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Biomedical subjects

W W Stead

Publications and source records attributed to W W Stead.

At least 73 records · Page 4Linked to original sources
PubMed1989

Special problems in tuberculosis. Tuberculosis in the elderly and in residents of nursing homes, correctional facilities, long-term care hospitals, mental hospitals, shelters for the homeless, and jails.

Now that tuberculosis is well controlled in most segments of our society, it is all too often forgotten as a disease that still plagues its less fortunate members. Thus, it may break out wherever persons are housed together for extended periods: for example, naval vessels (not discussed herein), nursing homes, prisons, jails, mental hospitals, chronic disease hospitals, juvenile detention facilities, and shelters for the homeless. It is the responsibility of the authorities operating any such facility to take the necessary precautions to prevent spread of tuberculous infection. This requires more than just keeping the facility clean; it requires the use of some technology--in this instance, in the form of performing tuberculin testing, taking chest radiographs of those who react positively, and treating appropriately those who are infected, whether they are already diseased or merely infected. It should not be forgotten that tuberculosis in any segment of the population endangers all citizens. If this disease is to be eliminated in America, special attention must be given to the segments of society in which both prevalence of infection and incidence of tuberculosis are still high. Probably the most efficient way to stop the spread of infection is through better control of the infection in institutions such as those described in this article.

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PubMed1989

Tuberculosis in the elderly.

During the past 25 years, the age distribution of tuberculosis (TB) in the United States has shifted remarkably from younger age to the later decades, ie, in persons over 70 years of age. Elderly persons, although infected many years ago, exhibit a positive tuberculin reaction in only 20% to 25% upon entry into nursing homes. Among members of this infected elderly population, case rates as high as 500 to 1,000 per 100,000 population are found. Endogenous breakdown of older lesions is the common mechanism for the development of the disease. Of the remaining 70% to 80% tuberculin-negative population, 10% are immunoincompetent and die soon upon entry into the nursing home. The remaining 90% of the nonreactors who survive are again susceptible to new infection. The point prevalence of positive tuberculin reactors approximately doubles after more than a 6 months stay at the nursing home. This inadvertent exposure usually occurs in the nursing home due to reactivation of old lesions among old reactors. Although 5% of persons over 65 years of age live in nursing homes, they account for 20% of TB cases. This gives a rate four times greater than the rate among the elderly living at home, or twelve times greater than in persons 40 to 60 years of age. In Arkansas, more than 53% of active cases occurred in persons over 65 years of age, who account for only 14% of the population. Diagnosis of TB in the elderly may be considerably delayed or even totally missed.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1989

Treatment of extrapulmonary tuberculosis.

The duration of therapy for pulmonary tuberculosis (TB) is now shortened to 6 or 9 months with the use of bactericidal drugs. There are few reports on the results of short course chemotherapy (SCC) in extrapulmonary tuberculosis (EP). It is unlikely that many controlled studies shall be forthcoming in the future because of involvement of many sites with the disease, each of which has special problems. However, available controlled studies and clinical experiences in EP indicate early success. The site of the disease appears to be less important since the bacterial population is much smaller in EP than in TB and is easily amenable to the bactericidal drugs. Present bactericidal drugs (isoniazid [INH], rifampin [RIF], pyrazinamide [PZA]) penetrate well into tissues and attain bactericidal levels to kill the organisms. Our experience with 9-month SCC consisting of INH 300 mg and RIF 600 mg daily for one month, followed by INH 900 mg and RIF 600 mg twice weekly for another 8 months in 478 cases of EP showed overall success in over 95% of those patients who completed therapy over a median follow-up of 42 months. The drugs may be given daily throughout with the same success. Thus, 9-month therapy with INH and RIF is highly effective in EP due to drug sensitive organisms. In TB, the duration may be shortened to 6-months with initial intensive four-drug therapy consisting of INH, RIF, PZA and streptomycin (SM) or ethambutol (EMB) daily for 2 months, followed by INH and RIF daily or twice weekly for another 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Information management through integration of distributed resources.

