PubMed Health⌕ Search

Biomedical subjects

D W Jahnigen

Publications and source records attributed to D W Jahnigen.

33 records · Page 2Linked to original sources
PubMed1987

Inefficacy of pneumococcal vaccine in a high-risk population.

Use of pneumococcal vaccine remains controversial. To further study this question, 89 patients hospitalized at the Denver Veterans Administration Medical Center with pneumococcal bacteremia were chosen as the case group for a case-control study. The control group was made up of patients matched on the basis of age, date of admission, and comorbid conditions. Vaccination status in the bacteremic patients and control patients was determined, as were pneumococcal serotypes among the bacteremic patients. If the vaccine were protective, vaccination rates should be higher among the control patients, and serotype distribution should be different in vaccinated and nonvaccinated bacteremic patients. There were no differences between vaccination rates among bacteremic patients (29 percent) and control patients (24 percent). Furthermore, 65 percent of the blood isolates from nonvaccinated bacteremic patients were serotypes included in the vaccine, as compared with 69 percent of the isolates in vaccinated bacteremic patients. Pneumococcal vaccine did not appear to be protective in this high-risk population.

Age Factors↗
PubMed1987

Binding the elderly: a prospective study of the use of mechanical restraints in an acute care hospital.

Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables. Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P less than 0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.

Aged↗
PubMed1987

Evaluation of eight methods for estimating creatinine clearance in men.

Eight methods for estimating creatinine clearance (CLcr) were compared in 65 men with serum creatinine concentrations (SCr) less than or equal to 1.5 mg/dL (group 1) and 65 men with SCr greater than 1.5 mg/dL (group 2). All patients had SCr values that did not fluctuate by more than +/- 10% for two weeks before and two weeks after measurement of CLcr. For each patient, predictions of CLcr by each of eight currently used formulas were compared with measured CLcr values; both regression analysis and predictive error analysis were used. Group 1 patients ranged in age from 32 to 64 years (mean, 53), weighed from 48 to 105 kg (mean, 73), and were from 63 to 79 inches in height (mean, 69). Group 2 patients ranged from 26 to 63 years of age (mean, 53), weighed from 34 to 141 kg (mean, 80), and were from 63 to 76 inches in height (mean, 70). Measured CLcr values ranged from 29.8 to 197 mL/min in group 1 and from 2.8 to 118 mL/min in group 2. Ranges of SCr values were 0.7-1.5 mg/dL (mean, 1.1) in group 1 and 1.6-7.1 mg/dL (mean, 2.8) in group 2; the formula of Cockcroft and Gault, which uses age, body weight, and SCr, had the highest correlation and the greatest accuracy in group 1, whereas the formula of Jelliffe, which uses body surface area and SCr, had the highest correlation and the greatest accuracy in group 2. Estimation of creatinine clearance can be improved by identification and use of the formula that is best suited to a specific patient population.

Adult↗
PubMed1986

Oral assessment of the dentulous elderly patient.

The percentage of elderly persons retaining natural teeth is increasing. Although many of these individuals cannot be convinced to see a dentist regularly, they are generally seen by a physician or nurse relatively frequently. The physician or nurse can provide a vital service for these patients by performing oral screening examinations. A technique is described for accomplishing this.

Aged↗
PubMed1986

The doctor/patient relationship in geriatric care.

Information derived from the relationship of the primary care physician with an older patient provides the best possible way to eliminate or minimize many ethical conflicts that arise in the care of the very old. The conscientious physician can seek information regarding the patient's personal value scheme and his or her expectations and utilize the breadth of available technology to best serve the patient. Many of the issues raised in this article are discussed in much greater detail in subsequent articles. The discussions of the issues they encompass are intended to inform and to stimulate. There is legitimate reason for optimism that, with education and thoughtful review, physicians will be able to improve the manner in which we care for older individuals.

Aged↗
PubMed1985

Academic affiliation with a nursing home. Impact on patient outcome.

