PubMed Health⌕ Search

Biomedical subjects

J Grigsby

Publications and source records attributed to J Grigsby.

At least 19 recordsLinked to original sources
PubMed1996

Panel discussion: impact of guidelines on third-party payors and HMOs.

Utilization management (preauthorization) has given way to disease management, i.e., the management, by providers in cooperation with third-party payors, of patients and their disease states from beginning to end. Managed-care organizations are seeking guidelines-based cancer disease management programs that result in: lower, more predictable costs; authoritative quality assurance; measured outcomes; reduced preauthorization disputes; and improved management of cases in clinical trials. Guidelines also need to provide some consistency and consensus regarding the management of common clinical problems. Good guidelines help assist managed-care companies gather data, build a more solid utilization management foundation and support a clinically sound disease management program. Aetna's Institutes of Excellence (IOE) program seeks to address the issue of coverage for high-dose chemotherapy and bone marrow transplantation, but can serve as a useful model for the development of comprehensive cancer networks.

Clinical Trials as Topic↗
PubMed1995

Current status of domestic telemedicine.

This manuscript addresses several aspects of the current status of telemedicine in the United States. Telemedicine programs have been in existence since the 1960s, but only in the last 2 or 3 years have they begun to proliferate. Teleradiology has grown rapidly, both in the number of systems and the volume of images transmitted. Clinical telemedicine consultation, using video-conferencing, has seen an increase in the number of programs, but patient volumes remain low. In this paper, I discuss the scope and effectiveness of telemedicine, the kinds of applications in use at various telemedicine centers, and issues of importance in the development and integration of telemedicine systems into the health care delivery infrastructure.

Diffusion of Innovation↗
PubMed1995

Alphanumeric sequencing and cognitive impairment among elderly persons.

Alphanumeric Sequencing involves the alternating recitation of counting and the alphabet. We report data on the use of this measure among 112 VA patients ranging in age from 61 to 100 years who were administered the Alphanumeric Sequencing, Trail Making Test, Digits Forward and Backward, the Mini-Mental State Examination, and the Behavioral Dyscontrol Scale. Persons who obtained scores < 27 on the Mini-Mental State Examination or < 14 on the Behavioral Dyscontrol Scale performed significantly more poorly than those who scored higher. Both the time and errors were correlated (.11 to -.49) with measures of information processing and short-term memory.

Aged↗
PubMed1995

Chronic pain is associated with deficits in information processing.

Beginning with the theoretical premise that pain stimuli are liable to perturb the ordinary dynamical state of the brain, we hypothesized that individuals in pain may experience impaired information processing. A sample of 19 persons complaining of chronic pain and a comparison sample of 25 persons having sustained head trauma were obtained by retrospective chart review. The chronic-pain group consisted of 19 persons whose primary complaint was significant chronic pain, with no known history of head trauma or neurologic disorder. The comparison group consisted of 25 persons who had sustained mild to moderate head traumas. All subjects were administered information processing and motor subtests of the Human Performance Measurement System, a computerized set of measures. Both groups obtained mean z scores below the normative mean on all measures except visual digit span. There were no differences between groups on motor measures, visual digit span, and visual-spatial memory. On 2 of 6 information-processing tests, pain patients performed more poorly than head-trauma patients. The results suggest that pain may disrupt cognitive performances which depend on intact speed and capacity of information processing.

Adult↗
PubMed1994

Working memory impairment among persons with chronic progressive multiple sclerosis.

We examined short-term memory (STM) among a group of 23 definite, chronic progressive multiple sclerosis (MS) patients, all of whom had experienced recent significant disease activity, and a control group matched closely on age and education. MS patients were impaired, relative to controls, on the majority of the measures used. Although there were no significant differences between groups on the Mini Mental State Examination, patients performed more poorly on digits forward and backward, the Brown-Peterson test, and the logical memory scale of the Revised Wechsler Memory Scale (both immediate and delayed). Performance on tests sensitive to central processing capacity was significantly correlated with measures of STM. Working memory was significantly impaired in this sample of chronic progressive MS patients. In conjunction with previous research showing deficient information processing and prefrontal dysfunction among this population, the findings suggest that an impairment of central information processing may be a fundamental aspect of the mnestic and cognitive decline observed in many chronic progressive MS patients.

Adult↗
PubMed1994

Simulated neural networks to predict outcomes, costs, and length of stay among orthopedic rehabilitation patients.

Our purpose was to develop a set of simulated neural networks that would predict functional outcomes, length of stay, and costs among orthopedic patients admitted to an inpatient rehabilitation hospital. We used retrospective data for a sample of 387 patients between the ages of 60 and 89 who had been admitted to a single rehabilitation facility over a period of 12 months. Using age and data on functional capacity at admission from the Functional Independence Measure, we were successful in constructing networks that were 86%, 87%, and 91% accurate in predicting functional outcome, length of stay, and costs to within +/- 15% of the actual value. In each case the accuracy of the network exceeded that of a multiple regression equation using the same variables. Our results show the feasibility of using simulated neural networks to predict rehabilitation outcomes, and the advantages of neural networks over conventional linear models. Networks of this kind may be of significant value to administrators and clinicians in predicting outcomes and resource usage as rehabilitation hospitals are faced with capitation and prospective payment schemes.

