Biomedical subjects
Publications and source records attributed to P English.
Although directional coronary atherectomy permits the treatment of complex coronary lesions, its use is limited in patients with peripheral vascular disease by the need to use a large guiding catheter. We describe a patient in whom the right brachial approach was successfully used to perform atherectomy of a semi-protected left main coronary stenosis.
A patient education program, based on the health belief model, promoting child passenger safety was developed and implemented at a health maintenance organization. The program included individual counseling by pediatricians, use of audiovisual materials and pamphlets, and (for newborn infants) a home visit by a child safety specialist. Based on parking lot observations, child safety device use increased to greater than 60% in both intervention and comparison-group children 1-4 years of age. During the child health supervision visit, pediatricians can play a leadership role in promoting child passenger safety.
A cohort of 2915 HIV-1-seronegative men from the four centers of the Multicenter AIDS Cohort Study (MACS) was followed at 6 month intervals for 24 months to identify men who developed antibodies to HIV-1. Two hundred thirty-two men (8%) seroconverted. The highest attack rate was among men who reported practicing both receptive and insertive anal-genital intercourse. The attack rate among men who reported practicing receptive but not insertive intercourse was 3.6 times higher than among men practicing insertive intercourse although those practicing insertive only reported 38% more different partners. Only two men seroconverted who reported not practicing analgenital intercourse in the 12 month prior to the first antibody-positive visit. Because men were followed every 6 months, one of these men could have been infected within 6 months of the actual development of HIV-1 antibodies. The seroconversion rate was significantly lower among men who reported using condoms with all their partners. The results of this study (a) reaffirm that receptive anal-genital intercourse is the major route of infection among homosexual men of HIV-1, (b) suggest that there is a low risk of HIV-1 infection to the insertive partner in anal-genital intercourse, (c) suggest that infection may rarely occur through sexual activities other than anal-genital intercourse, (d) provide evidence that condoms as currently used by men in the MACS provide significant but not complete protection against HIV-1 infection, and (e) suggest that the number of men in the homosexual community engaging in high-risk behavior is declining.
Tween 80 was shown to enhance significantly the cytotoxic activities of the four drugs (adriamycin, epodyl, mitomycin-c, thiotepa) most frequently administered intravesically to treat superficial bladder cancer. The colony forming ability of a human bladder cancer cell line, RT112, was measured following a 1 h exposure to each of the four drugs both alone and in combination with 0.1% and 0.3% Tween 80. Cell survival was not reduced by 0.1% Tween 80 alone. We conclude that the combination of Tween 80 with these drugs might increase the therapeutic index of intravesical chemotherapy.
Forty-six patients, 28 females and 18 males, underwent periurethral or perurethral Teflon injection. The results in females were satisfactory, especially where resting anatomy was normal. Male results were disappointing, no patients with post-prostatectomy stress incontinence being cured.
An educational curriculum entitled "Bucklebear" was designed to increase safety seat and seat belt use in young children enrolled in preschool programs (day care centers and nursery schools). Three basic concepts were emphasized: (1) "buckling up" is a good habit for everyone for every ride; (2) the back seat is the best seat; and (3) there are desirable passenger behaviors. The curriculum included training workshops with teachers, parent meetings, classroom lessons, sound filmstrip, puppet play, and many other activities. Six experimental programs and seven control programs with 402 and 427 enrolled children, respectively, participated. After their participation in the educational curriculum, children in the experimental program increased their use of a safety seat or seat belt from 21.9% to 44.3%. These children also increased their knowledge and simulated practice of car passenger safety.
Data from its first four operating years indicate that the Sepulveda VA Geriatric Evaluation Unit is having consistent beneficial effects on patient care. These benefits include improved diagnostic accuracy, reduced use of drugs, improved functional status, and improved placement location. However, not all patients benefit equally, and differences between patient responses highlight the need to select those who will benefit most from relatively costly Geriatric Evaluation Unit services. Discriminant and regression analyses were performed on 98 consecutive patients to determine which patients admitted to the Geriatric Evaluation Unit would show greatest improvement in terms of placement, functional status, one-year survival, and living location, and which patients would be treated most efficiently in terms of length of stay. Patient characteristics on admission significantly associated with discharge home included a relatively high functional and cognitive status, the absence of an unstable medical problem, and not being expected to need nursing home placement by the referring physician. The latter two factors alone predicted actual placement location on the next 101 patients admitted to the Geriatric Evaluation Unit with high predictive accuracy (88.5 per cent). Factors predictive of patients whose functional status would improve on the Geriatric Evaluation Unit included absence of an unstable medical problem and being over 75 years old (predictive accuracy was 82.5 per cent). Two major factors associated with long patient stays on the Geriatric Evaluation Unit were low functional status scores and not living in own home or with family. These analyses indicate criteria that may be useful in selecting patients for inpatient geriatric evaluation and rehabilitation programs.
Twenty-two patients with hemophilia A were successfully treated for fractures and dislocations without complication in the last 10 years, with the aid of recently developed methods of maintaining hemostasis, and conventional methods of reduction and immobilization. Most injuries were managed "conservatively," but 4 patients had operations. All the injuries healed in average time. A factor VIII level of 30% was maintained for the first 2 to 4 days for stable fractures and for 5 to 7 days for unstable fractures, but patients requiring operations were covered to a level of 60% for 2 weeks. Factor VIII concentrates were not given to 2 patients with inhibitors. Excessive bleeding occurred in one of the patients with inhibitors and in another in whom replacement therapy was delayed, but bleeding was not a problem in the remaining patients.
BACKGROUND: To examine the potential benefits of routine nurse home visiting after early discharge, we compared health service use among low-risk newborns with and without a nurse home visit and telephone follow-up after short hospital stays. METHODS: Records of newborns discharged routinely before (n = 83) and after (n = 91) implementation of a universal postpartum home visiting program were reviewed retrospectively. Acute care visits, rehospitalizations, and well-baby visits for newborns up to 74 days of age were compared between the groups. RESULTS: Acute care visits, rehospitalizations, and missed well-baby visits consistently appeared less likely among newborns receiving home visiting services, in both unadjusted and adjusted analyses. Adjusting for insurance, parity, and breast-feeding, a twofold reduction in acute care visits by 14 days was significant. Although not statistically significant, adjusted analyses of acute care and missed well-baby visits revealed apparently similar patterns at all time intervals. There were too few rehospitalizations for multivariate analysis. CONCLUSIONS: Despite the limitations of this small retrospective study, the consistency of the findings suggests potentially important benefits of home visiting services after early discharge of low-risk newborns, with substantial implications for clinical and reimbursement policy. Effects could be greater with more vulnerable populations and shorter stays than those in this study.