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W Baigelman

Publications and source records attributed to W Baigelman.

At least 19 recordsLinked to original sources
PubMed1993

Sputum eosinophilia negates need to perform sputum Gram's stain.

A total of 1878 sputum specimens were evaluated to assess the potential of encountering a sputum Gram's stain with clinically useful positive data in the presence of sputum eosinophilia. Wet preparations were used to assess the adequacy of the specimen and to quantitate eosinophils. Quantitative sputum Gram's stains were performed. When more than 50% of the cells observed on sputum wet preparation were eosinophils, there were no positive Gram's stains. When more than 20% of the cells were eosinophils, there was a 1% prevalence of potentially clinically useful positive Gram's stains. The data strongly suggest that sputum eosinophilia obviates the need to perform a sputum Gram's stain since it is extremely unlikely that it would be useful in diagnosing a bacterial infection of the lower respiratory tract.

Bacterial Infections↗
PubMed1991

This OWL (outpatient work-up liaison) would not fly. Environmental factors foil attempt to shift unnecessary inpatient days to the outpatient setting.

The last days of many appropriate hospital admissions have been identified as unnecessary when utilized for providing diagnostic or therapeutic modalities that could be provided in an outpatient setting. An outpatient work-up liaison team (OWL) was established to facilitate the completion of evaluations or therapy in the community. In spite of the commitment of experienced personnel and the cooperation of the staff physicians and hospital departments, the effort was unsuccessful. The failure is attributed to the socioeconomic environment in the immediate community that could not support the transfer of medical efforts. It is recommended that before any institution undertakes shifting hospital-based services to the community a realistic assessment be made of the socioeconomic milieu.

Ambulatory Care↗
PubMed1991

Identifying physicians and patterns generating unnecessary in-hospital days. An exploratory stage of developing an institution-specific physician-focused utilization effort.

A focused, concurrent utilization review effort identified the existence of a large number of unnecessary hospital days remaining even after a highly successful utilization review effort. Within a group of physicians identified as having the highest acuteness adjusted average lengths of stay, 38.3% of their patient's hospital days were unnecessary, with 83% of those days being within physician control. Observation, diagnostic undertakings or therapeutic efforts that were unnecessary or appropriate for the outpatient setting represented 81.3% of the unnecessary days. A future utilization study will compare the practice patterns among physicians in the same department in order to define future goals and develop necessary corrective actions that will be acceptable to the medical staff.

Boston↗
PubMed1988

Comparison of efficiency of cardiologists and internists in managing patients with suspected myocardial chest pain.

The charts of 56 patients with chest pain who were admitted to the critical care units to rule out myocardial infarction were evaluated concurrently and retrospectively to compare the efficiency of cardiologists and internists. The number of unnecessary days used to rule out myocardial infarction, the number of unnecessary inhospital days used after ruling out myocardial infarction, the length of cardiac work-up, and the length of hospital stay were determined for 23 patients of cardiologists and 33 patients of internists. The cardiologists' patients had fewer unnecessary days after ruling out myocardial infarction (2.76 vs. 0.43 days, p less than .01) and a shorter length of hospital stay (5.15 vs. 2.91 days, p less than .02). We concluded that consideration should be given to increasing and refining the supplementary role of physician-experts to primary care physicians as one means of improved resource allocation.

Angina Pectoris↗
PubMed1987

Congenital bronchial atresia. A report of 4 cases and a review of the literature.

The clinical, radiographic, and pathologic findings in 82 patients with congenital bronchial atresia (CBA) have been reviewed, and we have discussed 4 additional cases. Most patients are asymptomatic and come to attention because of abnormal radiographic findings of a round or lobulated perihilar, solid, or cystic mass--the mucoid impaction sign. Typically, the region distal to the mass is hyperinflated. Recently, computed tomography has been shown to be diagnostic and its use obviates the need for other more complex imaging modalities or surgical exploration. Excisional surgery has been performed to preserve lung function in younger patients, because of lack of familiarity with the entity or, as in 2 of our cases, to prevent recurrent infections. Pathologic findings include a cystic, blindly terminating, mucus-filled bronchocele without connection to the main bronchial tree, but with normal subsequent generations of bronchi. Distally there is noncollapsible hyperinflation of the corresponding lung segment or lobe as the result of collateral ventilation from the surrounding lung. The anomaly is the result of an insult to the growing bronchial tree in early development. The differential diagnosis most often includes allergic bronchopulmonary aspergillosis, but cystic bronchiectasis, bronchogenic cysts, and intrapulmonary sequestration should also be considered. Unusual features in our 4 cases included recurrent pulmonary infections in 2 patients and thoracic cage asymmetry in 1.

