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Biomedical subjects

M B Harper

Publications and source records attributed to M B Harper.

17 recordsLinked to original sources
PubMed1997

Office procedures. Flexible sigmoidoscopy.

The flexible sigmoidoscope is a flexible fiberoptic or video endoscope designed to examine the mucosal surface of the sigmoid colon and rectum. The flexible sigmoidoscope represents a technologic advancement over the earlier rigid sigmoidoscopes that were hindered by the relatively short length of bowel they could visualize and the rather uncomfortable examination the patient was required to endure in its use. It has clinical usefulness in the evaluation of many disease processes that involve the rectum and sigmoid colon.

Colonic Diseases↗
PubMed1997

Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia? A meta-analysis.

OBJECTIVE: To determine whether oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia. DATA SOURCES: Using the Medline database, the English-language literature was searched for all publications concerning bacteremia, fever, or S pneumoniae from 1966 to April 1996. STUDY SELECTION: All studies that included a series of children with S pneumoniae occult bacteremia containing orally treated and untreated groups. Children were excluded from individual studies if they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or received parenteral antibiotics. DATA EXTRACTION: Three authors independently reviewed each article to determine the number of eligible children and the outcome of children meeting entry criteria. DATA SYNTHESIS: Eleven of 21 studies were excluded, leaving 10 evaluable studies with 656 total cases of S pneumoniae occult bacteremia identified. Patients who received oral antibiotics had fewer serious bacterial infections than untreated patients (3.3% vs 9.7%; pooled odds ratio, 0.35; 95% confidence interval, 0.17 to 0.73). Meningitis developed in 3 (0.8%) of 399 children in the oral antibiotic group and 7 (2.7%) of 257 untreated children (pooled odds ratio, 0.51; 95% confidence interval, 0.12 to 2.09). CONCLUSION: Although oral antibiotics modestly decreased the risk of serious bacterial infections in children with S pneumoniae occult bacteremia, there was insufficient evidence to conclude that oral antibiotics prevent meningitis. Published recommendations that oral antibiotics be administered to prevent serious bacterial infections in children with possible S pneumoniae occult bacteremia should be reevaluated in light of the lower risk of sequelae from S pneumoniae occult bacteremia and newer data concerning side effects from treatment.

Administration, Oral↗
PubMed1995

Noncervical human papillomavirus genital infections.

The incidence of human papillomavirus infection is increasing. More than 60 types of human papillomavirus have been isolated; some types are known to have malignant potential. Differential diagnosis of the lesions includes condyloma latum, seborrheic keratoses, nevi, pearly penile papules and neoplasms. The goal in treating noncervical human papillomavirus infection is the elimination of lesions; eradication of the virus is not yet possible. Current forms of treatment include cryotherapy, podophyllum resin, podophilox, trichloroacetic acid, laser ablation, loop electrosurgical excision procedure (LEEP), fluorouracil and alpha interferon. Success in treating condyloma may be increased if the area is first soaked with 5 percent acetic acid to more clearly show the extent of the local infection. Recurrence is a problem no matter what form of therapy is used.

Condylomata Acuminata↗
PubMed1995

Effect of antibiotic therapy on the outcome of outpatients with unsuspected bacteremia.

The records of 559 consecutive outpatient children with unsuspected bacteremia (467 Streptococcus pneumoniae) were reviewed. When compared with patients receiving oral or parenteral antibiotics, those patients who received no antibiotics at the initial visit were in follow-up: (1) less likely to be improved (32% vs. 86%, P < 0.01); (2) more likely to be febrile (75% vs. 28%, P < 0.01); (3) more likely to be hospitalized (67% vs. 22%, P < 0.01); (4) more likely to have persistent bacteremia (28% vs. 3%, P < 0.01); and (5) more likely to have new focal infections (13% vs. 5%, P < 0.01). Compared with patients receiving parenteral antibiotics at the initial visit, patients receiving oral antibiotics were in follow-up: (1) less likely to be improved (81% vs. 89%, P < 0.05); and (2) more likely to have persistent bacteremia (5% vs. 0%, P < 0.05). There was no statistical difference between patients receiving parenteral or oral therapy in the development of focal infections, although children with new focal infections receiving oral antibiotics more often had persistent or new positive cultures. No patients receiving parenteral antibiotics at the initial visit had positive blood or spinal fluid cultures at the follow-up visit. Analyses of the subgroups with (1) occult bacteremia with all organisms, (2) unsuspected bacteremia S. pneumoniae and (3) occult bacteremia with S. pneumoniae show results similar to those for the entire group.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1995

Pediatric infectious disease emergencies.

