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Biomedical subjects

S L Solomon

Publications and source records attributed to S L Solomon.

16 recordsLinked to original sources
PubMed1991

Transmission of infectious diseases in outpatient health care settings.

Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures.

Ambulatory Care Facilities↗
PubMed1991

Nosocomial pneumonia in Medicare patients. Hospital costs and reimbursement patterns under the prospective payment system.

To determine the extent to which hospitals are reimbursed for Medicare patients who develop nosocomial pneumonia, we analyzed hospital accounting costs, reimbursements received, and the net income from 33 Medicare patients who developed nosocomial pneumonia. In 31 of the 33 cases, hospital costs for the entire admission exceeded reimbursements, with a median net loss of $5800 per case. Eleven randomly selected pneumonia cases were compared with control patients matched by diagnosis related group, age, sex, and service. Cases had significantly longer hospital stays, had greater total hospital costs, and caused greater net losses than did matched controls. We conclude that hospitals are seldom reimbursed adequately for Medicare patients who develop nosocomial pneumonia. With the advent of the prospective payment system, hospitals now have substantial financial incentives for implementing cost-effective measures for preventing nosocomial pneumonias.

Aged↗
PubMed1991

Anatomy of the major fissure: evaluation with standard and thin-section CT.

The major fissures of the right and left lungs were studied with standard computed tomography (CT) (10-mm-thick sections) and thin-section CT (2-mm-thick sections) in 50 patients. On standard CT scans, the major fissures were seen in 90%-100% of cases at each of three selected levels. They usually appeared as hypoattenuating bands and less often as lines or hyperattenuating bands. Although in most cases the major fissure was seen as a line on thin-section CT scans, this appearance was more common in the upper portion of the left major fissure than in the upper portion of the right major fissure. A "double-fissure sign" was most frequently seen at the base of the left lung; however, the sign was also seen at higher levels, with approximately equal frequency in the right and left lungs. An incomplete major fissure was noted in the right lung in 32 cases (64%) and in the left lung in 26 cases (52%). The upper and middle portions of the left major fissure were less frequently incomplete than were the comparable portions of the right major fissure. Thin-section CT provided better delineation of the major interlobar fissures than did standard CT.

Aged↗
PubMed1991

Artifacts in computed radiography.

Storage-phosphor digital radiographic systems are becoming widely used in a variety of diagnostic procedures. The equipment is reliable and produces images of consistently high quality. However, the images may contain artifacts directly related to the digital techniques used, to the phosphor imaging plate, or to radiography in general. This article illustrates many of the artifacts encountered that are specific to computed radiography, some of which can simulate pathologic lesions. Their causes and remedies are discussed briefly.

Algorithms↗
PubMed1991

Prevalence and incidence of human immunodeficiency virus among patients undergoing long-term hemodialysis. The Cooperative Dialysis Study Group.

PURPOSE: The purpose of this voluntary multicenter study was to estimate the prevalence and incidence of human immunodeficiency virus (HIV) infection and the risk of nosocomial transmission of HIV in hemodialysis patients in the United States. PATIENTS AND METHODS: In June 1986, we began collecting epidemiologic data, risk factor information, and serum for HIV antibody testing from long-term hemodialysis patients on entry into the study and 1 year later. RESULTS: Initial data and specimens were collected from 1,324 patients in 28 dialysis centers in 12 states. On entry, 26 were positive or equivocal by enzyme immunoassay; 13 of these were positive by Western blot assay (overall seroprevalence 0.98%). Seroprevalence was higher for patients tested in eight centers located in areas from which a high cumulative incidence of acquired immunodeficiency syndrome has been reported (500 or more cases per 1 million persons) than for patients in other areas (10 of 387 [2.6%] versus three of 937 [0.3%]; p = 0.00048). According to their dialysis records, all 13 of the Western blot-positive patients had received transfusions. Seropositive patients were not more likely to have received a transfusion than seronegative patients (13 of 13 versus 1,038 of 1,311; p = 0.08). The confidential risk factor questionnaire was completed by 1,206 (91%) patients including nine of 13 (69%) of the seropositive patients. A question on sharing needles for injection of drugs was answered by 1,158 patients; seropositive patients were more likely to report they had shared needles than seronegative patients (five of nine versus 17 of 1,149; p = 0.0000002). After 1 year of follow-up, data were collected from 667 patients, including 254 negative patients who underwent dialysis at centers with seropositive patients. None of the previously seronegative patients seroconverted, yielding an incidence rate of 0% (upper limit of 95% confidence interval = 0.45%). No case of possible nosocomial transmission was identified. CONCLUSION: These results suggest that use of long-standing infection control precautions is effective minimizing the risk of transmission of HIV in hemodialysis settings.

