Stephen A. McCurdy

Treatment of status epilepticus A prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin

In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p < 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p < 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.

Home Prothrombin Time Monitoring after the Initiation of Warfarin Therapy: A Randomized, Prospective Study

STUDY OBJECTIVE To evaluate the efficacy and accuracy of monitoring prothrombin times at home. DESIGN Randomized, prospective cohort study. SETTING Outpatients discharged from a university hospital or a community hospital. PATIENTS Fifty patients started on warfarin for the first time who demonstrated an ability to use the monitor and who had not achieved a stable response to warfarin in the hospital. INTERVENTION Oral anticoagulation therapy managed using a portable prothrombin time monitor compared with specialized anticoagulation clinic care. MEASUREMENTS AND MAIN RESULTS In the 46 patients who completed the 8-week study, the median percentage of time that patients in the home-monitor group (n = 23) were within a range equal to the target prothrombin ratio +/- 0.3, but always above 1.25, was 93%, compared with 75% for patients in the clinic group (n = 23) (P = 0.003). There was no significant difference between groups in the percentage of time above the therapeutic range; however, the percentage of time that patients were subtherapeutic was significantly greater in the clinic group (P less than 0.001). There were no major thromboembolic or hemorrhagic complications in either group. Differences between home monitor measurements and corresponding clinical laboratory measurements using blood samples drawn within 4 hours of the home test were comparable to differences observed between measurements using two different clinical laboratory instruments. CONCLUSIONS Use of a portable prothrombin time monitor by patients at home is feasible and provides accurate measurements. Patients doing home monitoring achieve superior anticoagulation control compared with those receiving standard anticoagulation clinic care.

The health of California's immigrant hired farmworkers

BACKGROUND Hispanic immigrant workers dominate Californias hired farm workforce. Little is known about their health status; even less is known about those lacking employment authorization. METHODS The California Agricultural Workers Health Survey (CAWHS) was a statewide cross-sectional household survey conducted in 1999. Six hundred fifty-four workers completed in-person interviews, comprehensive physical examinations, and personal risk behavior interviews. RESULTS The CAWHS PE Sample is comprised mostly of young Mexican men who lack health insurance and present elevated prevalence of indicators of chronic disease: overweight, obesity, high blood pressure, and high serum cholesterol. The self-reported, cumulative, farm work career incidence of paid claims for occupational injury under workers compensation was 27% for males and 11% for females. CONCLUSIONS The survey finds elevated prevalence of indicators of chronic disease but lack of health care access. Participants without employment authorization reported a greater prevalence of high-risk behaviors, such as binge drinking, and were less knowledgeable about workplace protections.

Costs of occupational injuries in agriculture

Objective. This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. Methods. The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. Results. Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated

Early morbidity after total hip replacement - Rheumatoid arthritis versus osteoarthritis

4.57 billion (range

The California Agricultural Workers Health Survey.

3.14 billion to

Agricultural Dust Exposure and Respiratory Symptoms Among California Farm Operators

13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be

Tuberculin reactivity among california hispanic migrant farm workers

1.66 billion and indirect costs,

Epidemiology of dermatitis among California farm workers

2.93 billion. Conclusions. The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Epistaxis due to glutaraldehyde exposure

The authors used the California Health Facilities Discharge data for 1984 and 1985 to compare retrospectively in-hospital morbidity and mortality of all 721 patients with rheumatoid arthritis versus all 8,859 patients with osteoarthritis who underwent a non-emergent, first-time, unilateral total hip arthroplasty. The lengths of hospitalization, in-hospital mortality rates, and incidences of post-operative complications were similar in the two groups except for higher rates of wound infection and wound dehiscence in the patients with rheumatoid arthritis and a higher rate of thromboembolic events in the osteoarthritis group. The short-term outcome of patients with rheumatoid arthritis appears comparable to that of patients with osteoarthritis.