Infectious diseases are the cause of the majority of pediatric emergency visits, although only a minority constitute true emergencies. Progress in identifying the true emergencies continues.

Bacteremia↗
PubMed1995

Group A beta-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella.

OBJECTIVE: To quantitate the increase in invasive group A beta-hemolytic streptococcal (GABHS) infections and to define a possible association between GABHS bacteremia and primary varicella zoster virus (VZV) infections. METHODS: This was a retrospective chart review conducted at Children's Hospital. Participants were patients with documented GABHS bacteremia occurring from January 1977 through December 1993. MEASUREMENTS/MAIN RESULTS: We identified 63 episodes of GABHS bacteremia in 62 patients. From 1977 to 1992, a mean of 3.2 +/- 2 cases occurred per year (range, 0 to 6), increasing by a factor of 3 (10 cases) in 1993. The median age was 4 years (range, 1 day to 20 years; mean, 8 years +/- 3 months); 36 were male; five children were immunocompromised. One child was dead on arrival and one had a cardiac arrest during evaluation in the emergency department. Primary sites of infection (oropharynx, skin, or middle ear) were identified in 40 (75%) of the cases; in addition, 10 cases occurred in patients with primary VZV. From 1977 to 1992, we identified five VZV-associated cases; an average of 7 +/- 11.5% of the patients with GABHS had concurrent VZV infection annually, with no more than one case per year. In 1993, 50% of the 10 new GABHS cases were in children with VZV infection (P = .003, Fisher's exact test). The diagnosis of invasive GABHS infection in patients with VZV was not readily recognized, requiring a median of two (range, one to four) physician visits before admission and the administration of antibiotics. All 10 children were diagnosed on the fourth or fifth day of the exanthem and were febrile (39.6 +/- 1.1 degrees C, range, 38.3 to 40.8 degrees C), with a mean white blood cell count (WBC) of 11,500 +/- 8,400/mm3 (8 of 10 cases had a WBC less than 15,000/mm3). None of the five VZV-associated cases in 1993 had signs of cutaneous bacterial superinfection; among these were two cases of streptococcal toxic shock syndrome (one death), one case of osteomyelitis, and two cases of occult bacteremia. Of the five VZV-associated cases before 1993, one patient was diagnosed with supraglottitis, one with septic arthritis, one with orbital cellulitis, and two solely with impetiginized or cellulitic lesions. CONCLUSIONS: We found that the incidence of invasive GABHS infections has risen dramatically, increasing by a factor of 3 over the past year. In 1993, 50% of new cases of invasive GABHS disease were associated with VZV infection. Invasive GABHS should be considered in children with VZV who manifest fever on or beyond the fourth day of the exanthem. The absence of an elevated WBC and impetiginized or cellulitic lesions should not eliminate this diagnosis from consideration.

Bacteremia↗
PubMed1995

A comparison of the reliability of repeat cervical smears and colposcopy in patients with abnormal cervical cytology.

BACKGROUND: To determine the reliability of repeat cervical smears (Papanicolaou smears) in patients who have had an abnormal initial smear, prospective data were collected on patients being followed up for a previously abnormal cervical smear. METHODS: All 428 patients who were referred for colposcopy because of abnormal cervical smears underwent simultaneous cervical smears and coloposcopy with directed biopsy. Patients with colposcopic evidence of invasive carcinoma or a history of prior colposcopy were excluded. Cervical smear results were compared with the histologic findings on colposcopically directed biopsy. The ability of cervical smears to identify cervical intraepithelial neoplasia (CIN) and high-grade lesions (CIN 2 and 3) were also calculated for the repeat cervical smear. RESULTS: The sensitivity of repeat Papanicolau screening for CIN was 48%. When differentiating high-grade lesions from low-grade and benign biopsies, the sensitivity of the repeat cervical smear was only 25%. Of 110 patients with biopsy-proven high-grade lesions, 68% had low-grade initial cervical smears and 73% had low-grade or benign repeat cervical smear cytology. CONCLUSIONS: This study demonstrates that repeated Pap smears often fail to identify high-grade lesions and that the sensitivity of a repeat cervical smear is very low in patients with low-grade abnormalities found on routine screening examinations. Using follow-up cervical smears to monitor patients who have low-grade squamous intraepithelial lesions (LGSIL) carries unacceptable risks. A more reliable diagnostic test such as colposcopy is indicated.

