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Biomedical subjects

J Freeman

Publications and source records attributed to J Freeman.

At least 253 records · Page 14Linked to original sources
PubMed1985

Reduced pulmonary capillary blood volume as a long-term sequel of ARDS.

Lung function was evaluated in nine survivors of ARDS. All patients were asymptomatic at rest at the time of the study, ie, 5.5 to 19 months after extubation (mean 12.5). Six had mild to moderate exertional dyspnea. Chest x-ray films showed no gross parenchymal abnormalities. Spirometry and pulmonary mechanics were either normal or minimally altered, particularly in smokers. At submaximal exercise levels, effort was limited by tachycardia in eight patients; one subject showed ventilatory and cardiovascular limitations. It was concluded that spirometry and pulmonary mechanics are restored to normal within six months after extubation, and gas exchange abnormalities persist after ARDS and might be related to intrapulmonary shunts at rest, whereas during exercise a decreased pulmonary capillary blood volume might be the primary factor.

Adult↗
PubMed1985

Pharmacokinetics of low-dose 1-beta-D-arabinofuranosylcytosine given by continuous intravenous infusion over twenty-one days.

The pharmacokinetic parameters of low dose 1-beta-D-arabinofuranosylcytosine (ara-C) infusions were studied in 11 patients, 6 males and 5 females, with a mean age of 68.5 +/- 13.8 (SD) years. The drug was infused to 4 patients with pre-leukemia (refractory anemia with excess blasts), 5 patients with acute myelogenous leukemia, and 2 patients with secondary leukemia due to chemotherapy, at a dosage of 20 mg/m2/day over 21 days. The patients' blood and urine were analyzed for ara-C content by radioimmunoassay. Mean steady state plasma levels of 7.7 +/- 4.7 ng/ml (31.7 +/- 19.3 nM) (n = 189) and a range 0.6 (2.5 nM) (lower limit of assay) to 29.7 ng/ml (122.1 nM), with significant inter- and intra-patient variations, were reached within about 2.7 h. The plasma levels of ara-C decreased rapidly, with a t1/2 alpha of about 12 min following discontinuation of the infusion, followed by a very slow t 1/2 beta of about 19 h. Other parameters (mean values of 10 or 11 patients) were: area under the curve, 182.1 +/- 64.8 ng X day/ml; total body clearance, 188.7 +/- 54.8 liters/h; renal clearance, 3.1 +/- 1.4 liters/h; volume of distribution at steady state, 53,913 +/- 17,626 liters; and recovery of ara-C in urine, 1.43 +/- 0.69% (n = 226) of daily administered ara-C. A linear relationship was observed with administered dose when the mean plasma levels of our study were compared with the ones reported for conventional ara-C infusions. Plasma clearance was comparable to that observed in conventional dose, when the observed values were extrapolated to the dose administered in this study.

Aged↗
PubMed1984

[The Cardiac Arrest Team of the Vaud University Hospital].

A resuscitation team has been organized in the CHUV for the purpose of immediate intervention on the scene of cardiac arrest or any other life-threatening condition. The team composition is as follows: 1 anesthesiologist, 1 internist (usually cardiologist) and 1 surgeon. The team is responsible for elaborate resuscitation of in-patients from the general wards as well as out-patients coming for examination or for diagnostic and medicotechnical procedures. The team was almost never called from the intensive care units, from the operating theatres or from the emergency ward. Organization of the CHUV in this respect includes (a) grouping the facilities in larger areas where an alarm is signalled both optically and acoustically, (b) a special priority paging system with pocket radio-receptors (beeps) which can reach all members of the team within seconds, and (c) standardized resuscitation carts strategically located in the hospital. During a period of 7 months the team's work was judged satisfactory. It is called in once every 3 days on average.

Computers↗
PubMed1984

Changing concepts in the management of otitic intracranial infection: use of computerized axial tomography in early detection and monitoring of cerebritis.

The pathogenesis and course of intracranial inflammatory disorders of otitic origin have been studied extensively in the past by clinical, surgical, and morbid means. The recent contribution by CT scanning cannot be overestimated as a modality for identification of the pathologic process. Its use for early detection and monitoring of a clinically suspected intracranial complication of otitic suppurative disease is documented for the first time in this report. Cerebritis or encephalitis as the early manifestation of impending brain dissolution can be identified and followed during specific antibiotic therapy. The proper timing for surgery to remove the otitic focus is enhanced. A review of the literature and a case report illustrate this contribution.

Adolescent↗
PubMed1983

Entry to general practice training.

Since 1979 general practitioner trainees in the North West Region of England have been assessed on knowledge and ability by several tests, including the multiple choice test. Trainers in the region require a score in the MCQ of 45% before taking a trainee into the practice. More British graduates have achieved this score than overseas graduates. The difference was statistically significant. Only applicants who show adequate factual recall should be appointed as trainees.

Education, Medical, Graduate↗
PubMed1983

[Reduction of pulmonary capillary volume following acute respiratory distress syndrome in adults].

