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Biomedical subjects

N L Smith

Publications and source records attributed to N L Smith.

At least 55 records · Page 3Linked to original sources
PubMed1995

Temporal patterns of antihypertensive medication use among older adults, 1989 through 1992. An effect of the major clinical trials on clinical practice?

OBJECTIVE: To describe the changing patterns of antihypertensive medication use in the years immediately before and after the publication of the results of three major clinical trials of the treatment of hypertension in older adults. DESIGN: In this cohort study, adults 65 years or older were examined annually on four occasions between June 1989 and May 1992, and the use of antihypertensive medications was assessed by inventory at each visit. The four visits defined the boundaries of three study periods. For each study period, participants receiving antihypertensive therapy were either continuous users (n = 1667, 1643, and 1605, respectively) or starters (n = 157, 142, 120) of hypertensive therapy. The large clinical trials that convincingly proved the efficacy and safety of low-dose diuretic therapy in older adults were published during the latter parts of period 2 and the early parts of period 3. RESULTS: Among starters, the proportion initiating therapy on diuretics increased from 35.9% in period 2 to 47.5% in period 3, significantly so among women (P = .04). The proportions initiating other drugs displayed no significant trends. Among continuous users, the use of diuretics, beta-blockers, and vasodilators generally decreased over the 3-year period, while the use of calcium channel blockers and angiotensin-converting enzyme inhibitors increased significantly in each of the three periods (P < .05). The decline of 2.7% in the prevalence of diuretic use in period 1 abated during period 2 (1.8% decline), and it slowed significantly (P = .03) to almost a complete halt during period 3 (0.2% decline). The rate of increase in the use of calcium channel blockers slowed significantly (P = .01) between period 1 (+6.7%) and period 3 (+2.8%). CONCLUSIONS: Although other factors such as cost may have been important, the temporal trends in antihypertensive drug therapy coincided in time with and may have reflected in part the influence of the major clinical trials on the patterns of clinical practice.

Aged↗
PubMed1994

Childhood and adult socioeconomic status as predictors of mortality in Finland.

Research has suggested that social-class differences in adult health may be at least partly determined by conditions earlier in life. In 2636 Finnish men, we assessed impact of childhood and adult socioeconomic conditions on adult mortality risk by examining whether differing socioeconomic life-courses from early childhood to adulthood were associated with different risks of all-cause and cardiovascular mortality. Compared with high-income adults, those with low income had increased relative risks of all-cause (2.54, 95% CI 1.83-3.53) and cardiovascular (2.37, 1.51-3.7) mortality, but these increased risks were not related in either adult group to childhood socioeconomic conditions. Men who went from low-income childhood to high-income adulthood had the same mortality risks as those whose socioeconomic circumstances were good in both childhood and adulthood (1.14, 0.56-2.31, all causes; 0.99, 0.39-2.51, cardiovascular). By contrast, men who experienced poor socioeconomic circumstances as both children and adults were about twice as likely to die as those whose position improved (2.39, 1.28-4.44, all causes; 2.02, 0.9-4.54, cardiovascular). Our findings suggest that socioeconomic conditions in childhood are not important determinants of adult health. We caution against this interpretation--a life-course approach to socioeconomic differences in adult health requires understanding of the social and economic context in which individual life-courses are determined.

Adult↗
PubMed1992

A comparison of clinical virulence of nosocomially acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections in a university hospital.

OBJECTIVES: To compare the clinical virulence of nosocomially acquired methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) infections in 1989. DESIGN: A retrospective comparison of host factors, in-hospital exposures, sites of infections, and outcomes of patients with nosocomial MRSA and MSSA infections. SETTING: University of Illinois Hospital, Chicago, Illinois. PARTICIPANTS: Forty-four adult patients with nosocomial S aureus infections. RESULTS: The 22 MRSA-infected and 22 MSSA-infected persons were similar regarding mean age, gender, underlying diseases, and exposure to surgery. Before developing infection, MRSA-infected persons were more likely to have received antibiotics (73% compared with 27%, odds ratio = 7.1, 95% confidence interval [CI95] = 2.0-25.8 p = .003) and to have stayed in the hospital > 2 weeks (64% compared with 18%, odds ratio = 7.9, CI95 = 2.0-31.6, p = .002). Bacteremia was the most common presentation in the MRSA and MSSA groups (55% and 59%, respectively). Infectious complications and death were infrequent in both groups. CONCLUSIONS: MRSA and MSSA strains infect patients with similar demographic features and underlying diseases, but MRSA infections are significantly more common among patients with previous antibiotic therapy and a prolonged preinfection hospital stay. Clinical presentations and outcomes did not differ significantly between the 2 groups. Thus, similar to studies in the early 1980s, our findings do not suggest greater intrinsic virulence of MRSA.