Adolescent↗
PubMed1995

Effectiveness and safety of esophagogastroduodenoscopy in family practice: experience at a university medical center.

BACKGROUND AND OBJECTIVES: As the use of esophagogastroduodenoscopy (EGD) by family physicians increases, a need exists to further demonstrate the procedure's clinical effectiveness and safety and the general experience of family physicians performing the procedure. This study examines the general experience of a group of family physicians performing EGDs in the university setting. METHODS: An analysis was done of all patients undergoing EGDs performed by family physicians at a university hospital during a consecutive 27-month period. Demographics, indications, findings, diagnoses, therapy, complications, and biopsies were analyzed. Clinical effectiveness was measured by recording whether an EGD resulted in changes in diagnosis, medical therapy, or clinical management. Endoscopic diagnoses also were correlated with biopsy pathological diagnoses. RESULTS: During the study period, 188 EGDs were performed. Clinical management of patients was changed in 88.6% of cases. The diagnosis was changed in 81.8% of cases, and drug therapy was changed in 55.7% of cases. Endoscopic impressions were confirmed by biopsy in 93.2% of cases. Procedures were completed in 98.3% of cases with no complications. CONCLUSIONS: This study demonstrates the clinical effectiveness of EGDs performed by family physicians. The feasibility of family practice endoscopy in the university medical center setting has been demonstrated, and continued benefits from this practice are anticipated.

Academic Medical Centers↗
PubMed1994

Care of bereaved parents. A study of patient satisfaction.

Death of a child is a family tragedy and may result in parental dissatisfaction with medical care. Numerous recommendations exist for physicians to help bereaved parents after perinatal or neonatal death, but the effectiveness of these treatments has not been measured. This study sought to evaluate the relationship between satisfaction with care and those recommended treatments. A study group of 37 bereaved parents completed a standardized patient satisfaction questionnaire and a questionnaire developed by the authors. Through the latter instrument, parents reported the degree to which 30 recommended treatments (seven categories) had been used by their physician. Subjects also reported the degree of helpfulness they perceived in retrospect from this care. Significant correlations were found between satisfaction scores and the use of most of the recommended treatments (five of seven categories). Being available, providing medical information and grief counseling were the categories of treatment with the greatest correlations. A change to a new physician had been made by 31% of the study group, and these parents reported their physicians had provided significantly less medical information when compared with parents who had not changed physicians. These findings support the use of currently recommended treatments for bereaved parents and suggest these parents appreciate and perceive help from medical information, support, help in overcoming denial, grief counseling and availability from their physicians.

Adolescent↗
PubMed1993

HIV-infected children in the pediatric emergency department.

Forty-three nonhemophiliac, confirmed HIV-positive children followed by the Children's Hospital AIDS Program made 184 visits to the children's Emergency Department (ED) during 1988 and 1989. The mean age was 30 +/- 28 months with a median of 25 months, a mode of 10 months, and a range from two days to 19 years. CD4 counts from within six months of the visit were available in 87% and were low enough to require Pneumocystis carinii pneumonia prophylaxis under current guidelines in 52%. Chief complaints included fever in 50%, respiratory symptoms in 21%, and gastrointestinal symptoms in 8%. The ED discharge diagnosis included fever/possible sepsis in 25%, pneumonia in 17%, otitis media in 9%, and upper respiratory tract infection or viral syndrome in 9%. Overall, an acute infection was identified at 62% of visits; of these, 33% were judged to be serious in nature. A total of 92 blood cultures were drawn, of which eight were positive with the following organisms: Streptococcus pneumoniae (3), Streptococcus faecalis (2), Escherichia coli (1), Torulopsis glabrata (1), and Staphylococcus non-aureus (1, a probable contaminant). Overall, 53% of patient encounters resulted in hospitalization. Patients with a white blood cell count more than 15,000/mm3 were more likely to be hospitalized (87 vs 62%, P < 0.01), though the white blood cell count was not helpful in identifying patients with bacteremia or serious infections. The mean temperature of patients admitted was higher than in those discharged (38.7 vs 37.9 degrees C, P < 0.01). In 1989, an estimated six per 1000 visits to our facility were by HIV-infected children.

