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Biomedical subjects

J R Feussner

Publications and source records attributed to J R Feussner.

At least 109 records · Page 6Linked to original sources
PubMed1987

Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension.

Epidemiological and experimental data suggest blood pressure-lowering effects of dietary potassium. A randomized, double-blind clinical trial was used to assess blood pressure response to orally administered potassium, 120 mEq/day, and to placebo in 101 adults with mild hypertension. Blood pressure was measured with a random-zero sphygmomanometer every 2 weeks of this 8-week trial. Systolic blood pressure in the potassium-treated group decreased by 6.4 +/- 13.7 (SD) mm Hg (p less than or equal to 0.025) compared with 0.11 +/- 13.0 mm Hg in the placebo-treated group (p = 0.96). Diastolic blood pressure in the potassium-treated group decreased by 4.1 +/- 8.3 mm Hg (p less than or equal to 0.05) compared with a 1.6 +/- 6.5 mm Hg decrease in placebo-treated subjects (p = 0.09). Baseline blood pressure of potassium-treated subjects was unexpectedly higher than that of controls. After correcting for baseline variation, blood pressure still decreased 3.4/1.8 mm Hg more in potassium recipients than in placebo recipients (p = 0.14 and 0.24, respectively). Blood pressure decreased by 19/13 mm Hg in five blacks taking potassium versus a 1/0 mm Hg increase in seven blacks taking placebo. Compliance with the potassium regimen was 91.5% by pill count; only one subject discontinued treatment because of side effects. In conclusion, 120 mEq/day of microencapsulated potassium chloride was well tolerated in adults with mild hypertension. An antihypertensive effect of potassium cannot be ruled out despite the fact that there was no statistically significant difference between potassium-treated and placebo-treated subjects after adjustment for differences in baseline blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.

Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency.

Aged↗
PubMed1987

Need for insulin therapy in type II diabetes mellitus. A randomized trial.

To identify patients with type II diabetes mellitus for whom insulin therapy is most beneficial, we conducted a randomized controlled trial in the general medicine clinic of a university hospital. Asymptomatic, obese, insulin-treated patients were given diet and diabetes education and, in half of these patients, insulin therapy was withdrawn. Over six months, patients developing hyperglycemic symptoms or acetonemia were counted as study failures. Failure criteria developed in 13 of 25 insulin-withdrawal patients, at a median of four weeks after withdrawal, compared with two of 24 control subjects. Elevated stimulated glucose levels predicted the need for insulin therapy. Hyperglycemia worsened in insulin-withdrawal patients who did not meet study failure criteria, but it improved in control patients. Study patients were insulin deficient as shown by low baseline C peptide values (0.43 +/- 0.05 nmol/L). The prompt metabolic decompensation precipitated by insulin withdrawal suggests that insulin-deficient patients may benefit from insulin therapy and may need it to prevent symptomatic hyperglycemia.

Adult↗
PubMed1987

Quantitative approaches to clinical diagnosis of cancer in elderly patients.

Recommendations for cancer detection in the elderly are based on even less evidence of efficacy than are recommendations for the general adult population. In this article, we present some quantitative measures of test performance--operating characteristics, effectiveness and cost effectiveness/cost benefit--and show examples of how to use these measures to adjust diagnostic strategies for factors especially relevant to the elderly.

Aged↗
PubMed1986

A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations.

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

Aged↗
PubMed1986

Observer error in systolic blood pressure measurement in the elderly. A case for automatic recorders?

Measurement of systolic blood pressure (BP) in the elderly can be inaccurate due to observer errors such as terminal digit preference and expectation bias. Efforts to reduce these errors include use of trained observers, random-zero sphygmomanometers, and automatic BP recorders. To evaluate the value of an infrasonic recorder, the infrasonde, we compared simultaneous systolic BP determinations obtained directly by intra-arterial measurements, and indirectly by a standard cuff-mercury sphygmomanometer using clinic nurses (casual and serial measurements), a trained physician assistant (PA), and the Infrasonde in 36 elderly hypertensive men. All the indirect measurements correlated positively with the direct measurement. A terminal digit preference for zero occurred more frequently in the casual and serial readings compared with the Infrasonde and PA cuff readings: 45% and 51% vs 21% and 22%, respectively. Our data suggest that the Infrasonde is a reliable, alternative device for systolic BP measurement that eliminates observer biases associated with standard cuff BP recordings.

Aged↗
PubMed1985

Overestimation of diastolic blood pressure in the elderly. Magnitude of the problem and a potential solution.

Indirect sphygmomanometric blood pressure measurement is the established method of diagnosing and monitoring hypertension, but it may overestimate the true blood pressure in certain elderly patients leading to unnecessary or excessive treatment. The authors studied 36 elderly (aged 60 years or older) hypertensive men and compared direct intraarterial diastolic blood pressure (DBP) measurements with indirect DBP measurements obtained concurrently by a standard mercury sphygmomanometer and also by an automatic blood pressure recorder to: assess the presence and degree of overestimation of DBP by indirect cuff measurement, and evaluate an alternative noninvasive method. The difference between sphygmomanometric and intraarterial DBP was 10 mmHg or greater in 14 of 36 patients, whereas that between the automatic recorder and intraarterial DBP was 10 mmHg or greater in 14 of 36 patients, whereas the between the automatic recorder and intraarterial DBP was 10 mmHg or greater in only three of 36 patients (P less than 0.05). Fourteen patients (39%) had a DBP of greater than or equal to 90 mmHg by the mercury sphygmomanometer compared with five patients (14%) by intraarterial measurement (P less than 0.05); only seven patients (19%) had a DBP of greater than or equal to 90 mmHg by the automatic recorder (P = .7). Thus, in the authors' patient population: indirect sphygmomanometer overestimated the frequency of elevated DBP by nearly threefold compared with intraarterial measurements, and the automatic recorder closely approximated intraarterial values offering a more accurate, noninvasive measure of DBP in the elderly.

