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Biomedical subjects

D E Peterson

Publications and source records attributed to D E Peterson.

At least 19 recordsLinked to original sources
PubMed2000

Analysis of ciprofloxacin activity against Streptococcus pneumoniae after 10 years of use in the United States.

As the most commonly used fluoroquinolone in the United States since 1987, ciprofloxacin has exerted the greatest selective pressure on S. pneumoniae and provides a valuable marker to evaluate the actual and potential emergence of fluoroquinolone resistance in this species. Analysis of susceptibility results obtained with 5,640 strains collected from throughout the United States showed that only 16 (0.3%) of the isolates demonstrated MICs of > or =4 microg/ml. The prevalence of this phenotype was significantly higher (P < 0.05) among penicillin-resistant populations, among isolates from patients >64 years old, and among respiratory isolates. However, >99% of strains had MICs of <4 microg/ml regardless of the risk group examined, and the MIC population distributions were the same for each risk group. These findings demonstrate that the phenotype of a MIC of > or =4 microg/ml remains uncommon after 10 years of ciprofloxacin use; however, these findings are no reason to become complacent with regard to appropriate use of fluoroquinolones and the need to carefully track resistance trends. Equally important is careful analysis of data that result from surveillance in terms of risk factors and other associated trends so that resistance and susceptibility, and their consequences, are neither over- nor underestimated.

Adolescent↗
PubMed1999

Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group.

BACKGROUND: An impediment to mucositis research has been the lack of an accepted, validated scoring system. The objective of this study was to design, test, and validate a new scoring system for mucositis that can be used easily, is reproducible, and provides an accurate system for research applications. METHODS: A panel of experts, convened to design an objective, simple, and reproducible assessment tool to evaluate mucositis with specific application to multicenter clinical trials, developed a scale that measured objective and subjective indicators of mucositis. Nine centers participated in the study's validation. Paired investigators at each center evaluated patients receiving chemotherapy or head and neck radiation. Objective measures of mucositis evaluated ulceration/pseudomembrane formation and erythema. Subjective outcomes of mouth pain, ability to swallow, and function were measured. Analgesia use for mouth sensitivity was recorded. RESULTS: One hundred eight chemotherapy and 56 radiation therapy patients were evaluated. Seventy-eight percent of chemotherapy patients and 64% of radiation therapy patients had clinically significant mucositis. Cumulative daily mucositis scores demonstrated a high correlation among observers. Using area under the curve analysis, it was found that for chemotherapy patients, the highest correlations (correlation coefficient > 0.92) occurred for the scores that selected the three highest daily values over the course of mucositis assessment. High interobserver correlations were noted for patients receiving radiation therapy. Objective mucositis scores demonstrated strong correlation with symptoms. CONCLUSIONS: The scoring system evaluated was easily used, showed high interobserver reproducibility, was responsive over time, and measured those elements deemed to be associated with mucositis. The use of concomitant symptomatic measurements appeared to be unnecessary.

Adult↗
PubMed1999

Oral infection.

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Antineoplastic Agents↗
PubMed1999

Research advances in oral mucositis.

Oral mucositis is a common toxicity of high-dose chemotherapy and upper mantle head and neck radiation. Published evidence from the past 14 months provides insight into the multiple possible mechanisms. In addition, the data highlight the clinical importance that this lesion exerts relative to infection risk, quality of life, and cost of care. Oral mucositis has emerged as a dose-limiting toxicity in selected cancer therapy models. Thus, it has direct impact on duration of disease remission, cure rates, and long-term survival. Because of its importance in the clinical setting, oral mucositis remains under extensive laboratory and clinical investigation. Advances in the 1980s relative to infection prevention and reduced duration of profound neutropenia via growth factors have elevated oral mucositis to a prominent toxicity of cancer therapy. A contemporary model for mucositis involving four principal phases was published in 1998. Future research will likely add further insight into this model relative to the roles of mucosal immune dysregulation, colonizing microflora, and wound-healing mechanisms. Basic and clinical studies directed to these several components may well lead to effective preventive strategies in the future, with positive impact on quality of life and survival of cancer patients.

