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J P Fogarty

Publications and source records attributed to J P Fogarty.

At least 19 recordsLinked to original sources
PubMed2001

Randomized controlled trial of concurrent hepatitis A and B vaccination.

Hepatitis A and B viruses are threats to deployed military forces. The objective of this study was to determine the feasibility of concurrent vaccination against hepatitis A and B viruses. One hundred five healthy persons, 20 to 49 years of age and without serologic markers to hepatitis A or B viruses, were randomized to receive an inactivated hepatitis A vaccine (HEP A; 25 units in 0.5 mL), recombinant hepatitis B vaccine (HEP B; 10 micrograms in 1.0 mL), or both (HEP A & B) concurrently in separate arms. Vaccines were administered intramuscularly at 0, 1, and 6 months. Sera obtained at 1, 2, 6, 7, and 12 months after the first dose were tested for quantitative antibody to hepatitis A virus (anti-HAV) and antibody to hepatitis B surface antigen. Local reactions (e.g., pain) were reported by less than half of the volunteers and were similar at the site of HEP A, whether given alone or concurrently. However, more persons complained of pain (usually mild) at the HEP B site when HEP B was given concurrently with HEP A compared with HEP B alone (43% vs. 15%, 34% vs. 9%, and 42% vs. 15% for doses 1, 2, and 3, respectively; p < 0.05 for each dose). Among persons immunized with HEP A alone or HEP A & B, the proportion with > or = 10 mIU/mL anti-HAV was 83% in both groups 1 month after dose 1 and 100% at months 2, 7, and 12. The geometric mean concentrations of anti-HAV increased from 21 mIU/mL at month 1 to 2,649 and 2,312 mIU/mL in the HEP A and HEP A & B groups, respectively, at month 7. The response to HEP B was similar whether administered alone or concurrently. Antibody responses were similar in those receiving HEP A or HEP B concurrently or alone, but more subjects reported pain (usually mild) at the HEP B site after concurrent vaccination than after HEP B alone. Further work should be conducted to approve HEP A for patients younger than 2 years of age and to develop combined HEP A and HEP B vaccines in the United States.

Adult↗
PubMed1999

Families at the bedside: an ethnographic study of vigilance.

BACKGROUND: Vigilance, the close protective involvement of family members with hospitalized relatives, is a relatively recent phenomenon in the hospital setting. Before the 1960s, hospital visiting policies restricted the presence of family members at the bedside. Policies changed during the 1960s and 1970s when health care professionals recognized that parents' staying with their hospitalized children was beneficial for both the parents and the children. Vigilance later became a phenomenon that included family members staying with adult patients. METHODS: Two ethnographic studies were conducted to examine the meanings, patterns, and day-to-day experience of vigilance. Sixteen family members, described by the nursing staff as staying with the patient, participated in informal semistructured interviews. Participant observation was also used in data collection. RESULTS: Data analysis yielded 5 categories of meaning that describe the experience of vigilance: commitment to care, emotional upheaval, dynamic nexus, transition, and resilience. CONCLUSIONS: Managed care, shortened hospital stays, and cost containment make early involvement of the family in the patient's care imperative. An understanding of the family's needs and experiences is prerequisite to that involvement. The categories of meaning discovered in this research can help health care providers understand family members' experience of vigilance. The implications for the family physician include sensitization and awareness of family members' experiences and the developing of specific actions and interactions fostering a commitment to family-centered care that extends to the hospital setting.

Adolescent↗
PubMed1999

Spouse abuse: physician guidelines to identification, diagnosis, and management in the uniformed services.

Spouse abuse is a major social issue in our country. Based on national samples, between 10 and 20% of couples report some type of violence during the course of their marriage. In the United States, 1.8 million women are physically abused by their spouses each year. Within the military, it is estimated that the incidence of spouse abuse is even greater than in the civilian sector. Estimates suggest that one-third of military spouses experience abuse during their marriage. Although 87% of women prefer discussing their victimization with their physician, physicians, as a group, have been least effective in helping them. Recently, several barriers to physician recognition and intervention in domestic violence have been identified, and recommendations for specific training on abuse have been published. This paper provides military physicians an in-depth review of the guidelines to identification, diagnosis, and management of spouse abuse, with a special emphasis on their implementation within the uniformed services.

Female↗
PubMed1997

Hepatitis B vaccine booster dose: low-dose recombinant hepatitis B vaccines as a booster dose.

BACKGROUND: The timing and best regimen for a booster dose of hepatitis B vaccine have not been determined. METHODS: Two studies were conducted to determine the response to a booster dose of 5 micrograms recombinant hepatitis B vaccine. In the first study, a 5 micrograms (0.5 ml) dose of Recombivax HB was administered intramuscularly 38 months after the initial dose to 71 volunteers. In a second study, we offered a 5 micrograms dose recombinant hepatitis B vaccine, either Recombivax HB (0.5 ml) or Engerix B (0.25 ml), to students who had previously been immunized with three doses of vaccine. RESULTS: In the first study, among the 44 persons for whom postbooster sera were available, the geometric mean concentration of anti-hepatitis B surface antigens increased from 42 to 2090 mIU/ml after the 5 micrograms (0.5 ml) dose of Recombivax. In the second study, after a 5 micrograms (0.5 ml) dose of Recombivax, the geometric mean concentration increased from 43 to 990 mIU/ml (n = 48), and in the group that received a 5 micrograms (0.25 ml) dose of Engerix B, the concentration increased from 83 to 2337 mIU/ml (n = 45) (p = 0.18 for postdose concentrations). CONCLUSION: A 5 micrograms dose of recombinant vaccine results in an excellent booster response at a cost one fourth to one half that of a full 1 ml dose of vaccine.

