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Biomedical subjects

J T Jacobson

Publications and source records attributed to J T Jacobson.

At least 19 recordsLinked to original sources
PubMed1992

Effect of irradiation on guinea pig ABR thresholds.

A significant number of patients undergo irradiation to the temporal bone for malignancies. Conflicting reports exist regarding the effects of irradiation on hearing thresholds. Although radiation-induced otitis media and osteoradionecrosis of the ossicles with resultant conductive hearing loss are well-documented, there is disagreement regarding the effect of irradiation on sensorineural hearing. Previous animal models, relying only on behavioral tests and reflex thresholds, have failed to reveal consistent threshold shifts after irradiation. However, with the advent of auditory brainstem response (ABR) testing, a reliable objective measurement of hearing in animals is available. Hearing thresholds were determined bilaterally by ABR testing in 21 albino guinea pigs. The left temporal bones of sixteen animals were then irradiated with a total dose ranging from 5750 to 7000 cGy over 7 weeks. The right ears of these animals, plus both ears of five nonirradiated guinea pigs, served as controls. Follow-up threshold ABRs were obtained immediately post-irradiation (RT), and at 6 and 12 months post-RT. Average thresholds in all groups increased over time: 60 dB in the control group; 53 dB in the control ears of the irradiated animals; and 46 dB in the irradiated ears. There were no statistically significant increases in ABR thresholds for irradiated ears vs. control ears. At the 6-month followup, hearing was actually better in the irradiated ears than the control ears and this difference between ears was significantly greater than the difference at baseline (p < 0.026). Overall, there was no evidence that irradiation produces changes in ABR thresholds.

Animals↗
PubMed1992

Cogan's syndrome: auditory and medical management.

Cogan's syndrome is a rare autoimmune disease characterized by the presence of interstitial keratitis and audiovestibular symptoms. The audiovestibular symptoms include fluctuating sensory hearing impairment, tinnitus, vertigo, and reduced vestibular response. Immediate diagnosis and medical intervention provides optimum auditory recovery. Frequent audiologic assessments are necessary to monitor the disease activity and to aid in the therapeutic levels of steroidal medications. Amplification is often required on a temporary or permanent basis. Two case studies are presented to illustrate the audiologist's role in the identification and management of patients with Cogan's syndrome.

Adrenal Cortex Hormones↗
PubMed1991

Assessing the effectiveness of a computerized blood order "consultation" system.

To optimize blood ordering and accurately assess transfusion practice, in 1987, an "on line" computerized, knowledge-based, blood order critiquing system was integrated into the HELP Hospital Information System (HIS) at LDS Hospital. Evaluations of the computerized ordering system demonstrated its benefits and limitations on transfusion practice. Based on this experience, a second generation blood ordering system using a consultation mode was developed. A pilot test of this blood order consultant system, using historical data in the HELP system's database, was performed. This pilot test demonstrated that the consultation system provided accurate recommendations for red blood cell (RBC) and platelet orders. Comparing the appropriateness of blood orders with the recommendations made by the director of the blood bank, the orders recommended by the computer "consultant" agreed 95.5% of the time. The computer consultation system also recommended fewer RBC units for transfusion. Preliminary results obtained using the consultant approach suggest that we may be able to simplify blood ordering practice and also reduce the number of units of blood products ordered. Based on these findings we are now preparing to compare the "critiquing" and "consultation" approaches using a clinical trial.

Artificial Intelligence↗
PubMed1990

Computer-critiqued blood ordering using the HELP system.

Recently the medical risk of blood transfusions has emphasized the need to improve the safe use of blood products. For the past 2 1/2 years at LDS Hospital we have used the HELP computer system to assist and critique ordering of blood products "on-line" by physicians and nurses. This report details the computer methods used to order blood products and to critique the appropriateness of those orders. Physicians personally enter the orders for more than 45% of the blood products using computer terminals, whereas 7% are from physician standing orders. Nurses enter the remaining orders from written orders (26%), verbal orders (14%), and phone orders (8%). There were 3396 blood orders for 1043 patients generated by 273 physicians during the fourth quarter of 1989. Each order is justified at the time it is entered by selecting from a menu of physician-approved criteria. The criteria are linked to supportive data in the data base, i.e., laboratory results and clinical data. The computer verified that 82% of these orders met criteria. Quality Assurance nurses verified the remaining 18%. Of these 18% only one in eight required manual chart review. After computer and Quality Assurance review, only eight (0.24%) of the orders were found to be true exceptions to established criteria. Physicians and nurses have accepted the computerized critiquing system. Through use of the computer we provide "on-line" critiquing and improve the use of scarce blood product resources.

Blood Banks↗
PubMed1990

Issues in newborn ABR screening.

The introduction of electrophysiologic measures has provided a renewed interest in the early identification of newborns and infants at risk for hearing loss. To date, 14 states have enacted mandatory legislation for newborn hearing screening, whereas other states have incorporated private and hospital-based programs. Although all state and local programs are inherently different, their common goal is to identify hearing loss as early as possible, and to provide appropriate management strategies in the rehabilitative process. While many technical and recording techniques have been established, there remain several unresolved problems associated with newborn screening programs. The purpose of this article is to bring to the forefront several issues of current concern. Major topic areas include screening versus diagnosis, program design, and stimulus variables. A final recommendation regarding the importance of follow-up services is reiterated.

