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Biomedical subjects

T R Townsend

Publications and source records attributed to T R Townsend.

13 recordsLinked to original sources
PubMed1992

Seroprevalence of human immunodeficiency virus type 1 among pregnant women.

Five (0.74%) of 678 women delivering in 1985 at a tertiary referral hospital for high-risk pregnancies and 16 (1.34%) of 1198 women visiting an urban prenatal obstetrics clinic in 1986-1987 had serologic evidence of human immunodeficiency virus type 1 (HIV-1) infection. Unlinked testing (removal of personal identifiers from the blood specimen and the epidemiologic data sheet) of residual serum from hepatitis B virus serologic testing was used. Neither age, marital status, payor status, nor serologic markers of hepatitis B virus infection was useful in identifying women at risk for HIV-1 infection. As a result of these data, we have initiated a program in which counseling is offered to all women and testing for those who consent. Unlinked testing of women who refuse consent is performed for epidemiologic purposes. This will allow us to continue to plan for health care resource needs and to track the course of the epidemic in various subgroups of pregnant women.

Adult↗
PubMed1989

Seroepidemiology of hepatitis B virus infection in the United States. 1976 to 1980.

The prevalence of hepatitis B virus (HBV) infection was determined using sera from persons participating in the second National Health and Nutrition Examination Survey, conducted from 1976 to 1980. Of 14,488 scientifically selected participants aged 12 to 74, 821 had evidence of past or present infection with HBV. In the white population, the weighted estimate of hepatitis B infection was 3.2 percent (95 percent confidence interval, 3.1 to 4.2). A steady increase with age was seen; by ages 65 to 74, the prevalence was 6.9 percent (95 percent confidence interval, 5.2 to 8.5). In the black population, the overall weighted estimate of prevalence was 13.7 percent (95 percent confidence interval, 11.6 to 15.8). In this racial group, there was a dramatic increase with age, with the oldest age groups having a prevalence of 39.6 percent (95 percent confidence interval, 29.1 to 50.0). In both racial groups, there was a low prevalence of infection in young children that began to rise between ages 12 and 18. In a multivariate analysis of factors associated with infection, there was an interaction of race with age; therefore, the odds ratio for race is presented for four ages. This ratio ranged from 3.0 (95 percent confidence interval, 1.8 to 4.2) for a 15-year-old to 8.2 (95 percent confidence interval, 6.5 to 10.3) for a 70-year-old. These relative odds estimates were not substantially affected by adjustment for the available information on risk factors for HBV infection. The results of this study in a representative sample of the United States population show that adult black Americans are at high risk for hepatitis B infection. Other independent predictors of HBV positivity include male sex; residing in the South, Northeast, or West; residing in a city of 250,000 or more people; serving in the armed forces; living below the poverty level; and having a positive treponemal test for syphilis. These data suggest that the immunization practices for controlling this disease should be re-examined.

Adolescent↗
PubMed1989

Comparison of nasal brush and nasopharyngeal aspirate techniques in obtaining specimens for detection of respiratory syncytial viral antigen by immunofluorescence.

Diagnosis of respiratory syncytial virus by antigen detection is dependent on obtaining adequate respiratory epithelial cells. Two specimen collection methods, nasopharyngeal aspiration (NPA) and nasal brushing (NB), were compared. Thirty-two pediatric patients with presumed viral pneumonia or bronchiolitis (34 episodes) had both NPA and NB performed. Of 34 specimens 15 were culture-positive for respiratory syncytial virus. Of these 12 NPA samples and 10 NB samples had viral inclusions by immunofluorescent antibody staining (IFA). Of culture-negative samples, 1 of 17 NB was positive by IFA. One specimen obtained by NB had too few cells to read by the IFA method. Sensitivity and specificity were 80 and 100% for NPA and 67 and 94% for NB. Total respiratory cells and IFA-positive cells (classified as few, moderate, or many) were greater with NPA; however, NB was also an effective procedure and was better tolerated by children, less expensive and easier to perform.

Antigens, Viral↗
PubMed1989

Immunity to diphtheria and tetanus in inner-city women of childbearing age.

This study was conducted to determine immunity to diphtheria and tetanus in 232 inner-city women experiencing a recent birth. Forty-three (18.5 percent) of the women had levels of diphtheria antitoxin below the protective level (less than 0.01 unit/ml), whereas only 10 (4.3 percent) had insufficient levels of tetanus antitoxin. The percent of women susceptible increased with age, with 33 percent and 25 percent of women over the age of 30 years susceptible to diphtheria and tetanus, respectively.

Adolescent↗
PubMed1986

The critical role of 3-D CT reconstructions for defining spinal disease.

Three dimensional processing of routine CT images has previously been applied to osseous related maxillo-facial and spinal disorders. Two groups of patients, 25 with substantial spinal trauma and 25 with 'failed back' syndrome had 2-D and 3-D like displays processed by the Cemax 1000 system. The goal was to objectify whether the adjunct of 3-D imaging was truly valuable diagnostically. All images were recorded on 35 mm slides and projected both randomly and as an organized case; intra- and interpersonal evaluations were made. 3-D imaging in 19 of the 25 (76%) trauma patients disclosed additional diagnostic information which was considerably important to both the neuroradiologist and the referring surgeon. In the 'failed back' group, the 3-D images showed supplementary information in 15 of 25 (60%) cases. 3-D displays were usually in color showing complete regional information obtained from high resolution, medium thickness (4 mm) CT slices with minor overlapping (1 mm). The displays were optimized to the plane best defining the pertinent osseous and joint morphology; this included variably rotated and sometimes hemisected views. The images presented here are static, however, when viewed rapidly or by dynamic rotation, the regional morphology results in a highly graphic 3-D presentation.

