Biomedical subjects
R W Curry
Publications and source records attributed to R W Curry.
Pseudoinfarction without underlying cardiopulmonary pathology.
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The effect of ibuprofen on serum digoxin concentrations.
This study was undertaken to determine the effects of ibuprofen (Motrin), in daily doses of at least 1600 mg, on steady-state digoxin concentrations. A total of 12 ambulatory patients (10, female; 2, male), with a mean age of 66 years (38-81 yr), completed the study. An initial baseline serum digoxin level was obtained, with follow-up levels at 7 days and, whenever possible, 28 days after ibuprofen initiation. Serum creatinine concentrations were not significantly different from baseline to 7 or 28 days of ibuprofen therapy. Results show a statistically significant (p less than 0.05) increase in digoxin levels after seven days of ibuprofen. The mean increase was 59 percent (range, 10.7-325.4 percent), with 10 of the 12 patients displaying increased seven-day levels. Digoxin levels drawn 28 days after ibuprofen initiation were not statistically different from baseline or seven-day digoxin levels.
Exercise testing and coronary artery disease.
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Acute renal failure after acetaminophen ingestion.
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The pharmacist as a member of the primary care team: experience in a university-based program.
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Antibiotic prescribing in a family medicine residency program.
A total of 227 ambulatory patients who received prescriptions for antibiotics in a family practice residency program was studied. The common infections treated were urinary tract infections, upper respiratory tract infections, impetigo, nonspecific vaginitis, and bronchitis. Cultures obtained in 21.1 percent of the patients were usually considered to be appropriate. Urinary tract infections were usually treated with co-trimoxazole or other drugs containing sulfonamides; upper respiratory tract infections with amoxicillin, ampicillin, or penicillin; impetigo with penicillin; nonspecific vaginitis with vaginal creams; and bronchitis with ampicillin or erythromycin. Most prescriptions (86 percent) were written generically at an approximate savings of $2 per prescription. A review panel audited the prescribing practices and often (32.2 percent) disagreed among themselves, yet they did determine 65.4 percent of the prescriptions to be appropriate. The rate of appropriate antibiotic prescribing practices among the residents was found to decrease as the level of supervision decreased (P less than 0.01).
Prediction of serum concentrations of digoxin in a family practice center.
Physicians and clinical pharmacists were compared in their ability to predict serum digoxin concentrations and to discriminate among patients who were subtherapeutic, therapeutic or toxic. Physicians correctly predicted patients having therapeutic serum digoxin concentrations 77 percent of the time, but they were unable to reliably identify subtherapeutic and toxic patients. By incorporating more compliance and pharmacokinetic data into their assessment, pharmacists proved to be more accurate than physicians both in the prediction of serum digoxin concentrations (P less than .01) and in therapeutic classifications (P less than .001). The clinical pharmacist can be a valuable aid to the physician in the prediction and interpretation of serum digoxin concentrations.
Potential for biodegradation of phthalic Acid esters in marine regions.
Di-(2-ethylhexyl) phthalate was the major phthalic acid ester in the Mississippi River estuary, with mean levels of 0.1 mug/g (dry weight) in surface sediments, 1.0 mug/liter in river water, and 0.7 mug/liter in delta water. Bacteria that grew aerobically on dibutyl phthalate and o-phthalic acid were readily detected in the sediments and water. Pure cultures of bacteria were isolated on seven different phthalic acid esters from freshwater and marine sources. The marine isolates were taxonomically diverse and grew on a variety of phthalic acid esters. Dibutyl phthalate and o-phthalic acid supported growth in full-strength synthetic sea-water medium, but Na -dependent catabolism was demonstrable only for o-phthalic acid.
Determining the "proper" gentamicin dosage in a hospital setting.
A method for determining a gentamicin dosage was applied to a patient in a community hospital setting. It was found that many factors, some beyond the practitioner's control, confused proper use of the drug. A case is used to illustrate the difficulties encountered in a community hospital setting when a seemingly straightforward protocol for gentamicin administration for therapy was initiated. The errors associated with each of five levels of personnel are illustrated which if summed could result in potentially serious consequences. In addition to reviewing the literature on gentamicin dosage schedules and making recommendations regarding future research in this area, specific guidelines are proposed for the use of gentamicin in clinical practice.
The referral process: a study of one method for improving communication between rural practitioners and consultants.
Communication between referring physicians and consultants, essential for successful completion of the consultative-referral process, was inadequate in a rural clinic. This finding prompted the authors to conduct a randomized prospective trial of a referral form and return mailer in three rural primary care clinics associated with a university medical center. The use of a return mailer increased the percentage of consultant feedback from 39 percent to 60 percent, a highly significant increase. An added benefit was a decrease in the median time interval between a patient's contact with a consultant and receipt of that consultant's report by the rural clinics. The positive effect of the return mailer was consistent among various consultant categories, with the greatest improvement coming from a teaching hospital Emergency Room. The type of referring provider or the emergency status of the patient did not affect the percentage of communications returned. The use of a referral form accompanied by a request for feedback and a return mailer is an inexpensive method of increasing communication between primary care providers and consultants, thereby enhancing the value of the consultative-referral process.
Ethics teaching on ward rounds.
Ethics teaching in medical settings usually takes place in the classroom or at specially designated times and places, as in "ethics grand rounds." The authors, an ethicist and an internist, have integrated ethics teaching into regular attending rounds. Three cases illustrated their approach.
Anemia of chronic disorders: more common than commonly appreciated.
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Recurrent ergotism: a case report.
A patient was seen with absent pulses and vague symptoms. History and clinical findings supported a diagnosis of ergotism due to heavy use of ergotamine suppositories. The patient continued to use ergotamine despite warnings and was seen on two additional occasions with ergotism. Previously a heavy user of ergotamine, she became sensitive to small doses, demonstrating marked vasospasm after only one suppository. This phenomenon, not previously reported, is postulated secondarily to drug interaction. The patient is presented with a review of the pharmacology, toxicity, and treatment of ergotamine-induced ergotism. Alerted to the possibility of drug interactions, physicians may safely use ergotamine in the treatment of migraine headache with careful monitoring for signs and symptoms of early toxicity.
Levothyroxine sodium tablets: chemical equivalence and bioequivalence.
Two brands of levothyroxine sodium tablets were compared in vivo for bioequivalence in a double-blind, randomized study. The tablets were identical in levothyroxine content. Evaluation was by means of triiodothyronine (uptake), tetraiodothyronine, free thyroxine index, total triiodothyronine by radioimmunoassay, and thyroid-stimulating hormone measurements. No differences in clinical response were found in a study with a high statistical power. It was concluded that the two brands were bioequivalent because of chemical equivalence, use of micronized levothyroxine powder in tablet production with at least one of the brands, and scrupulous attention to quality control during the manufacturing process, all of which contributed to assurance of homogeneity of the products and close adherence (+/- five percent) to the claimed potency.
Potential benefits of a computer ECG interpretation system for primary care physicians in a community hospital.
One hundred fifteen ECGs from a hospital service were interpreted by 2 primary care physicians and 2 expert electrocardiographers. When their interpretations were compared with one another and with the Marquette MAC II ECG Interpretation Program, there was great variability. Computer ECG interpretations appeared to benefit primary care physicians most by providing a backup opinion. This second opinion was also of use to expert electrocardiographers. Additional long-term benefits that may be derived from computer systems include improvement of physician interpretation ability, reduction in interpretation time, and standardization of electrocardiographic nomenclature and criteria.