Adult↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part I. A survey of current military family practice residency directors.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. To evaluate the degree of implementation and the perceived necessity of the MUC curricula and the attitudes and logistical factors relevant to military medicine instruction in military family practice residencies, questionnaires were sent to all 18 military family practice residency directors. The results reveal a wide range of opinions regarding the importance of military medicine and the amount of instruction of military medicine topics among the residency programs. The total number of topics taught was correlated (p < 0.05) with years as residency director, awareness of the MUC, and an opinion that the material would not be better taught at service-specific schools. There appears to have been little influence of the MUC on the curricula of military family practice residencies since its publication.

Attitude of Health Personnel↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part II, A survey of residency graduates from 1987-1990.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. Questionnaires were sent to 464 military family practice residency graduates from 1987-1990 to evaluate the degree of implementation of the MUC and attitudes and logistical factors relevant to military medicine instruction in military family practice residencies. Analysis reveals a range of opinions regarding the importance of military medicine and the amount of instruction on military medicine topics offered among programs. The total number of topics offered for instruction was positively correlated (p < 0.05) with the time available to teach the material, a perception that the material would not be best learned at the Combat Casualty Care Course, and the presence of a specific military medicine curriculum within the residency. This survey provides baseline information for future evaluation of the influence of MUC on military medicine instruction in residency programs. Suggestions are offered to improve instruction on military medicine topics in military family practice residencies.

Attitude of Health Personnel↗
PubMed1997

The year 2010.

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Forecasting↗
PubMed1996

Tuberculosis screening in medical students.

BACKGROUND AND OBJECTIVES: The Liaison Committee on Medical Education and the Association of American Medical Colleges have issued recommendations for screening medical students for tuberculosis. This report describes the initiation of a tuberculosis screening program at the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS). METHODS: A screening program was instituted in 1993 that included intradermal purified protein derivative, the "booster phenomenon," inter-reader variability, risk factor analysis, and administrative policy to improve compliance. RESULTS: There were 501 students screened (classes of 1996-1998). Initially, 19 (3.8%) students' tests were classified as positive, and 14 additional students tested positive when tested again 2 months later, due to the booster phenomenon. The subsequent conversion rate was 2.5% for those students who were followed for the next 3 years of medical school. All these students were placed on prevention therapy with isoniazid. No active cases of tuberculosis have been identified since the inception of the screening program. DISCUSSION: Only recently has the importance of screening medical students been emphasized. The USUHS program was designed to address the factors for a successful screening program, such as increased compliance, standardization, and documentation. With modifications according to resources, medical schools can offer an efficient tuberculosis screening program to students, faculty, and staff.

Humans↗
PubMed1995

An unusual case of lung torsion.

We report a case of complete torsion of the right lung induced by transthoracic needle biopsy. While a delay in diagnosis occurred, viability of the torsed lung was maintained, thereby allowing for effective surgical repair.

Aged↗
PubMed1995

Money is not evil.

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Health Care Costs↗
PubMed1989

Efficacy of routine postpartum uterine exploration and manual sponge curettage.

Many physicians feel that manual exploration and sponge curettage of the uterus should be a routine part of all vaginal deliveries. Three hundred twenty uncomplicated routine vaginal deliveries (185 with exploration and sponge curettage, 135 without) were prospectively analyzed for differences in outcome with regard to postpartum hemorrhage, postpartum infection, and the patient's perception of pain. Results revealed there to be no clinically or statistically significant difference between these two groups in postpartum bleeding, postpartum white blood cell counts, and postpartum fever during the three-day postdelivery hospitalization. All patients were followed for six weeks. Five of 185 patients (2.7 percent) in the explored group returned for postpartum bleeding complications, one requiring hospital admission. Three of 135 (2.2 percent) returned for postpartum bleeding in the unexplored group, none requiring hospital admission. No patients in either group had complications with postpartum endometritis in the follow-up period. The patient's perception of pain was significantly higher in the explored and curettaged group as opposed to the unexplored group (P less than .0002). This study reveals that routine elective postpartum manual exploration and sponge curettage of the uterus is a painful procedure that is not clinically indicated for reducing the potential risk of postpartum hemorrhage or endometritis and is unnecessary following routine vaginal delivery.

Adult↗
PubMed1985

New trends in surgical stabilization of thoraco-lumbar spinal fractures with emphasis for sublaminar wiring.

Sixteen patients with unstable thoracic and lumbar spinal fractures and fracture-dislocations were treated surgically by contoured Harrington instrumentation and spinal fusion. Instrumentation was supplemented by sublaminar wires above and below the level of injury. Complications occurred in ten patients. All had solid fusion at follow-up. No loss of reduction occurred. Fourteen patients had a Fewett hyperextension brace post-operatively, and two had no immobilization.

Adult↗