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Biomedical subjects

P Bijur

Publications and source records attributed to P Bijur.

10 recordsLinked to original sources
PubMed2004

Limited usefulness of initial blood cultures in community acquired pneumonia.

OBJECTIVE: The incidence of community acquired pneumonia (CAP) is about 4 million cases per year, with a hospitalisation rate of 20%. In non-immunocompromised patients hospitalised for CAP the rate of bacteraemia is less than 7% with predictable pathogens. Despite this, guidelines still recommend use of blood cultures (BCs) to direct treatment. This study tested the primary hypothesis that the proportion of false positive BCs would exceed the proportion of true positives. A secondary aim was to quantify the frequency with which antibiotic therapy was changed based on BC results. METHOD: Consecutive adults hospitalised from an urban emergency department (ED) with CAP between January 1999 and March 2001 were assessed retrospectively for study eligibility. Those with an infiltrate consistent with pneumonia on the admission chest radiograph and at least one set of BCs taken in the ED before antibiotics were given were entered into the study. Patients hospitalised within the previous two weeks, nursing home residents, and immunosuppressed patients were excluded. RESULTS: 821 patients were admitted for CAP and 355 met inclusion criteria. The proportion of false positive BCs (10%) exceeded the proportion of true positives (9%), by 1% (95%CI -3.3% to 5.5%). Antibiotic therapy was changed on the basis of BC results in 5% of patients (95%CI 3% to 8%). CONCLUSION: The rate of false positive BCs in patients hospitalised with CAP is similar to the rate of true positives. BCs only infrequently lead to changes in antibiotic therapy, and in no instance were therapeutic changes driven by detection of resistant organisms. The results question the utility of routine BCs in immunocompetent patients with CAP.

Adolescent↗
PubMed2001

Six-hour versus 12-hour protocols for AMI: CK-MB in conjunction with myoglobin.

The objective was to test the hypothesis that a protocol using myoglobin and creatine kinase-MB (CK-MB) can rapidly and safely exclude myocardial infarction (MI). The study used a prospective, convenience cohort of ED patients with clinically suspected myocardial ischemia. Myoglobin was measured on presentation, 2 and 6 hours later; CK-MB was measured on presentation, 6, 12, and 18 hours later. Of 519 patients, 76 (15%) had MIs, all of whom "ruled in" within 12 hours using a combination of myoglobin and CK-MB, for a sensitivity of 100% (95% CI, 95% to 100%), specificity of 92% (95% CI, 89% to 94%), LR (+) of 12 (95% CI, 9 to 16), and an LR (-) of 0.03 (95% CI, 0.0 to 0.05). Of the 76 patients with MIs, 73 ruled in with a 6 hour protocol, also using a combination of CK-MB and myoglobin, for a sensitivity of 96% (95% CI, 89% to 99%), specificity of 92% (95% CI, 89% to 94%), LR (+) of 11 (95% CI, 8 to 16), and an LR (-) of 0.04 (95% CI, 0.01 to 0.12). Our results support the hypothesis that, using an abbreviated protocol with CK-MB and myoglobin, MI can be reliably ruled out in ED patients with suspected ischemia.

Adult↗
PubMed2001

Advance directives in skilled nursing facility residents transferred to emergency departments.

OBJECTIVE: Ten years have passed since Congress enacted the Patient Self-Determination Act to promote the use of advance directives (ADs). This study was performed to determine the frequency, type, demographic distribution, and utility of ADs that accompany residents of skilled nursing facilities (SNFs) transferred to emergency departments (EDs). METHODS: This was an observational, cross-sectional cohort of SNF residents, transferred to two urban, academic EDs. Chart review and physician interviews were conducted on consecutive patients arriving during 12-hour data collection shifts. RESULTS: Among 715 patients entered, 315 [44%, 95% confidence interval (95% CI) = 40% to 48%] had an AD. Advance directives were significantly more prevalent among white (50%) than African American (34%) or Hispanic (39%) patients (p < 0.001), and varied from 0% to 94% among SNFs. Of the 315 patients with ADs, do-not-resuscitate (DNR) orders were the most prevalent (65%, 95% CI = 58% to 69%). Although 75% (95% CI = 69% to 81%) of the DNR orders addressed cardiopulmonary resuscitation (CPR), only 12% (95% CI = 8% to 16%) addressed intubation. Among 39 patients who required intubation or CPR, 44% had ADs, 82% (95% CI = 57% to 96%) of which were deemed useful. CONCLUSIONS: Despite a decade of legislation promoting their use, ADs are lacking in most SNF residents transferred to EDs for evaluation and in most settings in which a clinical indication exists for intubation or CPR. Variation in their prevalence appears to be associated with both ethnicity and SNF origin. Although about three-fourths of DNR ADs addressed CPR, only about one in ten offered guidance regarding intubation. When available, ADs are used in most instances to guide emergency care.

Advance Directives↗
PubMed1999

The differential impact of training stress and final examination stress on herpesvirus latency at the United States Military Academy at West Point.

