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Biomedical subjects

S J Lerman

Publications and source records attributed to S J Lerman.

At least 19 recordsLinked to original sources
PubMed1999

Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits.

BACKGROUND: Oral rehydration solutions (ORS) for the treatment of acute diarrhea remain an underutilized therapy in the United States, despite multiple clinical trials confirming their efficacy and safety. Economic barriers to their use have been identified. OBJECTIVE: To determine whether providing ORS to patients at the time of their office visit for acute diarrhea can increase ORS utilization and reduce unscheduled follow-up visits. DESIGN: Randomized, controlled clinical trial. SETTING: Seven health centers of a large health maintenance organization. PARTICIPANTS: Children (N = 479) 0 to 60 months of age with acute diarrhea (at least three watery or loose stools in the previous 24 hours for </=7 days). INTERVENTION: Prescription for 2 quarts of ORS filled for free at on-site pharmacy plus written instructions versus written instructions alone. PRIMARY OUTCOME MEASURES: Self-reported use of ORS; unscheduled follow-up visits in office, urgent care, and/or emergency department setting. RESULTS: Subjects in the intervention group were significantly more likely to use ORS after the initial office visit (85% vs 71%; RR: 1.19; 95% CI: 1.08-1.32). Of the standard treatment group subjects, 40 (17.3%) sought unscheduled follow-up care for diarrhea versus 27 (10.9%) of the intervention group subjects (RR: 0.63; 95% CI: 0.40-0.99). Subjects seeking unscheduled follow-up care tended to younger (15.7 vs 19.4 months old), have more stools (7.1 vs 6.2 stools), and more vomiting episodes (4.1 vs 3.0) in the 24 hours before initial evaluation than those not seeking unscheduled follow-up care. Multivariate analysis showed that randomization to the intervention group was associated with a 25% reduction in unscheduled follow-up visits for acute diarrhea. CONCLUSIONS: Providing ORS to families at the time of their office visit for acute diarrhea is associated with a significant increase in ORS use and substantially reduces the need for unscheduled follow-up visits. Health maintenance organizations should consider routine provision of ORS to children presenting with acute diarrhea.

Acute Disease↗
PubMed1985

Treatment of diarrhoea in Indonesian children: what it costs and who pays for it.

The annual economic burden of diarrhoea in four subdistricts in Indonesia averaged $2.27 per child aged under 5 years when health centre, hospital, and private expenditures were all considered. The community itself spent $1.03 per child or 46% of the total; 96% of community payments went to the private sector, and 4% were for fees at government health centres and hospitals. The widespread availability of oral rehydration therapy has led to only partial abandonment of ineffective or marginally effective medications; non-rehydration medications amounted to 44% of total treatment expenditures. Most medication costs were for antimicrobial agents, such as tetracycline in the government sector and iodochlorhydroxyquin in the private sector. If the use of tetracycline at health centres could be restricted to 10% of episodes treated instead of the present 88%, their costs could be reduced by 50%.

Child↗
PubMed1982

Systemic Hemophilus influenzae infection. A study of risk factors.

In Omaha, from 1974 to 79, 30 (12.5%) of 240 patients with Haemophilus influenzae bacteremia or meningitis had a wide variety of conditions known to be associated with increased susceptibility to bacterial infection. Neonates and adults accounted for 47 per cent of the infections. Non-type b and non-typable strains caused 41 per cent of the episodes. Forty-one per cent of patients had bacteremia with no detectable focus of infection. The incidence of meningitis was low. Mortality was 28 per cent, considerably higher than in patients who were previously healthy. A review of the medical literature indicated that low-birth weight infants and patients with leukemia and other malignancies undergoing chemotherapy, splenectomy, congenital asplenia, sickle cell anemia, immunoglobulin deficiency diseases, cerebrospinal fluid shunts, and skull defects are at greater risk for systemic H. influenzae disease than the general population.

Adolescent↗
PubMed1982

Treatment of giardiasis: literature review and recommendations.