Adolescent↗
PubMed1990

Digital mobile radiography.

A storage phosphor digital imaging system has been used to perform virtually all of an increasing number of mobile (portable) projectional roentgenographic examinations in a busy hospital. Approximately 130 such studies are done per day, of which about 110 are chest examinations. The processing unit suffices to keep pace with peak activity in the radiology department. This technique has decreased the repeat rate for portable anteroposterior chest radiographic examinations from 4.5% to less than 1% and has resulted in an even more dramatic reduction in the rate for lateral or decubitus chest examinations as well as for studies of the abdomen and those done in the operating room. The diagnostic accuracy and confidence level achieved in interpreting the complementary pair of digital images has been equivalent to or has exceeded that obtained with conventional mobile analog film-screen radiographs.

Equipment Design↗
PubMed1990

Thoracic aortic dissection: pitfalls and artifacts in MR imaging.

Results of 53 thoracic magnetic resonance (MR) imaging examinations were reviewed to determine the prevalence and severity of artifacts and pitfalls that may occur in the evaluation of acute aortic dissection. Grade 1 artifacts and pitfalls were mimics of aortic dissection on individual images but could be demonstrated not to represent a dissection when other images from the same sequence were evaluated. Grade 2 artifacts and pitfalls required the use of images from other planes or sequences to distinguish them from a dissection. Grade 3 artifacts and pitfalls could not be distinguished from a dissection without the use of other imaging modalities. Of the 53 cases examined, 34 (64%) had artifacts or pitfalls of grade 1 or higher, 10 (19%) had artifacts or pitfalls of grade 2 or higher, and one case (2%) had grade 3 artifacts or pitfalls. Sixteen cases had more than one artifact or pitfall. Pitfalls and artifacts that mimic aortic dissection occur in a significant percentage of thoracic MR imaging examinations. An awareness of their existence, knowledge of normal anatomy, the use of axial images in all cases with the addition of images in other planes as needed, rotation of phase and frequency gradients as needed, and clinical correlation may avert misinterpretation in nearly all cases.

Aortic Dissection↗
PubMed1989

MR imaging of the knee: comparison of three-dimensional FISP and two-dimensional spin-echo pulse sequences.

Two-dimensional (2D) spin-echo (SE) sequences and three-dimensional (3D) FISP (fast imaging with steady precession) sequences of the knee with the same section thickness and field of view were directly compared in 54 patients, 17 of whom underwent subsequent follow-up (15 arthroscopic and two arthrographic examinations). In those patients with follow-up, each sequence demonstrated 100% sensitivity, 80% specificity, and 94% accuracy for evaluation of the medial meniscus and 100% sensitivity, 100% specificity, and 100% accuracy for evaluation of the lateral meniscus. SE imaging demonstrated 100% sensitivity, 100% specificity, and 100% accuracy for evaluation of the anterior cruciate ligament, while 100% sensitivity, 82% specificity, and 88% accuracy were achieved with FISP imaging. In the 37 patients without follow-up, only two discrepancies were found between the 2D SE and the 3D FISP images for meniscal evaluation. Three discrepancies were found in the evaluation of the anterior cruciate ligament, two of which were likely false-positive 3D FISP results. We conclude that 2D SE and 3D FISP imaging provide comparable data for meniscal evaluation. FISP images are slightly less accurate than SE images of comparable resolution for the evaluation of the anterior cruciate ligament.

Adolescent↗
PubMed1988

[The definition of acquired immunodeficiency syndrome (AIDS)].

The new, revised CDC case definition of AIDS (1) specifies precisely, which laboratory results and which diseases may indicate HIV-infection. The indicator diseases are divided into those with HIV-positive and HIV-not positive laboratory findings. The latter group is subdivided into diseases diagnosed definitely and diagnosed presumptively. Appendices contain directions for the interpretation of results of laboratory examinations indicating, under which circumstances the diagnosis of AIDS can be excluded or can definitely be established or which findings must be considered inconclusive. Further, the methods are listed, which have to be employed in order to provide a definitive diagnosis of an indicator disease and under which conditions a presumptive diagnosis of a disease, indicative of AIDS, is admitted.

