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Biomedical subjects

J J Jacobson

Publications and source records attributed to J J Jacobson.

At least 19 recordsLinked to original sources
PubMed1992

A utility analysis of dental implants.

By applying a utility (usefulness) scale termed the "Feeling Thermometer" to 111 edentulous patients, a measure of effectiveness (quality-adjusted prosthesis years) that can be compared across several treatment strategies was developed. The results suggest that the utility scale was a valid (known group, P < .05), reliable (intraclass correlation coefficient = .713) measure of patients' preferences for the three treatment strategies: (1) conventional complete dentures (controls, n = 77), (2) transosteal implant-supported prostheses (n = 19), and (3) endosseous implant-supported prostheses (n = 15). The implant-treated patients rated their prostheses as high or higher (Feeling Thermometer score of 86.3 [endosseous] and 82.3 [transosteal]) than a functional fitting, esthetic conventional denture (score of 85.0 [endosseous] and 82.0 [transosteal]). They were also younger, more educated, and had received more sets of dentures (P < .05) than conventional denture patients.

Age Factors↗
PubMed1991

Energy levels and probe placement in contact transscleral semiconductor diode laser cyclophotocoagulation in human cadaver eyes.

We investigated the effects of semiconductor diode laser contact transscleral cyclophotocoagulation in human cadaver eyes by gross examination, light microscopy, and scanning electron microscopy to determine optimum clinical treatment parameters. Irradiation was performed using a continuous-wave semiconductor diode laser with a fiber-optic probe. At 1.0 to 1.25 mm posterior to the limbus, spots were centered on the pars plicata by gross examination. Exposures of less than 2 J produced no visible damage. A 2- to 3-J exposure produced mild whitening of the ciliary processes, while 4- to 5-J exposures created more intense whitening of the pars plicata. Energies higher than 5 J frequently produced explosive tissue damage. Light microscopy of tissue treated with 1.8 to 6 J at 1.0 to 1.25 mm posterior to the limbus revealed coagulation necrosis of the nonpigmented and pigmented epithelium, with evidence of thermal coagulation of the ciliary stroma and stromal vasculature. Coagulation necrosis was more intense with longer exposure times. We found the optimum parameters for contact transscleral diode laser cyclophotocoagulation in cadaver eyes to be 3 to 4.5 J of energy delivered with the anterior edge of the probe 1.0 to 1.25 mm posterior to the limbus.

Ciliary Body↗
PubMed1991

Chemoprophylaxis of prosthetic joint patients during dental treatment: a decision-utility analysis.

A decision-analytic model and a cost effectiveness analysis was performed on 1 million hypothetic prosthetic joint patients undergoing dental treatment, to determine the most cost-effective strategy to prevent late prosthetic joint infections. The cost per quality-adjusted life-year saved (QALY) was determined for three preventive strategies: no prophylaxis, oral penicillin, and oral cephalexin. The UCLA Pain-Walking-Function-Activity Scale was used to obtain quality-of-life adjustments (utility assessment) for the study population. Costs were derived from 70 patients hospitalized between July 1, 1982, and June 30, 1986, at the UCLA Center for Health Sciences. The most cost-effective preventive strategy was the no prophylaxis alternative ($196,500/QALY). However, by recommending a 1-day strategy of oral cephalexin only to those dental patients at high risk for late prosthetic joint infections rather than a 3-day regimen to all patients, the cost effectiveness improved from $1.1 million/QALY to $446,100/QALY while maintaining a low risk of death (0.38 deaths per 10(6) dental visits).

Cephalexin↗
PubMed1990

Experimental use of semiconductor diode laser in contact transscleral cyclophotocoagulation in rabbits.

Acute and long-term effects of contact transscleral semiconductor diode laser cyclophotocoagulation were studied in rabbits. Immediately following cyclophotocoagulation, light microscopy revealed coagulation necrosis of the ciliary pigmented and nonpigmented epithelia and stroma; destruction increased in relation to power. There was architectural disruption with higher energy levels. The findings with diode and continuous-wave contact neodymium-YAG lasers were similar. In rabbits treated and followed up for 6 weeks there was a decrease in intraocular pressure during the observation period (P less than .05, paired Student's t test). The gross and light microscopic examination revealed focal atrophy and fibrosis of the ciliary processes, with pigment-laden macrophages on the ciliary processes and in the outflow pathways. Higher energy levels caused lens capsule damage and vitritis. The diode laser produced ciliary destruction similar to the continuous-wave contact neodymium-YAG laser in rabbits, with significant intraocular pressure lowering during the 6-week follow-up.

Animals↗
PubMed1990

Characterization of the mycoflora from oral mucosal surfaces of some HIV-infected patients.

Oral mucosal surfaces from 54 patients seropositive for human immunodeficiency virus (HIV) were assayed for the presence of cultivable yeasts. Oral colonization with Candida albicans, represented by 6 biotypes, was evident in 35 persons. The closely related variant, Candida stellatoidea, was found in 3 patients. Single isolates of Candida parapsilosis, Candida glabrata, Candida tropicalis, and Candida paratropicalis were also identified. One patient harbored a population of Saccharomyces cerevisiae. The susceptibilities of these 43 isolates to clotrimazole and nystatin were compared by the disk diffusion technique.

Candida↗
PubMed1990

Semiconductor diode laser photocoagulation in retinal vascular disease.

The authors successfully performed clinical transpupillary retinal photocoagulation in 30 eyes of 26 patients with retinal vascular disease using a gallium-aluminium-arsenide (GaAlAs) diode laser emitting at 805 nm. Retinal photocoagulation was performed at treatment powers of 300 to 1300 mW and exposure durations of 0.2 to 0.5 seconds with a 200-microns diameter treatment spot. Patients treated with both diode and argon green lasers required 4.5 +/- 1.8 times greater mean laser energy with diode compared with argon to create ophthalmoscopically similar lesions. Parallel experimental retinal photocoagulation in Chinchilla rabbits required 3.1 +/- 0.9 times more power to create ophthalmoscopically similar lesions with the diode laser than with the argon laser. Intraoperative subretinal hemorrhage occurred rarely in patients with an incidence of 4 (0.44%) of 9021 treatment spots. Patients complained of moderate-to-marked pain in 10 (43%) of 23 treatments initiated under topical anesthesia. A transpupillary diode laser may be used clinically to perform therapeutic retinal photocoagulation.

Adult↗
PubMed1990

Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis.

A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 10(6) dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a "no prophylaxis" strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.

Anti-Bacterial Agents↗
PubMed1989

Acceptance of hepatitis B vaccine among dental health care workers.

Participation in hepatitis B vaccination programs by dental health care workers (DHCWs) has been low. Following a vaccination program at the University of Michigan School of Dentistry, a survey was conducted to determine the relation of sociodemographic status, health beliefs, amount of patient contact, and perceived barriers to participation or nonparticipation in the program by 618 students, faculty, and staff. Stepwise logistic regression revealed that a respondent's age, perceptions about susceptibility to hepatitis B, amount of patient contact, and perceptions about the cost of the vaccine were significant determinants of participation. Findings from this study suggest that a highly structured program format is necessary to lower barriers and facilitate access to vaccination, while also cueing the DHCW to appropriate preventive behavior. knowledge appears to be but one factor that may affect decisions regarding acceptance of hepatitis B vaccine; health beliefs, motivational factors, barriers, and program organization all have a significant impact on the DHCW's decision.

Attitude of Health Personnel↗
PubMed1988

Chemoprophylaxis of dental patients with prosthetic joints: a simulation model.

