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Biomedical subjects

S Spear

Publications and source records attributed to S Spear.

15 recordsLinked to original sources
PubMed2000

Risk factors for second urinary tract infection among college women.

To better understand the etiology of recurrent urinary tract infection (UTI), the authors followed a cohort of 285 female college students with first UTI for 6 months or until second UTI. A first UTI due to Escherichia coli was followed by a second UTI three times more often than was a non-E. coli first UTI (24 vs. 8%; p = 0.02). In a logistic regression analysis limited to the 224 women from the University of Michigan Health Service and the University of Texas at Austin Health Service from September 1992 to December 1994, with a first UTI due to E. coli, vaginal intercourse increased the risk of a second UTI with both a different (odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.19, 2.15) and the same (OR = 1.37, 95% CI: 0.91, 2.07) uropathogen, as did using a diaphragm, cervical cap, and/or spermicide (same uropathogen: OR = 1.53, 95% CI: 0.95, 2.47; different uropathogen: OR = 1.77, 95% CI: 1.22, 2.58). Condom use decreased the risk of a second UTI caused by a different uropathogen (OR = 0.68, 95% CI: 0.48, 0.99) but had no effect on a second UTI caused by the same E. coli (OR = 0.99; 95% CI: 0.66, 1.50). Type or duration of treatment was not associated with a second UTI. Although the risk of second UTI is strongly influenced by sexual behavior, women with a first UTI caused by E. coli are more likely than are those with a non-E. coli first UTI to have a second UTI within 6 months.

Adolescent↗
PubMed2000

Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients.

OBJECTIVES: The aim of this study was to assess the efficacy and safety of low doses of diclofenac sodium (DCF) in attaining normothermia with minimal major side effects in patients with acute cerebral damage. The study was designed to verify the adequate, prolonged antipyretic action of DCF infusion, to quantify its haemodynamic and cerebral impact and to assess any negative effect on renal and liver function. DESIGN: Retrospective, cohort study on prospectively collected data. SETTING: Intensive care unit (ICU) of a university hospital. PATIENT POPULATION: Five patients with subarachnoid haemorrhage and seven severe head-trauma victims with febrile illness of various infectious origin. INTERVENTIONS: Continuous i.v. infusion of a low dose (0.04 mg/kg/h) of DCF for 48 h. MEASUREMENTS AND RESULTS: Systemic and cerebral haemodynamic data were collected at 4 h intervals for 8 h before diclofenac infusion and 48 h after. Renal and liver functions were monitored. Normothermia, defined as external temperature < 37.5 degrees Celsius (degrees C), was achieved in all cases. Intracranial pressure was significantly lowered and mean arterial pressure was unaffected, so cerebral perfusion pressure rose after DCF. Hepatic and renal function were not altered in the 48 h post DCF. Mean urinary output was preserved at high flow and was not influenced by DCF. CONCLUSIONS: Continuous infusion of low-dose DCF attained normothermia without any major cerebral or systemic side effects. Renal and liver functions were unaffected. Once normothermia was achieved, intracranial and cerebral perfusion pressure improved.

Acute Disease↗
PubMed2000

"Broken windows" and the risk of gonorrhea.

OBJECTIVES: We examined the relationships between neighborhood conditions and gonorrhea. METHODS: We assessed 55 block groups by rating housing and street conditions. We mapped all cases of gonorrhea between 1994 and 1996 and calculated aggregated case rates by block group. We obtained public school inspection reports and assigned findings to the block groups served by the neighborhood schools. A "broken windows" index measured housing quality, abandoned cars, graffiti, trash, and public school deterioration. Using data from the 1990 census and 1995 updates, we determined the association between "broken windows," demographic characteristics, and gonorrhea rates. RESULTS: The broken windows index explained more of the variance in gonorrhea rates than did a poverty index measuring income, unemployment, and low education. In high-poverty neighborhoods, block groups with high broken windows scores had significantly higher gonorrhea rates than block groups with low broken windows scores (46.6 per 1000 vs 25.8 per 1000; P < .001). CONCLUSIONS: The robust association of deteriorated physical conditions of local neighborhoods with gonorrhea rates, independent of poverty, merits an intervention trial to test whether the environment has a causal role in influencing high-risk sexual behaviors.

Analysis of Variance↗
PubMed1999

Revising the unsatisfactory breast augmentation.

Revising an unsatisfactory result after breast augmentation requires a thorough understanding of the cause of the abnormality to develop a rational and effective treatment plan to achieve the best possible result. Often, more than one manipulation is required to correct the deformity. Using the techniques presented here, successful revision can be performed in the vast majority of cases.

Adult↗
PubMed1997

Condom use and first-time urinary tract infection.