Animals↗
PubMed1998

Labor induction with prostaglandin E1 misoprostol compared with dinoprostone vaginal insert: a randomized trial.

OBJECTIVE: To compare the safety, efficacy, and costs of intravaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction. METHODS: Two hundred twenty-three labor induction patients were assigned randomly to one of two treatment groups: 1) intravaginal misoprostol or 2) dinoprostone vaginal inserts. Fifty micrograms of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum period of 24 hours. Ten milligrams of dinoprostone was administered in a single application as a vaginal insert for 12 hours. RESULTS: Among 223 patients evaluated, 108 were allocated to the misoprostol group and 115 to the dinoprostone group. The median interval from induction to vaginal delivery was significantly shorter in the misoprostol group: 698 (range 395-1053) versus 1041 (range 792-1531) minutes (P < .001). Vaginal delivery within 12 hours of ripening occurred in 40.7% of patients who received misoprostol compared with 19.1% for those receiving dinoprostone (P < .001); no significant difference between the groups was noted for vaginal delivery within 24 hours. Uterine tachysystole occurred more frequently in patients in the misoprostol group (21.3%) than in the dinoprostone group (7.0%) (P = .004). Nevertheless, no statistically significant differences were noted between the groups with respect to intrapartum complications, including uterine hyperstimulation, mode of delivery, and neonatal or maternal adverse outcomes. The average cost per patient for misoprostol treatment was $85 compared with $606 for treatment with the vaginal insert. CONCLUSION: Intravaginal misoprostol and the dinoprostone vaginal insert appear to be safe agents for cervical ripening and labor induction. However, misoprostol is less expensive and more effective than the dinoprostone vaginal insert.

Dinoprostone↗
PubMed1998

The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp.

BACKGROUND: In January 1993, Nyamithuthu Camp in Malawi housed 64000 Mozambican refugees. Communicable diseases, primarily diarrhoea, pneumonia, malaria and measles, contribute to substantially higher mortality rates in refugee populations compared to similar non-displaced populations. METHOD: A systematic sample of 402 households in one portion of the camp were surveyed for diarrhoeal risk factors, and then interviewed twice weekly for 4 months regarding new diarrhoea episodes and the presence of soap in the household. Two-hundred grams of soap per person was distributed monthly. RESULTS: Households had soap on average only 38% of the interview days. Soap was used primarily for bathing and washing clothes (86%). Although 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. The presence of soap in a household showed a significant protective effect: there were 27% less episodes of diarrhoea in households when soap was present compared to when no soap was present (RR = 0.73, 95% CI: 0.54 < RR < 0.98). Potential confounding factors were assessed and did not appear to be responsible for the association between the presence of soap and reductions in diarrhoea incidence. CONCLUSION: In summary, our findings suggest that the provision of regular and adequate soap rations, even in the absence of a behaviour modification or education programme, can play an important role in reducing diarrhoea in refugee populations. If subsequent study confirms the soap as a cheap and effective measure to reduce diarrhoea, its provision in adequate amounts should be a high priority in refugee settings.

Adolescent↗
PubMed1998

Acute oral pain and mucositis in bone marrow transplant and leukemia patients: data from a pilot study.

The purposes of this prospective, repeated-measures descriptive pilot study were to describe patterns of acute oral pain and mucositis in patients receiving a bone marrow transplant or high-dose chemotherapy for leukemia, and to test procedures and instruments before initiating a larger intervention study. A nonprobability, purposive selection process was used to enroll 18 patients admitted to two acute care inpatient hospital units for bone marrow transplantation or leukemia therapy at a university health sciences center in the southeastern United States. Data were collected at baseline, then daily through patient interviews, oral examination, and chart review for at least 3 weeks or until discharge. Research variables were pain intensity, intolerable pain, verbal descriptors of pain, pain relief, and use of pain relief strategies (Pain Assessment Form), mucositis (erythema and ulceration) in eight anatomic locations of the oral cavity (Oral Mucositis Index), voice/talking (Oral Assessment Guide), and mood states (11-item Brief Profile of Mood States). Mild to moderate pain occurred in nearly 70% of patients and was described as "tender," "irritating," and "sore." Patients used pain medicines, mouth care, and mental and physical activities to relieve pain, and reported partial overall relief of pain. Mucositis was mild, with the tongue and buccal and labial mucosa most commonly affected with erythema and the buccal mucosa with ulceration. Voice/talking were only mildly impaired, and mood disturbance was mild. Patterns of pain, mucositis, and mood disturbance were consistent with each other and followed the trajectory described in previous research. Results suggest that nurses should continue to assess these symptoms vigorously and assist patients in selecting multiple management strategies. Research using repeated-measures designs in this acutely ill inpatient population is challenging and needs careful attention by researchers. The results have been used to improve the ongoing larger intervention study.

