Biomedical subjects

J Hennen

Publications and source records attributed to J Hennen.

42 records · Page 3Linked to original sources

PubMed1993

Creation of state-level Medicare database for healthcare evaluation applications.

The Health Care Quality Improvement Initiative (HCQII) of the Health Care Financing Administration (HCFA) calls for Professional Review Organizations (PROs) to undertake pattern analysis of large administrative datasets for the purposes of quality of care assessment. The limitations of such administrative databases (primarily the MEDPAR file and derivatives thereof) include impoverished information regarding clinical attributes of Medicare enrollees and the process and outcome of their healthcare. This paper describes preliminary efforts to address this problem by the creation of a database, the PRO Concatenated Database (PCD), from the pooled implicit judgment review data of four Peer Review Organizations (PROs). The data elements comprising the PCD were carefully selected to provide important information regarding quality and appropriateness of care. Preliminary inter-state comparative studies employing the PCD are discussed. A method is also described by which the analytical power of state-level databases may be enhanced by linkage to state-level Modeled MEDPAR data which are issued by HCFA and contain patient-level risk-adjusted mortality data. This approach to the acquisition of data whose clinical content is enriched may prove to be particularly useful to the PRO community during the pattern analysis phase of the HCQII. Such analyses will evolve into more detailed studies involving primary data collection followed by dissemination of the results to local healthcare providers. In this manner, the PCD may facilitate rapid feedback regarding the effectiveness of healthcare delivery to the local community.

Aged↗

PubMed1992

Occlusion of the pig superior sagittal sinus, bridging and cortical veins: multistep evolution of sinus-vein thrombosis.

Cerebral sinus-vein thrombosis may lead to severe hemodynamic changes, elevated intracranial pressure (ICP), and brain edema. It is supposed that progression of the thrombus from the sinus into bridging and cortical veins plays a key role in the development of these pathophysiological changes, but this hypothesis lacks experimental proof. The aim of this study, using a novel animal model of sinus-vein thrombosis, was to evaluate the effects of a standardized occlusion of the superior sagittal sinus and its bridging and cortical veins on hemodynamic alterations, on brain water content, and on ICP in domestic pigs. In 10 animals, the middle third of the superior sagittal sinus was occluded with a catheter-guided balloon. Five of these pigs received an additional injection of 1 ml fibrin glue into the superior sagittal sinus anterior to the inflated balloon, leading to an obstruction of bridging and cortical veins. In five control animals the balloon was inserted but not inflated. Five pigs underwent cerebral angiography. Four hours after occlusion, the brains were frozen in liquid nitrogen, and coronal slices were examined for Evans blue dye extravasation, regional water content, and histological changes. Occlusion of the superior sagittal sinus alone did not affect ICP or cerebral perfusion pressure (CPP). The additional injection of fibrin glue caused an obstruction of cortical and bridging veins as well as severe increases in mean (+/- standard deviation) ICP to 49.4 +/- 14.3 mm Hg, compared with 8.3 +/- 4.5 mm Hg in sham-treated controls and 7.1 +/- 3.9 mm Hg in animals with occlusion of the superior sagittal sinus alone. There was also a steep fall in the mean CPP to 34.2 +/- 19.6 mm Hg compared with 96.4 +/- 13.8 mm Hg in the control group. White-matter water content anterior to the occlusion site was elevated to 81.9 +/- 3.7 gm/100 gm frozen weight in the fibrin group as compared to 70.7 +/- 2.2 gm/100 gm in controls. Posterior to the occlusion site, water content did not differ among the three groups. Angiography demonstrated collateral flow via cortical and bridging veins in animals with occlusion of the superior sagittal sinus alone. Additional fibrin glue obstructed these collateral vessels. The data suggest a multistep process of pathophysiological alterations in patients with sinus-vein thrombosis and may explain why these patients present with a wide variety of symptoms: minor neurological deficits or headache might indicate thrombosis of the superior sagittal sinus and/or its bridging veins.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1990

Brain oedema and intracranial pressure in superior sagittal sinus balloon occlusion. An experimental study in pigs.

