Search PubMed⌕ Search

Biomedical subjects

C Safran

Publications and source records attributed to C Safran.

At least 19 recordsLinked to original sources
PubMed1992

Computer-based interview for screening blood donors for risk of HIV transmission.

OBJECTIVE: To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors and to determine donor reactions to the use of the interview. DESIGN: A comparison of the rate of detection of HIV-related factors elicited by a computer interview with that obtained by standard American Red Cross procedures for assessment of donor suitability, including a randomized crossover trial in which the order of the two methods was reversed. Information obtained by the computer was not available to influence the use of blood components for transfusion. SETTING: The computer interview was administered to donors at an American Red Cross blood donor center and at a mobile blood drive at a hospital. SUBJECTS: Consecutive sample of 294 male and female blood donors 18 to 75 years of age. MAIN OUTCOME MEASURES: Subjects' responses to the computer-based interview as well as responses to the standard Red Cross written questionnaires and face-to-face interviews were used for donor assessment. RESULTS: The interview took an average of 8 minutes to complete. From among 272 donors who provided complete data, the computer identified 12 donors who reported either behaviors associated with a risk of HIV acquisition or symptoms compatible with the acquired immunodeficiency syndrome; none of these donors had been so identified either by routine written questionnaires or by face-to-face interviews used to screen potential blood donors. Only one of the 12 identified donors used the confidential unit exclusion procedure to prevent use of his donated unit. The rate of elicitation of HIV-related factors by the computer interview was 12 (4.4%) of 272 (95% confidence interval [CI], 2.3% to 7.6%), compared with two (0.13%) of 1536 (95% confidence upper bound, 0.28%) using the standard Red Cross procedure (P less than .0001). Tests for antibodies to HIV were negative in blood samples from all of the 272 subjects studied. The subjects enjoyed the computer interview and judged it to be more private than the standard donor assessment method. They also predicted that donors would be more honest with the computer interview than with a human interviewer. CONCLUSIONS: Computer-based screening elicits more HIV-related factors in the health histories of blood donors than do the standard questionnaire and interviewing methods currently in use. Computer-based screening is also acceptable to blood donors.

Adolescent↗
PubMed1992

Serum albumin level on admission as a predictor of death, length of stay, and readmission.

We studied the serum albumin level within 48 hours of hospitalization for acute illness to predict in-hospital death, length of stay, and readmission in 15,511 patients older than 40 years. Patients with low serum albumin levels (less than 34 g/L), who made up 21% of the population, were more likely to die, had longer hospital stays, and were readmitted sooner and more frequently than patients with normal albumin levels. The in-hospital mortality was 14% among patients with low albumin levels, as compared with 4% among patients with normal levels. Although the serum albumin level was a nonspecific marker, it was a stronger predictor of death, length of stay, and readmission than age. We conclude that the serum albumin level on admission is an important variable that should be incorporated in severity-of-illness measures based on physiologic indexes.

Adult↗
PubMed1991

Frequency of low serum high-density lipoprotein cholesterol levels in hospitalized patients with "desirable" total cholesterol levels.

Because the National Cholesterol Education Program guidelines suggest that levels of total serum cholesterol less than 5.17 mmol/liter (200 mg/dl) are "desirable," we performed a retrospective observational analysis to determine the prevalence of coronary artery disease (CAD) in patients with total cholesterol less than 5.17 mmol/liter (200 mg/dl) and the prevalence of total cholesterol less than 5.17 mmol/liter (200 mg/dl) in patients with CAD by angiography. Cholesterol levels less than 5.17 mmol/liter (200 mg/dl) were found in 1,084 of 2,535 patients (42%) having cholesterol measured on hospital admission; 690 of these 1,084 (64%) had CAD. These patients were mostly men, had a family history of premature CAD, and 60% (414 of 690) had high-density lipoprotein (HDL) cholesterol less than 0.90 mmol/liter (35 mg/dl). In a separate group of patients defined from the same admission population but having angiographically established CAD, 32% (424 of 1,197) had a total cholesterol less than 5.17 mmol/liter (200 mg/dl), 59% of whom (252 of 424) had HDL less than 0.90 mmol/liter (35 mg/dl). An analysis of persons admitted electively for angiography (to exclude any effects of hospitalization per se on serum lipids) revealed a similar proportion of persons with total cholesterol less than 5.17 mmol/liter (200 mg/dl) (35%), CAD (82%), and HDL less than 0.90 mmol/liter (35 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1991

Using routinely collected data for clinical research.

Clinical research involving prospective data collection in randomized controlled trials is not always feasible. Increasingly, hospitals are developing large clinical databases that are waiting to be mined. We have developed a computer program, ClinQuery, that facilitates such exploration and analysis. We have also shown in a series of studies that the use of clinical data is a powerful tool in health services research. In some cases, we have shown that coded data are inaccurate and that alternative clinical data are preferable. In other cases, a combination of clinical data and coded discharge diagnoses is preferable.

