and injuries.

We used coroners' records to investigate the fatal accidents of cyclists recorded on death certificates in London during 1985-1992. There were 124 deaths: 68 cyclists were injured in London and 56 injured in the "home counties" around London and died in London hospitals. The cyclists' ages were from 8-88, and 70% were male; the drivers were aged 17-74, and 96% were male. Of the 108 vehicles involved, 53 were cars (including one parked) and 40 heavy goods vehicles (HGVs) (including 14 large lorries and 18 articulated lorries), 5 light goods vehicles, 5 buses and coaches and 5 motorcycles. Fatal accidents occurred with a wide range of manoeuvres; of vehicles turning left (driving is on the left in the U.K.), 14 out of 15 were HGVs. Accidents were most often on 2 lane roads and one half were near a road junction. Law violations were recorded in half the accidents; alcohol intoxication contributed only rarely. While injuries to the head were the commonest reported direct cause of death, Inner London deaths were frequently due to multiple injuries. The study confirms the serious danger to cyclists (particularly women) in Inner London from large and articulated lorries, causing death from multiple injuries.

Accidents, Traffic↗

PubMed1996

An experimental estimate of the maintenance energy requirement in children with cystic fibrosis.

OBJECTIVE: To determine experimentally the maintenance energy requirement MER of children with Cystic Fibrosis (CF). DESIGN: Paired energy balance studies were undertaken on eight children with CF during an infection exacerbation, each child was his own control. SETTING: Paired energy balance (EB) studies at home over three days. SUBJECTS: Children known (from clinic records) to be susceptible to frequent infections were contacted. Four eligible children volunteered and completed two studies. INTERVENTION: Energy intake was estimated by weighted dietary inventory during days 1-3 and 16-18 of convalescence and obligatory energy losses determined by analysis of synchronous faecal and urinary collections using bomb calorimetry and urea concentration respectively Resting energy expenditure (EE) was determined using the DeltatrakTM100 Metabolic Monitor Apparent energy balance (B) was calculated by difference between metabolizable energy intake ME and EE such that B = ME - EE. RESULTS: The linear relationship between B (y) and ME (x) is given by y = 0.85x - 206.6 (1) when B = 0, ME = MER with a value of 243.1kJ/kg/24h(95% CL 136.9 and 410.3kJ/kg/24h). CONCLUSION: When MER = 243.1 + 167.2 - 106.2kJ/kg/24h and ME = 93% of gross energy (GE), a GE intake of 261kJ/kg/24h(95% CL of 440kJ/kg/24h) meets the MER, and negative EB is avoided. Agreement with previous estimates of MER suggests no enhancement of MER in CF.

Calorimetry, Indirect↗

PubMed1994

Deaths of cyclists in London 1985-92: the hazards of road traffic.

OBJECTIVE: To determine the characteristics of cyclists and vehicles involved in fatal cycling accidents. DESIGN: Analysis of data routinely collected by police for each accident from January 1985 to December 1992 and held in a national master file (Stats 19) by the Department of Transport. SETTING: Greater London, which comprises inner London (12 boroughs and the City of London) and outer London (20 boroughs). SUBJECTS: 178 cyclists who died (78 in inner London and 100 in outer London; age range 3-88). MAIN OUTCOME MEASURES: Associations between characteristics of cyclists, type of vehicle involved, and place of accident. RESULTS: Motor vehicles were involved in 173 deaths. Heavy goods vehicles were involved in 75 deaths (30/100 (30%) in outer London and 45/78 (58%) in inner London); cars in 74 (54/100) (54%) in outer London and 20/78 (26%) in inner London); light goods vehicles in 12/178 (7%); and buses in 6/178 (3%). Thirty five of the people who died were children aged < or = 16. Female cyclists were especially at risk from heavy goods vehicles in inner London (22 deaths), while male cyclists were especially at risk from cars in outer London (50 deaths). DISCUSSION: Cyclists who died in urban areas are more likely to be adults than children. In inner London, in relation to their traffic volume, heavy goods vehicles are estimated to cause 30 times as many cyclists' deaths as cars and five times as many as buses. Until the factors leading to this excess risk are understood, a ban on heavy goods vehicles in urban areas should be considered.

Accidents, Traffic↗

PubMed1994

Short-term effects of inhaled albuterol on maternal and fetal circulations.

