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Biomedical subjects

J Doctor

Publications and source records attributed to J Doctor.

12 recordsLinked to original sources
PubMed2001

Discharge disposition from acute care after traumatic brain injury: the effect of insurance type.

OBJECTIVE: To determine if persons with traumatic brain injury (TBI) who are insured by Medicaid or health maintenance organizations (HMOs) are more likely to receive postacute care in skilled nursing facilities (SNFs) than in rehabilitation facilities, compared with persons insured by commercial fee-for-service (FFS) plans. DESIGN: Retrospective cohort study. SETTING: County hospital admitting 30% of all Washington State TBI patients. PATIENTS: Patients with moderate to severe TBI discharged to rehabilitation facilities or SNFs between 1992 and 1997 (n = 1271); 56.3% were insured by Medicaid, 26.1% by FFS plans, and 17.6% by HMOs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disposition on discharge from acute care (rehabilitation facilities vs SNF); adjusted relative risk (RR) and confidence interval (CI) for different insurance types. RESULTS: After accounting for confounding factors, Medicaid patients were 68% more likely (RR = 1.68, 95% CI = 1.34-2.11) and HMO patients were 23% more likely (RR = 1.23, 95% CI =.90-1.68) to go to a SNF than FFS patients. However, the latter difference was not statistically significant. CONCLUSIONS: An association exists between insurance type and postacute care site. Efforts should be made to determine the effect this relationship has on the cost and outcomes for TBI patients.

Abbreviated Injury Scale↗
PubMed2001

Functional status examination: a new instrument for assessing outcome in traumatic brain injury.

The Functional Status Examination (FSE) is a new measure designed to evaluate change in activities of everyday life as a function of an event or illness, including traumatic brain injury. The measure covers physical, social, and psychological domains. The FSE is based on a structured interview and includes levels of functioning that accommodate the full spectrum of possible outcomes, from death through recovery to preinjury functioning. Based on 133 prospectively studied patients with moderate to severe traumatic brain injury, the FSE has favorable psychometric properties including good test-retest reliability (r = 0.80) and close correspondence of assessments provided by the patient and their significant other (SO; r = 0.80). The FSE correlated significantly with each of three severity indices with closest relationships occurring between the FSE assessed by the SO and posttraumatic amnesia (r = 0.76). The FSE assessed by the SO was significantly (p < 0.05) more closely related to each severity index than the Glasgow Outcome Scale (GOS) or Sickness Impact Profile and, for two of the three indices, than the SF-36. All measures showed significant change from 1 to 6 months after injury with the FSE showing the largest effect sizes. The FSE is significantly related to important constructs such as family burden, SO depression, and sacrifices the family makes, as well as overall indices of recovery and satisfaction with level of functioning. The latter relationships are significantly stronger than for the GOS. The FSE has demonstrated good reliability, validity, and sensitivity, and appears to be a promising instrument for monitoring recovery and assessing functional status in clinical trials.

Activities of Daily Living↗
PubMed2000

Genomic imprinting in plants: observations and evolutionary implications.

The epigenetic phenomenon of genomic imprinting occurs among both plants and animals. In species where imprinting is observed, there are parent-of-origin effects on the expression of imprinted genes in offspring. This review focuses on imprinting in plants with examples from maize, where gene imprinting was first described, and Arabidopsis. Our current understanding of imprinting in plants is presented in the context of cytosine methylation and imprinting in mammals, where developmentally essential genes are imprinted. Important considerations include the structure and organization of imprinted genes and the role of regional, differential methylation. Imprinting in plants may be related to other epigenetic phenomena including paramutation and transgene silencing. Finally, we discuss the role of gene structure and evolutionary implications of imprinting in plants.

Animals↗
PubMed1998

Managed oncology care: the disease management model.

BACKGROUND: As oncology becomes an increasing financial burden on the U.S. health care system, effort is being focused on finding methods to more effectively deliver, manage, and monitor the highly complex panoply of cancer care services required by patients. This issue has growing significance and importance in light of an aging U.S. population and the rapid penetration of managed care. METHODS: SalickNet, Salick Health Care's disease management and managed care company, has been a pioneer in the development and implementation of cancer disease management programs. The cornerstone is a proprietary computer-based disease management system called OMARS (Oncology Management Assessment Reporting System). The flexible yet sophisticated architecture allows for the management of integrated care, data processing, and the generation of compelling custom reporting, fulfilling the goal of maximizing coordinated and effective patient care. CONCLUSIONS: Based on data collected and analyzed across critical clinical, quality of life, and patient satisfaction outcome measures, strong evidence exists that the SalickNet Disease Management Model is a highly effective vehicle for bringing about cost, quality, and outcomes advantages in cancer care.

Disease Management↗
PubMed1996

Effects of inhaled budesonide on allergen-induced airway responses and airway inflammation.

