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Biomedical subjects

G Gee

Publications and source records attributed to G Gee.

13 recordsLinked to original sources
PubMed1998

Pharmacists' attitudes about pharmacy sale of needles/syringes and needle exchange programs in a city without needle/syringe prescription laws.

We assessed pharmacists' practices for needle and syringe (NS) sales and their attitudes toward a needle exchange program through a telephone survey of 75 randomly selected pharmacies in Baltimore, Maryland, where possession of drug paraphernalia is illegal but where NS can be purchased without a prescription. Pharmacists' (n=46) procedures for NS sales included asking for picture identification (54%), requiring a prescription (34%), or requiring a diabetic identification (DID, 34%) for NS purchase; multiple responses were allowed. The median number of prescription and nonprescription NS sold per month was 950. Most (86.6%) pharmacists reported selling NS without prescriptions at their discretion. Pharmacists sold a median of 16 nonprescription NS per month. Pharmacists who required prescriptions or DID (56.5%) sold nonprescription NS significantly less often than those who did not require prescriptions or DID (p=.007). Most pharmacists (87%) were aware of the needle exchange program, 78.3% supported the program, and 67.4% supported selling nonprescription NS in pharmacies. Although there was no difference in anticipated effects of needle exchange or in support for needle exchange between pharmacists who did or did not require prescriptions, DID, or both, pharmacists who did require these items were significantly less likely to support pharmacy sales of nonprescription NS than pharmacists with less restrictive sales policies (p=.04). Although most pharmacists surveyed supported access to sterile NS by injection drug users through a needle exchange program, there was a diversity of approaches to nonprescription NS sales among pharmacists in a city that does not require prescriptions for access to sterile NS. Most supported nonpharmacy needle exchange programs, and more than one half limited injection drug users' access to NS through restrictive sales practices. To reduce injection drug users' exposure to HIV, pharmacists should be educated about HIV prevention and injection drug use and be included in development of HIV prevention programs, including legal pharmacy NS sales.

Attitude of Health Personnel↗
PubMed1996

Combined cardiac marker approach with adjunct two-dimensional echocardiography to diagnose acute myocardial infarction in the emergency department.

STUDY OBJECTIVE: To evaluate a combined cardiac marker approach with adjunct two-dimensional echocardiography in diagnosing acute myocardial infarction (AMI) in the emergency department. METHODS: This prospective, cohort study enrolled 190 patients aged 18 years and older who presented to the ED of a county teaching hospital and were admitted with chest pain suggestive of AMI. A standardized history and physical examination were performed. Serum sampling for myoglobin and creatine kinase-MB (CK-MB) was done at the time of presentation (time 0) and 3 hours later (time 3 hours). An echocardiographic study was obtained, and a left ventricular wall motion score was derived. RESULTS: Using World Health Organization criteria, 21 patients (11.2%) with AMI were identified. The serum markers were found to be clinically and statistically different between AMI and non-AMI groups at both time 0 and time 3 hours. Receiver operator characteristic curves were used to determine a "positive" myoglobin level at 88.7 ng/mL or higher at either time point, and a "positive" CK-MB level at 11.9 ng/mL or higher; these were used as the optimal cutoff values to predict AMI in the ED. Serum myoglobin was a more sensitive marker (90.5%) than CK-MB (81.0%). However, CK-MB was more specific (99.4%) than myoglobin (88.4%). A combination of both tests, which was rated positive if either test was positive, was a superior predictor overall, with a 100% capture rate of AMI patients and a 91.2% specificity. No significant difference in echocardiographic scores was appreciated in the AMI group compared with the non-AMI group (16.9 +/- 1.5 versus 15.3 +/- .5, respectively; P = .3252). CONCLUSION: Serum myoglobin shows greater sensitivity but is less specific than CK-MB in the early detection of AMI. Use of a combination of both rapid assays during a 3-hour time period in the ED appears to be superior to use of either enzyme assay alone. Two-dimensional echocardiography does not appear to be helpful in diagnosing AMI in the ED.

Aged↗
PubMed1993

Listeria-associated pericarditis in an AIDS patient.

Listeria monocytogenes is a pathogenic, facultative intracellular gram-positive rod, generally seen in cell-mediated immunocompromised states. In acquired immunodeficiency syndrome (AIDS), it most commonly presents as bacteremia or meningitis. An association with pericarditis has not been described previously in this group of patients. This article describes a case of pericarditis secondary to listeriosis involving a focal pancarditis and necrosis of the A-V node with subsequent refractory ventricular tachyarrhythmias in an immunodeficient patient presenting with altered mental status. Infectious etiologies should be considered for "benign" appearing pericardial effusions in AIDS patients and the diagnosis of listeriosis excluded in the presence of "diphtheroid-like" organisms.

Acquired Immunodeficiency Syndrome↗
PubMed1989

AIDS: context of care.

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Acquired Immunodeficiency Syndrome↗
PubMed1988

Use of intravenous amiodarone for emergency treatment of life-threatening ventricular arrhythmias.

Efficacy, side effects and predictors of response for intravenous amiodarone were evaluated in 46 patients with recurrent drug-refractory sustained ventricular tachycardia or ventricular fibrillation, or both, who were treated with intravenous amiodarone. Of the 46 patients, 27 (58.5%) responded early to intravenous amiodarone and 6 (13%) showed a late response to amiodarone. The majority of patients who responded to intravenous amiodarone did so within the first 2 h of therapy, and all responded within 84 h. Patients with an ejection fraction greater than 25% were more likely to respond (p less than 0.05). Major side effects occurred in 13% of patients. The cumulative 2 year mortality rate due to arrhythmia recurrence or sudden death for responders discharged from the hospital was 23% and the cumulative overall 2 year mortality rate was 46%. In conclusion, intravenous amiodarone is rapidly effective in the majority of patients with recurrent ventricular tachycardia or ventricular fibrillation refractory to other drugs. The poor long-term outcome of patients who require this therapy, respond to it and are discharged on long-term oral amiodarone therapy warrants consideration of other long-term treatment of these patients. Use of intravenous amiodarone is an important new modality in the treatment of drug-refractory malignant ventricular arrhythmias.

Amiodarone↗
PubMed1986

AIDS and AIDS-related conditions: screening for populations at risk.

Since its onset, the acquired immunodeficiency syndrome (AIDS) epidemic has been associated with certain subgroups in the U.S. population. These include gay and bisexual men, intravenous drug users, hemophiliacs and blood product transfusion recipients. Members of these groups feeling either well or unwell may present themselves at clinics with a high level of anxiety regarding AIDS. Their needs for clinical evaluation of symptoms, education and reassurance, or further referral may be acute. The experience of the AIDS screening clinic at the AIDS/oncology clinic at San Francisco General Hospital has led to the development of protocols for nurse practitioners to use in screening members of AIDS risk groups, both the "worried well" and those who are symptomatic. This is a presentation of the clinic's screening history and physical examination criteria, including the markers of suspicion and algorithms of diagnostic studies that have been useful tools in the clinic.

Acquired Immunodeficiency Syndrome↗