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Biomedical subjects

J W Ramsdell

Publications and source records attributed to J W Ramsdell.

At least 19 recordsLinked to original sources
PubMed1993

Body composition of patients with Alzheimer's disease.

Low body weight is frequently reported in patients with Alzheimer's disease. We sought to discover why by comparing the body composition of 28 cognitively normal elders and 23 institutionalized individuals with Alzheimer's disease. Body mass index was calculated from standing height and weight. Percentages of lean body mass, body fat, and body water were derived from bioimpedance measurements of resistance and reactance. Skinfold thickness was measured at seven body sites to estimate regional fat distribution. Variables were analyzed by analysis of variance with subjects grouped by cognitive status within gender. Activity level and age were not significant covariates. Both women and men with Alzheimer's disease weighed less than control subjects. Differences in body composition were more pronounced in women with Alzheimer's disease, who had lower body mass index (22.0 +/- 3.0 vs 26.1 +/- 5.1), higher percentage of lean body mass (73.8 +/- 5.1 vs 66.9 +/- 6.5), lower percentage of body fat (26.1 +/- 5.1 vs 33.1 +/- 6.5), and higher percentage of body water (55.8 +/- 5.0 vs 49.3 +/- 6.5) compared with control women. Except for lower body weight, the body composition of men with Alzheimer's disease was not significantly different from that of control men. Patients of both sexes with Alzheimer's disease had less truncal body fat compared with controls, which gave them a youthful body habitus. These differences were not accounted for by age, diet, or activity. Our findings indicate that patients with Alzheimer's disease have lower body weight and may require higher energy intake than cognitively normal elders.

Adipose Tissue↗
PubMed1991

Recommendations for a change in living situation resulting from an outpatient geriatric assessment: type, frequency and risk factors.

We analyzed the outcomes of 480 comprehensive outpatient geriatric assessments to determine the frequency of recommendations for home help or a change in residence and to determine whether simple clinical observations could predict such recommendations. Fifty-eight percent (280) of the patients received no recommendation for a change in the living situation. Of the 200 patients receiving a recommendation for a change in living situation, 97 (49%) were felt to be able to stay at home with increased in-home support and/or day care, and 51.5% (103) were advised to seek placement. After adjusting for age and gender, risk factors predicting a recommendation for change were dementia (odds-ratio = 9.98), vision deficits (odds ratio = 2.02), lower education level compared to college (odds-ratio = 1.88 high school, 1.42 for less than high school), an increasing number of medical diagnoses (odds-ratio = 1.49 per diagnosis), and a functional impairment on the Katz index (odds-ratio = 1.09). The presence of these risk factors should lead to consideration of further evaluation of the home environment in this study. We conclude that geriatric patients presenting for a comprehensive outpatient evaluation commonly need a change in home situation, though most can remain in their home, and that simple clinical observations can be helpful in screening patients for further evaluation of their home environment.

Aged↗
PubMed1991

Geriatric assessment in the home.

Home assessment of health, environmental, and social factors, and their interactions that may impair the patient's functional capabilities and quality of life can play a critical role in the care of frail elderly patients. Home assessments can reveal important new health and social problems not identified in a clinical visit. Recent information suggests that home assessment is identified with good patient outcomes. Although this type of assessment is traditionally carried out by a nurse in the context of an interdisciplinary team, an individual primary care physician can also establish an ad hoc, multidisciplinary team to help care for frail elderly patients using principles derived from a comprehensive home assessment.

Aged↗
PubMed1990

Cognitive function testing in comprehensive geriatric assessment. A comparison of cognitive test performance in residential and clinic settings.

Tests of cognitive function are frequently used in geriatric assessment, but the effect of test setting has rarely been explored. To determine the effect of testing site on the performance of elderly patients undergoing a comprehensive geriatric assessment, we administered the Mini-Mental State Exam to 116 geriatric patients in the clinic and at their residence. Their cognitive abilities varied from normal to severely impaired. The patients' scores were 1.5 +/- 3.6 (mean +/- SD) higher at their residence. The clinical importance of a difference in score of 1.5 is not clear. For this reason a second analysis was performed in which a difference in scores of five points or greater between settings was considered clinically meaningful. Twenty-five percent (29 of 116) differed by five points or more. Of these 29 patients, 22 (76%) tested better in the residential setting. These differences were statistically significant (P = .001). We conclude that the testing site may affect test performance and that in-home assessment may reveal the optimal cognitive function of geriatric patients.

Aged↗
PubMed1990

Airway levels of mast cell-derived mediators in exercise-induced asthma.

