Abdelmonem A. Afifi

Quantitation of severity of critical illness with special reference to blood lactate.

A total of 410 critically ill patients in critical care units of six community hospitals were surveyed for a period of 31 days. A prognostic index of survival was derived by discriminant function analysis utilizing measurement of blood lactate, blood pressure, heart rate, arrhythmias, spontaneous respiration, urine volume, body temperature, age, and a five-point rating of clinical condition by the nursing staff. The case fatality rate in patients in whom blood lactate exceeded 2.7 mM was 50% fatality rate was 5% when lactate was less than 2.7 mM. The best prediction of survival was obtained by combining the plasma lactate and the five-point rating of the patients condition. These data therefore could serve as a measure of the severity of illness at the time of admission and provide a quantitative guide for objective comparison of the effectiveness with which critical care services are delivered in acute care units. They can also provide an objective basis for priority assignment to cardiac care, intensive care, and other specialized units of the hospital

Occupational electric and magnetic field exposure and brain cancer: a meta-analysis.

We conducted a meta-analysis to acquire an understanding of the association between central nervous system cancer and occupational exposure to electric and magnetic fields. To explore sources of heterogeneity, study characteristics were scored and examined using regression analysis. An inverse-variance weighted pooling leads to a small overall increase in relative risk (10 to 20%) for the broad group of electrical occupations. One of the largest differences was lower relative risk for Scandinavian studies. Lower relative risks were also reported in cohort- and incidence-based studies. Findings were not sensitive to assumptions, including unpublished data, influence of individual studies, weighting schemes, and modeling. Whereas most studies present a small elevation in risk, there is considerable heterogeneity among the results.

Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: The Healthy Living Project randomized controlled study

Context:The US Centers for Disease Control and Prevention (CDC) strongly recommend comprehensive risk counceling and services for people living with HIV (PLH); yet, there are no evidence-based counseling protocols. Objective:To examine the effect of a 15-session, individually delivered, cognitive behavioral intervention on a diverse sample of PLH at risk of transmitting to others. Design:This was a multisite, 2-group, randomized, controlled trial. Participants:Nine hundred thirty-six HIV-infected participants considered to be at risk of transmitting HIV of 3818 persons screened were randomized into the trial. Participants were recruited in Los Angeles, Milwaukee, New York, and San Francisco. Intervention:Fifteen 90-minute individually delivered intervention sessions were divided into 3 modules: stress, coping, and adjustment; safer behaviors; and health behaviors. The control group received no intervention until the trial was completed. Both groups completed follow-up assessments at 5, 10, 15, 20, and 25 months after randomization. Main Outcome Measure:Transmission risk, as measured by the number of unprotected sexual risk acts with persons of HIV-negative or unknown status, was the main outcome measure. Results:Overall, a significance difference in mean transmission risk acts was shown between the intervention and control arms over 5 to 25 months (χ2 = 16.0, degrees of freedom = 5; P = 0.007). The greatest reduction occurred at the 20-month follow-up, with a 36% reduction in the intervention group compared with the control group. Conclusion:Cognitive behavioral intervention programs can effectively reduce the potential of HIV transmission to others among PLH who report significant transmission risk behavior.

Physical Complaints, Medical Service Use, and Social and Employment Changes Following Mild Traumatic Brain Injury: A 6–month Longitudinal Study

Using a prospective, dual-cohort study design in which selected preinjury factors were controlled, we present outcomes of 235 patients in a case cohort and 235 patients in a comparison cohort following emergency-department-diagnosed mild traumatic brain injury (MTBI). Symptoms, medical services use, and social and employment concerns were evaluated 6 months after the injury. After adjusting for preinjury characteristics, headaches, dizziness, vision difficulties, memory or learning problems, and alcohol intolerance were found to occur significantly more often in the MTBI cohort than in the comparison cohort. Problems sleeping, use of prescribed medications, and changes in employment were less likely in the MTBI cohort. Although MTBI is not life threatening, our findings suggest that 6 months after injury persons still have related health problems that require routine medical management.

