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Lancaster DJ, McClish DK, Smith WR. Computer-Assisted Instruction in Probabilistic Reasoning During the Inpatient Medicine Clerkship. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractThe acceptability and utility of computer-assisted instruction in probabilistic reasoning was assessed for medicine clerkship students. After a pretest, the experimental (n = 40), but not the control students (n = 39), completed a program that we designed. The program contained the test and its answers. After program exposure, experimental students rated their knowledge of the program’s content significantly higher (p = 10−4) than control students. On the identical posttest, experimental students also scored significantly higher than control students (p = 10−4) and improved their scores significantly more (p = 10−3). They rated ease-of-use items significantly higher than content-relevance items (p = 1CT−4). We conclude that computer-assisted instruction in probabilistic reasoning is acceptable to clerkship students, and that it may improve their knowledge and skills in this area. However, students may rate the vehicle of this instruction more highly than its content.
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Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, Henderson H, Kauffman CA, Haas DW, Saccente M, Hamill RJ, Holloway MS, Warren RM, Dismukes WE. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis 2001; 33:690-9. [PMID: 11477526 DOI: 10.1086/322597] [Citation(s) in RCA: 416] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2000] [Revised: 01/08/2001] [Indexed: 12/15/2022] Open
Abstract
We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age > or =60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.
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Affiliation(s)
- P G Pappas
- University of Alabama at Birmingham Medical Center, Birmingham, AL 35294-0006, USA.
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Smith WR, McClish DK, Poses RM, Pinson AG, Miller ST, Bobo-Moseley L, Morrison RE, Lancaster DJ. Bacteremia in young urban women admitted with pyelonephritis. Am J Med Sci 1997; 313:50-7. [PMID: 9001166 DOI: 10.1097/00000441-199701000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to determine the rate of bacteremia in young women admitted to the hospital with presumed pyelonephritis and compare it with other published rates. The study design was a retrospective, structured chart review and a review of published reports of bacteremic pyelonephritis. An urban county teaching hospital provided the setting for the study. The patients were nonpregnant women (n = 98) 44 years of age or younger who were without bladder dysfunction and who had not been admitted to an intensive care unit. Further criteria for participation included discharge with the diagnosis of acute pyelonephritis. Blood cultures were ordered for 69 women; the results of 64 were noted in the chart. Twenty-three women (35.9% of those cultured; 23.4% of all patients) were diagnosed with bacteremia. In patients for whom blood culture results were obtained, trends developed between those patients with bacteremia and those with complicated pyelonephritis, defined as a known or newly discovered genitourinary abnormality or a risk factor (P = 0.044), those who were black (P = .044), those with higher pulses on admission (P = .050), those with more white blood cells per high-powered field after urinalysis (P = 0.007), and those whose fever lasted longer (P = 0.033). Blood culture results were positive in two patients whose urine cultures were negative. This comparatively high bacteremia rate supports routine ordering of blood cultures for urban women suspected of having pyelonephritis.
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Affiliation(s)
- W R Smith
- Medical College of Virginia, Richmond, USA
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Miller ST, Lancaster DJ. Transformation of an internal medicine residency program to address the health of the Tennessee public. J Tenn Med Assoc 1994; 87:468-71. [PMID: 7983861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S T Miller
- Department of Medicine, Methodist Hospitals of Memphis, TN
