Shirley Quaskey

Antiemetic efficacy of dexamethasone. Randomized, double-blind, crossover study with prochlorperazine in patients receiving cancer chemotherapy.

We conducted a randomized, double-blind, crossover study comparing the antiemetic efficacy of dexamethasone and prochlorperazine in 42 patients with cancer who were receiving outpatient chemotherapy, mainly without cisplatin. Patients experienced significantly less nausea and vomiting with dexamethasone than with prochlorperazine (P less than 0.02 and less than 0.03, respectively). Twenty-five patients experienced no nausea with dexamethasone, as compared with 14 patients taking prochlorperazine (P less than 0.001). Similarly, 29 patients receiving dexamethasone did not vomit, as compared with 18 receiving prochlorperazine (P less than 0.001). Somnolence was the most frequent side effect, occurring in 60 per cent of patients receiving prochlorperazine and in 12 per cent of those receiving dexamethasone (P less than 0.001). Patients also experienced less suppression of appetite while receiving dexamethasone (P less than 0.02). We conclude that dexamethasone is an effective and safe antiemetic in patients receiving cancer chemotherapy without cisplatin.

Determinants of children's health care use: An investigation of psychosocial factors.

Factors related to the amount of health care used by 5− to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system.Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while childrens depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of childrens health care use.When included in a comprehensive analysis, child and family psychosocial characteristics help to explain childrens health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed. Key words: childrens health care; pediatrics; utilization; psychosocial factors. (Med Care 1993; 31:767–783)

Inter‐ and intraexaminer reliability of nerve conduction measurements in patients with diabetic neuropathy

We determined the inter- and intraexaminer reliability of nerve conduction measurements in six patients with diabetic peripheral neuropathy. Each patient was examined by six electromyographers on two separate occasions at least 1 week apart. We obtained attributes of nerve conduction at each examination and analyzed the data by analysis of variance. Intraexaminer reliability was high for 11 of 12 measurements, and interexaminer reliability was high for eight of twelve. Three of the four measurements that varied between examiners were either sensory or motor amplitudes, attributes frequently used to measure disease progression or to assess the result of therapeutic intervention. Our results suggest that longitudinal nerve conduction measurements used to assess worsening or improvement over time should optimally be performed by a single examiner to minimize the degree of variability associated with different examiners.

Haloperidol, Fluphenazine and Clonidine in Tourette Syndrome: Controversies in Treatment

The value of haloperidol, fluphenazine and clonidine as therapeutic agents for Tourettes syndrome was retrospectively reviewed. Haloperidol improved tic symptoms in 50/60 patients, but side effects often nullified these benefits. Fluphenazine was an effective drug for tic suppression in 24/31 patients. Direct comparison of these drugs in 23 patients confirmed the efficacy of fluphenazine and showed it to produce fewer adverse effects than haloperidol. Clonidine was helpful in 47% and caused few side effects. These results support the use of clonidine for the treatment of tics and suggest that fluphenazine can be considered an alternative to other neuroleptic drugs.

Relation between CT scan findings and human sense of smell

Symptom questionnaires were obtained from 106 patients immediately before nasal and sinus computed tomography scans at the Johns Hopkins Outpatient Center. Their scans were analyzed by two otolaryngologists and three neuroradiologists by using a semiob-jective rating system of the size and opacity of 36 anatomic areas. Patients estimated their own left and right sense of smell as excellent, diminished, or absent. Results of the data are as follows: (1) There is no correlation between smell ability and size of the nasal and sinus structures. This indicates that there is no gross effect of the bulging of sinuses into the nasal airway; (2) As a rule, opacity of only left-sided anatomic structures was correlated with both left and right sense of smell (p < 0.01). This suggests that our subjects were using their left smell receptors preferentially, to the exclusion of and in place of the right smell receptors; and (3) Total, not partial, opacity of the left olfactory cleft, frontal recess, or ethmoidal infundibulum was correlated with decreased sense of smell. This suggests that these anterior structures in the region of the olfactory cleft do affect airflow, but complete obstruction of these spaces is needed. Possible explanations for the effect of opacified sinuses on the sense of smell include (1) The presence of fluid or thickened mucosa in the sinuses may interfere with perceived olfactory ability by changing nasal airflow patterns or odorant access to receptors; (2) There may be olfactory receptors inside the sinuses; and (3) There may be a relation between the trigeminal receptors in the sinuses and the olfactory system.

Neurobehavioral Outcomes of Cardiac Surgery

Since the inception of cardiac surgery, postoperative neurobehavioral complaints have prompted intensive studies of neurologic and cognitive outcomes. There is now a wealth of information on the incidence of stroke, delirium, depression, and cognitive outcomes after car diac procedures. Stroke risk models have been devel oped to identify patients at high risk. Delirium, although much less objectively studied, still occurs frequently in the immediate postoperative period, but its relationship to long-term cognitive outcome has not been resolved. Postoperative depression may not be as common as was previously thought, and may be related to mood status before surgery. Cognitive decline may be short- term for some aspects of brain function, but more prolonged or delayed in others. Despite these extensive studies, it is not clear whether some of these outcomes are related to the surgical procedure itself, rather than the use of general anesthesia in an older population of patients with extensive atherosclerotic disease. Inclu sion of appropriate control groups, longer term follow- up, and larger sample sizes in future prospective studies will improve the design of intervention studies in this patient population.

Nerve conduction studies in diabetic neuropathy

To the Editor: The article by Chaudhry et al [1] addresses the reliability of nerve conduction studies (NCS) in patients with diabetic neuropathy. Perhaps the authors would consider providing additional information regarding the coefficient of variation, the standard deviation/mean, of their findings. Unlike ANOVA, the coefficient of variation can be readily understood by nonstatisticians and easily performed. It describes reliability in absolute numbers suitable …