Lung function after adult respiratory distress syndrome was evaluated in 8 survivors whose ages ranged from 20 to 54 years. At the time of the study, 5.5 to 19 months after extubation, all patients were asymptomatic at rest but 6 had mild to moderate exertional dyspnea. Physical examination was normal in 7 patients; lung volumes, flow rates and pulmonary mechanics were minimally altered, mainly in smokers. Chest X-rays showed no major abnormalities. On graded submaximal exercise test, performance was limited by tachycardia and not by ventilation. Resting arterial PO2 was low in 6 patients and increased only in one patient during submaximal exercise. The capillary blood volume was decreased in all patients. The mechanisms of hypoxia during exercise and decreased capillary blood volume, the latter apparently unrelated either to pulmonary microvascular obstruction or to fibrosis, remain unexplained. It is concluded that lung volumes and pulmonary mechanics are restored to normal within 6 months after ARDS, whereas gas exchanges persist after ARDS and are associated with a reduced pulmonary blood volume.

Acute Disease↗
PubMed1983

Nosocomial infection and death in a neonatal intensive care unit.

Based on five years of prospective surveillance in a neonatal intensive care unit (NICU), the association of nosocomial infection with death during hospitalization was studied. Low birth weight and patent ductus arteriosus (PDA) were the variables most strongly associated with nosocomial infection. After stratification for these variables, there was a persistent association between nosocomial infection and increased risk of death (relative risk = 1.96; 95% confidence interval, 1.09-4.44; P = 0.03). The relative risk of mortality with nosocomial infection was significantly modified (P = 0.02) by the presence of PDA (relative risk = 3.42; 95% confidence interval, 1.68-6.95 for infants without PDA; no effect for infants with PDA). Relocation of the NICU to an improved, better-staffed facility was associated with a significant decrease in the adjusted nosocomial infection rate (relative risk [old NICU/new NICU] = 9.73; 95% confidence interval, 4.30-22.0). This improvement was accompanied by a statistically insignificant reduction in the overall mortality because other causes of death, such as low birth weight and serious underlying disease, are much more common in this population and thus are more important determinants of outcome.

Boston↗
PubMed1983

Use of antibiotics and psychoactive preparations.

This is a report of selected aspects of a larger study of 70 general practitioners. The method involved a detailed study of performance over a period of three days using rating scales and check-lists to assess competence. A possible relationship between competence and rate of antibiotic prescribing was found. There was variation in the extent of psychiatric history-taking when psychoactive preparations were used. Advice about potential side effects was given in only a third of instances when a psychoactive preparation was prescribed for a new episode of illness.

Anti-Bacterial Agents↗
PubMed1981

Drug therapy for Plasmodium falciparum malaria resistant to pyrimethamine-sulfadoxine (Fansidar). A study of alternate regimens in Eastern Thailand, 1980.

A trial of drug regimens for treating Plasmodium falciparum malaria was conducted in a refugee camp in eastern Thailand where extensive 'Fansidar' (pyrimethamine-sulfadoxine) resistance had been demonstrated. The efficacy of quinine alone was compared to that of quinine combined with either fansidar or tetracycline. Quinine alone cleared the parasitaemia in 57 of 59 patients but failed to cure approximately one-third of these patients after 7 or 10 days of therapy. The addition of fansidar to quinine therapy did not significantly improve the overall cure rate. Tetracycline given for 10 days in combination with quinine cured all patients, suggesting that tetracycline should be considered in treating patients with falciparum malaria contracted in the area of the Thai-Kampuchean border.

Child↗
PubMed1981

Differential risk of nosocomial infection.

Our ability to interpret apparent differences in findings among surveys of nosocomial infection is limited by differences in the methods used, and differences among the study populations themselves. Methodologic areas in which there are substantial differences include definitions of rates of infection, criteria for infection and methods of case-finding. The studies themselves differ with respect to the characteristics of hospital populations, their underlying diseases, clinical procedures, patterns of lengths of hospital stay and efforts at prevention of infection. There are three separate concerns for constructing and interpreting comparisons: the choice of comparison or reference subjects, the control of confounding variables and the adjustment for variations in hospital stay. In order for studies to be credible, they must be accompanied by convincing evidence that the confounding effects of variables extraneous to the study have been identified and appropriately controlled in the analysis. It has been found that the day-specific incidence of nosocomial infection rises from near zero on the first hospital day to maximal during the fourth through the seventh weeks of hospital stay. Thus, the risk of nosocomial infection for a specific patient also depends on the hospital day. It may be possible to make better use of limited infection control resources by concentrating efforts to prevent infections on the patients who are at greater risk, during the time when the day-specific incidence is highest.

Bacterial Infections↗
PubMed1981

Inva retro.

Explore the source record for details and available documents.

Dental Equipment↗
PubMed1981

Nosocomial infections in a neonatal intensive care unit.

Based on five years of surveillance in a neonatal intensive care unit (NICU), host and therapeutic risk factors for nosocomial infection were determined and the impact of staffing and environment on the rate of nosocomial infection was evaluated. From January 1974 to February 1977, infants occupied a crowded, hectic NICU that lacked basic infection control features, and 5.2% of the infants had at least one major nosocomial infection. The risk of nosocomial infection was associated with low birth weight, patent ductus arteriosus, surgery, and multiple supportive measures. After a new NICU opened in February 1977, 0.9% of the patients had major nosocomial infections (relative risk [old nursery/new nursery] = 5.06; P less than 10(-5); 95% confidence interval, 2.62-9.73). Improvements included 50% more nurses, increased space per infant, convenient sinks, and isolation facilities. Host and therapeutic risk factors for nosocomial infections were comparable in the old and new nurseries. The decrease in the rate of nosocomial infections therefore appeared to be due to improved staffing and environment.

Birth Weight↗