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Dohn MN, Weinberg WG, Torres RA, Follansbee SE, Caldwell PT, Scott JD, Gathe JC, Haghighat DP, Sampson JH, Spotkov J, Deresinski SC, Meyer RD, Lancaster DJ. Oral atovaquone compared with intravenous pentamidine for Pneumocystis carinii pneumonia in patients with AIDS. Atovaquone Study Group. Ann Intern Med 1994; 121:174-80. [PMID: 7880228 DOI: 10.7326/0003-4819-121-3-199408010-00003] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To test the hypothesis that the therapeutic success rate of oral atovaquone is not worse than that of intravenous pentamidine in the primary treatment of mild and moderate Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome and to detect differences in the toxicity rates of the two treatments. DESIGN Patients were randomly assigned to receive 21 days of open-label therapy with either atovaquone, 750 mg orally with meals three times daily, or intravenous pentamidine, 3 to 4 mg per kg body weight once daily. SETTING Multicenter study including university and community treatment facilities. PATIENTS Patients with human immunodeficiency virus infection and clinical presentations consistent with mild or moderate P. carinii pneumonia were eligible. For efficacy and safety analyses, patients with histologically confirmed P. carinii pneumonia were emphasized. MEASUREMENTS Patients were monitored by clinical and laboratory evaluations for therapeutic efficacy and adverse events during the acute treatment phase and for 8 weeks after therapy was discontinued. RESULTS As initial therapy for a histologically confirmed episode of P. carinii pneumonia, 56 patients received atovaquone and 53 received pentamidine. More patients were successfully treated with atovaquone (57%) than with pentamidine (40%), a difference of 17% (95% CI, -3% to 38%; P = 0.085), but more patients failed to respond to atovaquone (29%) than to pentamidine (17%), a difference of 12% (CI, -6% to 29%; P = 0.18). Discontinuation of original therapy because of treatment-limiting adverse events was more frequent in the pentamidine group (36%) than in the atovaquone group (4%) (difference, -32%; CI, -48% to -17%; P < 0.001). Nine patients in each treatment group died during the study. CONCLUSIONS Oral atovaquone and intravenous pentamidine have similar rates for successful treatment of mild and moderate P. carinii pneumonia, but atovaquone has significantly fewer treatment-limiting adverse events.
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Affiliation(s)
- M N Dohn
- Pulmonary/Critical Care Division, University of Cincinnati, OH 45267-0564
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Abstract
The current status of antiretroviral therapy is in a state of flux. Clinical and immunologic benefit of antiretroviral treatment has been demonstrated, but the duration of benefit is finite and the effect on survival uncertain. Failure of antiretroviral treatment is closely associated with development of drug resistance. Strategies that may improve treatment outcome include combining or cycling antiretroviral agents. Given the current uncertainties in antiretroviral therapy, patients should be actively involved in treatment decisions.
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Affiliation(s)
- D J Lancaster
- Department of Medical Education, Methodist Hospitals of Memphis, TN 38104
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Gelfand MS, Lancaster DJ. Drug interactions: the death pen. JAMA 1993; 270:1316; author reply 1316-7. [PMID: 8103117 DOI: 10.1001/jama.270.11.1316b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Smith WR, Lancaster DJ, McClish DK. Computer-assisted instruction in probabilistic reasoning during the inpatient medicine clerkship. Methods Inf Med 1993; 32:309-13. [PMID: 8412826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The acceptability and utility of computer-assisted instruction in probabilistic reasoning was assessed for medicine clerkship students. After a pretest, the experimental (n = 40), but not the control students (n = 39), completed a program that we designed. The program contained the test and its answers. After program exposure, experimental students rated their knowledge of the program's content significantly higher (p = 10(-4)) than control students. On the identical posttest, experimental students also scored significantly higher than control students (p = 10(-4)) and improved their scores significantly more (p = 10(-3)). They rated ease-of-use items significantly higher than content-relevance items (p = 10(-4)). We conclude that computer-assisted instruction in probabilistic reasoning is acceptable to clerkship students, and that it may improve their knowledge and skills in this area. However, students may rate the vehicle of this instruction more highly than its content.
