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Biomedical subjects

I Jacoby

Publications and source records attributed to I Jacoby.

47 records · Page 3Linked to original sources
PubMed1977

Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis. A new approach to treatment.

Two patients with cirrhosis and ascites complicated by extensive unilateral pleural transudates refractory to therapy with dietary sodium restriction, diuretics, and repeated thoracentesis were successfully managed by tetracycline-induced pleural symphysis. The intrapleural instillation of this antibiotic prevented the recurrence of the effusion and substantially relieved the patients' symptoms with minimal undesirable side effects.

Female↗
PubMed1975

Task analysis in National Health Service Corps field stations: a methodological evaluation.

An occupational survey using a task inventory as survey instrument was conducted at four National Health Service Corps clinics providing primary ambulatory care. The prime objective of the study was to determine whether the methodology of task analysis could validly be applied to obtain data of potential value in improving personnel management in clinics. It is concluded that the taskinventory could generate such data. A first level analysis provides some interpretations of task interrelationships and role definition among clinic staff. In the clinics studied, no staff member's role was sufficiently well defined for efficient utilization of his capabilities. In particular, many tasks performed by the physicians and nurses could also be performed by less well-trained personnel. A number of steps are suggested for examining the task profiles of clinic staff and identifying areas of potential task redistribution. Also discussed are ways of improving the presentation of data obtained through task analysis to enhance the data's usefulness to local clinic management.

Community Health Services↗
PubMedDate not supplied

The roentgenographic findings associated with air embolism in sport scuba divers.

Records on all patients with arterial gas embolism (AGE) presenting to UCSD from 1982-1989 and for whom chest radiographs were available were reviewed. Of the 31 patients, 13 roentgenograms (42%) showed evidence of pulmonary barotrauma demonstrated by pneumomediastinum (N = 8), subcutaneous emphysema (N = 3), pneumocardium (N = 2), pneumoperitoneum (N = 1), or pneumothorax (N = 1). Pneumopericardium was not seen. Sixteen (52%) of the 31 patients had pulmonary infiltrates. Radiographic evidence of barotrauma was on occasion subtle, and in four cases was overlooked. Evidence of barotrauma (i.e., extra-alveolar air) was often identified along the left cardiac border, aortic arch, descending aorta, and hilar vessels. Subtle findings of ectopic air can confirm the clinical diagnosis of AGE; however, radiographic evidence of concomitant near drowning occurs more frequently.

Adolescent↗
PubMedDate not supplied

Disaster preparedness of home health care agencies in San Diego County.

A questionnaire was sent to 53 home health care agencies in San Diego to assess their state of disaster readiness. Thirty agencies returned completed questionnaires. Of these, 90% have written disaster plans, but only 33% conduct regular drills to practice their written plans. A 24-h telephone number is available to patients at 96% of the agencies. One-fourth of the agencies serving ventilator-dependent patients do not make utility companies aware of their special needs. Of 11 hospital-sponsored agencies, 18% include backup agreements with other agencies, while 79% of non-hospital-sponsored agencies have planned such backup. The majority (92%) of "private-for-profit" agencies have backup arrangements, but only 38% of the public or nonprofit agencies have such arrangements. Additionally, 31% of the home health care agencies do not feel they would be able to meet the needs of their clients in the event of a disaster. Specific recommendations for such agencies in developing disaster plans, and exercising them, are made.

California↗
PubMedDate not supplied

Fatal pulmonary barotrauma due to obstruction of the central circulation with air.

Cardiac arrest in cases of barotraumatic arterial gas embolism (AGE) is usually ascribed to reflex dysrhythmias secondary to brainstem embolization or secondary to coronary artery embolization. Several case reports suggest that obstruction of the central circulation (i.e., the heart, pulmonary arteries, aorta, and arteries to the head and neck) may play a role in the pathogenesis of sudden death in victims of pulmonary barotrauma. We report three consecutive cases of fatal AGE in patients in whom chest roentgenograms demonstrated confluent air lucencies filling the central vascular bed, the heart, and great vessels. In none of the victims was there evidence by history or at autopsy that the intravascular gas was iatrogenically introduced. Total occlusion of the central vascular bed with air is a mechanism of death in some victims of AGE, and resuscitation efforts for such patients should take this possibility into consideration.

Adult↗
PubMedDate not supplied

Technology assessment in health care: group process and decision theory.

As biomedical technologies proliferate, it is incumbent upon the scientific community to monitor, validate, and encourage adoption of worthwhile procedures, drugs, and devices across the interface from research to practice. As the largest U.S. sponsor of biomedical research, the National Institutes of Health (NIH) formally established the Consensus Development Program and the Office of Medical Applications of Research (OMAR), in order to foster and improve the translation of biomedical research results into knowledge useful in the practice of medicine and public health. Individual technology assessments are conducted through a succession of consensus development conferences, which convene expert biomedical scientists, practicing clinicians, and public representatives in an effort to assess safety and efficacy, and to recommend clinical application of important medical technologies. The Consensus Development Program has evolved through three distinct stages. The "first generation," from 1977-82, initiated the experimental, untested concept of consensus development; the "second generation" (1982-84) stressed formulation of the code of standard operating principles enunciated above; and the ongoing "third generation" is testing the utility of formal data synthesis to augment assessments. OMAR is experimenting with an explicit, normative and analytic approach to aid technology assessments. Real-time microcomputer-based decision models are created to help the panel explore the implications of the data. This paper describes and discusses decision analysis and its potential applicability to medical technology assessment and consensus development. It explores OMAR's experience in testing the model during several consensus development conferences, as well as plans and projections for future investigation and implementation.

Decision Theory↗