The occurrence of fever and the clinical profile of febrile patients on the medical service of a teaching hospital were studied prospectively. Thirty-six per cent of 972 patients developed fever (temperature exceeding 38 degrees C). Their 13% mortality rate and 13.2-day average hospital stay exceeded the 3% mortality and seven-day hospitalization for afebrile patients (p less than 0.0001 for both). Most fever episodes occurred during the first two hospital days. Approximately 30% of first and subsequent fever episodes were caused by bacterial infections; illnesses involving tissue necrosis (e.g., stroke, myocardial infarction) accounted for 20%. Five conditions comprised 53% of diagnoses: respiratory and urinary tract infections, neoplasm, myocardial infarction, and drug reaction. Only one patient had a fever of uncertain origin. Several clinical clues used frequently to identify bacterial infections were reevaluated. Patients with bacterial infections had higher temperatures on the first febrile day (mean 38.9 degrees C) and were more likely to have had prior infections than those with other causes of fever (mean 38.3 degrees C, p less than 0.001). Older patients (greater than 75 years) had a lower febrile response to bacterial infections than younger patients. Fever in hospitalized medical patients is a common and important concomitant of increased mortality and length of hospitalization.

Bacterial Infections↗

PubMedDate not supplied

Febrile inpatients: house officers' use of blood cultures.

The so-called "fever work-up" is time-consuming and costly. The authors examined the practices of medical house officers in obtaining blood cultures, an important part of this evaluation, as well as the ability of these physicians to predict bacteremia in febrile patients. They studied all 344 medical inpatients who experienced episodes of fever during two 30-day periods, as well as all 50 cases of bacteremia detected during these and two additional 30-day periods. House officers drew blood for culture within one day after the onset of fever in 52% of fever episodes. In 20% of these episodes only one set of cultures (representing one venipuncture) was obtained. House officers estimated the likelihood of bacteremia to be 20% or less in 15 of 40 bacteremic patients. They failed to obtain blood cultures promptly in 10% of bacteremic episodes and in 27% of episodes where the cause of fever was a nonbacteremic bacterial infection. They obtained prompt blood cultures in only a bare majority of febrile episodes, frequently underestimated the likelihood of bacteremia, and inadequately sampled blood for bacteremia. In this study, clinical judgment was not an adequate substitute for routinely obtaining blood cultures for febrile medical inpatients.

Aged↗

PubMedDate not supplied

The prediction of streptococcal pharyngitis in adults.

The usefulness of clinical and laboratory findings for prediction of the presence of Group A streptococci on throat culture and of an increase in antistreptococcal antibodies was investigated in 693 adult patients. Several findings were shown to increase the likelihood of streptococcal isolation, alone and in combination: tonsillar exudate, tonsillar enlargement, tender anterior cervical adenopathy, myalgias, and a positive throat culture in the preceding year. Compared with a frequency of 9.7% in all patients, the probabilities of a positive culture were quite different (ranging from 2 to 53%) in subgroups of patients with different combinations of these clinical findings. The results of a leukocyte count and measurement of C-reactive protein added little additional predictive information. While clinical findings can never predict perfectly the results of a throat culture, they nevertheless can provide useful information--particularly in tending to "rule out" streptococcal infection--in adult patients with pharyngitis.

Adolescent↗

PubMedDate not supplied

Nonsteroidal anti-inflammatory drugs, traditional opioids, and tramadol: contrasting therapies for the treatment of chronic pain.

The treatment of chronic pain is an important function of physicians. In the United States, available drug treatments for chronic pain currently include simple analgesics such as acetaminophen, salicylates and other nonsteroidal anti-inflammatory drugs, traditional opioid drugs, and adjuvant agents (eg, antidepressants, anticonvulsants). Typically, the choice of a drug is made by balancing the indications for treatment, the clinical efficacy of the drug, and its toxicity. An understanding of the mechanism of action of these drugs helps to establish their role in therapy. Tramadol is an effective analgesic that works through a combined mechanism of weak mu receptor binding and the inhibition of serotonin and norepinephrine reuptake. Tramadol has a favorable adverse-effect profile and therefore is likely to have an important role in the management of chronic pain syndromes.

Adult↗

PubMedDate not supplied

"Pseudo-giant P-waves" and pericardial friction rub following chlorpromazine therapy.

A patient is presented who manifested two previously undescribed complications of chlorpromazine therapy: a transient pericardial friction rub and "pseudo-giant P waves". After slowing of the heart rate, the "giant P-waves" proved to be superimposed U and P-waves. His history demonstrates the protean and at times unusual complications of chlorpromazine therapy and illustrates the dramatic therapeutic effects diphenhydramine may have in reversing some of this toxicity.

Adult↗

PubMedDate not supplied

Prevalence of pharyngeal gonorrhea in general medical patients with sore throats.

The prevalence of pharyngeal gonorrhea was investigated in a previously unstudied population: adult patients seeking care for sore throats and other symptoms of respiratory infection in general medical practices. The complaint of sore throat accounts for at least 15 million patient visits each year in the United States. A prospective study of 239 patients in three different settings revealed prevalences of 1% (95% confidence interval of 0.1-3%) in the 192 patients with sore throats, and of zero (95% confidence interval of zero to 3.4%) in 47 patients with respiratory infection symptoms other than sore throat. The data support the position that routine pharyngeal culturing for Neisseria gonorrhoeae for patients who have sore throats is not cost-efficient.

Adult↗

PubMedDate not supplied

The use of cervical cytology to identify women at risk for chlamydial infection.

Testing asymptomatic women for chlamydial infection is advocated for high-risk populations, but testing criteria in low-risk settings are less clear. To determine whether findings from Papanicolaou (Pap) smears could identify women at risk for Chlamydia, we studied 512 women, 18 to 50 years of age, seeking routine gynecologic care. The prevalence of positive cultures for Chlamydia was 4.7%. Three cytologic findings were independently associated with Chlamydia on logistic regression: transformed lymphocytes, polymorphonuclear leukocytes, and squamous metaplasia. The sensitivity and the specificity of the presence of any two of these three findings were 75% and 73.6%, respectively. The prevalence of Chlamydia if two findings were present was 12.2%, nearly three times the population prevalence. Certain findings on cervical cytology may be useful as an adjunct in preventive care for chlamydial cervicitis.

Adolescent↗

PubMedDate not supplied

Catch-22 in the era of peer review organizations.

Explore the source record for details and available documents.

Aged↗