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Affiliation(s)
- W R Smith
- Department of Medicine, University of Tennessee, Memphis
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Lancaster DJ, Palte S, Ray D. Recombinant human erythropoietin in the treatment of anemia in AIDS patients receiving concomitant amphotericin B and zidovudine. J Acquir Immune Defic Syndr (1988) 1993; 6:533-4. [PMID: 8483118 DOI: 10.1097/00126334-199305000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Stein DS, Stevens RC, Terry D, Laizure SC, Palte S, Lancaster DJ, Weems JJ, Williams CL. Use of low-dose trimethoprim-sulfamethoxazole thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 1991; 35:1705-9. [PMID: 1952835 PMCID: PMC245254 DOI: 10.1128/aac.35.9.1705] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We conducted an open prospective clinical trial to evaluate the efficacy and toxicity of trimethoprim-sulfamethoxazole given as one double-strength tablet thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus-infected (HIV+) patients. A total of 104 HIV+ patients were evaluated, with 74 being in the primary prophylaxis group and 30 being in the secondary prophylaxis group. All except six patients received concomitant zidovudine; five patients on primary prophylaxis and one patient on secondary prophylaxis refused zidovudine. There were 70 patients evaluated for the efficacy of primary prophylaxis. The mean CD4 count was 124.4 +/- 110.1 cells per microliter. The mean follow-up time was 11.8 +/- 5.8 months (median, 12 months; range, 1 to 32 months). Two noncompliant patients developed PCP after 1 and 3 months of chemoprophylaxis. The failure rate (under the intention to treat principle) was 2 of 70 patients (2.9%; 95% confidence interval, 0.35 to 10%), or 1 per 413 patient-months of observation. There were 27 patients evaluated for the efficacy of secondary prophylaxis. The mean follow-up time was 12.4 +/- 7.2 months (median, 11 months; range, 1 to 29 months). Two patients, one of whom was noncompliant, were treatment failures, developing PCP after 14 and 15 months of chemoprophylaxis; this gave a failure rate of 2 of 27 patients (7.4%; 95% confidence interval, 0.9 to 24.3%), or 1 per 167 patient-months of observation. Adverse reactions sufficient to permanently terminate therapy occurred in 9 of 104 patients (8.7%; 95% confidence interval, 4 to 15.7%) overall. The serum trimethoprim, sulfamethoxazole, and N4-acetyl-sulfamethoxazole concentrations measured by high-pressure liquid chromatography were uniformly low. One double-strength tablet of trimethoprim-sulfamethoxazole taken weekly on Monday, Wednesday, and Friday appeared to be well tolerated and efficacious for the prophylaxis of PCP in HIV+ patients at high risk and deserves further investigation.
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Affiliation(s)
- D S Stein
- Department of Medicine, University of Tennessee, Memphis
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Hughes WT, Kennedy W, Shenep JL, Flynn PM, Hetherington SV, Fullen G, Lancaster DJ, Stein DS, Palte S, Rosenbaum D. Safety and pharmacokinetics of 566C80, a hydroxynaphthoquinone with anti-Pneumocystis carinii activity: a phase I study in human immunodeficiency virus (HIV)-infected men. J Infect Dis 1991; 163:843-8. [PMID: 2010637 DOI: 10.1093/infdis/163.4.843] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A hydroxynaphthoquinone compound (566C80) has been shown to be effective in the prevention and treatment of murine Pneumocystis carinii pneumonitis. In a phase I study, five cohorts of four human immunodeficiency virus-infected men received 100, 250, 750, 1500, and 3000 mg of the compound orally once daily for 12 days. A sixth cohort received 750 mg three times daily for 5 days, then twice daily for 16 days. Evaluation included clinical, hematologic, and biochemical studies and the pharmacokinetics of 566C80. The only drug-related adverse effect was a maculopapular rash in one patient that resolved without discontinuation of the drug. With the largest dosage tested (3000 mg) the following pharmacokinetic measures were achieved: maximum plasma concentration, 39 micrograms/ml; time to maximum plasma concentration, 8.0 h; area under plasma concentration-time curve at steady state, 1088 h.micrograms/ml; plasma half-life, 51 h; and total plasma clearance, 4.09 l/h. Compound 566C80 offers promise as a new drug class for P. carinii pneumonia.
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Affiliation(s)
- W T Hughes
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38101-0318
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Affiliation(s)
- R E Morrison
- Regional Medical Center, University of Tennessee, Memphis 38103
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Palte SB, Lancaster DJ, Miller ST, Morrison RE, Bobo L. The pattern of HIV infection in a southern state and city: a model for the outpatient clinic. J Tenn Med Assoc 1990; 83:339-43. [PMID: 2374415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S B Palte
- Department of Medicine, University of Tennessee Center for the Health Sciences, Memphis
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Palte SB, Lancaster DJ. Indigent health care: the increasing contribution of AIDS to the health care budget deficit. J Health Soc Policy 1989; 2:47-53. [PMID: 10119068 DOI: 10.1300/j045v02n01_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the number of AIDS cases in the United States exceeding 100,000 and rising, it is becoming more of a financial burden to take care of this population. The Regional Medical Center at Memphis, like most hospitals providing indigent care, sustains annually a large deficit for both outpatient and inpatient care of AIDS patients. With the establishment of a dedicated AIDS clinic, it is hoped to maximize outpatient care and the utilization of available financial resources. Implementation of this model may help obviate the financial disaster that is impending for the already overburdened public hospitals and their patients.