Occupational electric and magnetic field exposure and leukemia. A meta-analysis.

We conducted a meta-analysis to acquire an understanding of the association between leukemia and occupational exposure to electric and magnetic fields. To explore sources of heterogeneity, study characteristics were scored and examined using regression analysis. While most studies present a small elevation in risk, the apparent lack of a clear pattern of exposure to EMF and risk of leukemia substantially detracts from the hypothesis that measured magnetic fields in the work environment are responsible for the observed excess risk of leukemia. Findings were not sensitive to assumptions, influence of individual studies, weighting schemes, and modeling. Some evidence of publication bias is noted.

A Method to Measure and Predict Rates of Regional Visual Field Decay in Glaucoma

PURPOSE This study was conducted to measure the rate of visual field (VF) decay in glaucoma, to separate faster and slower components of decay, and to predict the rate of VF decay. METHODS Patients who had primary glaucoma and 6 or more years of follow-up were included. Thresholds at each VF location were regressed with linear, quadratic, and exponential models. The best model was used to parse the VF into slower and faster rate components. Two independent cohorts (glaucoma [n = 87] and cataract [n = 38]) were used to determine the techniques ability to distinguish areas of glaucomatous VF changes from those caused by cataract. VF forecasts, derived from the first half of follow-up, were compared with actual VF thresholds at the end of follow-up. RESULTS The mean (±SD) years of follow-up and number of VFs for the main cohort (389 eyes of 309 patients) were 8.2 (±1.1) years and 15.7 (±3.0), respectively. The proportions of best fits were linear 2%, quadratic 1%, and exponential 97%. Proportions of eyes with exponential rates of decay ≥10% for the entire visual field (VF), faster components, and slower components were 20%, 56%, and 4%, respectively. The difference in decay rates between the faster and slower components was greater in the independent glaucoma cohort (19% ± 10%) than in the cataract cohort (5% ± 5%; P < 0.001). Test location forecasts significantly correlated with measured values (r(2) = 0.67; P < 0.001). CONCLUSIONS This method isolates faster and slower components of VF decay in glaucoma, can identify patients who are fast progressors, and can predict patterns of future VF loss with appropriate confidence intervals. (ClinicalTrials.gov number, NCT00000148.).

An Alternative Approach to Reducing the Costs of Patient Care? A Controlled Trial of the Multi-Disciplinary Doctor-Nurse Practitioner (MDNP) Model:

Objective. Hospitals adapt to changing market conditions by exploring new care models that allow them to maintain high quality while containing costs. The authors examined the net cost savings associated with care management by teams of physicians and nurse practitioners, along with daily multidisciplinary rounds and postdischarge patient follow-up. Methods. One thousand two hundred and seven general medicine inpatients in an academic medical center were randomized to the intervention versus usual care. Intervention costs were compared to the difference in nonintervention costs, estimated by comparing changes between preadmission and postadmission in regression-adjusted costs for intervention versus usual care patients. Intervention costs were calculated by assigning hourly costs to the time spent by different providers on the intervention. Patient costs during the index hospital stay were estimated from administrative records and during the 4-month follow-up by weighting selfreported utilization by unit costs. Results. Intervention costs were

Accumulative Prognostic Index for Patients with Barbiturate, Glutethimide and Meprobamate Intoxication

1187 per patient and associated with a significant

Public Health Impact of Extremely Low-Frequency Electromagnetic Fields

3331 reduction in nonintervention costs. About

Occupational Electromagnetic Fields and Leukemia and Brain Cancer : An Update to Two Meta-Analyses

1947 of the savings were realized during the initial hospital stay, with the remainder attributable to reductions in postdischarge service use. After adjustment for possible attrition bias, a reasonable estimate of the cost offset was