AIDS-Related Opportunistic Infections↗
PubMed1993

Occult bacteremia in the 3-month-old to 3-year-old age group.

Occult bacteremia precedes many serious infections in children. The vast majority of patients with occult bacteremia have an elevated temperature (> or = 39 degrees C), but fever is an extraordinarily common presenting complaint in the 3- to 36-month-old age group, which is at highest risk for S pneumoniae, H influenzae type b, and N meningitidis bacteremia. On examination, most patients with bacteremia will have no findings that distinguish them from nonbacteremic children. A white blood cell count of > 15,000/microL in a child with fever will identify about two thirds of children with occult bacteremia. Blood culture remains the most definitive test. It is important to establish a rational strategy to identify and treat these children before significant sequelae occur.

Algorithms↗
PubMed1993

Loop electrosurgical excisional procedure.

Loop electrosurgical excisional procedure, or LEEP, also known as loop diathermy treatment, loop excision of the transformation zone (LETZ), and large loop excision of the transformation zone (LLETZ), is a new technique for outpatient diagnosis and treatment of dysplastic cervical lesions. This procedure produces good specimens for cytologic evaluation, carries a low risk of affecting childbearing ability, and is likely to replace cryotherapy or laser treatment for cervical neoplasias. LEEP uses low-current, high-frequency electrical generators and thin stainless steel or tungsten loops to excise either lesions or the entire transformation zone. Complication rates are comparable to cryotherapy or laser treatment methods and include bleeding, incomplete removal of the lesion, and cervical stenosis. Compared with other methods, the advantages of LEEP include: removal of abnormal tissue in a manner permitting cytologic study, low cost, ease of acquiring necessary skills, and the ability to treat lesions with fewer visits. Patient acceptance of the procedure is high. Widespread use of LEEP by family physicians can be expected.

Ambulatory Surgical Procedures↗
PubMed1989

Vomiting, nausea, and abdominal pain: unrecognized symptoms of thyrotoxicosis.

The prevalence of symptoms in thyrotoxicosis at the time of diagnosis has received little attention in studies of this condition. Vomiting, nausea, and abdominal pain have not been included as common presenting symptoms for thyrotoxicosis in standard textbooks of medicine and endocrinology. Some reports in the medical literature, however, indicate that these abdominal symptoms may be important manifestations of this condition. A retrospective chart review was undertaken to determine the prevalence of vomiting, nausea, and abdominal pain in patients hospitalized for thyrotoxicosis at Louisiana State University Medical Center, Shreveport, from 1982 through 1986. Of 25 thyrotoxic patients who had thyrotoxicosis diagnosed during or immediately prior to admission, 44% reported vomiting, 28% reported nausea, and 20% complained of abdominal pain. One or more of these abdominal symptoms were included as a chief complaint in 36% of cases reviewed. Further study of the clinical presentation of thyrotoxicosis in the outpatient setting is needed to improve the timeliness and cost effectiveness of the clinical diagnosis of this condition.

Abdominal Pain↗
PubMed1983

Unresolved grief in the family.

Unresolved grief after a death in the family may have serious consequences not merely for individuals but for entire families, from grandparents to grandchildren. When the grieving process is abnormal or incomplete, the problem may manifest itself in the physician's office. Observation of a family system can reveal the extent of pathology and the nature of the blocks that keep grief alive. Treatment of unresolved grief ranges from a simple statement of the problem to extended therapy. The physician must be aware of this problem in order to manage it; the cases in this article illustrate presentations of unresolved grief in a variety of family members.

Adolescent↗
PubMedDate not supplied

Procedural training in family practice residencies: current status and impact on resident recruitment.

BACKGROUND: Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. METHODS: A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. RESULTS: Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. CONCLUSIONS: The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.

Family Practice↗