摘要:

Pneumocystis cariniipneumonia has been the most common life-threatening opportunistic infection in patients with acquired immunodeficiency syndrome. With a better understanding of the natural history of HIV infection, however, we have come to realize that prophylaxis against P carinii can prevent the majority of such pneumonias. In this article, I focus on the rationale behind such prophylaxis, as well as the choices and dilemmas the clinician faces in deciding on the most appropriate therapy and when it should be instituted.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The purpose of this study was to evaluate the value of preoperative electrocardiography in predicting postoperative cardiac complications. Four hundred eighty-one patients having elective surgery were eligible. The patients' ages and specific ECG findings were recorded preoperatively. The patients had prospective follow-up from admission to discharge for the development of postoperative cardiac complications. The data were analyzed using stepwise logistic regression. Postoperative ischemic events were predicted by ECG findings of ST segment abnormalities and ECG evidence of previous myocardial infarction. Age, P wave abnormalities, and preoperative dysrhythmias were independent predictors of postoperative dysrhythmic events. These specific ECG findings may identify patients at risk of postoperative ischemia or dysrhythmia. These patients may benefit from aggressive preoperative cardiac evaluation or close postoperative cardiac monitoring.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Regular physical activity increases a person's ability to perform daily activities more efficiently, reduces the risk of specific chronic diseases, including coronary artery disease, and lowers death rates in general. The Healthy People 2000 Physical Activity and Fitness Objectives underscored the importance of monitoring and tracking the prevalence of physical activity and fitness in the United States population for the purpose of planning, implementing, and evaluating efforts to improve the public's physical activity habits. This report examines the prevalence of self-reported leisure-time physical activity (LTPA) among southeastern adults aged 18 years and older living in the state of Georgia. Using data from the 1990 Behavioral Risk Factor Surveillance System (BRFSS) surveys from Georgia, we describe the LTPA patterns of Georgia adults aged 18 years and older. A total of 1,723 adults were interviewed during 1990. Results show the following: women are less active than men, blacks are less active than whites, persons of lower sociocconomic status (SES) are less active than those of higher SES, and older adults are less active than younger adults. These results suggest that a more concerted effort needs to be made in promoting physical activity for women, persons of lower SES, and older adults.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Birth defects in live-born infants were documented for 2 years in Jefferson County, Alabama (USA)—1986 and 1987—and in Uppsala County, Sweden—1985 and 1986. A total of 27,561 live births (9,179 white male, 8,728 white female, 4,883 black male, and 4,771 black female infants) occurred in Jefferson County; 6,896 live births (3,535 male and 3,361 female) were recorded in Uppsala County. These newborns were studied to establish a database of birth defects for the two small geographic areas and to study similarities and differences. Rates of hip dislocation, heart malformations, and clubfoot were high in Swedish infants. Similar frequencies of spina bifida and polydactyly were noted in Alabama whites and Swedish infants. Regional registries offer a systematic approach to detection of clustering of specific birth defects, identification of families for further study, location of patients with unique needs, and enhanced coordination of health services, including genetic counseling.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study is a 2-year follow-up to a 1987-1988 survey of North Carolina hospitals regarding hospital utilization by patients with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Almost 99% of the state's hospitals participated in the resurvey for the fiscal year 1989-1990. The number of general hospitals treating these patients grew by 57% HIV/AIDS inpatients increased by 189% from 540 to 1,561. Total general hospital charges for HIV/AIDS inpatients increased from $7,685,000 to $26,957,000, an increase of 251%. Of these charges the amount that was uncompensated by insurance increased by 293% to $7,733,000. Fifteen large tertiary general hospitals treated 80% of the HIV/AIDS inpatients and accounted for $6,093,000 (79%) of the uncompensated charges related to these patients.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To make informed career decisions, physicians must acquire a basic knowledge in medical management and health care economics as they evaluate the potential survival and growth of a primary care practice. Health care providers considering a specific community and local leaders and hospital administrators attempting to recruit internal medicine physicians need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, we conducted a detailed survey of nonmetropolitan internal medicine generalists and primary care physicians. Data collected from internal medicine physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 24 months/Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing an internal medicine practice in a specific community. This model can be used to project the number of adult primary care visits a community can generate for a prospective physician, as well as to estimate the direct and indirect costs, annualized capital costs, gross revenue, and net income of the practice.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Gefotaxime is a third-generation cephalosporin with excellent in vitro antimicrobial activity against Neisseria gonorrhoeae, including ß-lactamase-producing strains. A single 1-g intramuscular dose is suitable for the treatment of uncomplicated gonorrhea. We conducted an open, randomized study to evaluate the efficacy, safety, and cost impact of a lower dose (500 mg) of cefotaxime versus 250 mg ceftriaxone, an often recommended treatment for uncomplicated gonorrhea. Of the 222 patients enrolled, the cases of 151 were fully assessable. Bacteriologic elimination rates were 99% in the cefotaxime group and 100% in the ceftriaxone group. Clinical response rates were 78% and 83% in the two groups, respectively. Adverse clinical events occurred in 4% and 9% of patients in the two groups, respectively. The average wholesale price of 500 mg cefotaxime is 31% lower than that of 250 mg ceftriaxone. A 500-mg dose of cefotaxime appears to be a safe and cost-effective alternative to 250 mg ceftriaxone for the treatment of uncomplicated gonorrhea.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue. The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy). Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Mirizzi's syndrome is a partial obstruction of the biliary tree caused by a stone impacted in the cystic duct, with or without development of a cholecystobiliary fistula. We report our experience with five cases and review current methods of diagnosis and management. Preoperative diagnosis greatly facilitates management. Diagnosis may require a combination of ultrasonography, computed tomography, and cholangiography (percutaneous or endoscopic retrograde). At surgery, dissection in the triangle of Galot should be minimized to avoid injury to the common bile duct. Often, a partial cholecystectomy is the only safe option. Defects in the common bile duct can be repaired by a variety of methods. The morbidity and mortality associated with this rare syndrome can be relatively high. A number of patients may have late biliary strictures.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To define the clinical presentation of histoplasmosis among hospitalized children, we reviewed the charts of patients treated for histoplasmosis at Vanderbilt University Children's Hospital during the years 1968 through 1988. Thirty-five patients with histoplasmosis diagnosed by culture, pathologic examination, or serologic testing were identified, including 29 patients (83%) with pulmonary/mediastinal infection, 5 (14%) with disseminated disease, and 1 (3%) with primary cutaneous histoplasmosis. The most common symptoms included fever, present in 26 patients (74%), and cough, present in 20 (57%). Of 26 patients with fever, 18 (69%) had fever of >2 weeks' duration and 7 (27%) had temperatures ≥ 40.5°C (≥ 105°F). Abnormal physical findings were few, but 19 patients (54%) had wheezing. Chest radiographs were obtained in all cases except one; 31 (91%) showed abnormalities, including adenopathy in 25 cases (74%) and infiltrates in 19 (56%). Histoplasmin skin tests were positive for 22 (96%) of the 23 patients tested. No cases of classic disseminated histoplasmosis of infancy were identified. Histoplasmosis should be considered in the differential diagnosis when children living in endemic areas are evaluated for persistent fever, cough, and/or wheezing, particularly if adenopathy is seen on the chest radiograph.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID