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Biomedical subjects

F J Kroboth

Publications and source records attributed to F J Kroboth.

30 records · Page 2Linked to original sources
PubMed1983

Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study.

Most hospitals have yet to record a case of nosocomial legionnaires' disease; the importance of isolation of Legionella pneumophila in the water system of such an institution is unclear. We undertook a prospective pneumonia study in tandem at a veterans hospital where legionnaires' disease was known to be endemic and a community teaching hospital where legionnaires' disease had never been documented. Legionella serological tests were performed on all patients with pneumonia; selective culture media and direct fluorescent antibody testing for Legionella were made readily available. Simultaneous environmental surveys for Legionella were performed. At the community hospital, we discovered that 64% of sites in the water distribution system yielded L pneumophila and that 14.3% of nosocomial pneumonias were legionnaires' disease. The epidemiologic implications of these findings are discussed. Options concerning case detection and eradication measures in the face of hospital water contamination with L pneumophila are presented.

Adult↗
PubMed1983

Pneumonia and multiple lung abscesses caused by dual infection with Legionella micdadei and Legionella pneumophila.

An immunocompromised patient developed pneumonia in which both Legionella micdadei and L. pneumophila, serogroup 6, were isolated from transtracheal aspirates in the absence of any other bacteria. Unusual features included the development of disseminated intravascular coagulation and multiple pulmonary abscesses during treatment with erythromycin, and relapse of the legionellosis after extended therapy with both erythromycin and rifampin, which was heralded by septic shock. Because simultaneous infection with two distinct species of Legionella occurs, concurrent increases in antibody titer to more than one Legionella may, in some instances, reflect multiple infection rather than cross-reacting antibody.

Adult↗
PubMed1983

Clinicoradiographic correlation with the extent of Legionnaire disease.

Serial chest radiographs from 34 confirmed cases of legionnaire disease diagnosed between February 1979 and June 1981 were reviewed. Initial involvement was most often a peripheral patchy alveolar infiltrate (76%, 26/34) with progression to consolidative pneumonia in 70% (18/26) of these cases. Initial or eventual involvement of noncontiguous lobes (50%, 17/34) was common. Bilateral changes developed in 50% of cases and bilateral diffuse disease developed in 12%. Pleural effusions attributable to legionnaire disease occurred in 32% of the patients. Definite clearing took longer than 2 weeks in 50% of treated patients. The severity of radiographic abnormality correlated with the presence of Legionella pneumophila detectable in sputum by direct immunofluorescence (p less than 0.001). No correlation of radiographic severity to smoking, immunosuppression, advanced age, race, or underlying disease, nor to symptoms of abdominal pain, diarrhea, neurologic abnormalities or high fever, nor to laboratory data including hyponatremia, leukocytosis, or hematuria was found. A comparative review of the literature is provided.

Adult↗
PubMed1982

Impact of attending level supervision of the emergency department experience.

Medical experiences encountered in the activities of an emergency department are important for the development of a well-trained internist. Therefore, a rotation in the emergency department must remain an integral part of any program in internal medicine. At the University of Pittsburgh, faculty members from both the internal medicine and emergency medicine departments worked together in order to develop the emergency department to its fullest capacity as part of a broad educational program. The faculty attendings provide supervision, immediately available consultation, and an on-going curriculum, including daily lectures and chart review. The results of their programmatic change have been the following: 1) enthusiasm and satisfaction on the part of the housestaff; 2) a 20+ increase in admissions to the hospital from the emergency department; 3) decreased utilization of the observation unit; and 4) fewer patients leaving without being examined.

Ambulatory Care↗
PubMed1982

Pharmacokinetics of single-dose erythromycin in normal and alcoholic liver disease subjects.

Six normal males and eight male subjects with alcoholic liver disease (ALD) and ascites were given a single 500-mg dose of erythromycin base. Twelve serum samples were collected at 0, 1, 2, 3, 4, 6, 8, 10, 12, 14, 16, and 24 h after dosing and assayed microbiologically for erythromycin concentration. Absorption was characterized by a zero-order model for both groups. ALD subjects demonstrated a shorter lag time (2.0 versus 3.0 h), an earlier peak (4.6 versus 6.3 h, P less than 0.05), and higher peak concentrations (2.04 versus 1.50 micrograms/ml) than normal subjects. Previously unreported biphasic elimination kinetics after oral dosing were observed in five and four ALD subjects. In the ALD group, the mean half lives for the first (alpha) and terminal (beta) phases were 1.6 and 4.5 h, respectively, and in normal subjects, were 1.3 and 6.6 h. The difference in alpha between groups was significant, P less than 0.05. The clinical significance of this finding for ALD patients receiving prolonged courses of erythromycin is discussed.

Absorption↗
PubMed1982

Legionnaires' disease: new clinical perspective from a prospective pneumonia study.

In an attempt to ascertain the incidence of Legionnaires' disease at our hospital, a prospective case-control pneumonia study was conducted for 11 months. Specialized diagnostic tests for Legionella pneumophila, including serologic study, direct immunofluorescent examination, and selective culture, were made routinely available in our hospital. To our surprise, L. pneumophila was the most common cause of pneumonia (22.5 percent) attributable to a single pathogen, followed by Streptococcus pneumoniae (10.6 percent). In 68.8 percent of the cases, Legionnaires' pneumonia was hospital-acquired. In contrast to other investigators, we found that abdominal pain, diarrhea, neurologic signs, abnormal liver function results, hypophosphatemia, and hematuria did not occur significantly more frequently in pneumonia caused by L. pneumophila than in that caused by other microorganisms. However, hyponatremia within five days of onset of pneumonia occurred significantly more frequently in Legionnaires' disease (p less than 0.0001). Since the clinical presentation is nonspecific, specialized laboratory tests are necessary to make the diagnosis. As a result of our experience, we suggest an approach using serologic tests as a screen to determine whether more specialized tests for Legionnaires' disease should be introduced into a hospital without previously recognized cases of Legionnaires' disease.

