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Biomedical subjects

J R Freeman

Publications and source records attributed to J R Freeman.

At least 19 recordsLinked to original sources
PubMed2000

Management of sports-related concussions.

Mild head injury is a frequent occurrence in a multitude of athletic endeavors across all levels of play. Clinicians should carefully consider all interventions at their disposal to reduce the prevalence and severity of injury to protect those involved. The exploration and evaluation of using properly fitted mouthguards to provide effective, albeit limited, defense against brain injury merits attention. The minimal costs of such an intervention when properly applied would no doubt reap numerous benefits in terms of reducing the medical, financial, cognitive, psychological, and social consequences of mild head injury. The cosmetic salvation would be no small side effect to efficacious, properly fitted mouthguard use.

Athletic Injuries↗
PubMed1998

Primary traumatic anterior shoulder dislocation in patients 40 years of age and older.

During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.

Adult↗
PubMed1996

The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction.

A prospective study was designed to determine the impact of surgical timing on postoperative motion and stability following anterior cruciate ligament (ACL) reconstructive surgery. The study population was limited to acute ACL ruptures from downhill skiing undergoing arthroscopic ACL surgery without arthrotomy or surgical intervention for other ligamentous structures; 185 patients were entered into four separate groups based on the time interval from injury to surgery. Motion and stability were tested at multiple time points from the index surgery and adverse events were recorded. We found no statistical difference in restoration of extension or flexion in any group at any time point. KT-1000 data at 12 months showed a side-to-side difference of < or = 3 mm in 94%, with 6% showing a side-to-side difference of > 3 and < or = 5 mm. We conclude that, in this population, by using modern arthroscopic surgical techniques and an aggressive postoperative physical therapy protocol, motion and stability can be restored in a high percentage of patients and that surgical success is independent of the timing of surgery.

Adolescent↗
PubMed1995

A strategy for improving the supervision and performance of moonlighting residents.

BACKGROUND: In 1990 the Ambulatory Care Service of the Ralph H. Johnson Department of Veterans Affairs Medical Center, affiliated with the Medical University of South Carolina College of Medicine, developed written clinical protocols for the management of patients with certain high-risk medical conditions. METHOD: Appropriateness of care was assessed by determining physician compliance to the protocols over a 24-month period (October 1990-September 1992). All physicians who did not comply received individualized feedback from the service chief. For the first 12 months, both staff physicians and moonlighting second- and third-year medical residents were assessed (a total of seven staff physicians and 20 residents participated in the study). For the second 12 months, only the residents were assessed. RESULTS: The moonlighting residents were notably less consistent than the staff physicians in protocol compliance (95-100% for the staff physicians; 78-100% for the moonlighters). Additional interventions were then implemented to improve the moonlighters' utilization of the protocols. Moonlighters' compliance over the subsequent 12 months was less variable (mean compliance of 92%, SD, 3%, the first year versus 95%, SD, 8%, the second year). CONCLUSION: The strategy seemed to improve the supervision and performance of the moonlighting residents and promoted consistent delivery of high-quality outpatient care.

Clinical Protocols↗
PubMed1994

Grade III avulsion fracture repair on the UCL of the proximal joint of the thumb.

A technique is presented for repair of grade III avulsion fractures of the ulnar collateral ligament when the bony avulsion fragment in the thumb is too small or too comminuted to allow simple repair. The case presented demonstrates that a single suture-to-bone anchor can provide secure ligament fixation without the need for external pull-out wires or buttons and can make possible an early return to activity.

Collateral Ligaments↗
PubMed1990

Effects of intermittent feeding upon body weight and lifespan in inbred mice: interaction of genotype and age.

Beginning at either 1.5, 6 or 10 months of age, male mice from the A/J and C57BL/6J strains and their F1 hybrid, B6AF1/J were fed a diet (4.2 kcal/g) either ad libitum every day or in a restricted fashion by ad libitum feeding every other day. Relative to estimates for ad libitum controls, the body weights of the intermittently-fed restricted C57BL/6J and hybrid mice were reduced and mean and maximum life span were incremented when the every-other-day regimen was initiated at 1.5 or 6 months of age. When every-other-day feeding was introduced at 10 months of age, again both these genotypes lost body weight relative to controls; however, mean life span was not significantly affected although maximum life span was increased. Among A/J mice, intermittent feeding did not reduce body weight relative to ad libitum controls when introduced at 1.5 or 10 months of age; however, this treatment did increase mean and maximum life span when begun at 1.5 months, while it decreased mean and maximum life span when begun at 10 months. When restricted feeding was introduced to this genotype at 6 months of age, body weight reduction compared to control values was apparent at some ages, but the treatment had no significant effects on mean or maximum life span. These results illustrate that the effects of particular regimens of dietary restriction on body weight and life span are greatly dependent upon the genotype and age of initiation. Moreover, when examining the relationship of body weight to life span both between and within the various groups, it was clear that the complexity of this relationship made it difficult to predict that lower body weight would induce life span increment.

