Biomedical subjects

Michael Friedman

Publications and source records attributed to Michael Friedman.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Intravenous antibiotics for refractory rhinosinusitis in nonsurgical patients: preliminary findings of a prospective study.

BACKGROUND: Some patients with persistent chronic sinusitis have either had unsuccessful surgery or have simply refused surgery. In nonsurgical candidates, when oral antibiotics and traditional therapy are unsuccessful, home intravenous (i.v.) antibiotics present an effective alternative. METHODS: Forty-five patients were assessed before treatment using a semiquantitative scoring system and visual analog scales to measure major and minor symptoms of rhinosinusitis. Computed tomography (CT) scans were assessed using the Lund-MacKay staging system; nasal endoscopic findings were documented. Seven patients had nasal endoscopy and CT results. Medical diseases known to be associated with rhinosinusitis were documented. Endoscopic-guided culture and sensitivities were obtained. After successful insertion and radiological placement confirmation, home i.v. antibiotics were administered via a peripherally inserted central catheter line. Antibiotic choice was based on the culture and sensitivity reports. Treatment continued for 6 weeks; subsequent cultures were obtained at weeks 3, 6, and 9. Nasal endoscopy was performed, and rhinosinusitis symptoms were assessed at weeks 3, 6, and 9. Follow-up CT scans were obtained at week 12 in a subset of patients. RESULTS: Significant improvement in symptom analysis was seen in patients receiving home i.v. antibiotics when previous oral antibiotic treatment and/or surgery had failed. CONCLUSION: Home i.v. antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.

Anti-Bacterial Agents↗

PubMedDate not supplied

Audience response system: effect on learning in family medicine residents.

BACKGROUND AND OBJECTIVES: The use of an electronic audience response system (ARS) that promotes active participation during lectures has been shown to improve retention rates of factual information in nonmedical settings. This study (1) tested the hypothesis that the use of an ARS during didactic lectures can improve learning outcomes by family medicine residents and (2) identified factors influencing ARS-assisted learning outcomes in family medicine residents. METHODS: We conducted a prospective controlled crossover study of 24 family medicine residents, comparing quiz scores after didactic lectures delivered either as ordinary didactic lectures that contained no interactive component, lectures with an interactive component (asking questions to participants), or lectures with ARS. RESULTS: Post-lecture quiz scores (maximum score 7) were 4.25 +/- 0.28 (61% correct) with non-interactive lectures, 6.50 +/- 0.13 (n=22, 93% correct) following interactive lectures without ARS, and 6.70 +/- 0.13 (n=23, 96% correct) following ARS lectures. The difference in scores following ARS or interactive lectures versus non-interactive lectures was significant (P <.001). Mean quiz scores declined over 1 month in all three of the lecture groups but remained highest in the ARS group. Neither lecture factors (monthly sequence number) nor resident factors (crossover group, postgraduate training year, In-Training Examination score, or post-call status) contributed to these differences, although postcall residents performed worse in all lecture groups. CONCLUSIONS: Both audience interaction and ARS equipment were associated with improved learning outcomes following lectures to family medicine residents.

Cross-Over Studies↗

PubMedDate not supplied

Inspiratory and fixed nasal valve collapse: clinical and rhinometric assessment.

BACKGROUND: Acoustic rhinometry (AR) has been used to assess nasal valve obstruction. Standard AR measurement of the cross-sectional area (CSA) of the nasal valve is done in the apneic phase, whereas collapse often occurs on inspiration. We used the ratio of the CSA obtained during active inspiration and during apnea to compute a more meaningful method of diagnosing nasal valve collapse. METHODS: AR was performed in 40 patients without nasal valve obstruction and 47 patients diagnosed with nasal valve obstruction. Patients with septal deflection or anterior inferior turbinate hypertrophy were excluded. The internal and external nasal valve area was observed during apnea and on active inspiration. AR measurement of the CSA of both nasal valves was performed during the apneic phase and during active inspiration and the CSA (inspiratory)/CSA (apneic) ratio was calculated. RESULTS: The CSA (inspiratory)/CSA (apneic) ratio was > or = 1 in normal patients and in patients with fixed nasal valve collapse. The ratio was <1 in patients with inspiratory collapse. Data from history, physical examination, and dual-mode AR testing successfully differentiated patients into (1) normal valves, (2) fixed valve collapse, and (3) inspiratory valve collapse. A large number of patients with collapse had both internal and external valve obstruction and a large number also had a combination of inspiratory and fixed collapse. CONCLUSION: Dual-mode AR testing is an effective tool in more precisely identifying nasal valve obstruction and is the first objective test shown to be highly diagnostic of inspiratory nasal valve collapse.

Apnea↗