A clinical decision process model for evaluating vancomycin use with modified HICPAC guidelines. Hospital Infection Control Practice Advisory Committee.

Objective: The objective of this study was to evaluate a clinical decision process model for the appropriateness of vancomycin use, using modified Hospital Infection Control Practice Advisory Committee (HICPAC) guidelines.

Design: All nondialysis vancomycin use was reviewed using the retrospective chart review method. The HICPAC guidelines were modified to distinguish between documented and suspected infections and appropriateness of vancomycin use initially and after 3 days of therapy.

Lodoxamide in vernal keratoconjunctivitis.

Lodoxamide may be superior compared with cromolyn sodium for treatment of VKC. It is difficult, however, to conclusively determine the superiority of lodoxamide compared with cromolyn from the three studies reviewed in this article. Optimally, a triple-blind, randomized, placebo-controlled, multicenter trial involving the ophthalmic products cromolyn sodium 4%, lodoxamide 0.

Amniotic fluid index and perinatal morbidity.

Our purpose was: (1) to determine whether assessment of amniotic fluid index in high risk patients with a reactive nonstress test (NST) allowed improved recognition of the fetus at risk for perinatal morbidity than a reactive NST alone; and (2) to determine the optimal low amniotic fluid index (AFI) which should prompt clinical concern. The last NST performed within a week of delivery and amniotic fluid index were retro-spectively compared with various indices of perinatal morbidity. In fetuses with a reactive NST, decreasing AFI was directly correlated with a risk of 5-minute Apgar score of less than 7 and delivery for fetal distress.

Therapist-driven protocols for pediatric patients.

Most therapist-driven respiratory care protocols deal with adult care. The greatest difficulty we have encountered when implementing pediatric protocols involves patient assessment. We have found that with any protocol the key factor is to monitor closely the result of the treatment and to analyze that outcome and compare it with the purpose of the therapy.

Effects of tourniquet use in anterior cruciate ligament reconstruction.

Although tourniquets are used commonly during anterior cruciate ligament (ACL) surgery, little data are available regarding their effects on postoperative function. This retrospective study evaluated 94 patients who had an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction between 1988 and 1991 at the San Diego Kaiser Hospital. A tourniquet was used in 48 patients (T+ group).

Open vs. arthroscopic acromioplasty: a prospective, randomized study.

Between May 1988 and May 1990, 44 patients with Stage II impingement were randomized into open and arthroscopic treatment groups. Forty-one patients were available for final follow-up in May 1991: 22 in the open group, 19 in the arthroscopic group. Comparisons of pain, function, motion, and strength were made preoperatively and at 2, 6, 12, 26, and 52 weeks postoperatively.

Hamstrings--an anterior cruciate ligament protagonist. An in vitro study.

A cadaveric model that incorporated quadriceps and hamstrings muscle loads was developed to simulate the squat exercise. The addition of hamstrings load affected knee kinematics in two ways. First, anterior tibial translation during flexion ("femoral roll-back") was significantly reduced (P = 0.

Bone imaging after acute knee hemarthrosis.

Follow-up evaluations were carried out in 84 patients examined 5-8 years after sustaining an acute traumatic hemarthrosis of the knee. The initial examination performed within 2 weeks of injury had revealed 18 patients with a stable knee and 66 with anterior instability. Twelve of the patients underwent anterior cruciate ligament reconstruction within 3 months of injury and 11 more did so between 1 and 3 years after injury.

Efficacy of immobilization following aspiration of carpal and digital ganglions.

In a prospective study 69 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of the wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Follow-up was 1 year.

The effect of tibial attachment site on graft impingement in an anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstructions were performed in 14 cadaveric knee specimens using a 6-mm wide polypropylene graft. The graft was passed through a femoral tunnel at the attachment site of the anterior medial bundle of the anterior cruciate ligament. Seven tibial positions were evaluated as to the change in attachment site distance with passive range of motion and impingement on the intercondylar notch as the knee was passively ranged from 0 degree to 90 degrees of flexion.

Assessing the limits of knee motion.

Ten patients were examined clinically by 11 experienced knee surgeons and with three measurement devices (Genucom, Knee Signature System, and KT-1000). Nine of the 10 patients examined had sustained documented intraarticular ligament disruptions including eight ACL disruptions and five posterior cruciate ligament disruptions. The eight patients with ACL injuries had undergone reconstructive surgery.

College health services as a site for ambulatory care training of residents and medical students.

The education of residents and medical students in ambulatory care settings continues to play a greater role in medical education than was the case even a few years ago. This report documents the use of college health services, commonly called student health centers, at California institutions of higher education, as training sites for residents and medical students in 1988. Directors of residency programs that had used student health centers for their residents reported that they were pleased with the association.

Infectious complications of indwelling long-term central venous catheters.

The long-term CVC allows patients with a variety of diseases to lead a more normal and pain-free life. The use of these catheters has become commonplace in most hospitals, and the physician caring for patients in the ICU will be caring for increasing numbers of patients with an indwelling long-term CVC. Infections of these catheters can be manifested in many different ways: tunnel infections, exit site infections, catheter-related bacteremia, and septic thrombophlebitis.

Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee.

Orthopaedic surgeons routinely use passive tests, in which the displacing force is applied externally, to evaluate the integrity of the ligaments of the knee. Using a quadriceps active test, in which the muscle contractures of the subject served as the displacing force, tibial displacement was measured with an arthrometer in ninety-two subjects: sixty-seven who had an acute or chronic rupture of the posterior or anterior cruciate ligament and twenty-five who had normal knees. With the knee joint in 90 degrees of flexion, contraction of the quadriceps resulted in anterior translation of the tibia in forty-one of forty-two knees that had a documented disruption of the posterior cruciate ligament.