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Biomedical subjects

J D McCue

Publications and source records attributed to J D McCue.

79 records · Page 5Linked to original sources
PubMedDate not supplied

Patient attitudes and psychological considerations in dialysis discontinuation.

The authors surveyed 36 adult patients who were maintained with chronic renal dialysis concerning their attitudes about dialysis discontinuation. Few subjects reported having ever considered stopping the life-support treatment. When asked to consider 12 hypothetical scenarios in which they might consider stopping treatment (e.g., onset of dementia or blindness), most subjects would still not consider discontinuation. Consideration of dialysis discontinuation was directly correlated with the patient's educational level. Follow-up after 1 year underscored the substantial differences between the responses the subjects gave to the 12 hypothetical scenarios and their real-life responses when they were later faced with decisions to actually terminate treatment. Psychiatrists have an opportunity to participate in the complex clinical and ethical decisions associated with advance directives and patients' right to refuse life-support treatment.

Adult↗
PubMedDate not supplied

Denying the dying. Advance directives and dialysis discontinuation.

A structured interview was administered to a sample of patients on maintenance dialysis and their attending physicians to obtain information on the documentation of their end-of-life treatment preferences. The majority of the patients reported never having considered stopping dialysis, or having discussed with their nephrologist or family the circumstances in which treatment should be discontinued. Only 7 patients (6%) had completed an advance directive; these patients were all men (P = 0.01) and tended to be better educated (P = 0.02). Only one of the nine physicians had completed an advance directive. In most cases, the dialysis patients and their treatment team staff were preoccupied with the struggles of daily life and had avoided or denied considerations of terminal illness and death. The literature on denial, medical illness, and dying is also reviewed as it relates to dialysis patients, end-of-life treatment, and terminal care.

Adult↗
PubMedDate not supplied

Hospital charges for antibiotics.

Hospital charges for intravenous antibiotics were obtained in a survey of 71 hospitals in 25 U.S. cities. Only 56.3% of the hospitals used their actual drug acquisition cost to calculate patient charges; the remainder used a base price derived from one of the wholesale price guides, which often seriously overstate the cost of antibiotics. Sixty-eight percent added a markup, averaging 134.5%, and 63.4% added a dispensing fee, averaging $5.47. A relatively high-dose, single-antibiotic regimen costs patients $50-$150 per day, independent of dose-preparation charges (average, $9.09 per dose) for a piggyback-type system or intravenous line-related charges. Antibiotics were least expensive in large hospitals and in those located in the northeastern United States. Charges for antibiotics are often inconsistently calculated, vary enormously among hospitals, and may be unfair to patients and confusing to physicians. Cost-conscious prescribing of antibiotics by physicians would be facilitated by a more consistent relationship between charges and true costs.

Anti-Bacterial Agents↗
PubMedDate not supplied

Interference of new penicillins and cephalosporins with urine glucose monitoring tests.

The possibility that three new penicillins (mezlocillin, pipericillin, and azlocillin) and two new cephalosporins (ceftazidime and cefoperazone) might give false positive urine glucose testing results was studied. High and low concentrations of antibiotics were dissolved in urine and tested with Clinitest (Ames Division, Miles Laboratories, Elkhart, Indiana) and Tes-Tape (Eli Lilly and Company, Indianapolis, Indiana) at four different concentrations of glucose. None of the antibiotics interfered with the accuracy of Tes-Tape readings. All antibiotics interfered with Clinitest readings; the greatest interference was noted at high concentrations of antibiotics and low concentrations of glucose, and with the two cephalosporins. A summary of all reported cephalosporin interactions with Clinitest urine glucose testing is included.

Azlocillin↗
PubMedDate not supplied

Spontaneous bacterial peritonitis caused by a viridans Streptococcus or Neisseria perflava.

Eight patients had nine episodes of presumed spontaneous bacterial peritonitis (SBP) caused by commensal bacteria that usually inhabit the oropharynx, including Neisseria perflava and the viridans streptococci Streptococcus milleri, Streptococcus mitis, and Streptococcus sanguis. Nonpurulent ascites (ascitic fluid WBC count, less than 1,000/cu mm) was present in four episodes, possibly caused by either bacterial colonization or early peritonitis; purulent ascites was present in five episodes. None died of their infection, and three episodes remitted without treatment. Poor condition of gums and teeth may play a pathogenic role in SBP caused by these bacteria.

Adult↗
PubMedDate not supplied

Urinary tract infections in the elderly.

Urinary tract infection (UTI) is the most common infectious disease of the elderly and is especially prevalent in debilitated, institutionalized older individuals. Unlike UTI in younger women, which tends to be related to frequency of sexual intercourse and is uncomplicated, in the elderly it is more difficult to treat and its pathogenesis is related to abnormal bladder function, bladder outlet obstruction, vaginal and urethral atrophy, use of long-term indwelling catheters, and puddling related to bed rest. The spectrum of organisms causing infection relates to the ecology of the patients' environments; those residing in nursing homes and especially with permanent indwelling catheters tend to have a greater variety of pathogenic organisms, many of which may be relatively antibiotic resistant. Short-course antibiotic therapy is less effective in older patients, and relapse or recurrence is more common regardless of the duration of treatment. Asymptomatic bacteriuria is common in older patients with abnormal bladder function. The clinical significance of asymptomatic bacteriuria generally is minor, and treatment is not beneficial.

Aged↗