Biomedical subjects

T Sefcik

Publications and source records attributed to T Sefcik.

3 recordsLinked to original sources

PubMed1993

Fever of nosocomial origin: etiology, risk factors, and outcomes.

OBJECTIVES: To identify the etiologies and risk factors associated with fever of nosocomial origin and compare the outcomes of patients with and without nosocomial fever. DESIGN: A prospective study with a case-control component. SETTING: The three medical services of a university hospital. PATIENTS AND METHODS: We evaluated 100 patients with fever of nosocomial origin. Etiologies were assigned by the consensus of three independent reviewers using Centers for Disease Control guidelines. Predictors of bacterial etiology were identified using logistic regression methods. Controls matched for age (+/- 5 years), sex, and comorbidity were identified for 65 of the nosocomial fever cases. Cases and controls were compared with conditional logistic regression to identify risk factors for fever of nosocomial origin. Cases and controls were followed at 1 month to compare length of stay, mortality, and hospital readmission rates. MEASUREMENTS AND MAIN RESULTS: An etiology was assigned in 81 cases: 51 had bacterial infection, 5 had nonbacterial infection, and 25 had a noninfectious etiology. Multivariate predictors of bacterial infection were the presence of diabetes mellitus (odds ratio [OR] = 5.74; 95% confidence interval of the odds ratio [CI] = 1.61 to 20.40), length of stay to fever onset after admission greater than 10 days (OR = 3.98, CI = 1.04 to 15.22), maximum temperature greater than 38.7 degrees C (OR = 3.37, CI = 1.28 to 8.88), and white blood cell count greater than 10 x 10(9)/L (OR = 4.64, CI = 1.68 to 12.77). Comparison of cases and controls indicated that patients with nosocomial fever had more invasive procedures in the 72 hours preceding enrollment in the study than controls (OR = 1.46, CI = 1.03 to 2.08). Although cases were hospitalized almost twice as long as controls (21.5 versus 12.5 days; p < 0.0001), neither 30-day mortality nor hospital readmission rates differed between cases and controls. CONCLUSION: Nosocomial fever often does not represent nosocomial infection and may constitute a wide variety of other conditions. Since bacterial etiology of fever is a major concern, clinical and laboratory findings can be used to predict patients at high risk for an infectious process. A reduction in the number of invasive procedures may decrease the incidence of nosocomial fever. New-onset nosocomial fever leads to an increase in length of hospital stay but is not a significant predictor of mortality.

Case-Control Studies↗

PubMed1991

Syncope and orthostatic hypotension.

PURPOSE: The purpose of this study was to determine the postural blood pressure response over time, the prevalence of orthostatic hypotension in patients with syncope, and the relationship of orthostatic hypotension to recurrence of symptoms. PATIENTS AND METHODS: We prospectively evaluated 223 patients with syncope in a standardized manner. Orthostatic responses were measured in a standardized fashion at 0, 1, 2, 3, 5, and 10 minutes or until symptoms occurred. Follow-up was obtained at 3-month intervals. Causes of syncope were assigned by predetermined criteria. RESULTS: Orthostatic hypotension (20 mm Hg or greater systolic blood pressure decline) was found in 69 patients (31%). The median time to reach minimal standing systolic blood pressure was 1 minute for all subjects. In patients with orthostatic hypotension (20 mm Hg or greater), mean time to reach minimum blood pressure was 2.4 minutes. The vast majority of patients with significant orthostatic hypotension had this finding within 2 minutes of standing. Orthostatic hypotension was common in patients for whom other probable causes of syncope were assigned. The recurrence of syncope was not related to the degree of orthostatic hypotension; however, the recurrence of dizziness and syncope as end-points was lower in patients with 20 mm Hg or greater systolic blood pressure reductions as compared with patients with lesser degrees of orthostatic blood pressure declines. CONCLUSION: Orthostatic hypotension is common in patients with syncope and is detected in the vast majority of patients by 2 minutes. Although symptom recurrence on follow-up was lower in patients with more severe orthostatic hypotension, the clinical significance of this finding needs to be further defined by future studies.

Adolescent↗

PubMed1990

Health promotion and disease prevention in the elderly. Comparison of house staff and attending physician attitudes and practices.

The purpose of this study was to evaluate and compare attending physician and house staff attitudes and practices regarding health promotion and disease prevention in the elderly. Seventy-four physicians (38 house staff and 36 attending physicians) were surveyed from four sites in Pittsburgh, Pa, regarding their agreement with recommendations of the American Cancer Society and the Canadian Task Force. Two hundred fifty patients were interviewed and their charts were reviewed for performance of the recommendations. In all patients, physicians agreed highly with the American Cancer Society and the Canadian Task Force recommendations (agreement, 80% to 100%), with the exception of proctoscopy and thyroid examinations. Physicians performed screening procedures much less frequently. House staff and attending physicians differed regarding their attitudes about prevention. House staff felt the need for more formal instruction and were more positive regarding a healthy life-style and commitment to health promotion. The significant predictors of tests (defined as either examination or test ordered by a physician) were presence of a checklist, site of practice, and physician status. A logistic regression analysis was performed; however, this model could not entirely explain the variations found. Although physicians agreed with recommendations for screening, the attending physicians and house staff (particularly attending physicians) were less likely to perform the screening, especially in the elderly.

Aged↗