We evaluated the effects of condom use, lubricated condom use, and spermicide use on risk of acquiring first urinary tract infection in a case-control study of sexually active college women ages 18-39 years. Cases (N = 144) were women with first urinary tract infection that was confirmed by culture recruited at the student health service; controls (N = 286) were women without a history of urinary tract infection who were randomly sampled from all women enrolled at the university. Participants completed a self-administered questionnaire regarding type and frequency of condom use during the previous 2 weeks. Condoms and spermicides usually were used in combination with each other or oral contraceptives. After adjusting for frequency of vaginal intercourse, using unlubricated condoms compared with using no birth control method strongly increased the risk of first urinary tract infection (odds ratio = 29.1; 95% confidence interval = 3.1-1,335). Using a lubricated condom (with or without spermicide in the lubricant) or a spermicidal cream or gel with an unlubricated condom was associated with two- to eightfold risk of first urinary tract infection. Unlubricated condom use was strongly associated with risk of first urinary tract infection, but this effect was largely neutralized by using a spermicidal cream or gel with the unlubricated condom or by using a lubricated condom.

Adolescent↗
PubMed1991

The cost of home air-fluidized therapy for pressure sores. A randomized controlled trial.

BACKGROUND: Recurrent pressures sores are a serious problem that often cause chronically ill patients to be hospitalized. We hypothesized that home air-fluidized bed therapy may be a safe and effective way to treat these patients, thus avoiding the costs of hospitalization. METHODS: One hundred twelve patients with 3rd or 4th stage pressure sores were randomly assigned to 36 weeks of either (1) home air-fluidized bed therapy that included the services of a visiting nurse specialist as long as the patient had 3rd or 4th stage sores, or (2) conventional therapy. RESULTS: Compared with patients in the control group, patients receiving air-fluidized bed therapy spent fewer days in the hospital (11.4 days vs 25.5 days, P less than .01) and used fewer total inpatient resources, as reflected both in charges ($13,263 vs $25,736, P less than .05) and in Medicare DRG and physician payments ($6,646 vs $12,131, P less than .05). Total resources used (inpatient and outpatient) were lower for patients treated with air-fluidized bed therapy, but the difference was not statistically significant. Clinical outcomes were similar. CONCLUSIONS: Home air-fluidized bed therapy is safe, reduces hospitalizations, is no more costly than alternative therapy, and allows the patients to receive their needed care in a more desirable, nonhospital setting.

Aged↗
PubMed1986

Modified radical mastectomy with immediate breast reconstruction.

The authors reviewed 100 consecutive patients with breast cancer treated by modified radical mastectomy and immediate breast reconstruction in order to assess the safety and efficacy of this procedure in terms of cancer control. The study began in 1978 and is continuing. The procedure involves a two-team approach with both the general surgeon and the plastic surgeon interviewing the patient preoperatively. Virtually all breast reconstruction involved the use of a submuscular silicone saline type of implant. The median follow-up is 36 months. Slightly over half of these cases were Stage 0 or Stage I. There have been eight recurrences, including five local or regional and three distant. No patient has died of her disease at this point. Cosmesis was equal to or superior to that seen in delayed breast reconstruction. There have been no hidden recurrences. Postoperative depression has been significantly less. We conclude that modified radical mastectomy with immediate breast reconstruction is a safe and effective alternative to modified radical mastectomy alone.

Adult↗
PubMed1980

A cookery book for self-catering mentally handicapped.

The more able patients from hospitals for the mentally handicapped in Southmead Health District Bristol, are being established in minimal-support homes. Dietitians were asked to advise on how to teach practical cookery skills and encourage good nutrition. They were unable to recommend any of the available cookery books, and have designed a recipe folder in picture form of suitable meals for one week. The mentally handicapped patient's background is discussed as it relates to the practical problems of rehabilitation.

Adult↗
PubMedDate not supplied

Quantification of interventions and outcomes in an outpatient telemanagement and care management congestive heart failure program.

The congestive heart failure continuum was developed in collaboration with the medical management committee of our hospital in response to a need to decrease readmissions for this chronic and progressive disease. This is accomplished via a multidisciplinary team that provides education and long-term telemanagement, as well as care management to assist these patients in maintaining an optimum level of functioning and the ability to remain in their homes for as long as possible. Since October 1996 there have been 375 patients referred with a decrease in the 31-day readmission rate from 21% to an average of 5%. Costs are presently $55.00 per month per patient. Evaluation of the congestive heart failure phone management tool revealed a strong 77% positive correlation between the patient's score and the number of interventions needed to stabilize the patient. Care management visits, when necessary, help reduce the need for hospitalization. (c)2000 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Treatment for alteration in oral mucosa related to chemotherapy.

Possibly one of the most painful and difficult side effects of chemoradiotherapy is stomatitis. Early intervention to limit its severity and aggressive treatment to prevent related complications such as infection and hemorrhage are essential.

Adolescent↗