摘要:

Background.The widespread and often inappropriate use of broad spectrum antibiotics in the outpatient setting is recognized as a significant contributing factor to the spread of bacterial resistance. We hypothesized that residents prescribe broader spectrum antibiotics more frequently than staff physicians and adopt more appropriate prescribing practices with increasing levels of training.Methods.All patient visits for acute sinusitis in our teaching practice between July 1, 1995, and June 30, 1997, were reviewed. Comparisons of antibiotics prescribed were made between staff and residents at each level of training.Results.First‐ and second‐year residents were more likely to prescribe narrow spectrum antibiotics (56%) than third‐year residents (35%) or staff (34%).Conclusions.Junior residents in our program are more likely to prescribe narrow spectrum antibiotics for the treatment of acute sinusitis than are senior residents or staff. With advancement in level of training, prescribing practices of residents come to resemble those of their supervising staff physicians.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;Adverse drug reactions (ADRs) are underreported and consequently are an underestimated cause of morbidity and mortality. Recent epidemiologic evidence estimates that ADRs represent the fourth to the sixth leading cause of death. Public awareness is increasing as reports of ADRs and medication errors become more prevalent in the lay press. Reducing the number of ADRs can be accomplished by systems changes made at an individual and national level. At the individual level, increased diligence should be used with regard to reporting and documenting ADRs. At the national level, ADRs can be reduced by expanding the role of the arm of the Food and Drug Administration (FDA) responsible for postmarketing surveillance.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Although studies have identified physician beliefs that may cause them to avoid spiritual topics in the clinic (eg, lack of time), it is unknown to what extent these beliefs predict behavior. The purpose of the present study was to identify physician beliefs about religion and medicine that predict attention to religious issues in the clinic.Methods.The study was cross‐sectional and correlational. Seventy‐eight physicians completed a self‐report survey of religious behavior in the clinic and beliefs about religion and medicine.Results.Most physicians do not initiate religious discussions with patients, though a majority accept a link between religion and health. Physician personal discomfort with addressing religious topics was the sole multivariate predictor of clinical religious behavior. Time, role definition, health relevance of religion, and physician religiousness were not significant predictors.Conclusions.Avoidance of religion in the clinic may be primarily belief‐based. Future research is needed to examine the role of medical education in creating and/or maintaining these beliefs.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;A case of a pseudoaneurysm of the thyrocervical trunk after a pocketknife stab wound to zone I of the neck is reported. The patient was evaluated and treated in an emergency department with irrigation of the wound, bandage, and oral antibiotics. A large pseudoaneurysm slowly developed over the next 2 months. When the patient arrived at our hospital, he was immediately admitted and arteriograms were obtained. Arteriograms revealed an active leak of blood into a pseudoaneurysm from the thyrocervical trunk. Surgical treatment consisted of proximal and distal ligation of the thyrocervical trunk. This is the first case of a pseudoaneurysm developing only from the thyrocervical trunk due to a stab wound to zone I of the neck. This case and its complication serve to illustrate and emphasize the rationale for routinely imaging the great vessels after all penetrating trauma to zone I of the neck.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life‐threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. Patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. Patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist.Methods.We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were officebased, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient‐reported and physicianreported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow‐up period was 9 months.Results.A 1‐point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4‐point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was “high” in 50% and “medium” in 25%. No procedural complications occurred.Conclusion.Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost‐effective therapy.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.We retrospectively studied the duration of operations and the hospitalizations for impending and manifest fractures of weight‐bearing long bones with metastatic disease, which has rarely been done.Methods.The duration of operative fixation and the hospital stay in patients with an impending (n = 7) or actual (n = 15) fracture in a weight‐bearing long bone with metastatic tumor were assessed, including symptomatic response, posttreatment mobility, and survival rate.Results.Most patients had significant relief of pain. More than half of patients with impending fracture and 80% with actual fracture were ambulatory after therapy; 3‐year survival rates were 29% and 13%, respectively. Corresponding mean durations for the operations were 175 minutes and 185 minutes, respectively; mean durations of hospitalization were 22 days and 16 days, respectively.Conclusion.Surgical fixation of fractures in weight‐bearing long bones with metastatic cancer does not require excessive operative time as compared with that of impending fractures, does not extend hospitalization, and has an acceptable risk‐reward ratio.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.The proportion of older individuals infected with the human immunodeficiency virus (HIV) is rising.Methods.We performed a retrospective case‐control study of 58 patients more than 60 years old at the time of diagnosis of HIV infection and compared them with 232 controls (matched by CD4+lymphocyte count). Clinical and demographic data were obtained from the Adult Spectrum of Diseases (ASD) database at the Medical Center of Louisiana.Results.Patients in the older age group were more likely to be male and African American or Hispanic. The most common risk factor for acquisition of HIV infection among the patients was homosexual contact (53%). Disease staging was similar in both groups as determined by CD4+lymphocyte counts and history of opportunistic infections. There was no difference in the use of antiretroviral therapy. In a Cox proportional hazard model and regression models, age ≥60 years was associated with shorter survival.Conclusion.Patients who are older than 60 years at the time of diagnosis of HIV infection have a shorter survival than younger patients.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Prevention of pneumococcal sepsis in children with sickle cell disease (SCD) is threatened by the emergence of penicillin‐nonsusceptible pneumococci.Methods.In this study, nasopharyngeal colonization withStreptococcus pneumoniaeand penicillin susceptibility were compared in children with SCD and a control group. Nasopharyngeal cultures were obtained from 130 children with SCD and 123 control children. Penicillin susceptibility was determined by Epsilometer test. Compliance with penicillin prophylaxis in SCD patients was determined by parent interviews and review of patients' medical and pharmacy records.Results.Streptococcus pneumoniaewas isolated from 8 (6%) of 130 SCD patients, and 21 (17%) of 123 control patients. Of the 29S pneumoniaeisolates, 6 (21%) were nonsusceptible to penicillin; 4 of 8 (50%) were from the SCD group and 2 of 21 (10%) from the control group.Conclusions.Penicillin prophylaxis decreased the rate ofS pneumoniaecolonization in SCD patients; however, it also increased the risk of selective colonization with penicillin‐nonsusceptibleS pneumoniae.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;We present two cases of hemangiomatosis of the gastrointestinal tract. The first case describes a 59‐year‐old patient with upper gastrointestinal hemorrhage due to the blue rubber bleb nevus syndrome. The second case illustrates a 26‐year‐old patient with recurrent rectal bleeding due to Klippel‐Trenaunay syndrome. These two syndromes are distinct disorders characterized by cavernous hemangiomas of the skin, soft‐tissue, bones, and viscera. In addition, we review the available literature on the epidemiology, transmission, clinical features, associated conditions, diagnosis, and treatment of these two disorders.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID