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Biomedical subjects

J Jagger

Publications and source records attributed to J Jagger.

At least 73 records · Page 4Linked to original sources
PubMed1992

Serum cortisol levels predict infarct size and patient mortality.

We have investigated prospectively the serum cortisol response to acute myocardial infarction in 70 consecutive patients admitted to a coronary care unit and we have shown that the levels are significantly raised early in the course of the illness and prior to elevation of the cardiac specific enzyme fraction, creatine kinase MB. The magnitude of the cortisol response is related to the size of the ensuing infarction (rs = 0.54) as calculated from the total creatine kinase MB release (P < 0.001) and very high levels (> 2000 mumol/l) are predictive of mortality (P < 0.05). Serum cortisol levels may have a role in the early identification of myocardial infarction and in predicting those patients with a poor prognosis.

Anistreplase↗
PubMed1992

The Critikon ProtectIV catheter issue.

Most healthcare professionals have already read about the union grievance over the Critikon ProtectIV catheter filed at San Francisco General Hospital. The union's position was that the catheter which is designed to prevent needlesticks during insertion and removal, should be used in all applications at the hospital, rather than only in those that seemed to present greater risk of injury or infection. HHMM believes that engineering controls--specifically safety needles--should be fundamental to a good exposure control plan for bloodborne pathogens. If the primary pathway of exposure is the needlestick and the point of the control plan is to reduce needlesticks, then it is hard to refute the logic that safety devices are the best approach. The following material consists of the statement made by Dr. Peter Lurie to the grievance committee at San Francisco++ General and a letter from Dr. Janine Jagger presenting initial data on the effectiveness of the ProtectIV catheter in reducing injuries. Both are reprinted with permission. HHMM offers these documents for the information they contain, as well as for the guidance they offer in how to begin evaluating safety needle devices.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Prevention of brain trauma by legislation, regulation, and improved technology: a focus on motor vehicles.

More than half of all brain trauma is caused by motor vehicle crashes. Prevention strategies that reduce the likelihood of motor vehicle crashes or injuries to occupants will also prevent trauma. Many effective strategies have yet to be applied on a large scale. Roadway design improvements such as removal of fixed objects from roadsides, widening roadside recovery zones, installing dividers between opposing lanes of traffic, and replacing fixed utility poles with breakaway designs, have been effective in reducing crashes and injuries. Driver measures of documented benefit include the 55 mph speed limit, safety belt use laws, 21 year legal drinking age, administrative license suspension for drinking drivers, and driving curfews and postponement of licensure for teenagers. Motor vehicle safety has improved greatly since the National Highway Traffic Safety Administration began regulating vehicle design. Significant design requirements include lap and shoulder belts in front seat positions, and, more recently, automatic safety belts or air bags in front seat positions, head restraints in front seat positions, reinforcing side and roof beams, and the center-mounted brake light. The most significant future advance will be the provision of full front seat air bags in all passenger vehicles. As much as one-quarter of brain trauma can be prevented or reduced in severity by this measure alone. Further safety requirements should include head restraints in rear positions, a-pillar, b-pillar, and roof padding, antilock brakes, and a vehicle rollover standard.

Accidents, Traffic↗
PubMed1990

Sharp object injuries in the hospital: causes and strategies for prevention.

We identified characteristics of items causing sharp object injuries in hospital personnel during a 10-month interval. Sharp objects were defined as items that were not hollow-bore needles, that cause lacerations or puncture wounds. Workers reporting sharp object injuries were interviewed to determine what items caused injury and the circumstances of their injuries. Of 89 incidents, 51% were surgical instrument injuries, 19% were lancet injuries, 16% were glass injuries, and 15% were caused by other sharp items. A frequent feature of sharp objects causing injuries was the necessity of disengaging a disposable sharp item from a reusable holder. The application of manual force to fragile glass items also caused many injuries. Opportunities for safer product design and improved materials are discussed to reduce this common occupational hazard.

Accidents, Occupational↗
PubMed1990

Estimated cost of needlestick injuries for six major needled devices.

A major factor in the introduction of new products designed to decrease the risk of needlesticks to healthcare workers (HCWs) is whether the increased expense of a safer device is offset by the savings of preventing needlesticks. The itemized costs of needlestick injuries associated with six major needled devices were estimated and compared to the cost of the devices causing the injuries, based on 1988 dollars. Included was the cost of treatment, prophylaxis and employee health department personnel time. The average cost of needlestick injury was $405, with a narrow range of $390 to $456 for different devices. As a percent of the cost of the devices, needlesticks cost as little as 10% of the cost of the device, for the intravenous (IV) catheter, to as much as 457%, for needles used to connect IV lines. On the average, needlesticks cost 36% of the devices' cost. These data may be used to weigh the potential economic benefits of safer needle technology or other strategies intended to reduce the incidence of needlesticks.

Costs and Cost Analysis↗
PubMed1990

Refsum's disease: electron microscopy of an iris biopsy.

Refsum's disease (phytanic acid storage disease) results in an accumulation of lipid as a result of an absence of mitochondrial hydroxylation of phytanic acid. We describe a previously unrecorded electron microscopic study of lipid deposition in the iris pigment epithelium of a patient with Refsum's disease, and lipid was present in other sites within the iris.

Adult↗
PubMed1989

Neurologic assessment of subarachnoid hemorrhage in a large patient series.

Data from the International Cooperative Aneurysm Study including 3521 cases of aneurysmal subarachnoid hemorrhage were used to statistically derive a simple scoring method for assessing neurologic status of subarachnoid hemorrhage patients. Discriminant analysis was used to identify the best combination and weighting of seven neurologic assessment variables to classify outcomes at 6 months post-subarachnoid hemorrhage. The sum of eye opening response and worst motor response classified patient outcomes nearly as well as all variables combined. The validity of this summary score was tested using good recovery and mortality endpoints. The result is a useful scale for classifying subarachnoid hemorrhage patients.

Discriminant Analysis↗
PubMed1988

Rates of needle-stick injury caused by various devices in a university hospital.

We identified characteristics of devices that caused needle-stick injuries in a university hospital over a 10-month period. Hospital employees who reported needle sticks were interviewed about the types of devices causing injury and the circumstances of the injuries. Of 326 injuries studied, disposable syringes accounted for 35 percent, intravenous tubing and needle assemblies for 26 percent, prefilled cartridge syringes for 12 percent, winged steel-needle intravenous sets for 7 percent, phlebotomy needles for 5 percent, intravenous catheter stylets for 2 percent, and other devices for 13 percent. When the data were corrected for the number of each type of device purchased, disposable syringes had the lowest rate of needle sticks (6.9 per 100,000 syringes purchased). Devices that required disassembly had rates of injury of up to 5.3 times the rate for disposable syringes. One third of the injuries were related to recapping. Competing hazards were often cited as reasons for recapping. They included the risk of disassembling a device with an uncapped, contaminated needle and the difficulty of safely carrying several uncapped items to a disposal box in a single trip. New designs could provide safer methods for covering contaminated needles. Devices should be designed so that the worker's hands remain behind the needle as it is covered, the needle should be covered before disassembly of the device, and the needle should remain covered after disposal. Such improvements could reduce the incentives for recapping needles and lower the risk of needle-stick injuries among health care workers.

Accidents, Occupational↗