Search PubMed⌕ Search

Biomedical subjects

H Sherman

Publications and source records attributed to H Sherman.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Gonorrhea case-finding among asymptomatic men seeking ambulatory care: a cost effectiveness analysis.

Case-finding for gonorrhea in asymptomatic men is generally not performed in primary care settings and often not performed when men are seen for other reasons in clinics for sexually transmitted diseases. We performed a cost-effectiveness analysis of case-finding among asymptomatic men seeking ambulatory care, using culture of the first-voided urine and treatment of culture-positive patients with tetracycline. The analysis demonstrated that care-finding is increasingly cost-effective as the probability of asymptomatic gonorrhea becomes greater. Over a reasonable expected range of the probability of asymptomatic gonorrhea (0.1-15%) in such settings, the additional cost to avert one additional day of morbidity ranged from $47,000 to $260; the additional cost to avert one additional case of residual asymptomatic infection ranged from $26,000 to $140; and the additional cost to avert one additional case of pelvic inflammatory disease in a contact ranged from $250,000 to $1,400. We conclude that the cost-effectiveness of case-finding for gonorrhea among asymptomatic men compares favorably with that of other medical interventions when the probability of infection is relatively high (perhaps greater than or equal to 5%). In order to make use of such information, physicians in ambulatory care settings require better information about the probability of gonorrhea in asymptomatic men who differ in their medical histories and socioeconomic and ethnic backgrounds.

Ambulatory Care↗
PubMedDate not supplied

Protocols in ambulatory care.

Protocols offer a mechanism for bringing together two major trends in outpatient care. The first trend is the delegation of certain clinical tasks and responsibilities to health workers other than physicians, and to patients themselves. The second trend is the movement toward standard-setting, peer review, audit and quality assurance, and cost-effectiveness of medical practices. Most of the studies of the use of protocols have been with nurse practitioners, physician assistants, office nurses, and health workers. These studies indicate that non-physicians using protocols - in comparison with physicians using traditional methods - give care that is equally thorough, and that leads to comparably accurate diagnosis treatment, and appropriate referral to physicians. Additionally, health workers guided by protocols achieve relief of patients; symptoms and patient satisfaction, and provide care that is efficient in terms of practitioner time, medication, and test ordering. Consequently, health workers using protocols can reduce the cost of care. Protocols have been developed for use in out-patient areas in both developed and developing nations. Protocosl can also be easily audited as part of a quality assurance program, effecting even further saving in costly provider time.

Allied Health Personnel↗
PubMedDate not supplied

Thyroid tumors in rats from tetramethylthiourea.

Tetramethylthiourea (TMTU) was added to the diet of male and female ChR-CD rats for up to 2 years at levels of 0, 30 and 300 ppm. Fifty rats of each sex were used at each dietary level. High-level males and females and low-level males had a lower body weight and consumed less diet than did the controls. A slight anemia was found in the high-level males and females. Polyuria of a low osmolality was found in high level males and females. Serum thyroxine was lower in high-level males and females than in controls. TMTU-related gross and histologic changes were detected only in the thyroids of high-level males and females. After 3 months on test, the thyroids were enlarged and dark on gross examination. Histologically, there was an increase in follicle lumen size, loss of colloid staining, hypertrophy and hyperplasia of follicular cells, together with hyperemia. These early lesions were diffuse in distribution. Eight (28 percent) of 29 female high level rats, 18 to 24 months on test, developed follicular cell carcinomas with no such tumors in 26 comparable controls (p less than 0.005, Fisher's Exact Test, one tail). Although no metastases were found, capsular and vascular invasion by tumor cells was seen. TMTU was considered to be carcinogenic for the female rat under the conditions of this test.

Animals↗
PubMedDate not supplied

Urethritis in men: benefits, risks, and costs of alternative strategies of management.

Four alternative strategies for the management of men with acute urethritis were analyzed: treating patients with tetracycline, with or without a urethral culture, without basing the initial treatment decision on the results of a gram-stained smear; treating patients with penicillin, without basing initial treatment on the results of a gram-stained smear; basing initial treatment with tetracycline or penicillin on the results of a gram-stained smear; and basing treatment on the results of both a gram-stained smear and a culture. The tetracycline strategy resulted in fewer days of morbidity, a lower probability of premature death, lower dollar costs, and a much lower rate of uncured nongonococcal urethritis, but in slightly higher rates of uncured gonorrhea and syphilis than more traditional strategies. Use of culture with the tetracycline strategy (1A) permitted tracing of gonorrhea contacts, achieved the same low morbidity, and added little cost. The conclusions were true regardless of the probability of gonorrhea and for reasonable estimates of probable compliance with oral medication regimens. Test-of-cure cultures for patients who were asymptomatic after treatment for gonorrhea required the expenditure of from $4,900 to $109,800 for each case of asymptomatic persistent gonorrhea discovered and cured, depending on the strategy used.

Acute Disease↗
PubMedDate not supplied

Urinary bladder tumors in dogs from 4,4'-methylene-bis (2-chloroaniline) (MOCA).