Short-term circulatory effects with the maximum recommended dose of inhaled albuterol (Proventil) were studied on 12 asthmatic patients between 33 and 39 weeks' gestation. The mean maternal blood pressures and heart rates, systolic/diastolic ratios of the uterine arcuate and umbilical arteries, and fetal heart rates and aortic velocities were unaffected during the first 2 hours after dosing.

Adolescent↗

PubMed1994

Assessing prognosis and predicting patient outcomes in community-acquired pneumonia.

Community-acquired pneumonia is a common medical illness, with clinical outcomes ranging from mild illness with rapid and complete recovery to a fulminant clinical course with morbid complications followed by death. A systematic review of the literature on pneumonia prognosis has identified a variety of demographic factors, symptoms and physical examination findings, comorbid illnesses, laboratory abnormalities, and etiologic agents that are independently associated with short-term mortality in patients with this illness. By combining these prognostic factors, investigators have developed a variety of indices to predict short-term mortality. Although these predictive instruments vary with respect to the patient populations studied, number of predictor variables included, statistical methods used, and overall clinical performance, these models can assist physicians in assessing patient prognosis and in making important management decisions such as the initial site of care (ie, home v hospital). Assessment of patient prognosis has also been used by clinicians and health services researchers who use the hospital severity of illness-adjusted mortality rate as a measure of the quality of medical care provided. Because the majority of patients with this illness survive, future assessments or predictions of prognosis in patients with community-acquired pneumonia should also evaluate a spectrum of other important health outcome measures including the occurrence of morbid complications, symptom resolution, quality of life, return to work and usual activities, and patient satisfaction with care.

Adult↗

PubMed1991

Inhibition of 7,12-dimethylbenz(a)anthracene-induced mammary tumors and DNA adducts by dietary selenite.

The present studies were designed to examine the influence of dietary selenite supplementation on the initiation phase of 7,12-dimethylbenz(a)anthracene (DMBA)-induced mammary carcinogenesis and to correlate selenite-induced changes in the binding of DMBA metabolites to rat mammary cell DNA with the ultimate tumor incidence. Diets formulated to contain selenium, as sodium selenite at 0.1, 0.5, 1, 2, or 4 micrograms/g were fed for 2 weeks prior to and 2 weeks following treatment with DMBA (5 mg/kg body weight). Food intake and weight gain did not differ among treatments. Tumor incidence correlated inversely to the quantity of selenium consumed (r = -0.99). Final tumor incidences were 52, 32, 24, 14, and 10% for rats fed 0.1, 0.5, 1, and 4 micrograms selenium/g, respectively. In a separate group of rats fed a diet containing 4 micrograms selenium/g during both the initiation and promotion stages the final tumor incidence was 4.8%. Selenite supplementation for 2 weeks markedly depressed the occurrence of individual and total DMBA-DNA adducts. The final mammary tumor incidence correlated positively with total DMBA-DNA adducts (r = 0.99). These studies clearly demonstrate that selenite can inhibit the initiation stage of mammary carcinogenesis. This reduction in tumor incidence is likely due to a reduction in carcinogen metabolism and ultimately adduct formation.

9,10-Dimethyl-1,2-benzanthracene↗

PubMed1989

Genetic studies in four populations of the northern Aegean Sea, Greece.

A total of 945 non-related individuals from four isolated population groups from the Northern Aegean Sea (Greece)--Alonissos, Oxilithos, Skopelos, and Glossa, has been typed for 16 polymorphic systems of the blood, namely A1A2B0, MNS., Rhesus (C, c, Cw, D, E, e), Kell, Duffy (a,b), Kidd (a); Hp, Tf subtypes, Gc, Gm (1, 2, 3, 5, 13), Km (1); aP, AK, PGM1, EsD, and 6-PGD. The distribution of phenotype and gene/haplotype frequencies shows a considerable interpopulational variability, which is discussed considering the history of these populations as well as the impact of locally acting microevolutionary factors such as drift and founder effects. The average coefficient of gene diversity GST comes to 0.0147, whereas Wahlund's variance is on average 0.0154, and Wright's Fst = 0.0147. Genetic distance analysis reveals a pattern of similarities, which is in conformity with the history of the populations under study.

Blood Group Antigens↗