Activities of Daily Living↗
PubMed1994

Alphanumeric sequencing: a report on a brief measure of information processing used among persons with multiple sclerosis.

Alphanumeric Sequencing involves the alternating recitation of counting and the alphabet. We report data on the use of this measure with two clinical samples of persons with multiple sclerosis, having either the chronic progressive (n = 23) or relapsing-remitting form (n = 52) of the disease. Patients were administered Alphanumeric Sequencing and several other tests of information-processing speed/capacity and short-term memory. Chronic progressive MS patients performed worse than 23 healthy controls on both the speed and error components of the test, while relapsing-remitting patients were worse than 35 controls only on the total time to complete the task. The time score was correlated with several measures of information processing and short-term memory.

Adult↗
PubMed1994

Procedural learning and the development and stability of character.

This manuscript presents a neuropsychological model of the development and stability of human character. We define character as those things which people do routinely, automatically, and unconsciously--those which make people knowable and predictable. According to the model, the substrate of character is comprised of one's phenotypically based temperamental predispositions. This substrate is modified as a result of experience. Research has indicated the existence of multiple, relatively independent memory systems, and we are particularly interested in the distinction that has been made between declarative and procedural learning. Declarative memory involves recall of information and events, while procedural memory involves the learning of skills and other processes. In neurologically intact persons, these systems work in concert, yet they are relatively independent of one another. This model constrains the concept of character in a manner that allows researchers to address several issues, including (1) the manner in which character develops over time, (2) the mechanisms involved in the stability of character, and (3) the processes likely to be associated with character change.

Brain↗
PubMed1993

Prediction of deficits in behavioral self-regulation among persons with multiple sclerosis.

There is evidence that the lesions characteristic of multiple sclerosis (MS) may isolate prefrontal cortex from other regions of the brain. These findings are consistent with neuropsychological data that show many persons with MS to perform poorly on tests thought to assess the executive functions presumably mediated by the prefrontal area. Furthermore, prefrontal lesions have long been associated with the occurrence of various kinds of behavior pathology. These data prompted us to test the hypothesis that deficits in behavioral regulation typical of frontal lobe dysfunction might play a significant role in the occurrence of behavioral disturbances among persons with multiple sclerosis hospitalized for treatment with methylprednisolone and rehabilitation therapies. Twenty-three chronic progressive MS patients were compared with 23 healthy controls matched on age and education. Both groups were administered the Mini Mental State Exam (MMSE) and the Behavioral Dyscontrol Scale (BDS), a test based on Luria's studies of frontal lobe dysfunction that measures the capacity for regulation of purposeful activity. The MS patients performed more poorly than comparison subjects on the BDS, but not on the MMSE. The MS sample was then divided into two groups according to whether patients obtained low (n = 8) or high scores (n = 16) on the BDS. Compared with high-scoring patients, low-scoring patients showed greater behavioral inertia and greater disruption of the ability to regulate purposeful activity in the performance of activities of daily living. Behavioral disturbances in these individuals thus require careful assessment. Among those who show deficient capacity for behavioral control, the most efficacious interventions may involve the use of cueing, provision of structure, supervision, and environmental modifications.

Activities of Daily Living↗
PubMed1992

Reliabilities, norms and factor structure of the Behavioral Dyscontrol Scale.

This is a report on the statistical properties of a research and clinical measure of cognitive and behavioral functioning, which has so far demonstrated utility among elderly persons. This instrument, the Behavioral Dyscontrol Scale, is adapted from Luria's approach to the assessment of frontal lobe dysfunction. The scale shows high internal consistency and very good interrater reliability. In a clinically stable, elderly population, test-retest reliability is high. Normative data are presented for three different samples: 47 young adults, 141 cognitively normal elderly persons, and our total elderly sample of 229. A principal components analysis yielded 3 factors consistent with Luria's theory.

Aged↗
PubMed1992

High prevalence of cobalamin deficiency in elderly outpatients.

