Annals of internal medicine
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To identify self-perceived problems in managing science information needs of U.S. primary practitioners and their opinion leaders. ⋯ Primary practitioners require substantial help in meeting current science information needs. Increase in such resources as "validated reviews" or "expert networks" might help meet these needs.
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A 60-year-old woman had had recurrent acute migratory pneumonias for 9 months. The results of an evaluation, which included tests for serum precipitins, a transbronchial biopsy, and a bronchial provocation, confirmed a diagnosis of hypersensitivity pneumonitis caused by an Aspergillus species. The findings from gravity air cultures in the home showed a heavy infestation of mold. ⋯ Thirty months after the electrostatic dust filters were installed, total mold colony counts were still normal, the patient remained free of the signs and symptoms of hypersensitivity pneumonitis, and serum precipitins could no longer be demonstrated. The results of a bronchial challenge to Aspergillus species, however, remained positive; these positive results suggest that long-term memory immune mechanisms may play an important role in the pathogenesis of hypersensitivity pneumonitis and lessen the importance of precipitins in establishing a diagnosis. We report that electrostatic dust filters may be an effective treatment for patients with hypersensitivity pneumonitis when avoidance of the causative antigen cannot be easily and rapidly achieved.
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Randomized Controlled Trial Clinical Trial
Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.
To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. ⋯ Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in addition to advice if improvements are to be made.