Itraconazole prophylaxis for fungal infections in patients with advanced human immunodeficiency virus infection: randomized, placebo-controlled, double-blind study. National Institute of Allergy and Infectious Diseases Mycoses Study Group.

In a prospective, randomized, double-blind trial, 149 patients with advanced human immunodeficiency virus (HIV) infection were randomized to receive itraconazole capsules (200 mg daily) and 146 to receive a matched placebo. Both groups were monitored for evidence of fungal infections. Baseline characteristics of the two groups were similar. Failure of prophylaxis occurred in 29 (19%) of the itraconazole recipients and 42 (29%) of the placebo recipients (P = .004; log-rank test). There were 6 invasive fungal infections in the itraconazole group (4, histoplasmosis; 1, cryptococcosis; 1, aspergillosis) and 19 in the placebo group (10, histoplasmosis; 8, cryptococcosis; 1, aspergillosis) (P = .0007; log-rank test). Itraconazole significantly delayed time to onset of histoplasmosis (P = .03; log-rank test) and cryptococcosis (P = .0005; log-rank test). Prophylaxis failure due to recurrent or refractory mucosal candidiasis occurred with similar frequency in the two groups (itraconazole, 15%; placebo, 16%). A survival benefit was not demonstrated. Itraconazole generally was well tolerated. Primary prophylaxis with itraconazole capsules prevents histoplasmosis and cryptococcosis in patients with HIV infection.

Promoting quality and cost-effective care to geropsychiatric patients.

The goals of the project described here were to reduce the length of hospital stay, decrease financial losses, improve care for the elderly, and improve the attitudes and knowledge of nursing staff caring for the elderly. Data collected included reimbursement information, nursing staff variables, and outcomes of patient care. Staff knowledge and attitudes were measured by Palmore's "Facts on Aging" and Kogan's "Old People Scale." Patient data were collected through a retrospective review of records. Central to the project was the utilization of a geropsychiatry clinical nurse specialist who facilitated a number of interventions. Length of hospital stay and financial losses were significantly reduced. A change in knowledge levels and positive attitudes of nursing staff occurred, although the change was not statistically significant. An association between attitudes and job satisfaction was found, and patient outcomes were improved in approximately half the cases. Specialized programming can enhance the care of geropsychiatry patients and can be cost-effective.