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Biomedical subjects

J Clive

Publications and source records attributed to J Clive.

32 records · Page 2Linked to original sources
PubMed1998

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation.

A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation was conducted to ascertain the incidence and outcome of Streptococcus viridans bacteremia as well as to determine the role of prophylactic ampicillin therapy in the peri-transplant setting. Viridans streptococci were isolated from the blood of 35 individuals at a median of 6 days (range 2-8 days) following stem cell infusion. The most common isolates were S. sanguis and S. mitis. All patients received ciprofloxacin orally during the peri-transplant period. Additionally, 79 patients received oral ampicillin prophylactically against gram-positive cocci. Although none of the patients suffered a fatal outcome, three individuals developed respiratory compromise requiring mechanical ventilation. Female sex proved to be the only independent risk factor for viridans streptococcal bacteremia (P=0.04). The shorter duration of neutropenia observed after stem cell transplantation did not impact on the incidence of S. viridans infections. Moreover, the prophylactic use of ampicillin failed to decrease the incidence of viridans sepsis and selected out organisms that were resistant to beta-lactam antibiotics.

Adolescent↗
PubMed1996

The effect of inhaled albuterol in moderate to severe asthma.

BACKGROUND: Some recent clinical investigations suggest that regular use of inhaled bronchodilators may lead to deterioration in asthma control. OBJECTIVE: The purpose of this study was to evaluate the effect of albuterol dosing schedule on clinical outcome in subjects with moderate to severe stable asthma. METHODS: Seventeen adults were randomized to two 15-week treatment periods in a double-blind crossover design. Throughout the study, subjects were instructed to take two inhalations four times daily from an unlabeled "test" canister. In the four times daily and as-needed (QID + PRN) period, this canister contained albuterol; in the as-needed (PRN) period, it contained placebo. A "rescue" albuterol canister was available for as-needed use at all times. Inhaler actuations from both the test and rescue canisters were electronically recorded. Outcome measures included prednisone requirements, morning and evening symptoms and peak expiratory flow rates, total and nighttime rescue albuterol use, and asthma-specific quality of life. RESULTS: The two treatment periods did not differ in symptoms, nighttime albuterol use, or asthma quality of life. During the QID+PRN period both morning and evening peak expiratory flow rates were significantly higher (p < 0.01 and 0.001, respectively) and total rescue use of albuterol was significantly less (p < 0.05) than the PRN period. Days on prednisone tended to be lower in the regular dosing period (p = 0.08). CONCLUSION: In our sample of patients with moderate to severe asthma, four times daily dosing of albuterol did not lead to deterioration of asthma control.

Administration, Inhalation↗
PubMed1995

Helium-neon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients.

BACKGROUND: Oral mucositis is a common complication of bone marrow transplantation (BMT) conditioning therapy. Sequelae consist of increased risk for infection, moderate to severe pain, compromised oral function, and bleeding. This study investigated helium-neon laser treatment for prevention of conditioning-induced oral mucositis in BMT patients. Patterns and severity of mucositis for specific conditioning drug regimens also were analyzed. METHODS: Twenty patients received laser radiation to their oral mucosa, either left or right of midline. The contralateral side was sham-treated and served as a control. Mucositis severity was scored independently by two modified versions of the Oral Mucositis Index Scale (OMI-A and OMI-B) and the Eastern Cooperative Oncology Group (ECOG) Oral Toxicity Scale; pain severity was scored by subjects on a visual analogue scale (VAS). Cumulative scores were analyzed for differences between the laser-treated and sham-treated sides. RESULTS: Oral mucositis and pain scores were significantly lower for the treated versus the untreated side by OMI-A and B (P < 0.005) and VAS (P = 0.027) criteria, respectively. Ulcerative lesions occurred in all patients bilaterally; severity increased until Day +6, and lesions resolved by Day +21. Mucositis was more severe for patients conditioned with busulfan/carboplatin/thiotepa than for patients conditioned with busulfan/cyclophosphamide/etoposide. CONCLUSIONS: Helium-neon laser treatment was well-tolerated and reduced the severity of conditioning-induced oral mucositis in BMT patients.

