Southern medical journal
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Southern medical journal · Feb 1996
Screening for fever in an adult emergency department: oral vs tympanic thermometry.
The accuracy of tympanic thermometers in clinical practice continues to be questioned. We evaluated the Genius tympanic thermometer in our adult emergency department. All patients had both tympanic and oral temperature measurements. ⋯ Two patients in whom the tympanic thermometer failed to detect fever had AIDS, and their workup was altered by the detection of the fever. We conclude that the tympanic thermometer is not as sensitive as the oral thermometer in the detection of fever. The use of tympanic thermometers in the adult emergency department should be questioned.
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Amiodarone, a widely used antiarrhythmic drug, is associated with pulmonary toxicity, with an estimated mortality of 1% to 33%. Standard treatment for amiodarone pulmonary toxicity (APT) has been discontinuance of the drug and steroid therapy. We report a case of APT that recurred after withdrawal of steroids and failed to respond to reinstatement of steroid therapy. Recurrent APT is a rare clinical entity that has been reported only twice in recent literature.
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We evaluated 20 patients with pulmonary strongyloidiasis for risk factors, clinical and imaging manifestations, complications, treatment, and outcome. Eighteen (90%) had risk factors for strongyloidiasis including steroid use, age greater than 65, chronic lung disease, use of histamine blockers, or chronic debilitating illness. Pulmonary signs and symptoms, including cough, shortness of breath, wheezing, and hemoptysis, were present in 19 (95%); adult respiratory distress syndrome (ARDS) developed in 9 (45%). ⋯ All were treated with thiabendazole, 25 mg/kg twice daily; on average, patients without ARDS were treated for 3 days, versus 7 days for those with ARDS. Seventy percent responded to therapy; 30% died. Preexisting chronic lung disease and ARDS were statistically significant predictors of a poor prognosis.
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Southern medical journal · Jan 1996
Bayesian analysis of noninvasive versus oral temperature measurements to determine hypothermia in postoperative patients.
Measurement of body temperature in the postanesthesia care unit (PACU) is an important parameter in patient management. Failure to reach minimal acceptable body temperature standards has been associated with physiologic derangements, the application of additional therapy, and prolonged PACU stays. Newer methods to monitor temperature introduced into the PACU have been touted to be adequate for detecting clinically significant changes in temperature. ⋯ Mean temperatures obtained by LCT (35.5 +/- 1.0 degrees C), AT (35.1 +/- 0.9 degrees C), and ITT (36.3 +/- 0.8 degrees C) differed significantly from OT (36.0 +/- 0.7 degrees C) mean temperatures. We applied Bayesian analysis to assess the sensitivity and specificity of each method, using a hypothermia reference of < 36 degrees C. Results suggest that the definition of hypothermia may depend on the modality used to assess body temperature in the PACU.
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Southern medical journal · Dec 1995
Physician religious beliefs and the physician-patient relationship: a study of devout physicians.
The purpose of this study was to determine the type and frequency of religious interactions that occur between devout physicians and their patients. Physicians identified by their peers as having religious or spiritual beliefs that were an important part of their lives were surveyed. Forty physicians responded (response rate 77%). ⋯ Praying aloud with patients occurred with only 13% of patients, but 67% of respondents reported having done this on at least one occasion. Multivariate analysis showed the physician's religious group to be the most important determinant of sharing beliefs with patients, occurring most commonly with Protestant physicians. In this small sample of devout physicians, physician religious beliefs appear to influence the interactions between physicians and their patients.