Allergen inhalation by sensitized subjects results in acute bronchoconstriction, which can be followed by a later bronchoconstrictor response, allergen-induced airway hyperresponsiveness, and increases in airway inflammatory cells. Treatment with inhaled glucocorticosteroids attenuates allergen-induced asthmatic airway responses. The purpose of this study was to determine whether a 1-wk pretreatment with inhaled budesonide influences allergen-induced changes in inflammatory cells in blood and induced sputum. Seven subjects with mild atopic asthma were treated in a double-blind, placebo-controlled, randomized, crossover fashion with either inhaled budesonide 400 microg/d, or placebo for 7 d. Allergen challenges were carried out the morning after treatment was discontinued and sputum samples were obtained 7 h after allergen inhalation. Methacholine airway responsiveness was measured, and blood and sputum samples were obtained 24 h post-allergen. Budesonide treatment attenuated the magnitude of both the early and the late asthmatic response, reduced allergen-induced methacholine airway hyperresponsiveness, and attenuated allergen-induced increases in total eosinophils and activated eosinophils. These results suggest that the effects of inhaled glucocorticosteroids on allergen-induced airway responses may be mediated through their inhibition of allergen-induced eosinophil migration and activation.

Administration, Inhalation↗
PubMed1986

Differential responses of the dopa decarboxylase gene to 20-OH-ecdysone in Drosophila melanogaster.

The dopa decarboxylase gene (Ddc) of Drosophila melanogaster responds to 20-OH-ecdysone in the mature larval epidermis and in imaginal discs (presumptive adult epidermis) in a tissue-specific manner. Exposure of the mature larval epidermis to 20-OH-ecdysone caused a rapid accumulation of DDC transcripts. In the absence of protein synthesis, transcript accumulation was substantially reduced suggesting an indirect hormonal effect on DDC transcription (and/or RNA turnover). By contrast, neither DDC activity induction nor transcript accumulation was detected in imaginal discs cultured in the continuous presence of the hormone. However, when discs were exposed to 20-OH-ecdysone and then cultured in its absence, DDC activity and DDC transcript levels started to increase 6 hr after hormone withdrawal. A Northern analysis failed to reveal any novel transcripts in discs making the utilization of an alternative promotor an unlikely explanation for the very different responses of the Ddc gene in the two epidermal tissues. The results demonstrate that the Ddc gene in the larval epidermis responds rapidly to an increase in hormone titer. In imaginal discs a fall in hormone titer is required before DDC transcripts accumulate.

Animals↗
PubMed1985

The pupal cuticle of Drosophila: biphasic synthesis of pupal cuticle proteins in vivo and in vitro in response to 20-hydroxyecdysone.

We investigated the synthesis and localization of Drosophila pupal cuticle proteins by immunochemical techniques using both a complex antiserum and monoclonal antibodies. A set of low molecular weight (15,000-25,000) pupal cuticle proteins are synthesized by the imaginal disk epithelium before pupation. After pupation, synthesis of the low molecular weight proteins ceases and a set of unrelated high molecular weight proteins (40,000-82,000) are synthesized and incorporated into the pupal cuticle. Ultrastructural changes in the cuticle deposited before and after pupation correlate with the switch in cuticle protein synthesis. A similar biphasic accumulation of low and high molecular weight pupal cuticle proteins is also seen in imaginal discs cultured in vitro. The low molecular weight pupal cuticle proteins accumulate in response to a pulse of the insect steroid hormone 20-hydroxyecdysone and begin to appear 6 h after the withdrawal of the hormone from the culture medium. The high molecular weight pupal cuticle proteins accumulate later in culture; a second pulse of hormone appears to be necessary for the accumulation of two of these proteins.

Animals↗
PubMed1984

Pupal and larval cuticle proteins of Drosophila melanogaster.

Proteins, soluble in 7 M urea, were extracted from third-instar larval and pupal cuticles of Drosophila melanogaster. Both extracts contain a limited number of polypeptides resolved by one- or two-dimensional electrophoresis. The five major larval proteins have low molecular weights (less than 20000) and are not glycosylated. The major pupal cuticle proteins fall into two size classes: two with apparent molecular weights of 56K and 82K and four with molecular weights between 15K and 25K. The proteins with high apparent molecular weights are glycosylated. In nondenaturing gels, no components of the larval and pupal cuticle extracts comigrate. One-dimensional "fingerprints" indicate that cuticle proteins from these two stages have unique primary structures. Immunological results indicate that the major low molecular weight larval and pupal cuticle proteins are comprised of two families of proteins that share antigenic determinants. The high molecular weight pupal cuticle proteins are immunologically unrelated to the low molecular weight components. We conclude that the pupal and larval proteins are encoded in part by multigene families that have arisen by gene duplication and evolutionary divergence.

Amino Acid Sequence↗
PubMedDate not supplied

Describing and predicting the nature of procedural pain after thermal injuries: implications for research.

A prerequisite for studying and treating burn-related pain is the establishment of a good understanding of the nature of burn-related pain. However, in most investigations of pain, researchers have failed to examine pain over time or to create summary scores that capture differences in the nature of the pain experiences of individual patients. For 10 consecutive days, 47 patients treated for burn injuries reported on three aspects of procedural pain: worst pain, sensory pain, and affective pain. Three summary pain scores were constructed for each pain dimension: average pain, variability in pain, and linear change in pain. The authors found considerable variability in pain reports from the same patient and from different patients. Analyses indicated that pain reports decreased over time and that patients who had more trait anxiety reported more pain. Patients with larger burn injuries tended to report more affective pain and tended to have a pattern of high and low pain reports that differed from patients with less severe burn injuries. These findings suggest that adequate assessment of burn pain must occur frequently over the course of a single day, as well as for the duration of each patient's care.

Adult↗