Boston↗
PubMed1991

Outpatient medical records for a teaching hospital: beginning the physician-computer dialogue.

We have developed an outpatient medical record (OMR) system designed to facilitate direct physician interaction with the computer-based medical record. During the first two years the system was in use, staff physicians, residents, and nurse practitioners entered 15,121 active and 1996 inactive problems for 3524 patients, and 12,651 active medications and 1894 discontinued medications for 3430 patients. These clinicians entered 20,321 items on health promotion and disease prevention screening sheets and with the help of automatic updating by the computer an additional 21,897 entries on screening sheets were made for 8686 patients. On the computer, clinicians wrote more than twice as much--10.9 words per problem, in contrast to 4.3 words per problem in the paper record (p less than 0.0001, Student's t). We conclude that clinicians perceived the computer-based problem list to be more valuable than its paper counterpart.

Ambulatory Care Information Systems↗
PubMed1991

The effect of computer-based reminders on the management of hospitalized patients with worsening renal function.

We performed a prospective time-series study to determine whether computerized reminders to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic and renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to evaluate physician acceptance of computerized reminders. Laboratory data were followed on 10,076 patients over 13,703 admissions generating 1104 events of rising creatinine levels during treatment with nephrotoxic or renally excreted medications. During the intervention period, medications were adjusted or discontinued an average of 21.1 hours sooner (p less than 0.0001) after such an event occurred when compared with the control period. This effect of the reminders was strongest for patients receiving renally excreted and mildly nephrotoxic medications. Of physicians who responded to a computerized survey, 53% said that the reminders had been helpful in the care of their patients, while 31% felt that the reminders were annoying. Seventy-three percent wished to continue receiving computerized reminders. We conclude that computerized reminders are well-accepted in our hospital and have a strong effect on physician behavior.

Aged↗
PubMed1991

Exploring a hospital-wide database: integrating statistical functions with ClinQuery.

Routinely collected clinical data are a valuable source of information for clinical epidemiology, health services research, and outcomes research. To explore, graph, and analyze such a large amount of material easily, one needs three kind of tools: a database management system, graphic displays, and statistical software. Although commercial software packages with these three functions do exist, it may be difficult to find one that fulfills the multiple requirements of a large hospital, allowing researchers to use the hospital information system to study various hypotheses. To address this issue we have integrated new exploratory modules with ClinQuery, a user-friendly computer program for online searching of clinical data. In this paper we describe some of the newly implemented graphics and statistical functions, along with practical examples of the way they may be used.

Boston↗
PubMed1990

Cefpodoxime proxetil: dosage, efficacy and tolerance in adults suffering from respiratory tract infections.

The efficacy of cefpodoxime proxetil has been studied in ten clinical trials conducted in adults suffering from lower respiratory tract infections (pneumonia, acute bronchitis or acute on chronic bronchitis) and upper respiratory tract infections (tonsillitis/pharyngitis or sinusitis). All the trials were controlled, randomized, multicentre and international and seven were double-blind, double-dummy designed. Over a period of 18 months from July 1988 to December 1989, 2448 patients were included. Among them, 2429 (99%) were evaluated for tolerance, 2101 (86%) for tolerance and clinical efficacy and 1018 (42%) for tolerance and clinical and bacteriological efficacy. The clinical response was judged satisfactory in 1205/1263 (95.4%) patients treated with cefpodoxime proxetil and in 788/838 (94%) patients treated with comparative antibiotics. The bacteriological response was judged satisfactory for 662/699 (95%) pathogens for cefpodoxime proxetil treatment versus 427/463 (92, 2%) for comparators. Cefpodoxime proxetil has been given to 7351 patients in the course of its international development with no severe side-effect being observed. Common reactions have been noted with a similar frequency to that seen with the other beta-lactams. No pseudomembranous colitis has been observed during clinical trials. On this basis, cefpodoxime proxetil appears to be efficacious and well tolerated and could be an antibiotic of first choice in the treatment of lower and upper respiratory tract infections in adults and adolescents.

Adult↗
PubMed1990

Pharmacokinetics of cefotaxime in preterm infants.

Pharmacokinetic parameters of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DCTX) were assessed on the 3rd day of treatment in 10 preterm infants (28-37 weeks gestation) aged 3-8 days and receiving 25 mg/kg CTX twice daily. Blood samples were collected from an umbilical artery catheter at 0, 0.08, 0.25, 0.5, 0.75, 1, 2, 4, 8, 12 h after a short peripheral infusion (5 min) and were assayed by high-performance liquid chromatography. During the 12 h following the CTX infusion, serum concentrations of CTX remained above the mean bactericidal concentration for pathogens commonly isolated during the neonatal period. The mean (+/- SD) elimination half-life, volume of distribution, total body clearance and area under the serum concentration-time curve (AUC0-12 h) for CTX were: 3.68 +/- 1.48 h (range: 1.89-6.82), 431 +/- 149 ml/kg (219-636), 1.57 +/- 0.80 ml/kg/min (0.60-3.27) and 373 +/- 206 micrograms/ml/h (170-867), respectively. The AUC0-12 h for DCTX was 170 +/- 93 micrograms/ml/h (61-374). A significant inverse relationship was found between gestational age and the elimination half-life of CTX, and the AUC of both CTX and DCTX.

