Use of PRISM scores in triage of pediatric patients with diabetic ketoacidosis.
Triage guidelines are needed to help in the decision process of intensive care unit (ICU) versus non-ICU admission for patients with diabetic ketoacidosis (DKA). Pediatric risk of mortality (PRISM) scores have long been used to assess mortality risk. This study assess the usefulness of the traditional PRISM score and adaptation of that score (PRISM-ED, which uses presentation data only) in predicting hospital stay in pediatric patients with DKA. PRISM and PRISM-ED were tested for correlation with length of stay and length of ICU stay. A medical record review was conducted for patients admitted to The Children's Hospital of Alabama with DKA during an 18-month period (n = 79). Two scores were calculated for each study entrant: PRISM using the worst recorded values over the first 24 hours and PRISM-ED using arrival values. Median scores, median test, and Spearman rank correlations were determined for both tests. Median PRISM scores were PRISM = 11 and PRISM-ED = 12; Median PRISM and PRISM-ED scores for patients admitted to the ICU were less than median scores among floor-admitted patients: [table: see text] Spearman rank correlations were significant for both scores versus total stay: PRISM, rs = 0.29; P = 0.009; PRISM-ED, rs = 0.60, P < 0.001. Also, correlations were significant for both scores versus ICU stay: PRISM rs = 0.22, P = 0.05; PRISM-ED, rs = 0.41, P < 0.001. Triage guidelines for ICU versus floor admission for DKA patients could have significant economic impact (mean ICU charge = $11,417; mean charge for floor admission = $4,447). PRISM scores may be an important variable to include in a multiple regression model used to predict the need for ICU monitoring. (+info)
Diabetes and automobile crashes in the elderly. A population-based case-control study.
OBJECTIVE: The aim of this study was to estimate the association between diabetes and its complications and at-fault automobile crashes among older drivers. RESEARCH DESIGN AND METHODS: This was a population-based case-control study. Case subjects were drivers aged > or = 65 years who had been involved in a crash during 1996 in which they were at fault. Two control groups were selected: 1) crash-involved not-at-fault subjects and 2) non-crash-involved subjects. Telephone interviewers collected information on demographic characteristics, driving habits, diabetes sequelae and treatment, other chronic medical conditions, and visual function. RESULTS: Overall, there was no association between diabetes and at-fault crash involvement. The adjusted odds ratio (OR) for diabetes was 1.1 (CI 0.7-1.9) when case subjects were compared with either control group. However, the adjusted OR for diabetes was 2.5 (0.9-7.2) among subjects who had been involved in a crash in the 4 years preceding 1996, while it was only 0.9 (0.5-1.7) among those who had not. There was no evidence of an association between treatment modalities and at-fault crash involvement. Case subjects were, although not significantly (P = 0.25), more likely (OR 2.4) to report neuropathy compared with both control groups, and retinopathy was not associated with increased crash risk. CONCLUSIONS: This study provides no evidence that older drivers with diabetes are at increased risk for automobile crashes. There remains the possibility that those with diabetes who have more severe disease or have had multiple crashes are at increased risk. (+info)
Application of data mining to intensive care unit microbiologic data.
We describe refinements to and new experimental applications of the Data Mining Surveillance System (DMSS), which uses a large electronic health-care database for monitoring emerging infections and antimicrobial resistance. For example, information from DMSS can indicate potentially important shifts in infection and antimicrobial resistance patterns in the intensive care units of a single health-care facility. (+info)
Comparison of the PACE 2 assay, two amplification assays, and Clearview EIA for detection of Chlamydia trachomatis in female endocervical and urine specimens.
Screening for sexually transmitted diseases (STDs) in a greater proportion of sexually active patients has become an accepted protocol by most health care providers. The purpose of this study was to compare the current test methods for detection of Chlamydia trachomatis used at the University of South Alabama, the PACE 2 assay (Gen-Probe) and the Clearview EIA (Wampole Laboratories), with two amplification technologies, the AMP CT (Gen-Probe) and LCx (Abbott) assays. In addition, a number of demographic parameters were ascertained by asking questions at the time of examination as well as for health care provider concerns and preferences. One urine and four endocervical swab specimens were collected in random order from 787 female patients attending one of four obstetrics-gynecology clinics. Eighty-seven percent of patients had no STD-related symptoms. Patients were considered positive for C. trachomatis if three or more assays (swab and/or urine) were positive. Abbott and Gen-Probe confirmed discrepant results by alternate amplified assays. A total of 66 true-positive specimens were detected by use of the combination of endocervical swabs and urine specimens. After discrepant analysis, sensitivities for endocervical swab specimens for the EIA and the PACE 2, LCx, and AMP CT assays were 50, 81, 97, and 100%, respectively. Sensitivities for the LCx and AMP CT assays with urine specimens were 98 and 81%, respectively. The prevalence of C. trachomatis was 8.4%, as determined by amplification technology. Overall, the amplification technologies were the most sensitive methods with either swab (AMP CT assay) or urine (LCx assay) specimens. The PACE 2 assay offered the advantage of a simpler and less expensive assay with acceptable sensitivity. The clearview CT EIA, while yielding a rapid in-office result, had unacceptably low sensitivity. The wide variation in performance with amplification assays with urine specimens as reported in both this study and the literature obviates the need to clarify optimal parameters for this specimen type. (+info)
The Women's Health Trial Feasibility Study in Minority Populations: changes in dietary intakes.
