Jerome H. Kim

Observations on Spiraling Empiricism: Its Causes, Allure, and Perils, with Particular Reference to Antibiotic Therapy

Spiralicy empiricism describes the inappropriate treatment, or the unjustifiable escalation of treatment, of suspected but un documented infections diseases

Manifestations of human T-lymphotropic virus type I infection

HTLV-I, the first human oncovirus, is a type C retrovirus linked to the development of ATLL. The virus shows a striking ethnogeographic distribution that is only partially understood. Certain populations at high risk for AIDS appear to have a higher incidence of HTLV-I infection. The extended latent period renders present knowledge of the sequelae and natural history of HTLV-I seropositivity incomplete, although recent data suggest that HTLV-I infection may have important implications for blood transfusion, organ transfer, and public health policy. A variety of clinical syndromes have been associated with infection, ranging from an asymptomatic carrier state to acute ATLL with lymphadenopathy, hepatosplenomegaly, hypercalcemia, cutaneous lesions, and systemic immunosuppression. Conventional chemotherapy is marginally effective; innovative approaches to therapy are presently being evaluated.

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer

PURPOSEnThe goal of this study was to evaluate the feasibility, reliability, and validity of a computer-based geriatric assessment via two methods of electronic data capture ( SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer.nnnMETHODSnEligible patients were ≥ 65 years old, had a cancer diagnosis, and were fluent in English. Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated.nnnRESULTSnThe median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18%). For session 1, REDCap took significantly longer to complete than paper and pencil (median, 21 minutes [range, 11 to 44 minutes] v median, 15 minutes [range, 9 to 29 minutes], P < .01) or SupportScreen (median, 16 minutes [range, 6 to 38 minutes], P < .01). There were no significant differences in completion times between SupportScreen and paper and pencil ( P = .50). The computer-based geriatric assessment was feasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported that the length was just right, and 67% preferred the computer-based geriatric assessment to paper and pencil. Test-retest reliability was high (Spearman correlation coefficient ≥ 0.79) for all scales except for social activity. Validity among similar scales was demonstrated.nnnCONCLUSIONnDelivering a computer-based geriatric assessment is feasible, reliable, and valid. SupportScreen methodology is preferred to REDCap.

Echocardiographic detection and clinical significance of left atrial vegetations in active infective endocarditis

Abstract Involvement of the mural endocardium during infective endocarditis (IE) was commonly reported in early series of patients,1,2 but little new information has been added since antibiotic therapy dramatically reduced the mortality of this condition. Mural vegetations are thought to develop in 2 ways. The more common involves growth of a vegetation at the site of a “jet lesion,” that is, the impact site of a regurgitant stream. Much less common is isolated, primary mural endocarditis—through 1978 there had been only 22 reported cases.3 Two-dimensional echocardiography can detect vegetations of IE in 43 to 100% of patients.4 Some investigators have suggested that the detection of vegetations by echocardiography may identify a subgroup of patients at higher risk for embolic complications.4–6 Others have included it as a minor criterion for surgical intervention in active IE.7 Mural vegetations have not been well characterized echocardiographically, nor has their clinical significance been studied in detail. We report 6 patients with IE and left atrial (LA) masses demonstrated by 2-dimensional echocardiography. Doppler color flow imaging revealed a regurgitant stream striking endocardium at the base of the vegetation in all patients. Transesophageal echocardiography proved an excellent technique to study the location and size of vegetations attached to the posterior LA wall, which is difficult to visualize by standard 2-dimensional echocardiography.