Search

A telephone survey used to examine the percentage of compliance with social and safety recommendations in an outpatient comprehensive geriatric assessment program revealed increased compliance among patients with functional impairment. Compliance was higher in easy applicable recommendations. Recommendations associated with home safety measures were not properly implemented.

The most frequent cause of death among patients infected with HIV (human immunodeficiency virus, the agent associated with AIDS) is Pneumocystis carinii pneumonia (PCP). Although certain drugs prevent this disease in some AIDS patients and individuals whose immune systems are compromised by other disorders, HIV-infected people cannot tolerate these medications on a long-term basis. An agent that shows promise in this regard is aerosolized pentamidine; a report of a controlled, randomized trial of this drug is presented. Three dosages of aerosolized pentamidine (30 milligrams every two weeks, 150 milligrams every two weeks, or 300 milligrams every four weeks) were administered to 408 patients at 12 treatment centers in the San Francisco Bay area. The majority of patients (237) had one prior episode of PCP; other groups included patients with Kaposi's sarcoma (an AIDS-related condition) who had never had PCP (55), and patients with AIDS or AIDS-related complex who had never had PCP or Kaposi's sarcoma (116). Patients were followed from their first treatment on or near July 1, 1987 until their death or December 31, 1988. The results revealed that the number of PCP episodes was lowest for patients who received the 300 milligram dose of aerosolized pentamidine (8 episodes), and that this number differed significantly from the number of PCP episodes among patients who were given the 30 milligram dose (22 episodes). Although the difference between the 150 milligram and 300 milligram doses was not significant, the lower dose was less effective when compared with the 30 milligram dose of aerosolized pentamidine. Patients who began the study within three months of a previous episode of PCP had less chance of having another episode than those who started later. Participants who had never taken zidovudine (a drug for treating AIDS) had higher mortality than those who had taken it, and zidovudine itself had an independent preventive effect on PCP. Those with a previous history of PCP and CD4 cell counts (a type of T cell) below 200 per cubic millimeter had the highest risk of contracting PCP again. Overall, aerosolized pentamidine at certain doses was an effective prophylactic treatment for preventing PCP in high-risk HIV-infected people. The most effective therapeutic regimen included zidovudine. (Consumer Summary produced by Reliance Medical Information, Inc.)

The increase in new cases of AIDS (acquired immunodeficiency syndrome) has become a primary focus of concern for public health services in this country. Methods for reliably predicting new cases are needed to anticipate the medical care that will be required for these patients. A predictive model for AIDS has been developed using annual rates of human immunodeficiency virus (HIV) seroconversion (detection of HIV antibodies in the blood) for homosexual and bisexual men and for heterosexual intravenous drug users. Estimates were made using the size of the high risk population and the duration of HIV infection to predict morbidity in San Francisco, CA through June of 1993. The incubation period for the development of AIDS in those who were HIV-positive was ascertained and used as a key parameter; the course of AIDS is known to depend upon the length of infection. Mortality was predicted by using Kaplan-Meier estimates of survival time after initial diagnosis and the projected number of new cases. Data were collected beginning in 1978; the future effects of antiviral therapies, which most likely will be forthcoming, or of earlier treatments on survival rates were not factored into these figures. The median incubation period for AIDS was estimated to be 11.0 years. Based on this model, the number of new AIDS cases in San Francisco by 1993 is expected to be between 12,349 and 17,022, with between 9,966 and 12,767 cumulative deaths. Since 1983, a decline in seroconversion rates has occurred among the San Francisco population of homosexual and bisexual men. Conversely, the number of seroconversions for heterosexual intravenous drug users is expected to increase by about three percent annually through 1993. (Consumer Summary produced by Reliance Medical Information, Inc.)

The Guidant Corporation created an independent panel in 2005 to conduct an unbiased investigation into incidents of fatal malfunctions of its implantable defibrillators including the methods used to identify the malfunctions. A discussion on the panel's findings and its recommendations for corrective actions is presented.

Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (<2500 grams), high birth weight (>4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% conidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed. [ABSTRACT FROM AUTHOR]