About 2/3 of all patients with thrombosis of the superior sagittal sinus (SSS) develop signs of increased ICP and/or brain oedema (BE). The time of onset and the spectrum of symptoms in SSS thrombosis vary extremely. This variability might be caused by differences in pathomechanism like BE and rise of ICP, parameters studied in the present contribution. 10 domestic pigs received a standardized occlusion of the SSS with two different balloon types (spherical and cylindrical). They were monitored for several systemic and intracranial pressures. After 4 hours of occlusion the brains were examined for BE (Evans blue, water content). They were compared with those of 4 sham-operated control animals. 4 animals underwent cerebral angiography. Within 4 hours ICP rose to 60 mm Hg in the group with the spherical balloon. Normal ICP of 5-10 mm Hg was seen in the group with the cylindrical balloon and in the sham-operated controls. The water content of the white matter was elevated in both occlusion groups differing significantly from the control group. Haemorrhagic infarction of the frontal parts of the cerebrum occurred in animals with concomitant obliteration of bridging and cortical veins. We conclude from our experiments that SSS occlusion may initiate a multitude of possible pathomechanisms depending on the involvement of bridging veins, cortical veins and inner brain veins.

Animals↗

PubMedDate not supplied

The dissociative experiences of borderline patients.

The study objective was to assess the severity and quality of dissociative experiences reported by borderline patients. Two hundred ninety criteria-defined borderline patients and 72 axis II controls completed the Dissociative Experiences Scale (DES), a 28-item self-report measure with demonstrated reliability and validity. Thirty-two percent of borderline patients had a low level of dissociation, 42% a moderate level, and 26% a high level similar to that reported by patients meeting criteria for posttraumatic stress disorder (PTSD) or dissociative disorders. The controls had a significantly different distribution of overall DES scores: 71% reported a low level of dissociation, 26% reported a moderate level, and only 3% reported a high level. In addition, borderline patients had a significantly higher score than the controls on 21 of 28 DES items and a significantly higher overall DES score, as well as the score on the 3 factors that have been found to underlie the DES, absorption, amnesia, and depersonalization. The results of this study suggest that the severity of dissociation experienced by borderline patients is more heterogeneous than previously reported. They also suggest that borderline patients have a wider range of dissociative experiences than are commonly recognized, including experiences of absorption and amnesia, as well as experiences of depersonalization.

Adolescent↗

PubMedDate not supplied

The paraphilia-related disorders: an empirical investigation of nonparaphilic hypersexuality disorders in outpatient males.

The frequency distribution of nonparaphilic hypersexual behaviors was investigated in an outpatient sample of 206 consecutively evaluated males seeking help for sexual impulsivity disorders (SIDs), either paraphilia-related disorders (PRD; n = 63) or paraphilias (PA; n = 143). Paraphilia-related disorders associated with help-seeking behaviors included compulsive masturbation (sample prevalence, 69%), protracted heterosexual or homosexual promiscuity (51%), pornography dependence (50%), telephone-sex dependence (24%), and severe sexual desire incompatibility (12%). Eighty-six percent of the PA sample reported at least one lifetime PRD. The subgroup of males with both PAs and lifetime PRDs (n = 123) self-reported the greatest number of lifetime SIDs, the highest incidence of physical and sexual abuse, the fewest years of completed education, and the highest likelihood of current unemployment or disability. As well, the subgroup of males with PAs but no lifetime PRDs (n = 20) self-reported the fewest lifetime SIDs; this subgroup was not statistically different from the PRD group on these aforementioned variables. These data suggest that social disadvantage, as assessed in this sample, is associated with the cumulative incidence of SIDs but not necessarily with the diathesis to develop paraphilic disorders.

Adult↗

PubMedDate not supplied

The pain of being borderline: dysphoric states specific to borderline personality disorder.

The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria-defined borderline personality disorder and 34 Axis II controls filled out the Dysphoric Affect Scale, a 50-item self-report measure that was designed for this purpose and has good internal consistency and test-retest reliability. Twenty-five dysphoric states (mostly affects) were found to be significantly more common among borderline patients than controls but nonspecific to borderline personality disorder. Twenty-five other dysphoric states (mostly cognitions) were found to be both significantly more common among borderline patients than controls and highly specific to borderline personality disorder. These states tended to fall into one of four clusters: (1) extreme feelings, (2) destructiveness or self-destructiveness, (3) fragmentation or "identitylessness," and (4) victimization. In addition, three of the 25 more-specific states (feeling betrayed, like hurting myself, and completely out of control), when occurring together, were particularly strongly associated with the borderline diagnosis. Equally important, overall mean Dysphoric Affect Scale scores correctly distinguished borderline personality disorder from other personality disorders in 84% of the subjects. Taken together, the results of this study suggest that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognized, and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis.

Adolescent↗