In this study, we searched for evidence for reactivation of three latent herpesviruses, Epstein-Barr virus (EBV), herpes simplex virus type-1 (HSV-1), and human herpesvirus 6 (HHV-6), in West Point cadets experiencing two different stressors. Blood samples were obtained from cadets before and after a 6-week training period known as "Cadet Basic Training" (CBT), at a baseline prior to final examinations, and then once again during the week of final examinations. Antibody titers to latent HSV-1, EBV, and HHV-6 were determined as a measure of the steady-state expression of latent virus. EBV virus capsid antigen (VCA) IgG antibody titers were unchanged in blood samples obtained prior to and immediately after CBT. However, EBV antibody titers were significantly higher in the blood sample obtained during examination week than in the baseline period before examination; they were also higher than antibody titers before/after CBT. None of the serum samples were positive for EBV VCA IgM antibodies, indicating that the changes in antibody titers to EBV were not associated with recent EBV infections in the class. No significant changes in antibody titers to HSV-1 or HSV-6 were found over the identical time periods, including examination week. Academic stress but not CBT modulated the steady-state expression of latent EBV, resulting in the reactivation of latent virus. The same stressors, however, did not affect the steady-state expression of latent HSV-1 or HSV-6, at least as measured by changes in antibody titers. The data provide additional evidence of the impact of different psychological stressors on the steady-state expression of latent herpesviruses.

Adult↗
PubMed1999

Exploring intermittent transcutaneous CO2 monitoring.

OBJECTIVE: To explore the accuracy of a continuous transcutaneous CO2 (T(CCO2)) monitor, used in an intermittent rather than a continuous fashion, to obtain quick (<5 mins) CO2 readings. DESIGN: Prospective study. SETTING: An urban pediatric intensive care unit in a university teaching hospital. PATIENTS: A convenience sample of pediatric patients with indwelling arterial catheters. INTERVENTION: Transcutaneous monitoring was done simultaneous with arterial blood gas monitoring. MEASUREMENTS AND MAIN RESULTS: There were 49 simultaneous-readings on 19 patients, age 5 days to 16 years, with 13 different diagnoses. The T(CCO2) was related to the PCO2 by a Pearson product coefficient of 0.79 (p<.0005), with a mean difference of 1.94 (T(CCO2)>P(CO2) and 95% confidence interval of -0.12 to 4.07. The scatterplot produces a regression line characterized by the following equation: PCO2 = (T(CCO2)x1.05)-4.08. CONCLUSIONS: Further study to evaluate intermittent TCCO2 as a practical clinical variable is warranted. This study should encourage refinement of the technology to be more accurate for this use.

Adolescent↗
PubMed1988

Behavioral predictors of injury in school-age children.

The behavior of 10,394 British children was related prospectively to their injury history between ages 5 and 10 years, obtained from parents. Aggressive and overactive behaviors at age 5 years were measured by subscales of the Rutter Child Behavior Questionnaire completed by the parents. Multivariate techniques were used to assess the association between behavior and injuries while controlling for social, demographic, and psychological characteristics. Boys' behavior at age 5 years was more strongly predictive of injuries in the subsequent five years than was girls' behavior. The odds of experiencing injuries resulting in hospitalization in boys with high aggression scores was 2.4 times that of boys with low aggression scores. The identification of high-risk children provides the foundation for understanding the behavioral mechanisms that contribute to injuries and for developing preventive strategies tailored to the needs of these children.

Accidents↗
PubMed1986

Case definition in childhood accident studies: a vital factor in determining results.

Research into possible aetiological factors associated with childhood accidents has failed to produce a consistent picture. In this paper we investigate the extent to which these discrepancies are attributable to different methods of case ascertainment. The approach was to use three different criteria for identifying accidents and to apply a number of commonly used statistical techniques to eight social and environmental factors. The data base consists of a nationally representative sample of 13 135 children (the Child Health and Education Study). In this way, broadly similar profiles were obtained for children reported to have had at least one accident in the first five years and for those who were said to be accident repeaters--the major risk factors in common for these two outcomes were young maternal age and residence in 'average' or 'well-to-do' urban areas. On the other hand, there were major differences in the results when admission to hospital for an accident was taken as the outcome--although young maternal age was still strongly associated, large family size and the loss or replacement of a natural parent were now also dominant risk factors. There was no relationship with area of residence. The conclusion from these example analyses is therefore that variation in case selection can lead to different conclusions about the risk factors associated with childhood accidents.

Accidents↗
PubMed1978

An evaluation of the utility of high blood pressure detection fairs.

Our data indicate that voluntary casual screenings in essentially middle class locations may be of limited value in attracting the young, the black, and the male relative to the target population. Our screens attracted a large proportion of individuals who where already aware of their high blood pressure. Nevertheless, these screens can be useful in getting and keeping individuals under medical care: newly detected hypertensives, those who knew they have it and even some of those under treatment for it.

Evaluation Studies as Topic↗