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Biomedical subjects

G Gibson

Publications and source records attributed to G Gibson.

At least 19 recordsLinked to original sources
PubMed1992

Cytosolic free calcium and gene expression during chemical hypoxia.

Understanding the cellular response to hypoxia may help elucidate the role of altered oxidation in neuronal death or abnormal cell function. In PC12 cells, 30 min of chemical hypoxia (i.e., KCN) reduced ATP concentrations by 92%, but diminished viability by only 10%. Ten minutes of hypoxia increased cytosolic free calcium ([Ca2+]i) 2.5-fold above control, but after 30 min of hypoxia, [Ca2+]i was slightly below that of nonhypoxic cells. Short periods of hypoxia also exaggerated the K(+)-induced elevation of [Ca2+]i, but by 30 min these ATP-depleted cells reestablished a calcium gradient that was equal to nonhypoxic, K(+)-depolarized cells. Thus, 30 min of severe ATP depletion left [Ca2+]i and viability relatively unaffected. Nerve growth factor caused slight, but significant, improvements in ATP and viability of hypoxic cells, but had no effect on [Ca2+]i. Although [Ca2+]i was equivalent in control and hypoxic cells after 30 or 60 min, hypoxia abolished the K(+)-stimulated elevation of [Ca2+]i. The nerve growth factor induction of c-fos, an indicator of the genomic response, was diminished by approximately 80%. Thus, hypoxic PC12 cells with greatly reduced ATP stores maintained normal [Ca2+]i, but their ability to respond to external stimulation was impaired. Further, the reduced oxidation that occurs in the brain in a variety of pathological conditions may interfere with the cellular response to stimulation and growth factors.

Adenosine Triphosphate↗
PubMed1979

Emergency treatment of asthma. A comparison of two treatment regimens.

The effectiveness of epinephrine was compared to that of a combination of epinephrine and aminophylline in the initial treatment of acute asthma. Forty-four patients with 51 episodes of acute asthma were evaluated. Peak flow spirometry served as an objective measure of airway resistance, and theophylline levels were determined at fixed intervals throughout the study. Epinephrine and aminophylline were not found to be superior to epinephrine alone. There was no correlation between mean serum theophylline levels and the magnitude of improvement. Rapidity of emergency department discharge and frequency of admission was independent of treatment method. The failure of epinephrine-aminophylline to effect more rapid or profound improvement in pulmonary function might suggest that epinephrine alone, or an equivalent sympathomimetic is a rational choice in the initial treatment of acute asthma.

Acute Disease↗
PubMed1979

Education for self-treatment by adult asthmatics.

A prospective experimental design evaluated the ability of a series of educational and motivational interventions to enhance self-treatment by adult asthmatics and to reduce use of emergency department services for asthma attacks. After treatment for an asthma attack, subjects were randomly assigned to the following sequential interventions: (1) reinforcement by interpersonal similarity at the time of the emergency visit, (2) recepit of positive written appeals, and (3) follow-up telephone reinforcement. The asthmatic nurse educator was generally more effective in achieving short-term reduction of emergency department visits. Although the usefulness of the positive written appeal increased when employed by the asthmatic nurse, there were no substantive independent effects of the written message on emergency department use.

Activities of Daily Living↗
PubMed1979

Prophylactic antibiotics in surgery. Practices within surgical services of the Veterans Administration.

A survey of prophylactic antibiotic-prescribing habits among chiefs of surgical services of the Veterans Administration yielded a 99% response. These responses have been compared with guidelines set by an expert committee on antimicrobial use for the VA central office. Assuming that 100% concordance with the standards of the committee is a desired state, the average hospital is approximately one third away from this goal (average score, 62.4%). The majority of errors were those of overuse rather than underuse. The size of the service and the existence of a university affiliation had no influence on the results. Feedback to the chiefs of service regarding the use of antibiotics was informal and tended to be carried out on rounds rather than as a result of formal audits. Most senior surgeons indicated that they would be willing to be influenced by audit guidelines.

Anti-Bacterial Agents↗
PubMed1979

Human rotavirus in an adult population with travelers' diarrhea and its relationship to the location of food consumption.

The role of human rotavirus in adult diarrhea was evaluated in 164 newly arrived US students attending summer school at an urban Mexican university. Rotavirus was identified in stool samples by electron microscopy. Rotavirus was found in 26 of 109 students with diarrhea (24%) and in 8 of 55 asymptomatic control students (15%). Although bacterial pathogens were recovered from virus positive students with diarrhea, viral shedding also occurred independently of other agents. Clinical disease in students excreting only rotavirus tended to be mild and was accompanied by a low density of viral shedding. Food consumption in the home and at public eating establishments was examined the week before illness. While the location of food consumption was found to be important in the acquisition of diarrhea, there was no apparent relationship of the site where meals were eaten and the acquisition of rotavirus by students newly arrived in Mexico. These data support our previous study in a US student population residing in a rural setting in Mexico and implicate rotavirus as a cause of diarrhea among students traveling to Mexico from the United States. The present study offers additional evidence that rotavirus infection in this population might be spread by a nonfood vehicle of transmission which differs from spread of enterotoxigenic E coli, Shigella, or Salmonella strains in the same population.

Adolescent↗
PubMed1978

Walk-out patients in the hospital emergency department.