AIDS Serodiagnosis↗
PubMed1988

[Classification of manifestations in the course of infection with the human immunodeficiency virus (HIV)].

The vast number of symptoms, diseases and findings, which can be observed in the course of HIV-infection, required an arrangement in a systematic order. The classification system for adults of the Centers for Disease Control (CDC) distinguishes between 4 groups and some subgroups. Group I includes acute infection, group II asymptomatic infection, group II persistent generalized lymphadenopathy, group IV other diseases. Subgroup IV.A. stands for constitutional disease, IV.B. neurologic disease, IV.C. secondary infectious diseases, IV.D. secondary cancers and IV.E. other conditions. A somewhat different classification system is needed for children under 13 years of age. Class P-0 comprises indeterminate infection, P-1 asymptomatic infection and P-2 symptomatic infection. Subclass P-1.-A. concerns normal immune function, P-1.B. abnormal immune function, P-1.C. immune function not tested, P-2.A. nonspecific findings, P-2.B. progressive neurologic disease, P-2.C. lymphoid interstitial pneumonitis, P-2.D. secondary infectious diseases, P-2.E. secondary cancers and P-2.F. other diseases possibly due to HIV-infection.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Candida parapsilosis fungemia associated with parenteral nutrition and contaminated blood pressure transducers.

During the period September 1983 through May 1985, Candida parapsilosis was isolated from intravascular sites (blood or vascular catheter tips) in 12 patients at a pediatric hospital. Of 205 patients with cultures of any site positive for Candida species, 32 (16%) had cultures positive for C. parapsilosis. In contrast, of 23 patients with intravascular cultures positive for Candida species, 12 (51%) had cultures positive for C. parapsilosis (P less than 0.001, Fisher's exact test). The 12 patients with intravascular cultures positive for C. parapsilosis were more likely to have received central venous nutrition therapy (10 of 12 versus 7 of 23; P less than 0.01, Mantel-Haenzel chi-square test) and had a longer duration of exposure to blood pressure transducers (P less than 0.08, paired t test) than the 23 ward- and age-matched controls. C. parapsilosis was isolated from 11 (32%) of 34 in-use and stored blood pressure transducers. After ethylene oxide sterilization of blood pressure transducers was begun, in-use pressure transducers showed no growth of C. parapsilosis. This study emphasizes the role of C. parapsilosis as a nosocomial pathogen associated with invasive devices and parenteral nutrition; it also emphasizes the importance of adhering to recommended procedures for sterilizing blood pressure transducers.

Adolescent↗
PubMed1986

HTLV-III/LAV infection in hemodialysis patients.

Twenty-five (4.8%) of 520 hemodialysis patients were seropositive for antibody to human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) by enzyme immunoassay. Four had high reactivity on enzyme immunoassay and positive results of Western blot tests, and one of the four had a positive culture. The remaining 21 seropositive patients had low reactivity on enzyme immunoassay, negative results of Western blot tests, and negative cultures. All had received blood transfusions and 19 had antibodies to antigens associated with the H9 cell line used to propagate HTLV-III for serological tests. We found that HTLV-III/LAV was not transmitted in the dialysis centers. Frequent blood transfusion places dialysis patients at risk for HTLV-III/LAV infection, but may more commonly lead to false-positive results of enzyme immunoassay tests.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Health and economic impacts of antimicrobial resistance.

For comparison of the impacts of infections due to antimicrobial-resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria, data were evaluated from 175 published and unpublished reports of investigations of nosocomial and community-acquired infections with selected bacteria. The evaluation of outcomes of hospital-acquired infections with resistant organisms was often confounded by risk factors also associated with poor outcomes. Nevertheless, for both nosocomial and community-acquired infections, the mortality, the likelihood of hospitalization, and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria. Poor outcomes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical problems. Although the adverse economic and health effects of drug-resistant bacterial infections can only be roughly quantified, it is concluded that antimicrobial resistance is an important health problem and an economic burden to society.

Bacterial Infections↗