Diagnosis, Differential↗
PubMedDate not supplied

Comparison of the bioavailability of oral, rectal and intramuscular promethazine.

The bioavailabilities of generic and reference promethazine 50 mg rectal suppositories were compared with that of 50 mg reference oral solution (24 subjects), and all three treatments were compared with a 50 mg reference i.m. injection (six subjects). Plasma samples were assayed by an HPLC method with triflupromazine as the internal standard. Both suppositories produced lower peak plasma concentrations (Cmax) and longer times to peak concentration (Tmax) than did the oral solution. There were no significant differences in the mean area under the plasma concentration-time curves (AUC) from 0 to 24 h among the three treatments. The Cmax of the i.m. injection was significantly higher than the other three treatments, while the Tmax of the injection was significantly shorter than the reference suppository only. The mean AUC of the injection was significantly greater than the AUCs of the other three treatments. Rectal suppositories of promethazine are more slowly absorbed than oral solutions or i.m. injections; rectal suppositories and oral solutions are less bioavailable than i.m. injections. Diminished systemic bioavailability may result from extensive first-pass hepatic metabolism that occurs after both oral and rectal dosing. There is a high degree of intersubject variation in the bioavailability of promethazine rectal suppositories and oral solutions.

Administration, Oral↗
PubMedDate not supplied

The inter-rater reliability and internal consistency of a clinical evaluation exercise.

OBJECTIVE: To assess the internal consistency and inter-rater reliability of a clinical evaluation exercise (CEX) format that was designed to be easily utilized, but sufficiently detailed, to achieve uniform recording of the observed examination. DESIGN: A comparison of 128 CEXs conducted for 32 internal medicine interns by full-time faculty. This paper reports alpha coefficients as measures of internal consistency and several measures of inter-rater reliability. SETTING: A university internal medicine program. Observations were conducted at the end of the internship year. PARTICIPANTS: Participants were 32 interns and observers were 12 full-time faculty in the department of medicine. The entire intern group was chosen in order to optimize the spectrum of abilities represented. Patients used for the study were recruited by the chief resident from the inpatient medical service based on their ability and willingness to participate. INTERVENTION: Each intern was observed twice and there were two examiners during each CEX. The examiners were given a standardized preparation and used a format developed over five years of previous pilot studies. MEASUREMENTS AND MAIN RESULTS: The format appeared to have excellent internal consistency; alpha coefficients ranged from 0.79 to 0.99. However, multiple methods of determining inter-rater reliability yielded similar results; intraclass correlations ranged from 0.23 to 0.50 and generalizability coefficients from a low of 0.00 for the overall rating of the CEX to a high of 0.61 for the physical examination section. Transforming scores to eliminate rater effects and dichotomizing results into pass-fail did not appear to enhance the reliability results. CONCLUSIONS: Although the CEX is a valuable didactic tool, its psychometric properties preclude reliable assessment of clinical skills as a one-time observation.

Clinical Competence↗
PubMedDate not supplied

Practical problems of conducting patient-satisfaction surveys.

OBJECTIVE: Patient-satisfaction surveys have been used frequently to assess the humanistic behaviors and skills of internal medicine housestaff. In conducting their first such survey, the authors found that many practical problems affected the progress and outcome of the project. This discussion of the authors' experiences is intended to be helpful to others considering patient-satisfaction surveys as part of their housestaff-evaluation process. DESIGN: A description of the practical aspects of conducting a patient-satisfaction survey as well as the problems that the authors encountered. SETTING: Both inpatient and outpatient settings at a major university internal medicine residency program. PATIENTS/PARTICIPANTS: Ambulatory and hospitalized patients under the care of categorical internal medicine interns were eligible for participation in the study. INTERVENTIONS: An established, validated patient-satisfaction questionnaire with high reported reliability was given to patients. MEASUREMENTS AND MAIN RESULTS: Although well over 90% of patients were willing to participate, 10% of participating outpatients and 16% of participating hospital patients could not provide a usable patient-satisfaction questionnaire even with assistance. Certain patient characteristics were responsible for these decreased completion rates. Among the hospitalized patients, 42% of all eligible patients were either too ill or too cognitively impaired to even be approached for participation in the study. CONCLUSIONS: Patient-satisfaction surveys are labor-intensive, require significant resources, and are temporally demanding. Results from them must be viewed with certain caveats.

Adult↗
PubMedDate not supplied

Oral administration of micronized progesterone: a review and more experience.

Historically, oral progesterone has been regarded clinically ineffective because of its poor absorption and rapid clearance. Recent evidence suggests that an oral micronized form of natural progesterone is readily absorbed, produces luteal phase serum concentrations, provokes an end-organ response, and has no detrimental effect on the lipoprotein profile. Thus it is considered by many to be an attractive alternative to synthetic progestin. We evaluated the effects of a single oral dose of micronized progesterone 300 mg in eight healthy postmenopausal women. The maximum serum concentration ranged from 15.72-625.98 ng/ml. The extent of absorption increased with increasing age. The reviewed literature and our data indicate considerable intersubject variability in the extent of progesterone absorbed after administration of oral micronized progesterone.

Administration, Oral↗