Duke University Medical Center conducted a strategic planning process focused on information management needs beginning in 1983 and ending in 1985. That effort concluded that the institution was ready to establish an Integrated Academic Information Management System (IAIMS). A model was proposed in which information management was to be achieved through integrated distributed resources. The elements of the IAIMS model are ongoing policy development and planning; communications; an electronic library or resource inventory; coordination of the development or selection of the end-user function; user support; and ongoing evaluation. This model is being tested to determine its effectiveness in meeting the administrative, patient care, research, and educational needs of a basic science department and a clinical science department at Duke University.

Academic Medical Centers↗
PubMed1987

The significance of the tuberculin skin test in elderly persons.

Study of 49,467 persons over age 50 in Arkansas nursing homes afforded insight into the significance of the tuberculin skin test in the elderly. Whereas only 15% to 20% of persons showed a significant (10 mm or more) reaction to tuberculin on admission, 2% to 3% of these developed tuberculosis. Persons having no reactions comprised two subsets: a small group who died at an increased rate and were probably anergic, and a larger group who survived as well as persons who had reactions. Minor increases in reaction size with repeated testing appeared to be due to immunologic recall. However, conversions of 12 mm or more from a documented negative result indicated spread of infection. When not treated preventively, 7.6% (women) to 12.7% (men) of definite converters developed tuberculosis. The increase in number of persons showing positive reactions after entry may have been due to rapid demise of the anergic subset, improvement in nutrition of survivors, or unsuspected spread of tuberculous infection.

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PubMed1987

Benefit-risk considerations in preventive treatment for tuberculosis in elderly persons.

Of 2135 elderly residents of nursing homes in Arkansas (mean age, 79.4 years) who have been treated with isoniazid for prevention of tuberculosis, data from 1935 were suitable for analysis. About 12 months of therapy was successfully completed in 1600 persons. Therapy could not be completed in 84 persons (4.4%) because of incipient hepatic toxicity and in 116 (6.0%) because of other types of drug intolerance. Although 135 persons (7.0%) died during the course of therapy, no evidence was found that isoniazid contributed to any death. The ratio of benefit (reduction of risk for tuberculosis) to risk (for nonfatal isoniazid-related hepatitis) was clearly favorable in persons who had definite conversions (1.6 for women, 3.4 for men) but less so for persons who had tuberculin reactions of unknown duration and for persons with minor increases in size of tuberculin reaction (less than 12 mm increase from an initially negative reaction).

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PubMed1986

Short-course chemotherapy for pleural tuberculosis. Nine years' experience in routine treatment service.

Short-course chemotherapy (SCC) for pulmonary tuberculosis for nine months with isoniazid (INH) and rifampin (RIF) is well established. However, there is still no report on results of such therapy in pleural disease. From January 1976 through December 1984, we treated 201 patients (average age 61.6 years) for pleural tuberculosis, 143 with SCC for nine months of mainly INH and RIF and 58 with conventional therapy (CT) for 18 to 24 months. Findings indicated that SCC with INH and RIF was as effective as in pulmonary tuberculosis. The results were equivalent or even better than CT given for prolonged periods.

Adolescent↗
PubMed1986

Short-course chemotherapy for extrapulmonary tuberculosis. Nine years' experience.

Short-course chemotherapy with isoniazid and rifampin is well established for pulmonary tuberculosis but not yet for extrapulmonary disease. We report our 9-year experience with short-course chemotherapy in treating 350 patients; 402 extrapulmonary sites were involved. Therapy was largely self-administered with careful monitoring by local public health nurses. Administration of drugs was directly supervised in less than 2% of patients. Short-course chemotherapy with isoniazid and rifampin for 9 months was successful in 95% of patients, equivalent to conventional therapy with two to three drugs for 18 to 24 months. It was found that early drainage and complete debridement of necrotic material in bone lesions enhances healing. Short-course chemotherapy has excellent patient acceptance, short duration, fewer doses, and modest toxicity. Our largely twice-weekly regimen has the additional advantages of reduced cost, fewer doses, and ease of supervision when needed.

Adolescent↗
PubMed1985

Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes.