Aging↗
PubMed1990

Treatment of comminuted distal radial fractures with preliminary horizontal finger trap traction and a Roger-Anderson external fixation device.

Over a five-year period, 43 patients with comminuted distal radial fractures were treated with a Roger-Anderson external fixation device after the fracture was aligned in Strong's horizontal finger trap traction. Nineteen patients (21 wrists) were available for personal interview and radiographic follow-up. A 0.5-mm loss of radial height and an average loss of 2.4 degrees of palmar angulation presented. Range of motion (ROM) was excellent, stiffness was nonexistent or minimal in 81%, pain was nonexistent or minimal in 86%, and weakness of grasp was nonexistent or minimal in 81%. Complications were minimal; they included three pin tract infections, two of which required pin removal before they resolved. One patient fractured a pin that also required removal. Strong's horizontal finger trap traction and the Roger-Anderson external fixation device simplified the sometimes difficult treatment of this fracture. It seems to be most effective in young athletic individuals who have good bone stock and very comminuted fractures.

Adult↗
PubMed1987

Dietary restriction benefits learning and motor performance of aged mice.

Female C3B10RF1 mice maintained on either a control (approximately 95 kcal/week) or restricted (approximately 55 kcal/week) diet since weaning were tested in a behavioral battery at 11 to 15 or 31 to 35 months of age (middle-aged vs. aged). Age-related declines observed among control groups in tests of motor coordination (rotorod) and learning (complex maze) were prevented by the restriction regime. In addition, diet restriction increased locomotor activity in a runwheel cage among mice of both ages but did not affect exploratory activity in a novel arena.

Aging↗
PubMed1987

Changing patterns in tibial fractures resulting from skiing.

Of the 734 adult tibial fractures treated in Aspen, Colorado, from 1968-1978, follow-up results were obtained on 527 (72%). The fractures were analyzed with regard to rate of healing, age of patient, and location of fractures. There was a statistically significant increase in healing time with increasing age between ages 16-40. The location of tibial fracture (proximal, middle, distal) had no significant influence on rate of healing. The occurrence of open tibial fracture was low (3% of total) and in most instances wounds were benign (Class I). Compartment syndrome is rarely encountered in skiing fracture because of the relatively low energy involved. All tibial fractures occurring between 1982-1984 were reviewed and compared to the earlier series. This comparison confirmed the continual overall decline in rate of tibial fracture from skiing (from 12.9/100,000 skier days in 1968 to 2.9/100,000 skier days in 1983). This decline was primarily in spiral fractures (from 70% of total in 1968 to 50% in 1983). The percent of transverse fractures was unchanged (+/- 15%) while the percent of short oblique fractures increased from 11% to 33%. Properly adjusted and maintained safety equipment afforded reasonable protection from spiral fractures of the tibia, but a conceptual departure from the current release binding design would be required to protect against the benign moments that produced transverse and short oblique fracture. The current treatment philosophy is based on fracture type and the availability or experience with newer treatment modes.

Adolescent↗
PubMed1987

Acute surgical repair of the skier's thumb.

Complete ulnar collateral ligament tears incurred during the period fall 1977 through spring 1979 were treated under regional anesthesia by a single group of surgeons in an identical fashion as outpatients. Of 123 thumbs repaired, 69 (59%) were available for follow-up examination. There were 34 women and 35 men with an average age of 34.5 years (range, 16-61 years). The follow-up period averaged 31.6 months (range, 16-46 months). Weakness of pinch was described as none or mild in 66 (96%) and significant in only three (4%). Stiffness was described as none or mild in 66 (96%), moderate in two (3%), and severe in one (1%). Pain was described as none or mild in 68 (99%) and moderate in one (1%). Sixty-two patients (90%) preferred outpatient surgery with regional anesthesia whereas only seven (10%) did not. Forty-five (65%) of the 69 patients who required surgery had used traditional poles with straps, suggesting the pole as the causative factor. However, only 20% of noninjured skiers during the 1981-1982 season were using traditional poles with straps, and the total number of complete ulnar collateral ligament repairs did not decrease with the same number of skiers. Therefore, the change in pole design has not decreased the incidence of total ulnar collateral ligament tears. The results of acute surgical repair as an outpatient with regional anesthesia are excellent; 96% of the patients were pleased with the results. If the lesion is overlooked, the results of secondary construction are not nearly as good.