Acute Disease↗
PubMed1998

Risk factors for contracting plague in Nkayi district, Zimbabwe.

OBJECTIVE: To identify risk factors for contracting plague among the three to 16 year old age group. DESIGN: A matched case control study, carried out in two parts. SETTING: Nkayi District--a plague endemic area in Zimbabwe. SUBJECTS: A total of 86 cases were randomly selected from a line listing of all reported plague cases in the district. Two neighbourhood controls were selected from households at least 500 m on either side of the case household. MAIN OUTCOME MEASURES: Maximum likelihood estimate of the odds ratio (OR) for the 17 risk factors studied (grouped as personal, environmental, domestic animals and rat reports). RESULTS: Risk factors which were significantly associated with contracting plague were having a sick cat in the household (OR 3.4, 95% CI 1.1 to 13.0), herding cattle (OR 1.7, 95% CI 1.0 to 3.0), and age 10 years or older (OR 2.2, 95% CI 1.2 to 4.1). In a logistic model, only having a sick cat was found to be independently associated with being a case (OR 3.9, 95% CI 1.3 to 12.2). CONCLUSION: The presence of a sick domestic cat was identified as a risk factor for acquiring bubonic plague during this outbreak. Communities should be informed that sick cats may act as a warning of potential plague, and that if cats become sick they should be removed from the household.

Adolescent↗
PubMed1997

Effects of sanguinarium, chlorhexidine and tetracycline on neutrophil viability and functions in vitro.

The effectiveness of an ideal antimicrobial agent depends on its ability to kill microbes with minimal toxicity to host cells. Depending on the treatment regimen, antimicrobial agents come into contact with host cells for various intervals of time. Sanguinarium (SANG), chlorhexidine (CHX) and tetracycline (TET) are 3 antimicrobial agents frequently used in the management of periodontal infections. However, their effects on host immune cells during different treatment regimens are not known. Due to their ability to serve as the first line of host defense against microbial infections, we have compared the effects of these antimicrobial agents on human neutrophil functions and viability. The results show that SANG is not lytic to neutrophils from peripheral blood or crevicular fluid, at all concentrations tested. However, exposures of neutrophils to very low concentrations of SANG (0.001%) inhibits neutrophil chemotaxis, oxidative metabolism and degranulation within 5 min. Increasing the exposure time results in a similar inhibition of neutrophil functions, albeit at 50-100 fold lower concentrations of SANG. CHX rapidly disrupts the cell membrane of both crevicular and peripheral blood neutrophils at concentrations above 0.005% within 5 min, and inhibition of all neutrophil functions is due to its lytic properties. While TET is least toxic to neutrophils, a dose dependent inhibition of neutrophil functions is dependent on the calcium concentrations of the cellular environment, and is observed only above 0.04% or higher concentrations in the absence of calcium. The data suggest that a critical cumulative concentration of these drugs is essential for their toxicity and inhibition of neutrophil functions. Therefore, both the length of exposure and the dose of the drug both are critical while considering the effectiveness of SANG, CHX or TET in the treatment of infections. Furthermore, due to differences in their mechanisms of action, the consequences of their effects on neutrophils may have significant bearing on tissue pathology as well as on their therapeutic efficacy.

Adult↗
PubMed1997

Investigation of the validity and reliability of four objective techniques for measuring forward shoulder posture.