Humans↗
PubMed1979

Use of antimicrobial drugs in general hospitals: patterns of prophylaxis.

The patterns of prophylactic use of antimicrobial drugs were reviewed in 5288 charts drawn by a random method from 20 randomly selected short-stay general hospitals in Pennsylvania. About 10 per cent of hospitalized patients received antimicrobial drugs for prophylaxis in operations or nonsurgical procedures, and prophylaxis accounted for about 30 per cent of all antimicrobial drugs administered in hospitals. The drugs used most often for prophylaxis were cephalosporins, followed by benzyl penicillins, ampicillin and tetracyclines, in that order. Despite indications that prophylaxis, when useful at all, is effective only when given concurrently with and for 24 to 48 hours after operation, it was usually continued throughout hospitalization. Almost 80 per cent of prophylactic antimicrobial drugs were administered at least 48 hours after an operation or procedure -- suggesting that limiting prophylaxis to the first 24 to 48 hours, as currently recommended, would substantially reduce expenditures for antimicrobial drugs in hospitals.

Ampicillin↗
PubMed1979

Use of antimicrobial drugs in general hospitals. I. Description of population and definition of methods.

The patterns of use of antimicrobial drugs in a random sample of general hosptials in Pennsylvania were studied. The sample was tested for validity, and all deaths and discharges were analyzed for 10 random days drawn across the year spanning July 1973 to June 1974. Methods were developed for abstracting the hospital records and for determining the reproducibility of the findings of the physician and nonphysician chart reviewers. More than 99% of the requested charts were available. In the 5,288 charts reviewed, most of the required data were readily available. The study population was 84% white and 58% female; most patients were in hospitals that had more than 300 beds and that were located in towns with populations of greater than 10,000. In 41% of the 2,070 antimicrobial courses administered to almost 30% of the patients, an explicit clinical statement of why the drug was being given could be found in the chart. The information for review was found in clinical charts, but in half of the charts, the information required was not on face sheets and discharge summaries.

Anti-Bacterial Agents↗
PubMed1979

Use of antimicrobial drugs in general hospitals. II. Analysis of patterns of use.

The hospital charts were surveyed of 5,288 patients in 20 hospitals that were randomly selected from the 194 general hospitals in Pennsylvania. Antimicrobial drugs were administered to 28% of the patients, with little variation in pattern according to hospital size. Surgical services accounted for 61% of the patients who received antimicrobial drugs, and the proportion of patients receiving such drugs varied from 84% on thoracic and cardiovascular surgical services to 13% on obstetrical services. General medicine accounted for 29% of the patients who received antimicrobial drugs and pediatrics for 9%. Eight percent of the hospital population accounted for 50% of all antimicrobial drugs used. Ampicillin was the most frequently used drug, being given in 22% of all courses, with cephalosporins (18%), benzylpenicillins (14%), and tetracycline (13%) next in order. Approximately 30% of the antimicrobial courses were used for prophylaxis.

Anti-Bacterial Agents↗
PubMed1979

Development of a statewide program for surveillance and reporting of hospital-acquired infections.

In 1974, a statewide program was begun to improve surveillance of nosocomial infection in Virginia hospitals. Infection control practitioners were trained at the University of Virginia Hospital, Charlottesville, and were encouraged to submit monthly surveillance reports for analysis. In the first three years of the project, 141 students from 65 hospitals within the state attended a two-week basic course, with eight to 10 students per class. Of the 98 Virginia hospitals that sent students, 75 (73%) submitted monthly reports. The consistency of reporting (number of monthly reports received divided by the number of possible reporting months) was 83%. The sensitivity of reported data was estimated in comparative daily prospective surveys to be 69% for participating hospitals, and the specificity was 99%. The crude infection rate for the first 1.1 million patients at risk was 3.3%.

Cross Infection↗
PubMed1979

Use of antimicrobial drugs in general hospitals: IV. Infants and children.

The use of antimicrobial drugs was studied among 933 randomly selected infants and children who were hospitalized in 20 short-stay general hospitals in Pennsylvania. Twenty-two percent of pediatric patients received antimicrobial drugs: 5% of neonates and 57% of patients aged 12 to 18 months. Sixty-eight percent of the 265 antimicrobial courses administered to these children consisted of a penicillin or a penicillin analogue. Ampicillin was the single drug most frequently administered and was given in 32% of all courses. In contrast to the findings in older children, penicillin or penicillin analogues and aminoglycosides were the only antimicrobial drug groups administered to neonataes. Seventy-nine percent of courses were initiated for proved or suspected infections and 17% were initiated to prevent infections associated with surgical or nonsurgical invasive procedures. Cultures were associated with the initiation of 84% of courses among neonates and 39% of courses among children 6 to 9 years of age. This study provides the initial information, from data derived from randomly selected general hospitals, to permit a statement of norms of practice with respect to use of antimicrobial drugs in pediatric populations.

Adolescent↗
PubMed1977

Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study.

A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly aged patients matched for primary diagnosis of operation or both. Bacteremic cases for which no matched controls could be obtained and 109 additional cases of blood stream infection occurring after the study period were also characterized to determine any gross bias in the process of case selection. Mortality in bacteremic patients was 38% compared to 10% in controls; median hospital stay was 33 days for bacteremic patients and cost was $6,692, compared to 14 days' hospitalization and $2,322 cost for controls. Mortality among the unmatched cases as well as the 109 additional cases was 34%. The excess morbidity, mortality, and hospitalization costs offer a better estimate of the direct effects of the hospital-acquired blood stream infection.

Adult↗