By the numbers. Care for arthritis and other chronic conditions

This issue's "By the Numbers" highlights recent findings on care for patients with rheumatoid arthritis in HMO and fee-for-service (FFS) settings. It also looks at the prevalence of arthritis and other chronic conditions in these plans.     

Double β-lactam regimen compared to an aminoglycoside/β-lactam regimen as empiric antibiotic therapy for febrile granulocytopenic cancer patients

In a prospective, randomized trial, 205 febrile episodes in granulocytopenic cancer patients were treated with ceftazidime with or without tobramycin (C±T), both agents being administered only if the initial granulocyte count was below 200/l, or ceftazidime plus piperacillin (C+P). The overall response rate was 71% (39 of 60 for C±T and 45 of 58 for C+P). Logistic regression analyses documented no evidence of a significant difference between the two regimens in overall treatment effect after accounting for the linear effects of potentially important variables, such as infection type and granulocyte count. Although the response rates for the subgroup of patients with bacteremias was better with the C+P regimen (P=0.06), there was no difference in response for patients with bacteremia and profound (<100/gml) sustained granulocytopenia. The double -lactam combination demonstrated in vitro synergism in 73%; antagonism was not seen. Both regimens produced execllent serum bactericidal levels (C±T geometric mean peak 1:170; C+P peak 1:137) against gram-negative but not gram-positive pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emergence of resistance and significant coagulopathy and/or bleeding did not occur during therapy. Antibiotic-related nephrotoxicity was noted in 7 of 95 trials in the C+P and in 6 of 89 trials in the C±T group (P=0.19). The incidence of secondary infections in patients with profound (<100/l) sustained granulocytopenia was lower in the C±T group (P=0.04). Alimentary canal anaerobic flora preservation with C±T, and suppression with C+P, was demonstrated. These results suggest that these regimens are of similar effectiveness and neigher is associated with major toxicity.     

Nurse recruitment: strong health and safety programs make a difference

Today's nurse is looking for more than just a challenging position with appropriate compensation. The security afforded by a safe and healthy working environment in the hospital may actually be the deciding factor in a nurse's choice of employer.     

High School Students'' Knowledge of HIV/AIDS and Perceived Risk of Currently Having AIDS

Factors associated with AIDS knowledge and perceived risk of currently having HIV infection among adolescents were examined. A modified version of the Centers for Disease Control's Health Risk Survey was administered to 11th and 12th grade students (N = 2,483) in homerooms from nine schools in one southeastern community. Knowledge was based on cumulative responses to 12 questions. Many adolescents incorrectly answered seven questions. Based on multivariate analysis of variance, lower AIDS knowledge was associated with no prior school-based AIDS education (p less than or equal to 0.0001), previous IV drug use (p less than or equal to 0.0001), male gender (p less than or equal to 0.0001), and being Black or "other" ethnic group (p less than or equal to 0.0001). Based on interaction effects, Hispanics not receiving AIDS education in school (p less than or equal to 0.0001) and Black and "other" ethnic group IV drug users (p less than or equal to 0.0011) had a lower AIDS knowledge. When controlling for AIDS knowledge level (p less than or equal to 0.0001), higher perceived risk of current infection with HIV was associated with previous IV drug use (p less than or equal to 0.0001) and male gender (p less than or equal to 0.0001). However, previous IV drug users who never received AIDS education (p less than or equal to 0.0001) or were from Black or "other" ethnic group (p less than or equal to 0.008) had higher perceived risks of presently having HIV infection.     

Videofluoroscopic analysis of the infant swallow

A better understanding of the abnormal infant swallowing mechanism requires better knowledge of the normal infant swallow. Twenty-one full-term infants under six months of age were examined using videofluoroscopy of the swallowing portion of upper gastrointestinal examinations. Components of the oral and pharyngeal stages of swallowing were evaluated. Results showed high reliability between two raters in obtaining measurement data. There was variability in suck and oral transit time, which was correlated to the number of sucks per swallow. All infants appeared to move their tongue in a "stripping" motion, and collected the material in various sites in the oral cavity or oropharynx before initiation of the swallow. The incidence of nasopharyngeal reflux was low (9.5%). The majority of infants demonstrated a slight residue in their valleculae and hesitation in the cervical esophagus. These findings indicate that videofluoroscopy provides an objective and systematic method for analyzing the infant swallowing mechanism.     

Can knee replacements be assessed by post?

The audit of knee replacement surgery requires long-term follow-up. The aim of this Bristol study was to examine whether an accurate assessment of knee replacement surgery could be undertaken by post, thus obviating the need for patients to visit hospital. A patient's questionnaire was designed to complement the clinic therapist's assessment form currently in use, and this was completed by 73 patients without supervision prior to the therapist's assessment. A comparison of the two assessments shows a significant discrepancy between their results, particularly in the assessment of pain, walking distance, and range of movement. The authors conclude that postal follow-up of knee replacements should be viewed with caution.