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Biomedical subjects

J S Powers

Publications and source records attributed to J S Powers.

At least 19 recordsLinked to original sources
PubMed1991

Erythropoietin response to anemia as a function of age.

The erythropoietin (EPO) response to anemia was assessed for 244 subjects aged 1-64 years (mean 45.2 years) and 121 subjects aged 65-94 years (mean 68.3 years). Subjects included non-anemic individuals as well as those with anemia of various etiologies, excluding renal disease and pregnancy. Significant inverse correlations between serum immunoreactive EPO and hematocrit were noted for both groups. Regression lines failed to show a significantly lower slope or y-intercept for older compared to younger subjects. EPO levels were not significantly lower for older compared to younger subjects when controlled for hematocrit level. These results suggest that the EPO response to anemia in older subjects is similar to that of younger subjects.

Adolescent↗
PubMed1991

Use of recombinant human erythropoietin to enhance autologous blood donation in a patient with multiple red cell allo-antibodies and the anemia of chronic disease.

We treated a patient with alcohol-induced cirrhosis, intractable pain from a defective hip prosthesis, and multiple red cell allo-antibodies with recombinant human erythropoietin (EPO) in order to facilitate collection of blood for autologous transfusion during an elective total hip revision. This patient had experienced a delayed transfusion reaction 4 months earlier after receiving least incompatible packed red cells for gastrointestinal bleeding. His blood could not be crossmatched because of the development of multiple antibodies to homologous blood given during previous surgery and several episodes of gastrointestinal hemorrhage. Following initiation of EPO therapy, there was a prompt and persistent increase in the reticulocyte count from a baseline of 1.6% to a maximum of 8.6%. This was accompanied by maintenance of the hematocrit between 32% and 38.5% despite withdrawal of seven units of autologous blood over the 45-day treatment period. Poor venous access and availability of blood bank personnel, not hematocrit level, were the limiting factors that determined how frequently blood could be collected. We conclude that EPO stimulated erythropoiesis in this patient with underlying anemia of chronic disease and facilitated harvest of autologous blood for elective surgery.

Aged↗
PubMed1991

The evaluation of an intermediate care--geriatric evaluation unit in a Veterans Administration Hospital.

In response to the increasing care needs of geriatric patients and attendant hospital costs, the Nashville Veterans Administration Medical Center, which has 393 beds and admits 8400 patients annually, initiated an Intermediate Care Service in 1988. A geriatric team was formed, sharing staff and resources from existing units. To determine the efficacy of intermediate care, automated data sources at the Nashville Veterans Administration Medical Center provided data on discharge status, length of stay, and diagnoses of patients in both the acute and intermediate care units. The first year's experience indicated that careful communication and education of nursing staff was required to initiate the Intermediate Care Service with no staff resigning. An interdisciplinary team facilitated better patient care and discharge planning. Among 190 patients discharged from this service, 57% were discharged home and 22% into nursing homes; this can be compared to those discharged from acute care units of the hospital: 84% home and 4% to a nursing home; 20% of the patients in the Intermediate Care Service were discharged to a lower level of care than the initial hospital discharge plan had indicated. A 1.4-day decrease in average length of stay in the hospital has occurred since initiation of the Intermediate Care Service.

Aged↗
PubMed1989

Helping family and patients decide between home care and nursing home care.

Good home health and institutional care alternatives are important for the care of aging patients. The physician's assistance is crucial in helping family and patients decide on the optimal level of care. Knowledge of the patient's medical status, family and patient resources and preferences, cost factors, and the patient's functional status will make the physician an effective counselor for elderly patients and their families faced with deciding between nursing home and home care.

Activities of Daily Living↗
PubMed1989

Assessment of nutritional status in noninstitutionalized elderly.

Aging may modify both the availability of and needs for certain nutrients. Our study was done to assess the contribution of age alone to micronutrient levels in older volunteers (aged 60 or more). One hundred two healthy elderly white subjects, 63 women and 39 men, carefully screened by history or chart review, were studied in the fasting state. All were noninstitutionalized without serious chronic or acute illness; their diets were nutritionally adequate, containing more than two thirds of the recommended dietary allowance (RDA) for all nutrients, and no subject was taking more than twice the RDA of fat-soluble vitamins. These subjects had higher levels of plasma and red blood cell carnitine, and vitamins A, E, and C. They had lower levels of albumin, transferrin, and zinc than younger laboratory reference subjects. Retinol-binding protein, serum and red blood cell folate, and copper levels were not different. With increasing age, levels of transferrin and vitamins C and E fell; all other measured micronutrient levels were similar. Albumin, vitamin C, and copper values were higher among elderly women, and plasma and red blood cell carnitine values and zinc levels were higher in elderly men. There was great variability in the micronutrient levels despite similar nutrient intakes.

Age Factors↗
PubMed1988

Antecedent factors in urinary tract infections among nursing home patients.

By a retrospective relative risk analysis for conditions associated with urinary tract infection over a four-year period in a defined teaching nursing home population (n = 97), we reached the following conclusions: (1) UTI was associated with cerebrovascular accident (relative risk 2.2, 95% confidence interval 1.4 to 3.2), decreased activities of daily living (relative risk 2.6 to 3.2, 95% confidence interval 1.4 to 4.7), decreased mental status (relative risk 2.2, 95% confidence interval 1.2 to 3.1), urinary catheterization (relative risk 2.5, 95% confidence interval 1.3 to 3.7), and antibiotic prophylaxis (relative risk 2.1, 95% confidence interval 1.2 to 3.0). (2) Risk of UTI from urinary catheterization and antibiotic prophylaxis was additive for these functionally impaired patients. (3) Renal insufficiency, diabetes, anemia, malnutrition, age, and incontinence (without catheterization) were not related to risk of UTI.

Adult↗
PubMed1986

A teaching nursing home: the Vanderbilt experience.

A program to provide exposure to geriatrics as a teaching nursing home project was initiated at a large urban university medical center. Positive experiences, changes of attitude, and personal growth were noted among those involved in teaching, learning, and care of patients. A description of the program, its expansion, and plans for the future are detailed.

Academic Medical Centers↗
PubMed1985

Patient-physician communication and interaction: a unifying approach to the difficult patient.

Many difficult patients encountered by the primary care physician may be understood in terms of severe unmet dependency needs. These patients often evoke negative feelings on the part of physicians. A mutual participation approach to the patient-physician relationship is a means of providing effective care for these patients, at the same time preventing frustration and burnout in the physician by preserving his energies.

Aged↗