Aged↗
PubMed1985

The role of lumbar puncture in the evaluation of dementia: the Durham Veterans Administration/Duke University Study.

The use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis in the routine, initial evaluation of patients with dementia continues to be questioned. This is especially true in the investigation of infectious causes of dementia. To explore this question further, the authors performed a retrospective analysis of 672 hospitalized patients specifically evaluated for dementia. LP and CSF analysis were performed on 402 patients (60 per cent); routine bacteriologic, acid-fast, and fungal cultures were also obtained for 333 of these patients. Most patients were white (64 per cent) and male (63 per cent), their mean age being 66 +/- 11 years. Four patients were diagnosed as having meningitis--two with Cryptococcus neoformans, one with apparent Mycobacterium tuberculosis, and one with coagulase-positive Staphylococcus aureus. These patients were characterized by a subacute change in mental status, fever or meningismus, and CSF pleocytosis with abnormal CSF chemistries. None of the patients were found to have newly diagnosed neurosyphilis. The authors conclude that LP and CSF analysis should not be part of the routine evaluation of patients with dementia and should be performed only in the presence of such indications as a subacute duration of dementia, fever, and signs of meningeal irritation.

Aged↗
PubMed1984

Veterans Administration and ambulatory care: the "low-priority" veteran.

We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing "low-priority" veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition. Private providers were used exclusively by 35% of veterans, 33% continued to use VA medical services, 11% used a combination of VA and private care, and 16% used other miscellaneous sources of care. While most veterans (74%) paid cash for their care, 35% also used Medicare or Medicaid supplementally. In veterans with hypertension, the diastolic blood pressure distributions were ostensibly unchanged after release. These results suggest that a reduction in services provided to "low-priority" veterans is feasible without deleteriously affecting their medical status. With regard to blood pressure control, those veterans who obtained private sources of care did as well as those who remained in the GMC.

Adult↗
PubMed1984

Reevaluation of digitalis efficacy. New light on an old leaf.

Use of digitalis for the treatment of patients with congestive heart failure and sinus rhythm remains controversial. To ascertain the proper therapeutic role of digitalis, we have critically appraised the published clinical evidence of digitalis efficacy using standardized methodologic criteria. A search of the English literature from 1960 to 1982 identified 736 articles, of which 16 specifically addressed the clinical evaluation of digitalis therapy for patients with congestive heart failure and sinus rhythm. Only two double-blind, placebo-controlled trials provided clinically useful information. One study showed that digoxin therapy could be withdrawn successfully in elderly patients with stable congestive heart failure. The other showed that patients with chronic heart failure and an S3 gallop benefited from digoxin therapy.

Clinical Trials as Topic↗
PubMed1984

Spurious hypertension in the obese patient. Effect of sphygmomanometer cuff size on prevalence of hypertension.

We used standard, large adult, and thigh-size cuffs in random order to take BPs in 470 patients. The prevalences of definite high BP [( HBP]), greater than or equal to 160/95 mm Hg) and borderline HBP [( BHBP ], greater than or equal to 140/90 less than 160/95 mm Hg) were the same with all three cuffs in patients with an arm circumference less than 35 cm, a body mass index less than 34, and a weight of less than 95 kg. The large adult and thigh cuffs did not underestimate the prevalence of HBP in these nonobese patients. The prevalences of HBP and BHBP were twofold greater with the standard cuff than with the large adult or thigh cuffs in obese patients (arm circumference greater than or equal to 35 cm or body mass index greater than or equal to 34 or weight greater than or equal to 95 kg). Routine use of the large adult cuff will provide accurate BP measurement and avoid unneeded evaluation and treatment.

Adolescent↗
PubMed1983

BP control. Improvement in a university medical clinic by use of a physician's associate.

Many hypertensive patients, especially those in outpatient clinics at large teaching hospitals, do not achieve BP control. We incorporated a physician's associate into an existing house staff medical clinic and evaluated whether this improved BP control. In patients with moderate or severe hypertension, BP control was achieved in 56% of patients observed by both the physician's associate and the house staff and in 32% of patients observed solely by house staff. Possible contributing factors were more frequent follow-up, simplification of drug regimens, reduced waiting time, more time spent with the patients, and overall greater satisfaction with the physician's associate. We conclude that the addition of a physician's associate to an outpatient clinic is an effective method for enhancing BP control. This can be achieved without establishing a separate hypertension clinic or depriving house staff of experience in the management of hypertension.

Blood Pressure↗
PubMed1981

Computed tomography brain scanning in alcohol withdrawal seizures. Value of the neurologic examination.

We evaluated the usefulness of computed tomography (CT) brain scanning in alcoholic patients with withdrawal seizures (n = 151) and other neurologic problems (n = 87) and compared the findings of a detailed neurologic examination to the results of CT scanning. In patients with seizures, nearly 50% of CT scans were normal, 34% showed generalized cerebral atrophy, and only 15% showed focal structural lesions. When focal neurologic deficits were present, 30% of CT scans showed focal structural lesions compared to 6% when such deficits were absent (p less than 0.0002). The frequency of potentially reversible lesions was 18% in patients with and 1% in patients without focal neurologic deficits (p less than 0.0002). Of patients treated surgically, 9% had focal neurologic deficits and 1% did not (p less than 0.03). Results were similar in alcoholic patients with other neurologic problems. Careful use of the neurologic examination adequately determines which patients need prompt CT scanning. In the absence of either focal deficits on neurologic examination or signs of acute head trauma, CT brain scanning does not improve the evaluation of patients with alcohol withdrawal seizures.

Alcoholism↗