ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The acquired immunodeficiency syndrome epidemic has drawn attention to screening for sexually transmitted diseases by primary care physicians. A telephone survey of primary care physicians in an area with a high incidence of STDs (Washington, DC) to ascertain the determinants and the extent of screening and counseling for STDs was completed in 1987. Ninety-nine physicians (33 internists, 38 obstetrician/gynecologists, and 28 family/general practitioners), representing 61% of those eligible, completed the interview. One third (39.4%) were screening for gonorrhea, more than one half (57.5%) for syphilis, and almost all (94%) had tested at least one individual for human immunodeficiency virus infection. Analysis suggested that concomitant screening for hepatitis B was significantly and positively associated with screening for gonorrhea and syphilis. Less than half (45.9%) of the physicians asked new patients about their sexual practices. Physicians should take histories of sexual practices and do more preventive counseling.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The relative and absolute incidences of community-acquired bacterial and tuberculous pulmonary infections, in patients admitted to a public municipal hospital, and the clinical and radiographic characteristics of these infections were retrospectively determined for the first time in 20 years. The data were compared to those previously reported in the literature. Such data were also specifically determined for alcoholics and compared to those found in nonalcoholics. The absolute numbers of infections due to pneumococci and anaerobes, and to tuberculosis, were not dissimilar to those reported in the literature, even though relatively few hemophilus infections were documented. The lack ofKlebsiellasp infections was remarkable but not unexpected. Alcoholic patients had significantly higher rates of tuberculosis, cavitary disease, lung disease presumably due to anaerobes, and blood-culture-positive pneumonia. The relative concordance of our results for bacterial and tuberculous infections with those predicted from the published literature was striking. The high frequency of tuberculosis in our patients was particularly striking at a time when the incidence of tuberculosis nationwide, in patients without acquired immunodeficiency syndrome, has declined significantly.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The data from this study demonstrate that false-positive results from tests for Rocky Mountain spotted fever increase with the duration of pregnancy. The sera of 4.0% (2/50) of women in their first trimester of pregnancy, 10.9% (5/46) in their second trimester, and 12.1% (12/99) in their third trimester yielded false-positive results from latex agglutination assays forRickettsia rickettsiiinfections. The cause of these false-positive results was not determined by this study. These false-positive titers were not associated with clinical findings or other laboratory abnormalities. Even though these sera did not contain antibodies to R rickettsii detectable by indirect fluorescent antibody testing, such false-positive results from serologic tests for Rocky Mountain spotted fever can obscure the patient's correct diagnosis. This may lead to the unnecessary use of potentially toxic antibiotics and prevent initiation of appropriate therapy.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In a prospective, double-blind comparison, we assessed the efficacy of transdermal clonidine with that of chlordiazepoxide in the treatment of moderately severe acute alcohol withdrawal syndrome. While having significant withdrawal symptoms, 50 hospitalized men were randomly assigned to receive either transdermal clonidine or chlordiazepoxide over a 4-day study period. Outcome was evaluated daily, medically and psychiatrically, using both objective and subjective measurements for dependent variables. No patient in either study group had seizures or progression to delirium tremens. The group receiving transdermal clonidine had a more significant response globally for the signs and symptoms of alcohol withdrawal, as measured by the Alcohol Withdrawal Assessment Scale. Also, clonidine more effectively lowered elevated systolic and diastolic blood pressure and heart rate. The core target symptom, anxiety, decreased significantly more in the patients receiving transdermal clonidine when measured by the Hamilton Anxiety Rating Scale and its subscale for somatic anxiety. Cognitive function responded equally in both study populations. Clonidine-treated patients reported less diarrhea, dizziness, headache and fatigue, and the chlordiazepoxide-treated patients reported less nausea and vomiting. We conclude that transdermal clonidine is effective treatment for the acute alcohol withdrawal syndrome.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Mental illness can devastate persons intellectually and emotionally; with maintenance therapy, however, certain patients with chronic mental illnesses are capable of holding a variety of jobs. From the total population of psychiatric patients in our VA outpatient clinic, the 87 who were gainfully employed were identified to determine common factors among them. Affective disorders were the predominant diagnoses among patients who worked, while schizophrenia was more common among those who did not. Alcoholism was diagnosed in approximately 25% of working and nonworking groups.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

One hundred thirty-one patients who gave a history of childhood sexual abuse were seen in a general medical practice decades after the event and were compared with a control group. The subject patients were found to be distinct for chronic depression, morbid obesity, marital instability, high utilization of medical care, and certain psychosomatic symptoms, particularly chronic gastrointestinal distress and recurrent headaches. It is clear that these remote events can underlie difficult chronic medical problems. Questions about childhood sexual abuse must become part of the practitioner's review of systems in these difficult cases, if not routinely.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Patients with terminal cancer may have a series of severe and dehumanizing physical and psychologic symptoms. To improve symptom control in the final days and hours of life, we administer intravenous barbiturates continuously to provide heavy sedation or continuous somnolence. Titrated dosage is then reduced to a minimum, after a desired steady-state has been achieved. Improved symptom control is provided, and the patient's dignity is maintained until death.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Mortality data traditionally have been used to describe the epidemiology of childhood injury. Fatal outcomes, however, represent less than 1% of injury events and thus provide a limited characterization of the problem. Future epidemiologic study resulting in injury prevention depends upon the development of morbidity-based injury surveillance systems. “E-coded” hospital discharge data bases (used to indicate external cause of injury) are a valuable source of information for monitoring and controlling serious, nonfatal injuries. An E-coded injury discharge data base was developed and evaluated at The Children's Hospital of Alabama in Birmingham. In addition to patient demographics, length of stay, total charge, and method of payment, E-code and “N-code” (to indicate the anatomic site of injury) data were collected. During the 2-year study period, 1077 discharges from the hospital were documented in children with serious injuries under 15 years of age for an adjusted discharge rate of 78.0 per 10 000 child-years. Injuries accounted for $5.3 million in total charges and 4899 total days of stay. Falls, unintentional poisonings, burns, and bicycle, motor vehicle-passenger, and motor vehicle-pedestrian injuries were the six most common causes of injury. Closed-head trauma accounted for 55.4% of motor vehicle-passenger injuries, 67.6% of bicycle injuries, and 51.8% of falls. Hot water scalds caused 36.4% of burns, and clonidine ingestion accounted for 22.1% of unintentional poisonings.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID