PubMed Health⌕ Search

Biomedical subjects

T C Bailey

Publications and source records attributed to T C Bailey.

At least 19 recordsLinked to original sources
PubMed1997

Automated system for identifying potential dosage problems at a large university hospital.

A hospital's experience with an automated system for screening drug orders for potential dosage problems is described. DoseChecker was developed by the hospital pharmacy department in collaboration with a local university. Pharmacy, laboratory, and patient demographic data are transferred nightly from the hospital's mainframe system to a database server; DoseChecker uses these data and user-defined rules to (1) identify patients receiving any of 35 targeted medications, (2) evaluate the appropriateness of current dosages, and (3) generate alerts for patients potentially needing dosage adjustments. The alert reports are distributed to satellite pharmacists, who evaluate each patient's condition and make recommendations to physicians as needed. One of the system's primary purposes is to calculate creatinine clearance and verify that dosages are properly adjusted for renal function. Between May and October 1995, the system electronically screened 28,528 drug orders and detected potential dosage problems in 2859 (10%). The system recommended a lower daily dose in 1992 cases (70%) and a higher daily dose in 867 (30%). Pharmacists contacted physicians concerning 1163 (41%) of the 2859 alerts; in 868 cases (75%), the physicians agreed to adjust the dosage. The most common dosage problem identified was failure to adjust dosages on the basis of declining renal function. An automated system provided an efficient method of identifying inappropriate dosages at a large university hospital.

Adolescent↗
PubMed1997

Impact of cytomegalovirus serology on graft survival in living related kidney transplantation: implications for donor selection.

BACKGROUND: The impact of cytomegalovirus in living related kidney transplantation remains controversial. This study considers the implications of donor and recipient cytomegalovirus (CMV) serology for the selection of living related donor. METHODS: Graft survival was estimated by using the bivariate Kaplan-Meier method and multivariate Cox proportional hazards analysis for 7659 living related first transplantations performed in the United States between 1989 and 1994. The effects of donor CMV serology were estimated with respect to recipient CMV serology and compared with human leukocyte antigen (HLA) matching, transplantation, donor, and recipient characteristics. The implications of these estimates for the selection of living related donors were considered. RESULTS: From Kaplan-Meier estimates, donor CMV-seropositive kidneys were associated with significantly reduced graft survival for CMV-seronegative recipients (p = 0.0002) but not CMV-seropositive recipients (p = 0.1623). These findings were verified by use of Cox proportional hazards analysis accounting for covariate factors. The impact of donor CMV-seropositive kidneys on CMV-seronegative recipients was similar to one HLA-DR match, greater than one HLA-B match, and significantly greater than one HLA-A match (p = 0.0331). CONCLUSIONS: Results identify donor CMV serology as an important determinant of transplantation outcome for living related first kidney transplant recipients who are themselves CMV seronegative. Consideration should be given to donor and recipient CMV serology when selecting an appropriate donor for living related kidney transplantation.

Adult↗
PubMed1997

The effects of cytomegalovirus serology on graft and recipient survival in cadaveric renal transplantation: implications for organ allocation.

The potential benefits from allocating donated cadaveric kidneys based on donor and recipient cytomegalovirus (CMV) serology remain controversial. We estimated graft survival and recipient survival using bivariate Kaplan-Meier models and multivariate Cox proportional hazards models for 24,543 first cadaveric renal transplantations performed in the United States between 1989, coinciding with the introduction of ganciclovir, and 1994. The effects of donor and recipient CMV serology were estimated, and the implications of these estimates for CMV-based allocation of cadaveric kidneys were considered. From Kaplan-Meier estimates, the 3-year impact of CMV-seropositive donor kidneys was a 3.6% reduction in graft survival and a 2.4% reduction in recipient survival for CMV-seronegative recipients, and a 3.9% reduction in graft survival and a 3.0% reduction in recipient survival for CMV-seropositive recipients. Multivariate Cox analysis demonstrated an adverse impact of donor CMV seropositivity regardless of recipient CMV status. D-/R- CMV serologic pairs had the best 3-year outcomes, with 73.4% graft survival and 87.7% recipient survival. D+/R+ CMV serologic pairs were found to have the worst 3-year outcomes, with 68.4% graft survival and 83.1% recipient survival, and were significantly worse than D+/R- pairs in terms of recipient survival. The maximum estimated impact of a program allocating donor kidneys to maximize the number of D-/R- CMV serologic pairs, assuming no impact on HLA mismatches, was a 0.1% reduction in aggregate 3-year graft survival and a 0.2% reduction in aggregate recipient survival. An alternative program allocating donor kidneys to minimize the number of D+/R+ pairs had no estimated effect on either graft or recipient survival. We conclude that during the ganciclovir era, CMV continues to have an important impact on first cadaveric renal transplantation. However, even under ideal conditions, CMV-based kidney allocation to either maximize the number of D-/R- pairs or minimize the number of D+/R+ pairs is likely to provide little benefit to the population of cadaveric renal transplant recipients.