Giardia lamblia has emerged as the most common intestinal parasite in the United States. This article presents a brief review of the clinically important aspects of giardiasis and evaluates the currently used therapeutic agents. Three drugs have been advocated for the treatment of giardiasis; furazolidone (Furoxone), metronidazole (Flagyl), and quinacrine (Atabrine). None of them, however, is ideal. Metronidazole and quinacrine are more effective than furazolidone, but furazolidone has the advantage of a liquid formulation that makes administration to children easier. Quinacrine is much less expensive than the other two agents but has a somewhat higher rate of side effects and a bitter taste. There is concern about the carcinogenic potential of furazolidone and metronidazole, but this has not been evaluated for quinacrine. In the balance, we conclude that quinacrine is probably the preferable drug to use in the pediatric age group because of proven effectiveness and lower cost.

Animals↗
PubMed1981

High-performance liquid chromatographic analysis of iodochlorhydroxyquin in plasma.

A simple isocratic high-performance liquid chromatographic procedure for the analysis of iodochlorhydroxyquin in human plasma is described. Protein was precipitated using perchloric acid, and the supernatant and precipitated protein fractions were extracted with ether. The ether phases were evaporated to dryness, reconstituted in mobile phase, and chromatographed. A reversed-phase microparticulate C18 column, a precolumn, and a UV detector at 256 nm were used. A mobile phase containing 80% methanol and 20% of 0.05 M phosphoric acid was employed at a flow rate of 1 ml/min. Quantitation of iodochlorhydroxyquin in the 1--15-microgram/ml range in human plasma was demonstrated with a coefficient of variance of 0.1--0.06. Hydrocortisone, which is used in combination with iodochlorhydroxyquin in ointments and creams, does not interfere in the assay.

Chromatography, High Pressure Liquid↗
PubMed1981

Haemophilus influenzae infections of cerebrospinal fluid shunts. Report of two cases.

Two (1%) of 165 episodes of Haemophilus influenzae infection of the central nervous system occurred in patients with cerebrospinal fluid shunts. Both cases were caused by strains that could not yet be typed. The clinical presentation was similar to that of other forms of shunt infection, yet the pathogenesis may be similar to that of H. influenzae meningitis in children without shunts. Systemic antibiotic therapy, without shunt replacement or intraventricular antibiotic administration, may be more successful in shunt infections caused by H. influenzae than in those caused by other organisms.

Anti-Bacterial Agents↗
PubMed1981

Clinical and serologic evaluation of measles, mumps, and rubella (HPV-77:DE-5 and RA 27/3) virus vaccines, singly and in combination.

A double-blind, placebo-controlled comparison of single component and combination measles, mumps, and rubella (HPV-77:DE-5 and RA 27/3) virus vaccines involving 502 young children was conducted. The rubella antibody response was similar with RA 27/3 rubella and measles-mumps-rubella (RA 27/3) vaccines, but was diminished with the combination vaccine that incorporated HPV-77:DE-5 rubella. There was no evidence of enhanced clinical reactivity with either of the measles-mumps-rubella vaccines.

Antibodies, Viral↗
PubMed1980

Rise and fall of shigella antibiotic resistance.

Ampicillin resistance of shigellae first appeared in Omaha in 1971, peaked at 68% between 1973 and 1974, and declined to 7% between 1977 and 1978. This reflected the rise and fall of strains with nine different multiple antibiotic resistance patterns that included ampicillin.

Ampicillin↗
PubMed1979

Nasopharyngeal carriage of antibiotic-resistant Haemophilus influenzae in healthy children.

We selected 16 schools representing a broad socioeconomic cross-section of metropolitan Omaha and obtained nasopharyngeal cultures for Haemophilus influenzae from 1,084 healthy 4- to 7-year-old children. We found that 34.2% of the children carried nontypable strains and 2.0% carried type b strains. Carriage rates were not influenced by recent illness, family size, or number of people sharing a bedroom. The prevalence of ampicillin-resistant H influenzae in the sample population was 0.9% for nontypable strains and 0.4% for type b strains; it was not significantly different in the group of children who had recently used beta-lactam antibiotics. One child carried a nontypable strain which was resistant to both chloramphenicol and tetracycline, the first chloramphenicol-resistant H influenzae detected in Omaha. A survey of healthy children may be a useful method for projecting a community's risk of disease caused by ampicillin-resistant H influenzae. Among the nasopharyngeal isolates from healthy children, 2.7% of nontypable strains and 18.2% of type b strains were resistant to ampicillin (P less than .01). During the same five-month period in Omaha, clinical failure in the treatment of otitis media with ampicillin was uncommon and four (20.0%) of 20 cases of H influenzae type b bacteremia and meningitis were caused by ampicillin-resistant organisms.

Ampicillin↗