Adolescent↗
PubMed1985

Primary knee ligament repair--revisited.

There were 4710 knee sprains resulting from skiing in the four Aspen ski areas between 1976 and 1979. Twenty percent of the patients (942) had complete tears. Of these, 302 elected to remain in Aspen for treatment. All were treated by primary ligament repair without augmentation. These cases were evaluated an average of 42 months after injury. Patients with isolated tears of the medial collateral ligament were found to be doing well; virtually all of them had returned to preinjury activity levels. Thirty-six percent of the isolated anterior cruciate repairs were rated failures, and 43% of the combination ACL-MCL injuries had failed because of anterior cruciate deficiency. Twenty-nine percent of the ACL and ACL-MCL injuries had meniscal tears. Cases that included meniscectomy had a failure rate twice as great as those in which the meniscus was preserved. The results following repair of anterior cruciate tears were not acceptable, and augmentation was indicated. Primary repair of medial collateral ligament tears produced excellent results. Meniscal tears were frequent in association with ligament disruption. Ligament repairs were less satisfactory when meniscectomy was performed at the time of the repair.

Athletic Injuries↗
PubMed1983

Effects of intermittent feeding upon growth, activity, and lifespan in rats allowed voluntary exercise.

From weaning until death, male Wistar rats were housed in activity-wheel cages with one group maintained on an ad libitum (AL) diet and another provided the diet every-other-day (EOD). EOD-fed rats had a mean lifespan of 124 weeks compared to 103 weeks for AL-fed rats. While post-weaning body weight and growth rates were reduced among the EOD-fed animals compared to AL-fed animals, there was no significant difference in growth duration. Positive correlations were observed between lifespan and estimates of growth rate and duration in the AL group but not in the EOD group; thus, little evidence was produced to support the hypothesis that growth rate is inversely related to longevity. While the EOD feeding regimen resulted in higher activity levels later in life, wheel activity levels were actually lower in this group in early life compared to the AL group. The observation of reduced wheel activity among young rats fed EOD was replicated in a second experiment. Thus, little support was obtained for the hypothesis that increased activity mediates the beneficial effects of dietary restriction on longevity, unless this mechanism is active late in the lifespan.

Animals↗
PubMed1983

Differential effects of intermittent feeding and voluntary exercise on body weight and lifespan in adult rats.

Male wistar rats were housed in laboratory cages or activity-wheel cages at eight 10.5 or 18 months of age. Part of each cage group continued to be fed ad libitum, whereas the remaining animals were fed every other day. Compared with the ad libitum condition, intermittent feeding decreased body weight and increased lifespan at both ages in both caging conditions. Compared with the caged condition, voluntary exercise in activity wheels reduced body weight only in the 10.5-month-old group fed ad libitum but produced no effect on survival of either age group. The results suggest that intermittent feeding can enhance survival in mature rats even beyond ages at which body weight growth usually ceases, whereas voluntary exercise appears to have an early threshold beyond which increases in longevity are not observed.

Animals↗
PubMed1982

Effects of intermittent feeding upon growth and life span in rats.

From weaning to death, 28 male Wistar rats were maintained on an ad libitum (AL) diet, and 24 counterparts were provided the diet every-other-day (EOD). The mean life span of the EOD group represented an 83% increase over that of the AL group. Furthermore, a Gompertzian analysis of mortality rates suggested that the rate of aging was retarded in the EOD group. While body weight and growth rate were reduced in the EOD group, their growth duration was 75% longer compared to the AL group. Significant positive relationships emerged between life span and growth rate parameters in the AL group; however, no significant relationships were found between life span and body weight parameters in the EOD group. Therefore, in support of the hypothesis that dietary restriction effects prolongevity through retarded development, evidence was produced only in the between-group comparisons of AL- and EOD-fed animals.

Aging↗
PubMed1976

Hospital managers need management information systems.

A new hospital director seeking to bring his institution to the brink of solvency found himself with ten pounds of data but no "information"--at least, not the kind of information he could use as a basis for management decisions. What he needed was a system that would not only present data, but the meaning of the data. Such a system is the integrated MIS.

Computers↗
PubMed1970

Systems engineering.

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Appointments and Schedules↗