Adult↗
PubMed1995

Dynamic balance in older persons: effects of reduced visual and proprioceptive input.

BACKGROUND: Understanding the motor and sensory contributions to balance function in older persons is important in order to design effective interventions to prevent falls and loss of mobility. We tested the contributions of visual and proprioceptive input, muscle strength, and age to balance performance in 110 subjects free of clinical evidence of neurologic disease (mean age 80 years). METHODS: The EquiTest Sensory Organization Test was used to present sequential conditions that altered sensory input in a 2 (tactile/proprioceptive input) x 3 (visual input) design. Center of force and shear force data were recorded from the platform; the primary outcomes were loss of balance (LOB) and anterior-posterior center of force (COF) displacement as a proportion of foot length (COFD). RESULTS: Subjects had 3.5 +/- 2.7 LOB during testing. Reduction of vision input increased the odds ratio of a LOB 5.7 fold (3.9, 8.4, 95% CI) in unstable surface conditions, but adaptation with repeated trials was substantial. The adjusted odds ratio of a LOB was 0.65 and 0.45 in the second and third trials, respectively, compared to the first. Muscle strength and age were independent predictors of LOB. Gait velocity, single stance balance, and reported difficulty with ambulation, mobility, and instrumental activities of daily living were also associated with LOB. CONCLUSIONS: Performance on clinical tests of strength, balance, and gait was associated with performance on a challenging balance test which reduced sensory input and effectiveness of motor responses. Adaptation to challenging balance conditions was substantial in this group of older subjects, but was diminished in the oldest subjects.

Activities of Daily Living↗
PubMed1994

Common measures of asthma severity lack association for describing its clinical course.

BACKGROUND AND OBJECTIVE: To address the problems of increasing asthma morbidity and mortality rates, reliable severity measures must be identified. Accordingly, we compared three measures and their relationship to beclomethasone compliance. METHODS: Three clinical measures (symptom scores, morning peak expiratory flow rates, and number of as needed albuterol inhalations with Nebulizer Chronologs [Forefront Technologies, Inc., Lakewood, Colo.]) were assessed daily in 13 adults with asthma for 8.9 +/- 2.1 weeks. The relationships among these three variables were analyzed in terms of Pearson correlation coefficients. These were evaluated for each of the three possible pairs of the three clinical measures for each of the 13 patients. The relationship between inhaled beclomethasone compliance and the pairwise correlations was studied with the use of nonparametric statistical procedures. RESULTS: In four of the 13 patients, no pairwise correlations between any of the three severity measures were observed. The peak expiratory flow rate-symptom score relationship was observed in eight patients, whereas peak expiratory flow rate-albuterol use and albuterol use-symptom score correlations were each seen in four patients. Mean beclomethasone compliance was 64% and was greatest in those patients whose albuterol use increased concurrently with symptom scores (94% vs 50%, p = 0.02). CONCLUSIONS: The commonly used measures of asthma severity, symptom scores, peak flow rate, and beta-agonist use may not be interchangeable in describing the clinical course. Patients whose beta-agonist use is driven by symptoms tend to be more compliant with use of inhaled corticosteroids.

Administration, Inhalation↗
PubMed1990

Quality of life as a vital clinical sign.

Hypertension is a significant public health problem in the United States. Despite this, many patients fail to seek or comply with treatment, owing to potential adverse effects on the patient's quality of life (QOL). This paper reports on the development and evaluation of an instrument for evaluating the QOL of black patients who are being treated for hypertension. The scale proved highly reliable (Cronbach's alpha = 0.949), and correlated well with lengthier instruments for assessing QOL. Results are presented from administration of the questionnaire to 998 patients.

Adult↗
PubMed1989

Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education.