Evoked Potentials, Auditory, Brain Stem↗
PubMed1990

Follow-up services in newborn hearing screening programs.

Newborn hearing screening programs have gained wide acceptance as a means of identifying infants at risk for hearing loss. For the most part, the auditory brainstem response (ABR) technique has been the measurement tool universally adopted in the evaluation of high-risk infants. Over the years, the ABR has been used successfully with a negligible false-negative rate. Unfortunately, program follow-up services have not received similar attention, and there is a lack in program development. This article describes a series of follow-up measures that include the use of a questionnaire sent to the parents/caregivers of 401 infants who pass either the initial or retest ABR screen. A total of 262 (65%) response questionnaires were returned. The results of the questionnaire and recommendations regarding follow-up services are discussed.

Child Health Services↗
PubMed1990

Automated and conventional ABR screening techniques in high-risk infants.

Test validity is determined by the proportion of results that are diagnostically confirmed and predicted on the measures used to identify the disease process. This article summarizes the results of a series of 224 stable high-risk infants who were screened by automated (ALGO-1) and conventional (Bio-logics LT) ABR instrumentation. Failure criteria was defined as the absence or prolongation of a replicable wave V response (conventional) or Refer by the automated system. The overall failure rates at a 35 dB screening level were comparable between devices. Sensitivity and specificity measures for the ALGO-1 unit were 100 and 96 percent, respectively. Permanent hearing loss was demonstrated in 5 percent of the newborns screened in this study. Advantages of the automated system include a dual artifact rejection system, attenuating ear couplers, and a battery operated design. These findings suggest that the automated ABR screener is a viable alternative to conventional ABR instrumentation for the limited purpose of neonatal auditory screening.

Algorithms↗
PubMed1989

Hearing loss in prison inmates.

The incidence of hearing disorders in 34 State Penitentiary prison inmates all with a previous history of drug abuse were investigated. Subjects were evaluated using routine pure-tone air conduction audiometry, immittance measures, and short-latency auditory brain stem responses. Of the 34 inmates, 20 (58.8%) demonstrated normal bilateral peripheral hearing sensitivity, whereas 10 (29.4%) inmates presented with some degree of hearing impairment. In addition, the conflicting results of elevated pure-tone thresholds with normal immittance measures and normal ABR findings suggested that four (11.8%) subjects exhibited functional hearing loss. The results of this study support the reported high incidence of hearing loss in the prison population. The synergistic effects of drug abuse, noise exposure, and head trauma as possible contributing factors are discussed.

Adolescent↗
PubMed1988

Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography.

After observing a single case of Pseudomonas aeruginosa bacteremia following endoscopic retrograde cholangiopancreatography (ERCP), six other P. aeruginosa infections that were temporally related to ERCP were retrospectively found over one year (August 1985 through July 1986) at LDS Hospital. In all seven patients, infection developed within five days after an ERCP. Five patients had bacteremia and two had cholangitis. All five of the Pseudomonas isolates available for testing were serotype 010. Cultures from the ERCP endoscope and several other endoscopes also yielded P. aeruginosa serotype 10, as did environmental cultures from equipment used to clean endoscopes. Among 167 ERCPs performed during the outbreak period, no other patient acquired P. aeruginosa infection. Each of the patients in the outbreak received the first scheduled ERCP of the day. The mean duration between the cleaning of the ERCP endoscope and its subsequent use was significantly longer in cases than in matched controls, a factor that may have permitted contaminating organisms to achieve high inocula in the inadequately cleaned endoscope. Epidemic control measures included improved disinfection of endoscopes, ongoing surveillance, and appropriate antimicrobial prophylaxis. This experience suggests that exogenous infection with Pseudomonas is associated with ERCP, that protracted and insidious outbreaks may occur, and that the occurrence of even a single case of Pseudomonas infection after ERCP should stimulate an epidemiologic investigation.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1987

The effects of ABR stimulus repetition rate in multiple sclerosis.

The purpose of this study was to monitor the effects of auditory brain stem response (ABR) repetition rate in previously confirmed multiple sclerosis (MS) patients. Ten definite MS patients (20 ears) presenting neurological evidence of brain stem involvement were tested. All patients had hearing thresholds of 20 dB HL or better between 250 and 4000 Hz. ABRs were recorded with four click stimulus repetition rates at 70 dB SL. An analysis of variance (ANOVA: Group X Rate X Ear) resulted in significant group (normal versus MS) and rate (10, 33, 67, and 80/sec) effects. Increasing the repetition rate significantly improved the detection of abnormal latency measures (Duncan's multiple range test). Absent or prolonged wave I response latencies were recorded in 25 to 40% of all MS patients tested and were rate dependent. The findings of this study encourage the inclusion of faster repetition rates when using ABR as a supportive measure in the diagnosis of suspected MS patients.

Acoustic Stimulation↗
PubMed1986

Adapting disease-specific isolation guidelines to a hospital information system.

The authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; an order for the appropriate supplies; a patient charge based on the supplies required; and an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary. Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in-service education and surveillance efforts.

Centers for Disease Control and Prevention, U.S.↗