Antibodies, Viral↗
PubMed1997

A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides.

We conducted a meta-analysis of 22 randomized, controlled trials in which extended-interval dosing of aminoglycosides was compared with multiple daily dosing. When we classified intermediate outcomes as successes, we found that patients receiving extended-interval dosing were at significantly reduced risk of clinical treatment failure (risk difference, -3.4%; 95% confidence interval [CI], -6.7% to -0.2%; P = .039) and that there was a trend toward reduced risk of bacteriologic failure (risk difference, -1.7%; 95% CI, -5.4% to +2.1%; P = .38). Reclassification of intermediate outcomes as failures yielded similar results. There was significant heterogeneity among the trials, necessitating cautious interpretation of these outcomes. There were negligible differences in the risk of nephrotoxicity (risk difference, -0.6%; 95% CI, -2.4% to +1.1%; P = .46) and ototoxicity (risk difference, +0.3%; 95% CI, -1.2% to +1.8%; P = .71). We conclude that for many indications, extended-interval dosing of aminoglycosides appears to be as effective as conventional dosing, with similar rates of toxicity. The added convenience of extended-interval dosing makes it an attractive alternative to conventional dosing.

Aminoglycosides↗
PubMed1996

Pilot study of topical trifluridine for the treatment of acyclovir-resistant mucocutaneous herpes simplex disease in patients with AIDS (ACTG 172). AIDS Clinical Trials Group.

SUMMARY: Twenty-six AIDS patients were enrolled in an open label pilot study to evaluate the efficacy and toxicity of topical 1 percent ophthalmic trifluridine solution for the treatment of chronic mucocutaneous herpes simplex virus disease unresponsive to at least 10 days of acyclovir therapy. Susceptibility testing to acyclovir, trifluridine, and foscarnet was determined by plaque reduction assay. Twenty-four patients were evaluable for efficacy and 25 for toxicity analyses. Seven patients (29 percent) had complete healing of lesions. The overall estimated median time to complete healing was 7.1 weeks. An additional seven patients had > or = 50 percent reduction in lesion area. The overall estimated median time to 50 percent healing was 2.4 weeks. Ten (42 percent) patients discontinued treatment for reasons other than primary treatment failure and seven (29 percent) for failure to respond to therapy. Baseline patient characteristics associated with greater reduction in lesion area included higher Karnofsky score (p = 0.05), fewer lesions (p = 0.07), smaller lesion area (p = 0.11), and trifluridine susceptibility (p = 0.07). Eight (33 percent) patients developed new lesions outside of the treatment area while on study, reflecting the local nature of this therapy. No dose-limiting toxicity attributable to trifluridine was reported. Given the limited options for the treatment of acyclovir-resistant herpes simplex disease, topical trifluridine may be a useful alternative in selected patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

Interactive spatial data analysis in medical geography.

Interactive spatial data analysis involves the use of software environments that permit the visualization, exploration and, perhaps, modelling of geographically-referenced data. Such systems are of obvious value in epidemiological research, both of an environmental and geographical nature. There is an increasing number of such software environments available on a variety of platforms and operating systems. This paper considers the use of the proprietary Geographical Information System, ARC/INFO, in a spatial analysis context, showing how the spatial analytic tools that may be added to it can be exploited by geographical epidemiologists; such tools include those for modelling possible raised incidence of disease around suspected sources of pollution. The paper also reviews the use of systems such as S-Plus and XLISP-STAT, statistical programming environments to which spatial analysis functions or libraries may be added. The use of INFO-MAP, a system designed to aid in the teaching of interactive spatial data analysis, is also highlighted. The various software environments are illustrated with reference to examples concerned with: clustering of childhood leukaemia in part of Lancashire, England; Burkitt's lymphoma in Uganda; larynx cancer in Lancashire; and childhood mortality in Auckland, New Zealand.

Adolescent↗
PubMed1995

Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital.