Bacterial Infections↗
PubMed1989

ClinQuery: a system for online searching of data in a teaching hospital.

We designed a user-friendly computer program that permits physicians to search the clinical database of Boston's Beth Israel Hospital by clinical and demographic descriptors. For example, the user can identify all admissions in which diabetic ketoacidosis was diagnosed, the serum bicarbonate level was under 12 mmol/L, and the length of stay exceeded 7 days. Once particular admissions are identified, all data stored in the computerized record can be displayed. Authorized persons can also request the patient's complete medical record for further study. Over a 30-month period, 530 doctors, nurses, medical students, and administrators used the program to search the hospital's clinical database 1786 times. They displayed detailed information on 30,851 patients and requested the complete medical record 5319 times. In 1389 of the 1786 searches completed, the searcher responded to a computer-based questionnaire about motivation for the search. Responses indicated that 32% of the searches were for clinical research, 17% for patient care, 17% for teaching and education, 11% for hospital administration, and 12% for general exploration. In 58% of the searches, respondents indicated definite or probable success in finding the desired information. We conclude that physicians and allied personnel will repeatedly obtain, view, and analyze aggregate clinical information if they are provided with appropriate tools. We believe that such access to clinical information is an important resource for patient care, teaching, and clinical research.

Boston↗
PubMed1989

Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal.

PURPOSE, PATIENTS, AND METHODS: We used decision analysis to calculate the economic implications of routine testing for Neisseria gonorrhoeae infection of the cervix. This study compared performing endocervical cultures in all women seeking routine gynecologic care to a no-test strategy. Estimates derived from the medical literature were varied in a sensitivity analysis, and a Monte Carlo technique was used to incorporate the estimates of experts into the analysis. RESULTS: We found that routinely testing for gonorrhea reduced overall medical costs when the prevalence of infection exceeded 1.5 percent. This result was most sensitive to variation in the cost of the culture and the assumption that treatment prevents adverse sequelae. Reducing the estimated cost of the culture from $9 to $5 decreased the threshold prevalence from 1.5 to 0.8 percent. When we considered the variation in estimates of experts, the threshold prevalence increased from 1.5 to 2.1 percent. CONCLUSION: We conclude that a strategy of testing and treating selected women with risk factors for gonorrhea will not only reduce the likelihood of the development of serious adverse sequelae but will also result in a reduction of medical costs.

Adult↗
PubMed1989

Interventions to prevent readmission. The constraints of cost and efficacy.

Decision analysis was used to examine the interrelationship of cost and success for an intervention program designed to prevent unexpected readmissions to an acute care hospital. Three separate strategies were considered: 1) intervention for patients who are at high risk for unexpected readmission; 2) intervention for all patients who are admitted to the medical service; and 3) no intervention. Risk and cost data were derived from an analysis of 4,769 patients discharged from Boston's Beth Israel Hospital medical service during a 1-year period. It was found that interventions that cost $250.00 per patient could be cost saving given reasonable expectations of success. If an intervention for high risk patients costs $250.00 per patient, overall costs would be reduced if the success rate of the intervention was 9% or greater. If the success rate exceeded 17%, offering the intervention to all patients would reduce costs. If the cost of an intervention increases by a factor of two, it must be twice as likely to succeed to achieve the same economic benefit. Decision analysis provides a useful framework for evaluation of the economic implications of intervention strategies, and it is recommended that these methods be used in the planning and implementing of medical interventions.

Ambulatory Care↗
PubMed1988

Identification of factors associated with the diagnosis of delirium in elderly hospitalized patients.

We analyzed factors associated with the discharge diagnosis of delirium among 1,285 patients admitted to a major teaching hospital during a 2-year period, developed a model to classify the risk of developing delirium on the basis of clinical and diagnostic data, and tested the model on 471 patients admitted during the subsequent year. Using the multivariate technique of recursive partitioning, we identified four factors that distinguished 80% of all cases of delirium: 1) a urinary tract infection at any time during the hospital stay (odds ratio = 3.1; 95% confidence interval = 2.02-4.58); 2) no urinary tract infection, but low serum albumin on admission (odds ratio = 2.4; 95% confidence interval = 1.43-3.99); 3) neither urinary tract infection nor low serum albumin, but elevated white blood cell count on admission (odds ratio = 1.99; 95% confidence interval = 1.18-3.37); 4) none of these risk factors, but proteinuria on admission (odds ratio = 1.82; 95% confidence interval = 1.25-2.66). Patients without any of these four risk factors had the lowest probability of developing delirium during their hospital stay. Among individuals with delirium, in-hospital mortality and hospital charges were higher. The model developed accurately characterized the risk of delirium when it was tested on patients admitted to the same hospital during the subsequent year.

