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Biomedical subjects

G C Lamb

Publications and source records attributed to G C Lamb.

26 records · Page 2Linked to original sources
PubMed1995

Oral versus repository corticosteroid therapy after hospitalization for treatment of asthma.

Tapering regimens of oral steroids may be difficult or confusing for some patients. Repository steroids have been shown to be as effective as tapering oral doses in preventing relapse after emergency treatment. This study was undertaken to determine whether repository steroids are as effective as tapering oral steroids in preventing relapse after hospitalization for treatment of asthma. Twenty-six patients with acute exacerbations of asthma requiring treatment for 24 to 72 hours with parenteral steroids were randomized into two groups. Both groups received oral prednisone, 60 mg daily, when parenteral steroids were discontinued. At discharge, one group received intramuscular placebo and oral prednisone tapered over 8 days, and the other received 80 mg intramuscular methylprednisolone sodium acetate and oral placebo. At discharge and 2-week follow-up, patients were interviewed and examined, and spirometry results were obtained. There was little difference between groups in ratings of symptoms at discharge or follow-up. Both groups had less wheezing at follow-up than at discharge, though the improvement was significant only in the repository steroid group (p < 0.05). Mean forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow rate improved at follow-up in both groups. No significant differences in outcome were found between the oral and repository steroid groups.

Acute Disease↗
PubMed1993

Is chronic spinal cord injury associated with increased risk of venous thromboembolism?

To determine the incidence of symptomatic thromboembolism in patients with chronic spinal cord injury, a retrospective review of patients followed in a Veteran's Affairs Spinal Cord Injury Unit was conducted. Followed for a mean of 13.7 years after injury, 287 patients were reviewed. Forty events were identified, an incidence of 10 percent. Thirty-three (83 percent) occurred in the first 6 months following injury. The remainder occurred at 1, 1.5, 7, 9, 10, 12, and 14 years after injury, an incidence of 0.17 percent per year. The incidence of clinically significant thromboembolism in spinal cord injury decreases dramatically after the first 6 months to a level similar to that in the general population (0.18 percent). Possible explanations for this include: 1) immobilization by itself may not be a risk factor for thromboembolism; 2) physiologic adaptations in the chronic state may protect against thromboembolism; and, 3) thromboembolism occurs, but remains subclinical in most patients.

Adult↗
PubMedDate not supplied

Can physicians warn patients of potential side effects without fear of causing those side effects?

BACKGROUND: When initiating treatment, it has been shown that only one quarter of the physicians discuss potential side effects with patients. There are several possible reasons, but, in particular, many physicians are concerned that the power of suggestion may lead some patients to experience an increase in side effects if they are fully informed. Accordingly, this study was designed to determine whether providing patients with information about potential side effects of new medications increases the reported incidence of those side effects. METHODS: All clinic patients are randomly assigned to one of four firms. Two firms served as the intervention group and two served as control groups. All patients receiving new prescriptions for the angiotensin-converting enzyme inhibitors, trimethoprim/sulfamethoxazole, or nonsteroidal anti-inflammatory drugs were recruited. Patients without telephones were excluded. Intervention patients received verbal instructions and a handout describing the name, purpose, dose, and three most common side effects of the drug. Control patients received usual discharge instructions. Patients were interviewed 14 to 21 days later using a standardized questionnaire. RESULTS: There was no difference in incidence of targeted side effects for specific medications between the study groups (38% vs 37%). Study groups were similar with regard to age, sex, financial status, and type of medication prescribed. CONCLUSION: Informing patients of potential side effects prior to starting a new medication does not lead to an increased incidence of those side effects. This should not be a reason for physicians to avoid warning patients of potential side effects.

Drug-Related Side Effects and Adverse Reactions↗
PubMedDate not supplied

The accuracy of alkaline phosphatase isoenzyme determination.

Alkaline phosphatase isoenzyme determination (APID) is in common use despite evidence suggesting that the results correlate poorly with actual sites of disease. To assess the predictive value of this test in clinical practice, 99 APIDs performed on 94 patients were identified and the patients' charts were reviewed. Results of APID were compared with actual patient diagnoses as determined by other means. The liver isoenzyme fraction was not very accurate in predicting the presence of liver disease (positive predictive value 68%). In contrast, the bone isoenzyme fraction was insensitive (56%) but a positive test predicted bone disease well (positive predictive value 93%). The association of elevated transaminases with elevated alkaline phosphatase on a chemistry profile was as useful as APID in identifying liver disease, suggesting that APID should not be done in this setting. Using this information, APID can be helpful in the assessment of an ill patient with an elevated alkaline phosphatase.

Aged↗
PubMedDate not supplied

Primary care-based dermatology practice: internists need more training.

OBJECTIVE: To evaluate the ability of teachers in an internal medicine clinic to appropriately diagnose, treat, and refer for specific dermatologic disorders. DESIGN: Prospective study. SETTING: Medical school-affiliated primary care clinic. PATIENTS/PARTICIPANTS: Case presentations of 20 patients who had dermatologic problems were prepared in the form of photographs with accompanying histories. All cases were presented to 17 of 21 available faculty internists who answered questions concerning diagnosis and management of the cases on a questionnaire. The responses of three board-certified faculty dermatologists were used as a reference standard. MEASUREMENTS AND MAIN RESULTS: The internists had had an average of three weeks' total formal dermatology training. Overall, 60% of cases were correctly diagnosed by the internists and 89% of these were either treated appropriately or referred to dermatologists. In 40% of incorrectly diagnosed cases, internists failed to refer and the majority of these were treated inappropriately. Of referrals deemed appropriate by dermatologists, only 62% were made. Conversely, 33% of referrals were deemed unnecessary. CONCLUSIONS: Faculty internists were able to diagnose many common skin diseases despite having received little dermatology training. However, errors in diagnosis occurred frequently and when diagnoses were incorrect there was a tendency to mismanage. These data suggest that the current amount of dermatology training is inadequate to prepare future primary care physicians for their increased role in the management of skin disorders.

Adult↗