In a prospective study, 46 patients discharged from a teaching hospital to a "teaching unit" nursing home, where primary medical care was provided by faculty geriatricians, medical students, and medical housestaff, were compared with 78 similar patients discharged to one of five community nursing homes without a teaching affiliation. At the time of hospital discharge, patients were determined to have a terminal, rehabilitative, or long stay prognosis based on a review of hospital discharge summaries using specific criteria. Among 34 study and 55 control patients with a long stay prognosis, ten of the study group compared with seven of the control group returned home (P = .03). Seven of 34 long stay patients in the study group were rehospitalized, while 15 of a matched control group of 34 required hospitalization (P = .04). There was no increase in mortality or emergency service use in the study population. Patients considered to be terminal or rehabilitative showed no difference in ultimate outcome or hospital use. In the study group patients experienced an average reduction in total medications prescribed from 6.2 to 5.3, while patients in the control group had an increase from 5.4 medications prescribed to 7.6 (P less than .001). Of 16 study patients discharged from the teaching unit nursing home, all remained home at least three months after discharge; only 12 of 18 control group patients discharged from the nursing home remained at home at three months (P less than .01). Long-term care by geriatric faculty, students, and housestaff appeared to have favorably influenced patient outcomes.

Aged↗
PubMed1985

Relationship in very elderly veterans of nutritional status, self-perceived chewing ability, dental status, and social isolation.

The relationship of nutritional status, self-perceived chewing ability, dental status, and social isolation was examined. Seventy-three ambulatory, elderly (means = 86 years) veterans were studied. Parameters of nutritional status included intakes of protein, carbohydrate, fat, and total calories, and hemoglobin, serum albumin, total lymphocyte count, and height/weight ratio were determined. Dental status was measured, and self-perceived chewing problems and social isolation were assessed by interview. Results showed a significant correlation between perceived chewing problems and diminished protein and total caloric intake and increased carbohydrate intake. No association was found between measured dental status and nutritional status. Social isolation was weakly correlated with greater protein and calorie intake. These results support the contention that the presence of self-perceived chewing problems are more reliable than the quality of the dentition itself as an indicator of altered nutritional status.

Aged↗
PubMed1983

Attitudes of house officers toward a hospice on a medical service.

A hospice program (HP) was established on the medical service at the Denver Veterans Administration Medical Center (DVAMC) for the care of the terminally ill cancer patients and to integrate such care into house staff training. A two-bed inpatient unit was managed by an intern, a resident, and the attending physician with the aid of a multidisciplinary team. During the program's first year, 29 patients were cared for with an average inpatient stay of 26 days. Twenty-nine out of a possible 33 house officers returned questionnaires evaluating their hospice experience. Twenty-eight respondents felt that the hospice program was appropriate in a teaching hospital. Over half indicated improved awareness of the psychological problems of their patients and families. Two-thirds of the house staff members felt that the HP changed their approach to pain control and made them more comfortable in dealing with terminally ill patients. From this study, it can be concluded that a hospice program can be successfully integrated into an active medical teaching service.

Attitude of Health Personnel↗
PubMed1983

Oral assessment of the edentulous elderly patient.

While the need for regular oral examinations increases in the aged, edentulous elderly persons generally see their dentists rarely, while most see their physicians relatively frequently. If these patients cannot be convinced to see a dentist, the physician should perform regular oral screening examinations. A technique is described for accomplishing this.

Aged↗
PubMed1983

A mobile internal medicine clinic.

The Denver Veterans Administration Medical Center (DVAMC) established a mobile internal medicine clinic (MediVAn) to provide access to primary care for veterans living more than fifty miles from the center and to study the costs of such an outreach program. A fully equipped van staffed by an internist visited four Colorado cities weekly for scheduled appointments. In the first two years of operation there were 4,655 visits by 766 veterans with a mean age of 56 years, with 3.9 diagnoses, and receiving 3.0 medicines. The cost per MediVAn visit was $68, compared with $67 per outpatient visit at DVAMC. We conclude that a mobile medical clinic is a convenient method of delivering primary care over distances and is comparable in cost to outpatient hospital visits.

Colorado↗