OBJECTIVE: To measure the prevalence of cobalamin (vitamin B12) deficiency in geriatric outpatients as documented by both low serum cobalamin levels and elevations of serum methylmalonic acid and homocysteine and to determine the response to cobalamin treatment. DESIGN: Prospective study screening elderly subjects for cobalamin deficiency using radiodilution cobalamin assays as well as stable isotope dilution gas chromatography-mass spectrometry methylmalonic acid and homocysteine assays. In patients with serum cobalamin levels < or = 300 pg/mL, the response to cobalamin treatment in the group with levels of methylmalonic acid and/or homocysteine > 3 standard deviations (SD) above the mean for normals was compared with that of those without such elevations. SETTING: Outpatient geriatric clinics at the VA Medical Center and University Health Sciences Center, Denver, CO. PATIENTS: One-hundred and fifty-two consecutive outpatients, ages 65 to 99, were screened. Twenty-nine subjects with serum cobalamin levels < or = 300 pg/mL were prospectively evaluated and treated with cobalamin. MAIN OUTCOME MEASURES: Cobalamin, methylmalonic acid, homocysteine, complete blood counts, neurologic examination, and neuropsychological testing. RESULTS: The prevalence of cobalamin deficiency as defined by a serum cobalamin level < or = 300 pg/mL and levels of serum methylmalonic acid and/or homocysteine elevated to > 3 SD was 14.5% of the screened outpatients. A similar proportion of patients with low normal serum cobalamin levels (between 201 and 300 pg/mL) demonstrated elevated metabolites > 3 SD (56%) compared with patients with low serum cobalamin levels (< or = 200 pg/mL) (62%). Cobalamin therapy caused a marked fall or complete correction of the elevated methylmalonic acid and homocysteine levels in each patient who was treated prospectively. Results for complete blood count, lactate dehydrogenase, bilirubin, baseline neurologic score, and baseline neuropsychologic scores did not differ in the group of patients with elevated metabolites compared with those with normal metabolites. The mean red cell volume fell significantly in the patients with elevated metabolites after 6 months of cobalamin treatment. One patient with elevated metabolites had marked improvement in his neurologic abnormalities after 6 months of cobalamin treatment. CONCLUSION: There was a high (14.5%) prevalence of cobalamin deficiency as demonstrated by elevations in serum methylmalonic acid and homocysteine in addition to low or low normal serum cobalamin levels in elderly outpatients. The serum cobalamin level was insensitive for screening since similar numbers of patients with low normal serum cobalamin levels of 201-300 pg/mL compared with patients with low cobalamin levels (< or = 200 pg/mL) had markedly elevated metabolites which fell with cobalamin treatment. Additional studies will be required to define the full clinical benefit from treatment with Cbl in elderly subjects.

Aged↗
PubMed1991

Neuroscience, modularity and personality theory: conceptual foundations of a model of complex human functioning.

The purpose of this paper is to lay the groundwork for the development of a scientific theory of complex human functioning. We first discuss the assumptions on which our thinking is based, then advance the argument that behavior, and human activity in general, may be more fully understood in light of current data on the structural organization of the central nervous system. The brain is organized as a modular, distributed, self-organizing system, which is in constant transaction with the environment. Because of its plasticity, structural and functional change occurs in the brain as a result of experience throughout life. It is our thesis that complex human behavior is organized in a similar manner - that is, human personality and behavior manifest themselves as modular systems. The insights provided by an understanding of the relationship of brain and behavior may enhance the capacity to explain both normal and pathological personality functioning.

Adaptation, Psychological↗
PubMed1990

Prediction of independent functioning and behavior problems in geriatric patients.

Folstein's Mini Mental State Exam, a test assessing the capacity to perform novel and/or repetitive motor tasks (Behavioral Dyscontrol Scale) and a brief measure of working memory were used in a sample of 50 male Veterans Affairs geriatric clinic patients who ranged in age from 63 to 105 (mean, 80.1). The purpose of this study was to attempt to predict the patients' capacity to regulate their behavior independently. We hypothesized that frontal lobe disorders often impair a patient's ability to function autonomously and that the Behavioral Dyscontrol Scale, a measure of frontal lobe impairment, would best predict the capacity for independent regulation of purposeful behavior. Therefore, we examined the relationship of the Behavioral Dyscontrol Scale with spouses' and caregivers' ratings of patients' independent living skills, and with behaviors that interfere with independent functioning. The results of hierarchial regression analyses indicated that the Behavioral Dyscontrol Scale was the only predictor of functional autonomy and was the best predictor of both impulsivity and apathy among geriatric patients. The Behavioral Dyscontrol Scale appears to assess a different functional domain than do the MMSE and similar measures, which rely heavily on the evaluation of orientation and gross cognitive status.

Activities of Daily Living↗
PubMedDate not supplied

Verbal learning and memory among heterozygous fragile X females.

In this paper we report the results of a brief examination of verbal learning and memory in 20 heterozygous fragile X [fra(X)] positive females and in 2 control groups of 20 subjects each. One control group was composed of fra(X)-negative mothers (obligate carriers) and sisters of male probands with fra(X) syndrome, while the other consisted of 14 head injured and 6 learning disabled females. Intellectual functioning was assessed by means of the Wechsler scales, and learning was assessed by several different clinical memory tests. Significant differences were found between groups on measures of short-term memory and learning efficiency. Groups did not differ on measures of cued recall or delayed recall. The findings are consistent with other data and suggest the possibility that central information processing and/or specific encoding processes are defective in persons with fra(X).

Adolescent↗
PubMedDate not supplied

Rural telemedicine data/image transfer methods and purposes of interactive video sessions.

A national survey conducted for the Office of Rural Health Policy in 1995 identified 558 participants in rural telemedicine; 499 (89%) responded to a detailed follow-up survey to describe type of use. While 84% of respondents reported using interactive video, only 25% reported access to e-mail for exchange of data. The challenge to medical informatics is to connect dispersed providers, not just with videoconferencing, but also with other information-sharing methods.

Computer Communication Networks↗