Adult↗
PubMed1986

Bacteriologic assessment of the lower respiratory tract in intubated patients.

Twelve patients with an endotracheal tube and a new infiltrate were assessed for differences in the bacteriologic information that could be obtained by routine tracheal suctioning (RTS), a double-lumen protected-sheath brush passed through a flexible fiberoptic bronchoscope (B-FFB), and suctioning through a flexible fiberoptic bronchoscope (S-FEB). Gram stains and cultures were performed on all specimens. There was 100% agreement for the culture results obtained by RTS and S-FEB. It is concluded that RTS obtains comparable information to that obtained by the more expensive and more personnel-intensive B-FFB.

Bacteriological Techniques↗
PubMed1985

Overutilization of serum electrolyte determinations in critical care units. Savings may be more apparent than real but what is real is of increasing importance.

Electrolyte (E) utilization by medical and surgical house staff in the critical care units of a community teaching hospital was audited over a two-month period. One hundred forty-five patients involved in 708 patient days had 924 sets of electrolytes (SE). Of the 581 SE that were ordered as an additional set within 24 h, 10% were considered unnecessary and 65% could have had a single E substituted for the complete set. The conclusion of this study and literature review are: (1) Electrolytes are excessively ordered in the management of critical care patients. (2) When additional electrolyte data is required within 24 h, a single electrolyte will usually suffice. (3) Misutilization is equally prevalent among medical house staff and surgical house staff. (4) The cost savings to be realized from improved laboratory utilization are only a small percentage of the potential savings in charges. (5) No single, proven modality has been identified which will consistently, continually, and appropriately decrease laboratory overutilization.

Boston↗
PubMed1984

Relation of inspired oxygen fraction to hypoxemia in mechanically ventilated adults.

To evaluate the recommendation that all adult patients started on mechanical ventilation (MV) should have an initial fraction of inspired oxygen (FIO2) of 1.0, 207 consecutive adult patients started on MV in the critical care units were studied. The initial FIO2, the resultant PaO2, and the level of training of the physician ordering the initial ventilator settings were recorded for each patient. Patients treated with an initial FIO2 less than 1.0 had a PaO2 under 60 torr significantly more often than did patients treated with FIO2 of 1.0. Staff-level physicians tended to employ an initial FIO2 less than 1.0 more often than did physicians-in-training, and the latter had a 19% incidence of PaO2 less than 60 torr, while staff-level physicians had no PaO2 values less than 60 torr when using an initial FIO2 less than 1.0. It is concluded that all adult patients started on MV should receive an initial FIO2 of 1.0, especially when the physician ordering the initial FIO2 is a physician-in-training.

Blood Gas Analysis↗
PubMed1983

Patient readmission to critical care units during the same hospitalization at a community teaching hospital.

The incidence and cause of patient readmission, during the same hospitalization, to a critical care unit was studied in an urban community teaching hospital. During a 12-month period, there were 1069 admissions to the critical care units with 640 patients being at risk for readmission. The readmission rate was 11.7%. Prematurity of transfer out of a critical care unit may have been a contributing factor in 4.2% of the readmissions. Cardiac and respiratory problems were the major contributing causes for readmission. Improved communication between physicians, nurses and therapists could probably decrease premature transfers that contribute to readmission. Enhanced awareness of need for, and ability to provide aggressive pulmonary toilet may diminish the incidence of respiratory relapse. More data is needed regarding acceptable readmission rates; prospective studies are needed to better define the patient population at risk.