Six female beagle dogs were given a daily dose of 100 mg MOCA, by capsule, 3 days per week for the first 6 weeks and then 5 days per week continuously for periods up to 9.0 years. The dose varied from 8 to 15 mg/kg body weight/day among the dogs. Six female beagle dogs were kept as untreated controls. The test was terminated after 9.0 years of treatment. The average plasma glutamic-pyruvic transaminase activity of the dogs fed MOCA was higher than that of the controls during the first and last two years on test. During the eighth and ninth years the urine sediment from MOCA dogs contained excessive numbers of erythrocytes, leukocytes, and epithelial cells. Some epithelial cells contained abnormalities that suggested neoplasia in the genitourinary tract. One MOCA dog, sacrificed after 8.3 years on test was found to have a papillary transitional cell carcinoma of the urinary bladder. Of four MOCA dogs sacrificed after 9.0 years on test, three were found to have papillary transitional cell carcinomas of the urinary bladder and one had a combined transitional cell carcinoma and adenocarcinoma of the urethra. The urethral tumor had metastasized to the liver, but the papillary transitional cell carcinomas found in the other four dogs did not invade the muscle layers of the bladder wall and did not metastasize. Since no urinary bladder tumors were found in the six control dogs, MOCA was considered to be carcinogenic for the urinary bladder of dogs under the conditions employed (p less than 0.025, Fisher's Exact Test, one tail). Three of five MOCA dogs contained hyperplastic nodules in the liver with no such nodules in six control dogs (p greater than 0.05, Fisher's Exact Test, one tail). This was considered to be suggestive of an effect of MOCA treatment.

Animals↗
PubMedDate not supplied

Kidney and liver tumors in rats from 4,4'-methylene bis (2-carbomethoxyaniline).

4,4'-Methylene bis (2-carbomethoxyaniline), also known as methylene-bis methyl anthranilate (MBMA), was added to the diet of male and female ChR-CD rats for up to two years at levels of 0, 1500, and 15,000 ppm. Fifty rats of each sex were used at each dietary level. Female rats at both dietary levels of MBMA had a lower body weight gain and lower food efficiency values than did the controls. High-level males and females showed a slight anemia; all other clinical laboratory tests were within normal limits. MBMA caused slight degenerative histologic changes in the liver and kidney of both sexes at both dietary levels. High-level males developed a statistically significant increase in kidney and liver tumors when compared to controls (p less than 0.05, Fisher's Exact Test, one tail). High-level females had an elevated kidney tumor incidence compared with controls (p less than 0.10). There was a statistically significant lower incidence in pituitary tumors in high-level males (p less than 0.05) and in high-level females (p less than 0.10) than in controls. High-level females had a lower incidence of mammary tumors (p less than 0.05) compared to controls. MBMA was considered to be a carcinogen of moderate potency in rats, since tumors were not found until 18 months on test using a comparative large dose (1.5% of diet).

Animals↗
PubMedDate not supplied

Liver and lung tumors in dogs from 4,4'-methylene-bis(2-methylaniline).

Six female beagle dogs were given, by capsule, a daily dose of 100 mg 4,4'-methylene-bis(2-methylaniline) (MeMDA), 3 times per week for 6 weeks, then 5 times per week for 5 weeks, at which time the dose was reduced to 50 mg 5 times per week, continuously for periods up to 7.0 years. Six female beagle dogs were kept as untreated controls for several studies and were sacrificed after 8.3 to 9 years test. MeMDA dogs developed renal atrophy with an elevated blood urea nitrogen during an approximate six-month period prior to death or being sacrificed in extremis. As three of three MeMDA dogs that survived for 5.2 years to 7.0 years developed hepatocellular carcinomas and two of the three dogs also developed primary lung tumors, with no liver or lung tumor in six control dogs, MeMDA was considered to be carcinogenic for the dog (liver tumors: p less than .05; lung tumors: p less than 10; Fisher's Exact Test, one tail).

Animals↗
PubMedDate not supplied

Liver and urinary bladder tumors in dogs from 3,3'-dichlorobenzidine.

Six female beagle dogs were given, by capsule, a daily oral dose of 100 mg of 3,3'-dichlorobenzidine (DCB), 3 times per week for 6 weeks, then 5 times per week continuously for periods up to 7.1 years. The DCB test was terminated after 7.1 years. Six untreated female beagle dogs served as controls for several tests and were sacrificed after 8.3 to 9.0 years on test. All 6 DCB dogs had an elevated plasma glutamic-pyruvic transaminase activity during the first 3 years on test; two dogs showed persistent elevation throughout the test. One DCB dog, sacrificed in extremis after 3.5 years on test, had no tumors. Another DCB dog, sacrificed in extremis after 6.6 years on test, developed an undifferentiated carcinoma of the liver with metastases to many organs; this dog also had a papillary transitional cell carcinoma of the urinary bladder. Of the 4 remaining DCB dogs sacrificed after 7.1 years on test, 3 developed hepatocellular carcinomas and all 4 had papillary transitional cell carcinomas of the urinary bladder. No liver or urinary bladder tumors were found in the 6 control dogs. DCB was found to be carcinogenic for the liver and urinary bladder in dogs under the conditions employed (p less than .025, Fisher's Exact Test, one tail).

3,3'-Dichlorobenzidine↗