Clinicians often rely on visual inspection and descriptive terms to documents a patient's forward shoulder posture. The purpose of this study was to assess the validity and intrarater reliability of four objective techniques to measure forward shoulder posture. Subjects were 25 males and 24 females. Subjects had a lateral cervical spine radiograph taken, from which the horizontal distance from the C7 spinous process to the anterior tip of the left anterior acromion process was measured. Subjects then proceeded twice through a random order of four measurements: the Baylor square, the double square, the Sahrmann technique, and scapular position. These results were then used to determine the intrarater reliability of each technique. Multiple regression analyses were performed on each measure's mean scores to determine both the correlation with and the predictive value for the radiographic measurement. The intraclass correlation coefficients for intrarater reliability ranged from .89 to .91. The correlation coefficients ranged from -.33 to .77, and the coefficients of determination ranged from .10 to .59 (N = 49). The researchers demonstrated clinical reliability for each technique; however, validity compared with the radiographic measurement could not be established. These techniques may have clinical value in objectively measuring change in a patient's shoulder posture as a result of a treatment program. Before any of these measures could be universally recommended in clinical practice, future research is necessary to establish interrater reliability and assess each technique's ability to detect postural changes over time.

Adult↗
PubMed1997

The health information system in the City of Bulawayo, Zimbabwe: how good is it?

OBJECTIVE: To evaluate the operations and attributes of the outpatient diseases (OPD) surveillance system in the City of Bulawayo. DESIGN: Cross sectional and descriptive study. The system's attributes were evaluated using Centres for Disease Control and Prevention (CDC) evaluation guidelines. We also held focus group discussions with health personnel regarding the use of collected data. SETTING: 6 of 17 health care clinics in Bulawayo, the second largest city in Zimbabwe. SUBJECTS: 34 health personnel were interviewed. MAIN OUTCOME MEASURES: Knowledge of the system's operations, and attributes of the system. RESULTS: Data providers interviewed and all those who participated in Focus Group Discussions (FGDs) had good knowledge of the system's operations. The system is complex. It reports on 94 health events, of which only six (6%) have standard case definitions. All 17 clinics participated in this surveillance. However, of 54 returns studied, 67% were incomplete, and 69% were sent in after the deadline. The system has no plans on how data should be analyzed, used and disseminated. CONCLUSIONS: The CODROPA system is potentially useful in detecting trends of diseases. However, the long delay between data collection and data analysis does not allow for early detection of epidemics and clusters of diseases may be missed. A simpler and less time consuming surveillance system should be started to improve the system's attributes particularly, timeliness of reporting and acceptability of the system to those who have or need to participate.

Ambulatory Care↗
PubMed1997

Using epidemiologic tools to control an outbreak of diarrhoea in a textile factory, Bulawayo, Zimbabwe.

Dysentery is endemic in Zimbabwe. More than 260,000 cases and a case fatality of four per thousand were reported in 1993. In late July 1994, the Health Services Department in Bulawayo was informed of two cases of Shigella dysenteriae type I at a textile factory that employs 138 workers. Workers were interviewed at the factory regarding the date of the onset of illness, symptoms, food consumed, and treatment received. Factory water supply, cooking, and sanitary facilities were inspected. Stool and water samples were obtained for analysis. A case was defined as an employee presenting with diarrhoea with onset from July 24 to August 25, 1994. Of the 99 workers on day and evening shifts, 75 (75%) were interviewed. Thirty eight workers met the case definition (Attack Rate 51%). Common symptoms were abdominal cramps (71%), and blood in stools (37%); median duration of diarrhoea was 11 days (range 5 to 32 days). Thirty seven (64%) of 58 workers who drank borehole water were ill compared to one (6%) of the 17 who did not (RR = 10.8, 95% CI = 1.6-73). No food items consumed were significantly associated with the illness. Two different shigella species (2 sonnei and 2 boydii) were isolated from five (13%) of 38 stool specimens. Water samples from the two boreholes yielded numerous faecal coliforms. Neither borehole was registered as required by the municipal bylaws, which also forbid use of borehole water for drinking. The epidemiologic and laboratory evidence implicate contaminated borehole water as the most likely cause of this outbreak. Enforcement of municipal bylaws on drilling, registration and use of boreholes is essential to avoid further outbreaks of waterborne diseases.

Disease Outbreaks↗