OBJECTIVE: To determine the prevalence and incidence of and the relative risks for positive tuberculin skin tests among employees of a large, urban teaching hospital. DESIGN: Retrospective cohort study. SETTING: Barnes Hospital, St. Louis, Missouri. PARTICIPANTS: Hospital personnel employed at any time between January 1989 and July 1991. RESULTS: 684 of 6070 employees screened (11.3% [95% CI, 10.4% to 12.1%]) had positive tuberculin skin tests. Factors associated with a positive result were age (odds ratio, 2.02 per decade [CI, 1.87 to 2.18]; P < 0.0001); black race (odds ratio, 1.58 [Cl, 1.26 to 2.00]; P < 0.0001); Asian race (odds ratio, 16.7 [CI, 9.33 to 29.9]; P < 0.0001); Hispanic ethnicity (odds ratio, 9.45 [CI, 3.58 to 25.0]; P < 0.0001); and percentage of low-income persons within the employee's residential postal zone (odds ratio, 1.14 per 10% [CI, 1.05 to 1.23]; P = 0.001). Twenty-nine of 3106 employees who had at least two tests had skin-test conversions (0.93% [CI, 0.60% to 1.3%]); 15 of these conversions (52%) occurred among employees who had no direct contact with patients. Only the percentage of low-income persons within the employee's residential postal zone (odds ratio 1.39 [CI, 1.09 to 1.78]; P = 0.0075) was independently associated with conversion. CONCLUSIONS: The most important associations with a positive tuberculin skin test were older age, minority group status, and the proportion of low-income persons within the employee's residential postal zone. Skin-test conversion was independently associated only with the percentage of low-income persons in the employee's postal zone. Stratifying employees according to degree of contact with patients or according to departmental group was not useful in determining risk for a positive tuberculin skin test or for skin-test conversion. For certain groups of employees, an exposure to tuberculosis in the community probably poses a greater risk than exposure in the hospital setting.

Adult↗
PubMed1995

The geographical epidemiology of ocular diseases: some principles and methods.

With the increasing availability of geographically referenced data in health research the time is ripe to review the use of particular geographical and spatial analysis techniques in ophthalmic research. Analysis of the geographical distribution of ocular diseases, particularly in Britain, has not had a high profile, but there are certain diseases, such as congenital eye malformations in children, where such analysis methods are particularly appropriate. We review the data requirements and then a variety of analytical techniques, some of which partition geographical space into areal units (such as counties or electoral wards), others of which treat space as continuous. We conclude with some comments on software that is available for such analyses.

Data Collection↗
PubMed1995

Quantitative analysis of cytomegalovirus viremia in lung transplant recipients.

A quantitative culture method was used to test serial blood specimens from 28 lung transplant recipients at risk of cytomegalovirus (CMV) infection (donor [D] or recipient [R] seropositive for CMV). Viremia occurred in 26 (93%) of 28 patients. Highest levels were seen when the donor was seropositive. The median of individual maximum levels was 2.13 infectious centers (ICs/10(5) leukocytes for D+/R- patients (interquartile range [iqr], 0.12-21.77), 1.01 for D+/R+ (iqr, 0.3-2.32), and 0.10 for D-/R+ (iqr, 0.07-0.36; P = .030, Kruskal-Wallis test). Higher levels were seen in patients with biopsy-proven CMV pneumonitis compared with those with negative biopsies (mean, 0.24 [SD 0.51] ICs/10(5) leukocytes vs. 0.01 [SD 0.03]; P = .039, Wilcoxon test) and with symptomatic CMV episodes compared with asymptomatic episodes (median, 0.34 ICs/10(5) [iqr, 0.11-0.61] vs. 0.08 ICs/10(5) [iqr, 0.03-0.13]; P = .045, Wilcoxon test). Further studies are required to determine whether quantification of CMV viremia by this method will be of practical value in the recognition of significant CMV infection in lung transplant recipients.

Antigens, Viral↗
PubMed1995

In vitro activities of various beta-lactam antimicrobial agents against clinical isolates of Escherichia coli and Klebsiella spp. resistant to oxyimino cephalosporins.

Broth microdilution testing was used to study the activity of several beta-lactam antimicrobial agents, including piperacillin-tazobactam and cefepime, against 108 clinically derived Escherichia coli and Klebsiella sp. strains resistant to oxyimino cephalosporins (i.e., putative extended-spectrum beta-lactamase producers). On the basis of the percentage of susceptible strains, imipenem (100%), cefotetan (> or = 92%), and piperacillin-tazobactam (> or = 86%) were the most active agents. Cefepime activity (52 to 64% susceptible) was comparable to that of cefotaxime (40 to 63% susceptible) and aztreonam (20 to 63% susceptible). Among all beta-lactams tested, imipenem and cefotetan demonstrated the highest and most consistent level of activity and were the least affected by challenges with increased sizes of inocula of these resistant organisms.