We studied reactivity to tuberculin skin testing in nearly all nursing home residents in Arkansas. Only 12 per cent of the 12,196 newly admitted residents were tuberculin positive, as compared with 20.8 per cent of the 13,441 residents who were first tested more than a month (mean, 30 months) after admission. The proportion of persons who were positive on initial testing varied greatly with the time spent in the home before testing. Those who were not reactive on initial testing had a 5 per cent rate of conversion for each year spent in a home with a known recent infectious case (within three years) and a 3.5 per cent rate for each year in a home with no recognized recent case. Active tuberculosis developed in only 1 of 534 persons with positive tuberculin tests or previous reactions who were treated with isoniazid, but in 79 (2.4 per cent) of 3270 persons who were not (P less than 0.001). The disease developed in only 1 (0.16 per cent) of 605 persons whose tests converted to positive and who were treated with isoniazid, as compared with 45 (5.9 per cent) of 757 whose tests converted but who were not treated (P less than 0.001). We conclude that new infection with tuberculosis is an important risk for nursing home patients and that greater care should be taken to detect and treat new infections before the disease develops and the infection spreads.

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PubMed1985

Epidemic tuberculosis in a nursing home: a retrospective cohort study.

In a retrospective study, the results of tuberculin skin tests done in a nursing home were examined, where most residents admitted during 1972-1981 were tested using purified protein derivative of tuberculin administered intradermally. Of 514 residents who were tested at least once during the study period, results of the admission skin test were available for 254 and follow-up skin test results were available for 226. On admission, 13 per cent (35/254) were skin-test positive (greater than or equal to 10 mm induration at 48 hours). Skin test positivity for males was 16 per cent, females, 11 per cent, nonwhites, 19 per cent, and whites, 12 per cent. Highest skin test positivity was for persons received as transfers from other nursing homes (24 per cent) and lowest was for those entering from individual homes (8 per cent, P = 0.016, Fisher's Exact Test). On follow-up, 38/226 (17 per cent) residents who had been tuberculin-negative on at least two previous occasions were found to be positive; 24 (63 per cent) of these conversions occurred in a single year (1975) following detection of an infectious patient. The infection rate for persons residing in the nursing home during that year was 28 per cent (28/99) compared with 7.9 per cent (10/127) for persons either discharged before or admitted after 1975 (relative risk = 3.6, P less than 0.001). Ten to 15 per cent of new residents are tuberculin-positive (harbour a dormant tuberculous infection), leaving 85-90 per cent of newly admitted persons who are tuberculin-negative and thus susceptible to infection if exposed. The study shows that tuberculosis must be considered as a potential nosocomial infection in nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Tuberculosis chemotherapy today.

Effective chemotherapy of tuberculosis not only reduces morbidity and mortality, but it is a powerful mechanism to control further spread of infection. Although conventional therapy for 18-24 months is highly effective, a major disadvantage is non-compliance of patients in completing the full course of therapy. With better understanding of bacteriologic action of many antituberculous drugs, the disease can now be cured in six to nine months of bactericidal chemotherapy. Isoniazid and rifampin for nine months, either given daily throughout or initially for one month followed by twice weekly administration for another eight months, is highly effective for cure of the disease. However, this is not recommended for patients in developing countries due to high frequency of initial isoniazid resistance. Bactericidal therapy with four drugs (streptomycin or ethambutol (25 mg/kg), isoniazid, rifampin and pyrazinamide) daily for two months followed by isoniazid and rifampin daily or twice weekly for another four months is very effective. In suspected or proved isoniazid resistance, the therapy has also proven effective. However, therapy may also be changed during the continuation phase to streptomycin, rifampin and pyrazinamide daily or twice weekly for another four to six months. The treatment of extrapulmonary tuberculosis, alone or when associated with other medical disorders, is the same as for pulmonary tuberculosis. There are several short course regimens available for use in developing countries while keeping in consideration the shortage of major drugs and financial constraints. Modern short course chemotherapy has the potential advantage of success in developing countries by increasing the population of patients completing therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitubercular Agents↗