Biomedical subjects
Publications and source records attributed to S McGrath.
Agar dilution anaerobic susceptibility studies using rifampin, vancomycin, metronidazole, and bacitracin individually and in combination were performed with Clostridium difficile. Fifty-five strains of C. difficile were studied. Eighty-five percent of strains tested (29 of 34) were synergistically inhibited by the combination of bacitracin and rifampin (fractional inhibitory concentration, less than or equal to 0.50).
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Thrombocytopenia absent radius (TAR) syndrome, associated with small, echogenic kidneys and subsequent end-stage renal disease, was seen in a full-term newborn. In this infant, renal insufficiency may have increased the known risk of bleeding that is associated with TAR syndrome. Renal abnormalities and dysfunction are unusual in TAR syndrome. When they are present, however, treatment with frequent transfusions and early dialysis may be necessary to prevent serious and life-threatening hemorrhagic episodes.
The use of nurse practitioners and other non-physician health care professionals is a cost-effective means of providing health care services. Since NPs, PAs, CNMs and others provide services comparable to physicians, their use in ambulatory care settings can also significantly increase the availability and accessibility to health care services, especially to low-income individuals and those requiring services in areas of physician shortage. While current obstacles such as reimbursement policies, legislative restrictions and prescriptive authority limit the use and effectiveness of non-physician health care providers, more physicians, hospitals, clinics, HMOs and public health care systems will view their use as a means of containing escalating health care costs. To the patient this will mean an increase in the availability of comprehensive health care services and the prevention and early detection of medical problems through wellness care. A discussion is presented regarding the ways in which use of NPs and other non-physician professionals can reduce costs and increase the quality and availability of health care services.
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BACKGROUND: There has been recent concern about long-term morbidity associated with arthroscopic co-planing of the acromioclavicular joint in the treatment of impingement syndrome. OBJECTIVE: The purpose of this study was to assess the results of the co-planing procedure, special attention being paid to acromioclavicular joint morbidity. METHODS: The study included 56 patients who were operated on by the senior author. Outcomes were evaluated both objectively and subjectively through physical examinations and telephone surveying. Each patient had subacromial decompression at the time of the index surgery. Other concomitant arthroscopic procedures included rotator cuff repair and labral debridement or repair. RESULTS: Average follow-up was 4 years (range, 2-7 years). Thirty-five (95%) of 37 patients had no subjective pain and no objective tenderness to direct palpation or compression of the acromioclavicular joint. The joint was not clinically hypermobile in comparison with that on the opposite side in any patient. In all, 95% of patients had good or excellent results in terms of the University of California at Los Angeles Shoulder Score. Of the 2 patients who did have pain and tenderness at the acromioclavicular joint, both had had multiple operations on their shoulders before the index procedure. Nineteen patients were not examined clinically but did complete a telephone survey; these 19 patients were not symptomatic at the acromioclavicular joint. CONCLUSIONS: To fully treat impingement syndrome, the surgeon should remove osteophytes under the lateral clavicle and medial acromion. With good technique, the surgeon can leave the anterior, posterior, and superior acromioclavicular joint capsule intact. We conclude that for appropriate clinical indications, beveling the inferior 20% to 25% of the clavicle to make it co-planar with the decompressed acromion is safe and is not an etiologic factor in acromioclavicular joint pain or instability.