A computer simulation model was created to assess the risks and effects of no prophylaxis, oral penicillin, and oral cephalexin regimens for dental patients at risk for late prosthetic joint infection (LPJI). Given the assumptions made, this analysis suggests that there is a very small risk of LPJI (29-68 cases per 10(6) dental visits), which is outweighed by a greater risk of death from a fatal antibiotic reaction. Thus, routine predental antibiotic prophylaxis for all dental patients with prosthetic joints may lead to higher mortality. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in "high risk" patients.

Administration, Oral↗
PubMed1988

A comparison of potential treatment costs for group capitation versus voluntary individual enrollment plans.

As competition among insurance companies for increased market share intensifies, dental plans designed for new markets have begun to appear. One such plan is marketed to individuals not eligible for group plans. The purpose of this study was to determine if differences in potential treatment costs exist between patients enrolling in individual-targeted plans and those in group-based plans. The cost of treatment plans to eliminate dental disease and replace missing teeth whenever possible and/or practical was calculated for 119 patient pairs from both types of plans. Individually targeted patients had significantly higher levels of potential treatment costs, which were due primarily to significantly greater needs for operative, periodontal surgery, and endodontic services. These findings are important to insurance companies in designing plans that are both equitable and attractive to consumers and potential providers of care, who must weigh their costs of providing care against anticipated revenues.

Adult↗
PubMed1987

Bacteria isolated from late prosthetic joint infections: dental treatment and chemoprophylaxis.

The recommended administration of prophylactic antibiotics, before and during dental procedures, to persons with total joint prostheses is not without controversy. Hospital and dental charts of 2,693 patients in whom total prosthetic joints were placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as the University of Michigan Hospital, were analyzed. The identity of the micro-organism associated with the late (6 months after placement) infected prosthetic joint and the sensitivity of the organisms to specific antibiotics were recorded. Of the 30 (1.1%) late prosthetic joint infections, only one (0.04%) could be temporally associated with dental treatment. Fifty-three percent of the isolates were gram-positive staphylococci, the most common isolate being Staphylococcus epidermidis (36%). Pseudomonas aeruginosa was the most frequent gram-negative isolate cultured. Twenty-five of 34 isolates tested were resistant to penicillin, while only 3 of 36 isolates tested were resistant to a cephalosporin and 5 of 21 isolates tested were resistant to methicillin.

Anti-Bacterial Agents↗
PubMed1987

Cost effectiveness of prevaccination screening for hepatitis B antibody.

The cost effectiveness of screening for hepatitis B antibodies prior to instituting a vaccination program was investigated. Prevaccination screening tests for anti-HBs were performed on sera from 295 faculty and staff. Anti-HBs positive titers were found for 58 persons, and 43 (14.6 percent) of these had titers high enough to confer immunity. The cost of screening 295 persons was $1,666.64, or $5.65 per participant. By not vaccinating 43 persons, $4,498.23 was saved. A prevaccination screening would be most cost effective if only faculty with patient contact were screened.

Cost-Benefit Analysis↗
PubMed1986

Dental treatment and late prosthetic joint infections.

Hospital and dental charts of 2,693 patients in whom total prosthetic joints had been placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as at The University of Michigan Hospital, were analyzed. Of the thirty (1.1%) late prosthetic joint infections (greater than 6 months after placement), only one (0.04%) could be temporally associated with dental treatment. A Fisher's exact test of the data reflected that dental treatment in this population did not increase the incidence of late prosthetic joint infections (p value is 0.0005). Nine of the thirty late infections occurred in insulin-dependent diabetic patients and patients on long-term immunosuppressive therapy. An analysis of the organisms isolated from the late infections shows that 54% where Staphylococcus epidermidis and Staphylococcus aureus. These data do not support the practice of prescribing prophylactic antibiotic coverage of prosthetic hip and knee joints prior to all dental therapy. Rather, use of antibiotics during dental treatment appears warranted only if a chronic bacteremia is anticipated or where a predisposing systemic condition may exist.

Bacterial Infections↗