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Biomedical subjects

P A Gross

Publications and source records attributed to P A Gross.

At least 19 recordsLinked to original sources
PubMed1996

Basics of stratifying for severity of illness.

Conventional wisdom suggests that those who assess healthcare processes and outcomes always should stratify cases by severity of illness; however, infection control personnel should analyze each quality assessment tool with and without severity adjustment and determine whether such adjustment in necessary. This article briefly reviews severity adjustments for diseases or procedures involving specific organ systems, as well as those applicable to all diseases, including the commercially available systems. Also discussed is whether and how these various systems for severity adjustment can be compared. Finally, the article will provide selected references for individuals who will use these scoring systems and need more information.

Communicable Diseases↗
PubMed1996

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗
PubMed1996

Time to peak serum antibody response to influenza vaccine in the elderly.

The earliest time at which serum antibody peaks following administration of influenza virus vaccine in elderly persons is not clearly defined. We compared the time intervals of 2 and 4 weeks after vaccination. A commercial trivalent vaccine containing the hemagglutinins of influenza viruses A/Texas/36/91(H1N1), A/Shangdong/9/93(H3N2), and B/Panama/45/90 was used. The hemagglutination inhibition antibody titers at 2 weeks after vaccination were identical to the hemagglutination inhibition antibody titers at 4 weeks for all three vaccine components.

Aged↗
PubMed1995

The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature.

OBJECTIVE: To quantify the protective efficacy of influenza vaccine in elderly persons. DATA SOURCES: A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, mortality, hospitalized, and pneumonia. Appropriate references in the initially selected articles were also reviewed. STUDY SELECTION: Only cohort observational studies with mortality assessment were included in the meta-analysis. In addition, 3 recent case-control studies, 2 cost-effectiveness studies, and 1 randomized, double-blind, placebo-controlled trial were reviewed. DATA EXTRACTION: Vaccine and epidemic virus strains, age and sex of patients, severity of illness, patient status, and study design were recorded. Upper respiratory illness, hospitalization, pneumonia, and mortality were used as outcome measures. DATA SYNTHESIS: In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% Cl, 39% to 68%) for preventing respiratory illness, 53% (Cl, 35% to 66%) for preventing pneumonia, 50% (Cl, 28% to 65%) for preventing hospitalization, and 68% (Cl, 56% to 76%) for preventing death. Vaccine efficacy in the case-control studies ranged from 32% to 45% for preventing hospitalization for pneumonia, from 31% to 65% for preventing hospital deaths from pneumonia and influenza, from 43% to 50% for preventing hospital deaths from all respiratory conditions, and from 27% to 30% for preventing deaths from all causes. The randomized, double-blind, placebo-controlled trial showed a 50% or greater reduction in influenza-related illness. Recent cost-effectiveness studies confirm the efficacy of influenza vaccine in reducing influenza-related morbidity and mortality and show that vaccine provides important cost savings per year per vaccinated person. CONCLUSION: Despite the paucity of randomized trials, many studies confirm that influenza vaccine reduces the risks for pneumonia, hospitalization, and death in elderly persons during an influenza epidemic if the vaccine strain is identical or similar to the epidemic strain. Influenza immunization is an indispensable part of the care of persons 65 years of age and older. Annual vaccine administration requires the attention of all physicians and public health organizations.

Age Factors↗
PubMed1995

Time to peak serum antibody response to influenza vaccine.

The time to the appearance of a peak serum antibody response to influenza virus vaccine is not clearly defined. We compared the most commonly used time intervals described in the literature--4 and 6 weeks after vaccination. We studied 118 elderly patients from three different geographic sites. The 1992 to 1993 trivalent inactivated influenza virus vaccine containing influenza virus A/Beijing/353/89 (H3N2), influenza virus A/Texas/36/91 (H1N1), and influenza virus B/Panama/45/90 was used. No statistically significant differences were found at the 4- and 6-week intervals after vaccination.

Aged↗
PubMed1994

Serum HLA class I levels in elderly humans. Utilization in following the response to influenza vaccine.

Some healthy elderly people (30%-40%) do not respond to influenza vaccination. Subjects who respond to influenza vaccination show a significant increase in serum HLA class I levels 2 weeks after immunization. In the present study, serum HLA class I levels were measured prior to vaccination and 4 and 6 weeks after vaccination. The responders (HAI titers > or = 40) had higher prevaccination HLA class I levels (2.03 +/- 0.12 microgram/ml) than nonresponders (HAI titers < 40) (1.57 +/- 0.14 microgram/ml) (P = 0.03). The responders' sHLA levels remained stable at 4 (1.98 +/- 0.12 microgram/ml) and 6 (2.13 +/- 0.12 microgram/ml) weeks postvaccination. In contrast, nonresponders' sHLA levels increased at 4 weeks (1.85 +/- 0.18 microgram/ml) but declined to prevaccination levels at 6 weeks (1.59 +/- 0.16 microgram/ml). Lymphocytes isolated from the responders (n = 4) 4 weeks after vaccination had a higher in vitro proliferative response (mean SI = 20) than lymphocytes from nonresponders (n = 4, mean SI = 6.4) to the influenza vaccine. This proliferative response was significantly inhibited (mean SI = 6.3, P = 0.04) in the responders by the addition of an anti-HLA class I mAb and was associated with increased cell surface expression of HLA class I molecules. Two forms of sHLA class I molecules of relative mass of M(r) 42,000 and 40,000 were immunoprecipitated from the serum of nonresponders whereas only the M(r) 40,000 form was detected in the sera of young controls and of elderly responders.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