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P Drinka

Publications and source records attributed to P Drinka.

18 recordsLinked to original sources
PubMed1991

A pertussis outbreak in a Wisconsin nursing home.

The epidemiologic features and clinical spectrum of pertussis in the elderly are poorly understood. In October 1985, the Wisconsin Division of Health investigated an outbreak of pertussis in residents of a nursing home in rural Wisconsin. Clinical information and nasopharyngeal swab and acute- and convalescent-phase serum specimens were obtained from all consenting residents and employees. Of 105 residents, 38 (36.2%) were seropositive, including four who were culture-positive for Bordetella pertussis. Culture-positive residents (age range, 52-81 years) had cough lasting 43-54 days. Three of these residents had paroxysmal cough, and all four had cough that interrupted sleep; none of the residents had cough with apnea or vomiting, and all recovered without sequelae. Of six seropositive residents with clinical pertussis, five lived on the south wing of the facility. Of 104 employees, 8 (7.7%) were seropositive, but none were culture-positive for B. pertussis. The higher attack rate for residents and the clustering of clinical cases were consistent with ongoing transmission within the nursing home.

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PubMed1991

The utilization of fecal occult blood testing in the institutionalized elderly.

OBJECTIVE: To examine physician use of stool guaiac testing in order to determine indications for testing, how the test was used, and the consequences of a particular test result. DESIGN: Retrospective case series. SETTING: Large midwestern inpatient nursing home facility. PATIENTS: All patients with positive fecal occult blood tests (FOBT) and one-third of patients with negative FOBT. RESULTS: In an 18-month period, 916 occult blood tests were performed on 339 patients (37% of the nursing home census). Patients over age 90 were as likely to receive FOBT as those under age 70. Fourteen percent of those tested had at least one positive test. Fifty-eight percent of the patients with positive tests underwent no additional diagnostic testing. No cause for the positive FOBT was found for 68% of patients receiving the test for routine screening. Physician estimates of how frequently they employed FOBT for these patients correlated very poorly with their actual practices (r = .17). CONCLUSION: There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.

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PubMed1991

Effect of a sensitive thyrotropin-stimulating hormone assay on dosing of L-thyroxine.

The Wisconsin Veterans Home has had a special interest in thyroid disease since 1986. Until recently, dosage adjustment of L-thyroxine in residents with primary hypothyroidism was accomplished by individual physicians guided by standard thyroid function tests. A shift to a sensitive thyrotropin-stimulating hormone (TSH) assay provided an opportunity to assess the frequency of sensitive TSH suppression secondary to excessive doses of L-thyroxine which would not be recognized by the standard TSH assay. We reviewed the charts of 46 residents who were not acutely ill and had been in the facility at least 6 months. Sensitive TSH was determined while on a stable dose of L-thyroxine for a minimum of 6 weeks. Six residents (13%) had low sensitive TSH levels indicating an excessive dose of L-thyroxine. The application of the sensitive TSH assay resulted in dose reduction.

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PubMed1990

Do the elderly sue physicians?

We reviewed malpractice data from the state of Wisconsin for 1983 and 1984 to determine the frequency and the outcome of malpractice litigation by the elderly. Research data were obtained from court dockets filed with Wisconsin's Patients Compensation Panel and from 281 attorneys who provided the age for 431 claimants. The results showed that 10.0% of malpractice suits in Wisconsin were filed by the elderly during the study years. When we compared the frequency of litigation with the use of the health care system (number of hospitalizations and inpatient days), the elderly were significantly less likely than younger persons to initiate malpractice litigation despite greater exposure to potential negligence. However, once a malpractice suit was filed, there was no significant difference between older and younger litigants in the disposition of the case or in the likelihood of being the prevailing party when a finding or award was made. These findings suggest that the elderly are less likely to file malpractice claims against health care providers than would be expected given their use of the health care system. This finding may be related to social, economic, and legal barriers to malpractice litigation by older adults.

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PubMed1989

Augmentation of influenza antibody response in elderly men by thymosin alpha one. A double-blind placebo-controlled clinical study.

Influenza remains a major cause of illness and death in elderly people despite current vaccination programs. One factor is an immunization failure rate in the elderly that may be as high as 50%. To test whether administration of thymosin alpha 1 would result in greater antibody production, we administered it (900 micrograms/m2 subcutaneously twice weekly for eight doses) in conjunction with the 1986 trivalent influenza vaccine. Ninety men (65-99 years old, mean age 77.3 years) were randomized double-blind to receive thymosin alpha 1 or placebo by the same schedule; the sera from 85 of these men were acceptable for analysis. The two groups were similar with respect to underlying disease, medications, and age. No toxicity was observed in either group. Antibody response rate was defined as a four-fold rise in antibody titer over 3-6 weeks following vaccination and was measured by an enzyme-linked immunosorbent assay (ELISA). Analysis was performed on treatment groups and subgroups divided by the mean age: the older group consisted of subjects aged 77 years and older, and the younger group those aged from 65-76 years. Baseline and change in absolute antibody levels were compared by t test and using age as a continuous variable by multiple regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1985

Curb those tubes.

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