Anti-Bacterial Agents↗
PubMed1995

Supporting ad-hoc queries in an integrated clinical database.

Whether caring for patients or conducting research, medical decision-makers need access to clinical data. To fulfill that need, commercial software developers have produced a wide range of database query tools that differ greatly in functionality and cost. Generally, tools that have a greater ability to conceal database complexity from the user also require more effort for administrative setup. We describe a cost-effective, commercially-available query tool that requires no special setup to perform most simple queries, yet can be customized to satisfy users' more complex querying requirements.

Clinical Pharmacy Information Systems↗
PubMed1994

Screening of physicians for tuberculosis.

OBJECTIVE: To determine the prevalence of tuberculous infection among a sample of physicians at Barnes Hospital and to determine the frequency of tuberculin skin testing and the adequacy of follow-up for physicians with positive tuberculin skin tests. DESIGN: Convenience sample. SETTING: 1,000-bed, university-affiliated tertiary care hospital. SUBJECTS: Physicians attending departmental conferences were screened for tuberculosis. Prior history of tuberculosis, antituberculous therapy, BCG vaccination, and previous tuberculin skin test results were obtained with a standardized questionnaire. Tuberculin skin tests were performed on those who were previously skin-test negative. OUTCOME MEASURE: Tuberculosis infection, prophylactic therapy. RESULTS: Eighty-six (24.5%) of 351 physicians in the study were skin test positive by history or currently performed skin test. Of 61 who reported a previously reactive skin test, 40 (66%) had been eligible for isoniazid prophylaxis, but only 15 (37.5%) of 40 had completed at least six months of therapy. Of 290 physicians reporting a previously negative skin test, 25 conversions (8.6%) were identified. Previously undiagnosed, asymptomatic pulmonary tuberculosis was identified in one physician. CONCLUSIONS: Infection with Mycobacterium tuberculosis is common among physicians. Physicians were screened irregularly for tuberculosis, and the use of prophylactic therapy was inconsistent. Aggressive tuberculosis screening programs for healthcare workers should be instituted (Infect Control Hosp Epidemiol 1994;15:95-100).

Adult↗
PubMed1994

Comparison of PCR and pp65 antigenemia assay with quantitative shell vial culture for detection of cytomegalovirus in blood leukocytes from solid-organ transplant recipients.

This study compared PCR and an assay for cytomegalovirus (CMV) pp65 antigenemia (CMV-vue; INCSTAR Corp.) with a quantitative shell vial culture (QSVC) technique for the detection of CMV in serial blood specimens from 46 solid-organ transplant recipients. In a comparison based on 535 specimens tested by PCR and QSVC, CMV was detected by PCR in 41 and by QSVC in 37 of 43 recipients at risk of CMV infection. The mean number of days after transplantation of initial detection of CMV was 29.9 for PCR and 34.0 for QSVC (P = 0.01). The antigenemia assay was performed on 395 specimens, including 304 of those also tested by PCR. In these specimens, CMV was detected by the antigenemia assay, QSVC, and PCR in 30, 32, and 35 (respectively) of 38 patients at risk, with no statistically significant difference in the time to detection. Each of the assays detected CMV in similar proportions of patients with and without clinically significant CMV infection. PCR stayed positive longer after transplantation than the other assays but frequently returned to negative when more than 6 months had elapsed after transplantation. The antigenemia assay and PCR stayed positive longer after institution of antiviral therapy than QSVC. PCR can provide highly sensitive detection of CMV viremia, but a PCR assay for CMV is not yet available in kit form. The pp65 antigenemia assay and shell vial culture are quantifiable and comparable in sensitivity. Either is recommended for rapid detection of CMV in blood specimens from solid-organ transplant recipients.

Antigens, Viral↗
PubMed1993

Failure of high-dose oral acyclovir with or without immune globulin to prevent primary cytomegalovirus disease in recipients of solid organ transplants.

PURPOSE: To assess the efficacy of acyclovir and intravenous immune globulin (IVIG) for cytomegalovirus (CMV) prophylaxis in high-risk recipients of solid organ transplants. PATIENTS AND METHODS: We randomized 21 CMV-seronegative organ transplant recipients with seropositive donors (D+R-) to receive oral acyclovir, 800 mg four times daily, or, in addition to acyclovir, IVIG, 300 mg/kg, every 2 weeks for six doses. Patients were followed closely for the development of CMV infection and disease. RESULTS: All but one prophylactically treated patient (95%) developed CMV infection. Fifteen of 21 patients (71%) who received prophylaxis fulfilled criteria for CMV disease. Disease onset was delayed in those who received IVIG, but this did not reach statistical significance. Ganciclovir was used for treatment in 15 of the 21 patients (71%). CONCLUSIONS: Acyclovir, with or without IVIG, did not prevent primary CMV infection or disease in D+R- solid organ transplant recipients at our institution. Moreover, most patients were treated with ganciclovir despite the use of prophylaxis. Given the ready availability of ganciclovir to treat CMV disease, we recommend a reappraisal of the role of CMV prophylaxis by these means in the solid organ transplant population.