This randomized clinical trial examined the feasibility of low-fat dietary interventions among postmenopausal women of diverse backgrounds. During 1992-1994, 2,208 women aged 50-79 years, 28% of whom were black and 16% Hispanic, enrolled at clinics in Atlanta, Georgia, Birmingham, Alabama, and Miami, Florida. Intervention/support groups met periodically with a nutritionist to reduce fat intake to 20% of energy and to make other diet modifications. At 6 months postrandomization, the intervention group reduced fat intake from 39.7% of energy at baseline to 26.4%, a reduction of 13.3% of energy, compared with 2.3% among controls. Saturated fatty acid and cholesterol intakes were reduced, but intakes of fruits and vegetables, but not grain products, increased. Similar effects were observed at 12 and 18 months. Black and non-Hispanic white women had similar levels of reduction in fat, but the decrease in Hispanic women was less. Changes did not vary significantly by education. While bias in self-reported intakes may have resulted in somewhat overestimated changes in fat intake, the reported reduction was similar to the approximately 10% of energy decrease found in most trials and suggests that large changes in fat consumption can be attained in diverse study populations and in many subgroups. (+info)
High prevalence of chlamydial and gonococcal infection in women entering jails and juvenile detention centers--Chicago, Birmingham, and San Francisco, 1998.
The prevalence of sexually transmitted diseases (STDs) is high among women entering corrections facilities. Screening for STDs in these facilities, however, is difficult because of the large number of persons admitted each day and the frequent shortage of medical staff and examination space. New, sensitive urine tests for gonorrhea and chlamydia have made screening practical outside of medical settings. To assess the feasibility of screening women in corrections facilities for chlamydial and gonococcal infection using urine tests and to determine the prevalences of these infections, the Chicago Department of Public Health and the University of Alabama at Birmingham (UAB) began testing women and adolescent females entering the Cook County Jail and the Cook County Juvenile Temporary Detention Center in Chicago and the Jefferson County Jail and the Jefferson County Youth Detention Center in Birmingham, respectively, in 1998. The San Francisco Department of Public Health has been testing women at the San Francisco County jails for chlamydial and gonococcal infections using urine tests since 1996 and adolescent females at the San Francisco Youth Guidance Center since 1997. This report summarizes the findings for testing incarcerated women in 1998 in the three cities; preliminary results indicate that, in these facilities, testing for chlamydial and gonococcal infections is feasible and that a high percentage of women test positive for these infections. (+info)
Medcast: evaluation of an intelligent pull technology to support the information needs of physicians.
This study reports the initial results of an evaluation of Medcast, a commercial medical information service that uses intelligent pull technology to deliver medical information to practicing physicians. Medical news, CME, and other information are transferred by modem nightly to the physician's computers where this information can be accessed at a convenient time. A survey was faxed to 195 subscribers to the system. A total of 73 (39%) responded. The results indicate that prior to implementation of the Medcast system, almost 40 percent of the respondents did not use their computers for professional activities because of time constraints, costs and computer literacy problems. After implementation of Medcast, almost 70 percent of the respondents used the system two or more hours per week. Ninety percent of the respondents felt that use of the system has enhanced their practice. These findings have important implications for future efforts to implement medical informatics applications to support the information needs of practicing physicians. Experience with intelligent pull technology that is relatively easy to use may be a good way to break down attitudes and barriers to the use of computer systems to support clinical practice and may prepare physicians for a wider use of the Internet to support their future information needs. (+info)
Teaching international animal agriculture.
Students who major in animal science at U.S. institutions are generally exposed to a curriculum that emphasizes commercial, large-scale production of the few traditional food animals: cattle, poultry, sheep, and swine. Globally, most farmers live in lesser-developed countries under limited-resource conditions of land, feed supplies, equipment, and capital. The promotion of commercial animal production enterprises may not be appropriate for such farms because it can subject farmers to considerable economic risk. Rather, use of limited numbers of large livestock, locally adapted breeds, or smaller livestock (e.g., ducks, goats, guinea pigs, and rabbits) may be more appropriate under subsistence, integrated farming systems. In this global context, a course in international animal agriculture has been taught for 15 yr to undergraduate and graduate students. The course consists of a review of traditional and potential livestock species well suited for impoverished families on small farms and methods to implement sustainable livestock projects, including feasibility, design, implementation, monitoring, and evaluation stages. To enhance student understanding, global food issues and challenges are illustrated with case studies. A term paper is also assigned for which students choose three suitable livestock species or local breeds that would be complementary on a small crop farm (< 5 ha). Daily dietary requirements of protein and energy per family member are calculated. Itemized enterprise budgets and production tables are prepared. Early in the course, the general consensus of students was that people who are malnourished and live in poverty have low personal ambition and motivation, and that their problems should be amenable to solution by application of American technology and expertise. The course modifies such attitudes and enhances a student's critical thinking and problem-solving abilities and communication skills. Course evaluations indicated that students believed that it is important to acquire some international knowledge and understanding when seeking a job, and that certain animal science courses should contain some international content. Students gain an understanding of global animal agriculture and an appreciation of the complexity of food production and hunger issues. (+info)