Chicago↗
PubMed1992

Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses.

We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians' confidence in their diagnoses.

Clinical Laboratory Techniques↗
PubMed1985

Variational anatomy of the deep femoral artery.

The deep femoral artery is frequently incorporated in vascular reconstructive procedures in the proximal leg. To study the branching variations of this artery, we dissected 100 legs and then classified the anatomical patterns. The deep femoral artery originates a median distance of 4.4 cm from the inguinal ligament. The origin of the lateral circumflex artery varied greatly. When it branched from the deep femoral, the origin of the lateral circumflex was 1.5 cm (median) from the origin of the deep femoral. The medial circumflex artery originated from the deep femoral in 63% of the specimens. It arose separately from the common femoral and more proximally in 26% of the specimens, branching an average of 2.15 cm (median) above the deep femoral origin. Familiarity with these variations is essential to the vascular surgeon and,therefore, we have included diagrams based on our study as a ready reference.

Female↗
PubMed1985

Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread.

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the early, rapid, and radical debridement of all devitalized tissues and prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.

Aged↗
PubMed1985

Urinoma--a rare presentation of carcinoma of the bladder.

Urinoma as a presenting sign of carcinoma of the bladder, as occurred in this case, is rare. Aspiration of the cystic mass under sonography and chemistry of the fluid confirmed the diagnosis. The inferior extension of the urinoma on CT scan confirmed the gradual fading of Gerota's fascia into the retroperitoneum. Abdominal mass in the form of a urinoma is an uncommon presentation and only a few documented cases are reported in the literature. This case illustrates that the Gerota's fascia fades inferiorly into the retroperitoneum.

Biopsy↗
PubMed1984

Management consulting and evaluation.

The basic functions and procedures of management consulting are contrasted here with formal program evaluation. A case example further illustrates the differing approaches used in programmatic problem solving. The similarities and differences between these two professional specializations are highlighted in order to understand better the unique but complementary contribution each makes to the improvement of program operations.

Consultants↗
PubMed1983

Randomized prospective study of the comparative efficacy of spectinomycin and gentamicin in urinary tract infections.

A prospective, randomized study was undertaken in 32 hospitalized patients with urinary tract infections to compare the efficacy of spectinomycin versus gentamicin. Spectinomycin was found to be of equal efficacy if not more efficacious in eradicating Escherichia coli, Klebsiella and Proteus mirabilis in our patient population. No significant side-effects were noted. A review of the literature with emphasis on the use of spectinomycin in infections other than anogenital gonorrhea is made.

Adult↗
PubMed1982

Sweat gland carcinoma with hypercalcemia.

A case is presented in which a large recurrent malignant tumor of the thigh of probable sweat gland origin is associated with hypercalcemia. The tumor invaded the periosteum of the pubis. Hypercalcemia subsided following hemipelvectomy and the patient has remained asymptomatic since 1977.

Adult↗
PubMed1982

An unusual case of delayed rectosigmoid compression by pelvic mass following cystectomy: report of a case.

A rare case of rectosigmoid compression by an enormous obscure pelvic mass after cystectomy is reported. Pelvic collections in the form of abscess, hematoma, lymphocele, and urinoma are not uncommon in the early postoperative period following pelvic surgery. However, delayed appearance of a benign pelvic mass as a late complication of surgery is very rare. Localized pelvic masses discovered years after cystectomy for bladder tumor may lead to an erroneous clinical impression of local recurrence of the primary neoplasm. Differential diagnosis of common pelvic masses, diagnostic studies, and treatment are discussed.

Cysts↗