Heart Diseases↗
PubMed1983

Sputum and blood eosinophils during corticosteroid treatment of acute exacerbations of asthma.

Eleven patients with chronic bronchial asthma were studied during a noninfectious exacerbation. Each patient received 80 mg of prednisone daily for three days. Spirometric values, total blood eosinophil counts, and 24-hour quantitation of sputum eosinophils were studied. Three patients had total blood eosinophil counts of less than 250 at the time of presentation. Statistical comparisons with findings on Day 0 showed significant improvements for the one-second forced expiratory volume, total blood eosinophil count, and sputum eosinophil number. On Day 7, the one-second forced expiratory volume maintained a statistically significant difference from that on Day 0, but the total blood eosinophil count did not. Analysis of correlation coefficients showed significant relation between the total blood eosinophil count and one-second forced expiratory volume, the sputum eosinophil count and one-second forced expiratory volume, and the sputum eosinophil and total blood eosinophil counts. The conclusions are (1) blood eosinophilia is not an invariable feature of acute exacerbations of asthma; (2) numbers of blood and sputum eosinophils reflect the response of an acute exacerbation of asthma to corticosteroids; (3) sputum eosinophils may be more meaningful for monitoring the stable postcorticosteroid state; (4) there is no support for the belief that eosinophils disappear from the sputum of asthmatic patients with clinically effective doses of corticosteroids.

Acute Disease↗
PubMed1982

Occult mycetoma.

Explore the source record for details and available documents.

Adult↗
PubMed1981

Pulmonary effects of head trauma.

Knowledge of the interrelation of the central nervous system-respiratory axis is crucial to the management of patients with head injuries with or without concomitant pulmonary-thoracic problems. Damage to the central nervous system (CNS) can result in unexplained hypoxemia, noncardiac pulmonary edema, altered patterns of respiration, and an increased risk of aspiration. The damaged thorax and lung can contribute to brain ischemia and rises in intracranial pressure. The treatment of one end of the CNS-respiratory axis is not without effect on the other end of the continuum. Corticosteroids, diuretics, mannitol, iatrogenic hyperventilation, barbiturates, and vasopressors are used in the management of patients with head trauma, but may have an impact on oxygenation and ventilation. When positive end expiratory pressure is used in the management of a pulmonary process, it should be optimized and used with caution while monitoring for its effect on intracranial pressure. Pulmonary toilet, while remaining a necessity, must be performed in a manner so as to minimize potential negative effects on the brain. Hyperoxia and hypothermia should be avoided. Mechanical ventilation should be used as dictated by the desired PaCO2 and not as a mandatory adjunct to endotracheal intubation.

Adrenal Cortex Hormones↗
PubMed1977

Bronchodilator action of the anticholinergic drug, ipratropium bromide (Sch 1000), as an aerosol in chronic bronchitis and asthma.

Ipratropium bromide (also known as Sch 1000) is a new atropine-like bronchodilator drug whose mechanism of action is via an anticholinergic pathway and may decrease cyclic guanosine monophosphate. Although of established efficacy in asthma, there are no studies of the use of ipratropium in patients with chronic bronchitis. The single metered aerosol doses of 10 mug, 20 mug, 40 mug and 80 mug of ipratropium bromide, 75 mug and 150 mug of isoproterenol, and placebo were studied in 20 adult patients, half with asthma and half with chronic bronchitis. To qualify, all patients demonstrated at least 20% improvement in the forced expiratory volume in one second while in the drug-free state when tested with isoproterenol. All subjects were tested for six hours with each agent in a double-blind crossover design. The dose-response aspects of the study indicate that in bronchial asthma the optimal range of dosage is 40 mug to 80 mug of ipratropium bromide. These doses are superior to isoproterenol in duration of action. In chronic bronchitis, all doses of ipratropium showed prolonged efficacy, but 80 mug was superior. Isoproterenol lacked this sustained efficacy. No significant alteration in pulse or blood pressure was observed. Ipratropium appears to be an important addition to the bronchodilator agents used in isoproterenol-responsive obstructive pulmonary disease.

Aerosols↗