Faculty Bibliography

BACKGROUND AND METHODS: Although studies have demonstrated that medical rehabilitation patients have many complications that warrant attention, none has attempted to categorize complications by severity. This retrospective cohort study examined the incidence, types, and severity of problems that interrupt rehabilitation and the major risk factors for these events. RESULTS: Of 1075 patients, 359 (33.4%) had acute medical complications on rehabilitation considered severe enough to interrupt treatment. Of the 359 patients, 158 (44%) required an unexpected transfer off rehabilitation. The most common reasons for unexpected transfer were surgical causes (22.8%), followed by infection or fever (17.1%) and by thromboembolic events (16.5%). Logistic regression revealed that major risk factors for complications requiring transfer were a primary diagnosis of deconditioning or nontraumatic spinal cord injury (adjusted odds ratio, 2.7; confidence interval, 1.8 to 4.2), severity of initial disability (adjusted odds ratio, 1.2; confidence interval, 1.1 to 1.3 for every 10-point drop in a Modified Barthel Index), and number of comorbid conditions (adjusted odds ratio, 1.1; confidence interval, 1.0 to 1.2). Risk factors for any complication were similar, but there was an interaction between comorbidity and the degree of functional impairment; in patients who were severely functionally impaired, the number of comorbidities was not as strongly associated with the risk of complications as it was in patients who were less functionally impaired. CONCLUSION: There is a complex relationship among the type of underlying medical impairment, severity of functional limitation, comorbidity, and unanticipated medical or surgical complications that interrupt rehabilitation. The interruptions vary both in type and in severity.

Health officials said on Oct 4, 1994 that six countries, including the US, have investigated suspected cases of plague from India, but none have been confirmed

On Tuesday, for example, laboratory tests confirmed that a 12-year old boy in Long Beach had developed dengue fever, not plague, 10 days after his return from India, said Dr. Duane J. Gubler of the Centers for Disease Control and Prevention in Atlanta. Although the World Health Organization has not advised against travel to India, the U.N. agency in Geneva is about to add New Delhi to its list of plague-infected areas because Indian officials have reported four secondary cases there. New Delhi will remain on the list for two weeks after the last case is reported there, Dr. Lindsey Martinez, a WHO official, said. Pneumonic plague symptoms usually develop within one to six days after exposure to the plague bacillus. As symptoms develop, an infected individual can pass the plague-causing bacterium, Yersinia pestis, to others through droplets in the air from coughs or sneezes

Both J.A.M.A. and The Lancet, a prestigious journal published in London, have criticized the practice under which drug companies pay prominent doctors to sign their names to ghostwritten scholarly reviews about new drugs. An editorial in J.A.M.A. described the editors' frustration in telephoning the senior 'author' of a submitted paper only to be switched back and forth between the scientist whose name was on it, 'who had no idea what had been written,' and the writer, 'who did not understand the science.' The changing nature of the medical-industrial complex has led many journals over the last decade to begin imposing rules on would-be authors, requiring disclosure about potential financial conflicts of interest. These rules cover only support from industry, a definition that makes Dr. Edward J. Huth, the editor of The Annals of Internal Medicine, 'a bit uneasy,' unless such disclosure is 'a uniform requirement to cover other sources of income,' as well. Dr. [Jerome P. Kassirer] said he was unaware of the general practice. 'If that is the case, it doesn't look that way from here,' he said with a laugh. 'From the amount of work we do with manuscripts, they are not getting their money's worth.'

So when residents of Surat, India, learned in recent weeks that pneumonic plague had struck there, hundreds of thousands fled the western port city. And some apparently spread it to other cities, including India's three biggest -- Bombay, Calcutta and New Delhi. How many areas and people are affected remains unclear

'The results are dramatic,' Zach W. Hall, director of the National Institute of Neurological Disorders and Stroke, part of the N.I.H., said at a news conference. 'The study has the potential of improving the health and quality of life for thousands of Americans.' All participants had a 60 percent or greater narrowing of a carotid artery as determined by Doppler ultrasound or special X-rays known as arteriograms. The technology used was of the mid-1980's vintage, Dr. [James F. Toole] said. Some neurologists not connected with the study have criticized it because results of the ultrasound tests were not reviewed independently by a central committee as were the data about those who suffered strokes. Such a review was not possible, Dr. Toole said. 'THE PROCEDURE: Surgery to Prevent Strokes' shows methods for a new study that backs removal of fatty deposits from carotid arteries before thaey can cause symptoms or peoduce strokes. (Source: 'Heart Talk: Understanding Cardiovascular Diseases,' Dr. M.V. Barrow (COR-ED Publishing Company) (pg. 30)

A controversial operation to remove fatty deposits from a major artery in the neck sharply reduced the risk of stroke in people with no outward symptoms, scientists who conducted a large federally sponsored study said here Friday. Application of the findings could prevent many thousands of crippling and disabling strokes among the 500,000 to 600,000 people who now suffer a stroke each year in the United States and could save thousands of lives among the 150,000 who die from strokes each year, said Dr. Michael D. Walker of the NIH. The two carotid arteries, one on each side of the neck, are the main suppliers of oxygen and blood to the brain from the heart. With age, fat tends to build up in what are known as plaques in the carotid arteries, particularly at a site where the artery divides at the angle of the jaw

While the rat-catchers go after a rodent population that some say outnumbers India's population of at least 850 million, doctors, pharmacists and epidemiologists have reported using computer-operated electronic mail systems to exchange information on the latest plague suspects, to order drugs, and to catch up on the latest developments in plague research elsewhere in the world. The outbreak in India has reawakened ancient panic, highlighted faults in the country's approach to public health and even raised questions about the program toward an open, market economy. For most of its history, plague has been endemic in India. The last major outbreak was in 1955 when about 7,000 people died. Ten years before, the plague had struck Bombay, killing 12,000. Black & White Photo; Map; Graphic, Diagram; JOHN MOORE; AP; SURAT SLUM: RESIDENTS GO ABOUT THEIR BUSINESS AS OPEN SEWER FLOWS THROUGH REUTER; FLEEING THE PLAGUE: PEOPLE LEAVING SURAT THIS WEEK RAISED FEARS THAT DISEASE WOULD SPREAD TO OTHER PARTS OF THE COUNTRY MAP OF INDIA PAUL PERREAULT; SOUTHAM NEWS GRAPHICS; PNEUMONIC PLAGUE: HOW THE PLAGUE SPREAD HOW IT IS TREATED

A controversial operation to remove fatty deposits from a major artery in the neck sharply reduced the risk of stroke in individuals with no outward symptoms, scientists who conducted a large federally sponsored study said Friday. Those who stand to benefit have no outward sign of disease but are at risk for stroke from severe narrowing of either of the two carotid arteries in the neck due to a buildup of fatty substances from atherosclerosis. Application of the findings could prevent many thousands of crippling and disabling strokes among the 500,000 to 600,000 people who now suffer a stroke each year in the United States and could save thousands of lives among the 150,000 who die from strokes each year, said Dr. Michael Walker of the NIH

In the medical evaluation of older men with erectile dysfunction, obtain a detailed history to determine whether the dysfunction is organic or psychogenic. Determine if there are underlying pathologic processes--most notably vascular diseases--or other factors responsible for the dysfunction, such as medications or nerve or arterial damage from surgery. Lifestyle changes in mid-life (regular exercise, a low-fat diet, and smoking cessation) increase a man's chances of remaining potent as he grows older. Treatments for impotence include injection therapy, vacuum devices, and implants. Each therapy has advantages and disadvantages, and the informed patient plays an important role in choosing the therapy that is right for him