A controlled trial of a probabilistic reasoning curriculum to change test ordering behavior was conducted. Twenty-four medical interns in university, veterans, and community hospitals were randomly assigned to "probabilities" or "placebo" groups. Four months after the curriculum sessions, interns in the probabilities group wrote 16% fewer orders for "little ticket" laboratory tests than placebo group interns (P = 0.032). The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital. Probabilities interns ordered ten of 97 tests significantly less often in the postcurriculum period than at baseline; multitest panels were particularly affected. Placebo curriculum interns ordered three of 97 tests less often in the postcurriculum period. Differences in test ordering were not explained by differences in case mix. Testing rates correlated slightly with case mix and length of stay at baseline; all three measures correlated strongly in the postcurriculum period. Teaching about probabilistic reasoning improves the efficiency of test ordering.

Clinical Laboratory Techniques↗
PubMed1988

Sexual symptoms in hypertensive patients. A clinical trial of antihypertensive medications.

The effects of captopril, methyldopa, and propranolol hydrochloride on reported distress over sexual symptoms over a 24-week treatment period were examined as part of a multicenter, randomized, double-blind clinical trial in which 626 men with mild to moderate hypertension participated. On entry into the clinical trial, 58% of patients taking antihypertensive medications and 44% of men not receiving antihypertensive drugs reported distress over one or more sexual symptoms. Among 304 patients treated with monotherapy who completed the trial, total symptoms distress scores of treatment groups did not differ from each other in change from baseline to week 24, but in particular, problems of maintaining an erection were significantly worsened with propranolol therapy. Among 177 patients treated with monotherapy plus a diuretic, total sexual symptoms distress scores worsened among the groups taking methyldopa or propranolol, with significant worsening in all individual symptoms among patients taking propranolol, and problems in maintaining an erection and in ejaculation among patients receiving methyldopa. Among patients treated with captopril plus a diuretic, no change from baseline appeared in scores for any of the sexual symptoms. The findings underline the importance of taking an adequate sexual history and document that selection of antihypertensive drugs may significantly affect the incidence of sexual symptoms.

Adult↗
PubMed1985

Competitive displacement of mutans streptococci and inhibition of tooth decay by Streptococcus salivarius TOVE-R.

The ability of Streptococcus salivarius TOVE-R to displace virulent representatives of the most prevalent human mutans streptococci from the teeth of rats, and thereby to inhibit caries, was studied. Streptococcus mutans 10449S- or Streptococcus sobrinus 6715-13WT-infected specific-pathogen-free rats consuming a high-sucrose diet were inoculated by TOVE-R. The infectants were differentially recovered from swabs of the teeth over the time course of infection and from sonically treated material of extracted teeth and excised tongues. Despite initial colonization of the teeth by the mutans streptococci, TOVE-R colonized the teeth, unlike other essentially nonvirulent plaque formers already described. It did not colonize the tongues of the rats. TOVE-R emerged and persisted as a prominent member of the plaque ecology. There was an associated decline in the mutans streptococci on the teeth, and this decline was associated with significant inhibition of the caries component attributable to 10449S infection (56%) and to 6715-13WT infection (52%). TOVE-R did not reliably inhibit the component of fissure caries attributable to the nonmutans indigenous flora of the rats. TOVE-R itself induced no detectable decay. The data suggest the potential therapeutic utility of TOVE-R to inhibit caries by displacement of mutans streptococci from the teeth. These results supplement the already reported ability of TOVE-R to preempt initial colonization of teeth by the mutans streptococci.

Animals↗
PubMed1985

Inhibition of ecological emergence of mutans streptococci naturally transmitted between rats and consequent caries inhibition by Streptococcus salivarius TOVE-R infection.