Aged↗
PubMed1988

Cefotaxime optimal dosage in adult patients. A reappraisal.

Cefotaxime, a third generation cephalosporin, is used throughout the world over a wide range of doses. The purpose of this paper is to discuss the rationale for determination of the optimal dosage and of adequate modes of administration. Among the factors determining in vivo activity, the most important are: (1) the time dependence of the antibacterial effect of cephalosporins, (2) the limited effect of increasing the drug concentration in contact with the bacteria and (3) the absence of a significant post-antibiotic effect. Combined with the rather short elimination half-life of cefotaxime, these factors argue for the use of a unitary dose of 1g in adult patients and for a 6- or 8-hour interval between doses. Information obtained from various animal models of infection are discussed. Clinical and bacteriological studies published in the international literature report a high rate of cure (between 80 and 100%) according to the type of infection and to the criteria of efficacy, with daily doses ranging from 2 to 4g bid or qid. The results obtained with the lowest doses are detailed, particularly for infections permitting the use of a low dosage. The necessity for increasing the dose is discussed in the following situations: (1) in specific infections requiring high local drug concentrations such as meningitis and endocarditis, (2) against micro-organisms exhibiting moderate susceptibility to cefotaxime (MIC greater than or equal to 1 mg/L) and (3) in immunocompromised patients. It is now well established that third generation cephalosporins have to be combined with other antimicrobial agents (e.g. aminoglycosides) for the treatment of patients with infections caused by bacteria able to become resistant. For susceptible strains, it has not been established that a synergistic effect of cefotaxime with another agent allows a reduction of the dosage of each member of the combination.

Adult↗
PubMed1987

Need for better severity indexes of acute myocardial infarction under diagnosis-related groups.

Clinical, demographic and administrative data, including length of stay and institutional charges, were examined for 219 patients hospitalized for acute myocardial infarction (AMI). Neither length of stay nor charges differed among AMI patients with or without cardiovascular complications as defined by Medicare's diagnosis-related group (DRG) categories (DRG 121 and 122, respectively) for patients who are discharged alive. Myocardial enzyme peak levels are the best predictors of hospital resource consumption for patients with AMI when considered alone or in combination with other factors. The "cardiovascular complications" designated by discharge diagnoses did not reflect resource consumption in our patient population. Sixteen percent of the patients studied underwent cardiac catheterization during hospitalization. These patients stayed in the hospital longer and incurred 70% higher charges; nevertheless, they were grouped with the remaining AMI patients in the current DRG formulation. Clinical evaluations such as cardiovascular complications are subject to interpretation, and are therefore less credible than enzyme measurements for recognizing the severity of a patient's AMI. Reimbursement based on objective measurements may avoid payment inequities.

Aged↗
PubMed1987

Pharmacokinetics of roxithromycin in paediatrics.

Macrolides are well known for their high lipid solubility and good tissue penetration. The pharmacokinetic properties of roxithromycin, a new semisynthetic macrolide, appear to be very interesting in healthy adult patients. Five paediatric pharmacokinetic studies are summarized and show that the pharmacokinetic properties of roxithromycin in paediatrics are very similar to those previously reported in adults and suggest that the same dose every 12 h is appropriate in paediatrics, 2.5 mg/kg. The diffusion of roxithromycin into upper respiratory tract tissues appears to be good in children.

Child, Preschool↗
PubMed1987

Should tests for Chlamydia trachomatis cervical infection be done during routine gynecologic visits? An analysis of the costs of alternative strategies.

We used decision analysis to estimate the clinical and economic implications of testing for cervical infection caused by Chlamydia trachomatis in women during routine gynecologic visits. We compared a strategy of no routine testing with a strategy involving the use of routine cultures or the use of less expensive rapid tests for chlamydial infection (the direct fluorescent assay or the enzyme immunoassay). We used different assumptions for the costs and operating characteristics of the diagnostic tests, complications of undetected infection, and the cost of false-positive test results. We found that using one of the rapid tests would reduce overall costs if the prevalence of infection was 7% or greater. The use of routine cultures would reduce costs if the frequency of infection was 14% or greater. We conclude that testing for cervical infection with C. trachomatis in women seeking routine gynecologic care may reduce overall costs. The choice of diagnostic test should depend on the expected prevalence of infection, local cost considerations, and laboratory expertise in the execution of these tests.

Anti-Bacterial Agents↗