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Affiliation(s)
- S B Palte
- University of Tennessee Center for the Health Sciences, Memphis 38103
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Bobo L, Miller ST, Smith WR, Elam JT, Rosmarin PC, Lancaster DJ. Health perceptions and medical care opinions of inner-city adults with sickle cell disease or asthma compared with those of their siblings. South Med J 1989; 82:9-12. [PMID: 2911768 DOI: 10.1097/00007611-198901000-00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Inner-city adults (n = 108) with a chronic disease (sickle cell disease or asthma) and their unaffected siblings (n = 50) were interviewed and ratings of health perceptions and opinions about medical care were compared. Persons with a chronic disease reported unfavorable ratings of their health (P less than .001). Their siblings reported moderately favorable health perceptions but much worry and concern about their health. When compared with the asthma subgroup, persons with sickle cell disease reported more adverse ratings of health outlook susceptibility to illness, sickness orientation, humaneness of medical care, and satisfaction with medical care (P less than .05). These observations demonstrate low health perceptions in adults with two chronic medical conditions and more negative perceptions in persons with sickle cell disease. They indicate possible opportunities for improving medical care for patients with these conditions to achieve better perceptions of health, outlook, and medical services.
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Affiliation(s)
- L Bobo
- Department of Medicine, University of Tennessee College of Medicine, Memphis 38163
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Morrison RE, Lancaster DJ, Smith WR. Rocky Mountain spotted fever (American tick typhus). J Tenn Med Assoc 1988; 81:691-4. [PMID: 3068422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Affiliation(s)
- R W Baird
- University of Tennessee, Memphis 38163
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Lancaster DJ, Myburgh L. Methicillin resistant Staphylococcus aureus--a nursing perspective. Nurs RSA 1987; 2:53-4. [PMID: 3444475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lancaster DJ. History of the caesarean section. Nurs RSA 1986; 1:3-5. [PMID: 3540678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Sanchez PL, Lancaster DJ, Berg SW, Kerbs SB, Harrison WO. Cefonicid as therapy for uncomplicated gonococcal urethritis caused by penicillinase-producing Neisseria gonorrhoeae. West J Med 1984; 140:224-6. [PMID: 6428048 PMCID: PMC1021601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Young men with uncomplicated gonococcal urethritis were treated with 1 gram of cefonicid given intramuscularly plus 1 gram of probenecid by mouth. Of 53 evaluable patients, 33 (62%) had penicillinase-producing Neisseria gonorrhoeae. All but one of these patients were cured. All men who had penicillin-sensitive infections were cured. Cefonicid was highly effective in the treatment of both penicillin-sensitive and penicillin-resistant N gonorrhoeae. Other than moderate pain at the site of injection, there were no adverse side effects. Cefonicid can be added to the group of newer cephalosporins that are effective in the treatment of gonococcal urethritis caused by either penicillin-sensitive or penicillin-resistant strains.
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Harrison WO, Sanchez PL, Lancaster DJ, Kerbs SB, Berg SW. Ceftizoxime (FK-749) is effective therapy for urethritis caused by penicillinase-producing Neisseria gonorrhoeae. Sex Transm Dis 1984; 11:30-1. [PMID: 6324399 DOI: 10.1097/00007435-198401000-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fifty-five men with culture-proved gonococcal urethritis caused by either penicillin-sensitive or penicillinase-producing Neisseria gonorrhoeae were treated with 1 g of ceftizoxime given intramuscularly. All patients were cured, including 26 (47%) with penicillinase-producing strains. Patients experienced no local or systemic side effects and tolerated the injection of ceftizoxime well. These results show that ceftizoxime is an effective alternative to either spectinomycin or cefoxitin in treatment of uncomplicated gonococcal urethritis caused by penicillin-resistant bacteria.
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Lancaster DJ. Education in obstetrics and gynaecology. The needs of South Pacific Territories. Aust N Z J Obstet Gynaecol 1971; 11:48-50. [PMID: 5281223 DOI: 10.1111/j.1479-828x.1971.tb00450.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Lancaster DJ. Maternal mortality in Fiji. Aust N Z J Obstet Gynaecol 1967; 7:160-4. [PMID: 5235529 DOI: 10.1111/j.1479-828x.1967.tb01624.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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