Acyclovir↗
PubMed1993

Symptomatic cytomegalovirus infection in renal transplant recipients given either Minnesota antilymphoblast globulin (MALG) or OKT3 for rejection prophylaxis.

To compare the impact of using Minnesota antilymphoblast globulin (MALG) versus the monoclonal antibody, OKT3, on the development of symptomatic cytomegalovirus (CMV) infection, we reviewed a cohort of 130 cadaveric renal transplant recipients enrolled in a prospective comparison of MALG versus OKT3 for rejection prophylaxis. Among the 112 patients at risk for CMV, prophylactic MALG was associated with an increased risk of symptomatic infection (relative hazard [rh] = 3.31; 95% confidence interval CI], 1.50 to 7.30; P = 0.003). Transplantation of kidneys from CMV-seropositive donors into CMV-seronegative recipients (rh = 5.22; 95% CI, 2.34 to 11.63; P = 0.00004), first transplantation (rh = 4.76; 95% CI, 1.06 to 21.3; P = 0.039), and acute rejection therapy (rh = 2.03; 95% CI, 0.98 to 4.21; P = 0.055) were also associated with an increased risk. Prophylactic MALG followed by treatment with any agent for acute rejection was strongly correlated with symptomatic CMV infection (rh = 4.46; 95% CI, 3.71 to 5.21; P = 0.00006). Symptomatic CMV infection was not only more frequent, but more severe in recipients of prophylactic MALG, and more MALG recipients were treated with ganciclovir. There was no difference in rejection rate for the two rejection prophylaxis regimens (P = 0.625). Prophylactic OKT3 results in less risk of symptomatic CMV infection than prophylactic MALG in cadaveric renal transplant recipients who are seropositive for CMV or whose donors are seropositive for CMV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cytomegalovirus infection and pneumonitis. Impact after isolated lung transplantation. Washington University Lung Transplant Group.

Using aggressive surveillance of blood, bronchoalveolar lavage (BAL) fluid, and lung tissue, we sought to determine the incidence of cytomegalovirus (CMV) pneumonitis in isolated lung transplant recipients and to characterize its impact on pulmonary function, chronic rejection, and survival. Forty-six lung transplant recipients who survived greater than 30 days had prospective documentation of CMV infection in blood and BAL fluid and regular surveillance with transbronchial lung biopsy. CMV infection was documented in 92% of patients who were D-/R+, D+/R+, or D+/R-, and the incidence of histologically confirmed CMV pneumonitis among these patients was 75%. No D-/R- patient experienced CMV infection or disease. D+/R- patients experienced more frequent and severe episodes, and ganciclovir prophylaxis during the first 2 wk was not useful. CMV pneumonitis was accompanied by detectable radiographic changes in less than one third of cases. The detection of CMV in BAL fluid was not predictive of CMV pneumonitis on biopsy, except in D+/R- patients during the first 90 days after transplantation. There was no evidence of an adverse impact because of CMV infection on pulmonary function during the first year after transplantation. A relationship between CMV infection and bronchiolitis obliterans could not be documented; however, D+/R- patients had higher morbidity and a trend toward lower survival. In a multivariate analysis, D+/R- status was an independent predictor of death.

Adult↗
PubMed1993

Prevention of cytomegalovirus disease.

Cytomegalovirus (CMV) disease is a significant cause of morbidity in allogeneic bone-marrow and solid-organ transplant recipients. Because of this, a number of strategies to prevent this disease have been attempted, many of which were investigated before the approval of agents that are effective in treatment. However, in bone-marrow transplantation, treatment of established disease, particularly CMV pneumonitis, carries a high mortality rate despite appropriate management. A patient-survival benefit has been shown for preemptive therapy with ganciclovir initiated on the basis of a positive CMV surveillance culture from any site before post-transplant day 100, and this should be considered the current standard of care. Among solid-organ transplant recipients, no clear standard of care has emerged, and for most patients, the basic question of whether prophylaxis is more beneficial than treatment of symptomatic infection goes unanswered.

Acyclovir↗