Four hundred twenty-six patients walked out of The Johns Hopkins Hospital Adult Emergency Department before being treated between April 1976 and March 1977. Of these, 179 were matched for sex, race, age, shift and presenting complaint with controls to identify the distinguishing characteristics of walk-out patients. Walk-out patients have recent onset of symptoms, report a great deal of pain and discomfort at the time of initial visit, and wait a relatively short period of time before walking out. They are, however, likely to report little continuing pain or discomfort one to two weeks after followup, although they believe that they still need care. Walk-out patients do not seem to be exposed to objectively worse treatment in the emergency departemnt but seem to have less subjective tolerance for waiting.

Adolescent↗
PubMed1978

Evaluation of the emergency department as a site for hypertension screening.

To see if the emergency department is an appropriate site for hypertension screening, the coverage, appropriateness of the target population and the adequacy of follow-up procedures were evaluated. The study was conducted in the Adult Emergency Department of The Johns Hopkins Hospital, which 61% of the community regard as their regular source of care. All patients had their blood pressure read in the emergency department. A reading of 95 diastolic or greater was used as the definition of hypertension. Data from the 1970 census and The Johns Hopkins outpatient department billing system were used to evaluate screening coverage. Data to judge the appropriateness of the target population and adequacy of follow-up were collected in a retrospective audit of a random sample of emergency department records. The overall prevalence rate of hypertensive blood pressure reading was 19.5%. Blood pressure was read in only 75% of sample cases. The potential screeining coverage ranged from 9.9% to 38.6% with an overall community coverage of 24.2%. Less than 10% of the detected hypertensives were referred for follow-up. Therefore, in some emergency departments, including the Adult Emergency Department of The Johns Hopkins Hospital, hypertension screening may be feasible.

Adolescent↗
PubMed1978

Severity, satisfaction and symptom resolution in patients of emergency medicine residents.

Emergency department patients treated by first and second year emergency medicine residents were compared with those treated by surgical interns and residents and medical interns and residents to see if emergency medicine residents are exposed to patients with problems that aid in teaching and whether there is a suitable correspondence between patient severity and clinical training level. The Emergency Department Surveillance System at The Johns Hopkins Health Services Research and Development Center was used to gather data. Results indicated emergency medicine residents were exposed to fewer severe medical causes than medical housestaff but saw a significantly greater number of severe surgical cases than surgical interns and residents. Patients reported greater satisfaction with nonemergency medicine residents. Regarding outcome, there was no significant difference among the clinician groups. For all the patients, pain and anxiety levels improved significantly. Although the findings may be specific to The Johns Hopkins Adult Emergency Department, they demonstrate the methods and motivation for examining the training experience offered emergency medicine residents.

Consumer Behavior↗
PubMed1978

Prioritizing clinical and nonclinical issues for emergency department quality assessment studies.

There is a need at both the emergency department and national level for a systematic method to prioritize clinical and nonclinical areas for research and quality assessment. A method has been developed and applied that allows frequently presenting diagnoses and management issues to be rated in terms of morbidity generated, efficacy of (optimal) clinical intervention, discrepancy between optimal and current treatment, and the impact of an evaluative intervention study on improving care. Also, a summary research priority score was derived. When this method was used by physicians, nurses and administrators at the Johns Hopkins Hospital Adult Emergency Department, a reasonable level of agreement between the three responding groups emerged.

Baltimore↗
PubMed1978

Evaluation of an Emergency Department Patient Advocacy Program.

In the Patient Advocacy Program at the Adult Emergency Department of The Johns Hopkins Hospital, first year medical and health associate students provide patient teaching, crisis intervention, emotional support, assistance in patient-provider-family communication, resource referrals, information and assistance in maintaining patients' rights. The advocacy program was evaluated through a three-month trial of a Control Group, Patient Advocacy Group, Halo Group and Placebo Group, including 412 study subjects in all. It was hypothesized that patients' satisfaction, behavior and knowledge would improve significantly as a result of the advocate's intervention in this order: Patient Advocacy, Halo, Placebo and Control. Patient interviews and medical reports were used to assess the impact of patient advocacy. Results did not support the hypotheses of either improvement or the ranked order. Competition with traditional roles, identification of advocates with providers rather than patients, and placing the needs of the institution over patients were suggested as explanations for the advocacy program's failure.

Emergency Service, Hospital↗
PubMed1978

Categorization of hospital emergency capabilities: some empirical methods to evaluate appropriateness of emergency department utilization.

Despite the emphasis on appropriateness of emergency department utilization, there is currently no methodology for assessing appropriateness nor measures for a community to evaluate and improve effectiveness of its E.M.S. system in treating emergencies at the appropriate emergency room and nonemergencies at appropriate alternative settings. The writer feels that the one current strategy which is widely accepted, the A.M.A.'s concept of categorization, has substantial methodologic limitations. The present paper suggests a methodology and a set of measures to assess appropriateness of utilization and illustrates them with data from Buffalo, New York, on a chart review of 24,594 emergency department patient medical records and interviews with 888 patients and their attending physicians. The measures include: 1) distribution of ambulance and critically ill patients by A.M.A. category of hospital, 2) utilization, characterized as system under- or over-response or as appropriate utilization, and 3) physician judgments as to indicated alternative treatment sites, which are suggested as evaluative tools to hospital and communities for E.M.S. assessment, and to federal and state agencies as performance standards, for project selection for funding and monitoring for outcome evaluation.

Adolescent↗