The ability of Streptococcus salivarius strain TOVE-R to inhibit the ecological emergence of virulent representatives of the most prevalent human mutans streptococci on the teeth of specific pathogen-free Osborne-Mendel rats was studied. Rats which were infected by TOVE-R, or either S. mutans 10449S or S. sobrinus 6715-13WT, or uninfected were transiently co-caged so as to allow natural fecal transfer of organisms due to coprophagy. The infectants were differentially recovered from swabs of the teeth over the time course of the experiments and from sonified teeth at termination. Data were expressed on both relative (percentage) and absolute (CFU) bases. Initial oral colonization of rats by TOVE-R inhibited the ecological emergence of fecally transmitted S. mutans 10449S and S. sobrinus 6715-13WT. There was a generally inverse relationship between the percentages and absolute numbers of TOVE-R and the mutans streptococci on the teeth, which strongly suggested their competition for tooth sites. Absolute numbers of total recoverable flora from the teeth upon sonification were correlated with caries scores, thus suggesting that total recoverable flora counts substantially reflect cavitation status. TOVE-R itself induced no apparent caries activity and its transmission to rats already infected by 10449S or its colonization of rats before 10449S infection inhibition caries induction by this S. mutans strain; similar anticaries effects were not statistically significant for TOVE-R against 6715-13WT in these experiments. These data on the inhibition of the ecological emergence of the mutans streptococci supplement the already reported ability of TOVE-R to preempt initial colonization of teeth and partially displace the colonization of teeth by the mutans streptococci.

Animals↗
PubMed1983

Fuzzy and crisp set-theoretic-based classification of health and disease. A qualitative and quantitative comparison.

Conventional cluster analyses of patient populations are intended to assist in the identification and characterization of groups that may represent etiological or pathological subtypes within a particular disease class. These methods have been criticized as being insensitive to subtle patient differences, which may be masked as a result of the all-or-nothing concept of cluster membership intrinsic to crisp set-theoretic-based grouping algorithms. As an alternative to conventional clustering procedures, several investigators have studied the use of fuzzy classification methods. In general, these measure a patient's clinical status in terms of a real number defined on the closed unit interval, reflecting the extent or degree to which a particular grouping entity characterizes the patient. This paper compares and contrasts the applications of crisp and fuzzy set-theoretic-based clustering procedures to a set of data describing the cognitive and intellectual functioning of a group of subjects participating in a longitudinal study of aging. Emphasis is placed on both qualitative and quantitative aspects corresponding, respectively, to the clinical interpretation of cluster definitions, and the robustness or sensitivity of the classification procedures to changes in patient profiles over time. The fuzzy set-theoretic-based model was found to be more sensitive to changes in subject level of functioning over time, to provide superior quantitative protrayals of patterns of aging, and to reflect properties of the aging process derived from other research.

Aged↗
PubMed1983

Evaluation of a focused dental utilization review system.

It has been suggested that the efficiency of claim-based utilization review systems could be improved by focusing on providers with very high utilization rates. This strategy assumes that 1) high utilizers are more likely to be overutilizers, 2) labeling claims (e.g., "high utilizer") do not bias the review, and 3) the claim review process is sufficiently reliable. These issues were studied in prospective dental utilization review system where dentists submit claims and radiographs to an insurance carrier so that they may obtain treatment authorization. A sample of dentists with very high and moderate utilization rates for amalgams, crowns, and bridges were identified and their pretreatment claims containing these services (N = 553) were collected. Half the services from high and moderate utilizer practices were labeled "high utilizer," and the other half were unlabeled. Seven dental consultants from two large insurance carriers independently assessed the appropriateness of the services (approve or deny) from radiographs. The results indicate that services submitted by dentists with high utilization rates were no more likely to be denied than those with moderate rates, labeling claims did not appear to bias the reviewers, and interconsultant agreement levels for denials seldom exceeded 50 per cent. The study suggests that further development of focused review systems requires a better understanding of the association between utilization rates and overutilization and new methods for improving the reliability of reviewers.

Evaluation Studies as Topic↗
PubMed1981

The development of dental practice profiles.

This study examines the amount and sources of variation in dental practice profiles. Three years of insurance claims data on 227 general dental practices were used to generate practice-specific utilization rates for 16 treatment service categories. The results indicated considerable heterogeneity among and within practices in the distribution of service utilization rates such that most distributions could not be described by conventional parametric probability models. Basic standardization methods were used to examine sources of variation among practices. Of the patient and insurance characteristics investigated, only patient age had a major effect on utilization rates. However, there was considerable stability in utilization rates within practices over four consecutive six-month time intervals. The implications of these findings for profile-based utilization review and quality-assurance systems are discussed.

Adolescent↗