In order to assess the role of mast cell-derived mediators in the pathogenesis of exercise-induced asthma (EIA), we completed pre- and postexercise bronchoalveolar lavage (BAL) in seven atopic subjects with EIA. The study subjects were defined as having EIA if they exhibited a greater than 15% decrease in FEV1 after completing 6 min of treadmill exercise. There were no significant differences between mean preexercise and mean postexercise mast cell-derived BAL histamine (186 +/- 67 versus 148 +/- 36 pg/ml), tryptase (4.5 +/- 2.0 versus 2.8 +/- 2.0 ng/ml), prostaglandin D2 (26 +/- 11 versus 32 +/- 25 pg/ml), or leukotriene C4 (less than 100 versus less than 100 pg/ml). In addition, mast cells present in BAL fluid after exercise contained similar amounts of cellular histamine compared with BAL mast cells obtained before exercise (preexercise BAL cellular histamine, 26.6 +/- 12.3 ng/10(6) BAL cells; postexercise BAL cellular histamine, 22.7 +/- 9.1 ng/10(6) BAL cells), indicating that depletion of preformed mast cell mediators are unlikely to account for the refractory period in EIA. This study suggests that the cellular pathogenesis of EIA (mast cell-independent) differs from current theories of the pathogenesis of extrinsic allergen-induced asthma (mast cell-dependent).

Adolescent↗
PubMed1989

Nutritional status of free-living Alzheimer's patients.

Self-reported, dietary intake and biochemical estimates of thiamine, riboflavin, folate, vitamin B-12, protein, and iron were compared in 22, free-living elders by individuals who had senile dementia of the Alzheimer's type (SDAT) and in 41 who were cognitively normal (CN). The two groups did not differ significantly in their intake of these nutrients or the number of deficiency states for intake (less than 67% RDA). Low serum transketolase (thiamin; p less than 0.055), red blood cell (RBC) folate (p less than 0.06), and serum vitamin B-12 (p less than 0.05) levels occurred more often in SDAT patients than in CN subjects. Individuals in both groups who used multivitamin supplements had significantly higher biochemical values for thiamine (p less than 0.03), riboflavin (p less than 0.01), and vitamin B-12 (p less than 0.003) than nonsupplement users. Because of the differences in vitamin B-12 and RBC folate levels between groups, a retrospective analysis was performed on a larger group of subjects drawn from a geriatric assessment clinic. Patients with SDAT had significantly lower serum vitamin B-12 (p less than 0.01) and lower RBC folate (p less than 0.03) values than CN subjects. Which mean values for vitamin B-12 and RBC folate were grouped by degree of impairment in SDAT subjects, vitamin B-12 was significantly lower in mildly and moderately impaired subjects than in those with normal cognition. Mean values for both nutrients did not differ significantly between severely impaired and CN subjects. There was a significant quadratic relationship between cognitive impairment and biochemical values for vitamin B-12.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

The yield of a home visit in the assessment of geriatric patients.

Elderly patients often have problems not easily detected during an office visit. We investigated the yield of a home visit by a geriatric nurse specialist as part of an interdisciplinary assessment process. Compared with the findings of an office-based assessment by a general internist, the home visit resulted in up to four new problems (median = 2, mean = 1.7, 95% confidence interval = 1.5-1.8) and one to eight new recommendations (median = 4, mean = 3.6, 95% confidence interval = 3.4-3.9). Twenty-three percent of the problems could have resulted in death or significant morbidity. The most frequent problems related to psychobehavioral difficulties (23.1% of problems involving 38.3% of patients), safety (21.6% of problems involving 35.7% of patients), and caregiver related problems (20.4% of problems involving 33.8% of patients). The most common recommendations related to safety (30.7% of recommendations involving 81.8% of patients), caregiver well-being (19.8% of recommendations involving 52.6% of patients), and social issues (12.7% involving 33.8% of patients). Baseline clinical information did not predict the yield of the home visit in this sample. We conclude that an in-home assessment contributes unique and meaningful information to the geriatric assessment process.

Activities of Daily Living↗
PubMed1987

Effect of medical records' checklists on implementation of periodic health measures.

Recent re-evaluation of preventive health care has resulted in more limited and directed guidelines; nonetheless, physician compliance has remained poor. This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures. Residents in internal medicine were randomly placed into two groups: one received a copy of the appropriate checklist with each patient's medical record; the other did not. After one year, 200 randomly selected records were audited to determine the proportion of recommendations implemented for each patient. Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not (0.56 +/- 0.26 versus 0.39 +/- 0.22, p less than 0.002). The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received (0.70 +/- 0.21 versus 0.44 +/- 0.24 and 0.39 +/- 0.22, respectively, p less than 0.002). These data suggest that a physician's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance.

California↗
PubMed1986

Metabolic acidosis as a presenting feature in acute asthma.

Acid-base abnormalities in adults with acute asthma are highly variable. The major abnormalities have been attributed to changes in PaCO2 secondary to altered alveolar ventilation. Primary metabolic alterations have been thought to be rare in adults. The frequency of metabolic acidosis in acute asthma was reevaluated by way of a review of the medical records of 164 hospitalizations involving 109 adults. The hydrogen ion concentration varied widely and in 27 of 164 episodes (16.5%) the arterial pH was lower than expected for the measured PaCO2. We conclude that the presenting acid-base status of adults with acute asthma is highly variable and metabolic acidosis is not an infrequent finding.

Acidosis↗
PubMed1986

Clinical implications of serum creatine kinase levels in acute asthma.

An elevated serum creatine kinase (CK) level is common in patients being treated for acute asthma, but such an elevation should not lead to further investigation unless otherwise clinically warranted. Moreover, serum CK levels need not be routinely measured in young patients with an uncomplicated exacerbation of asthma.

Acute Disease↗
PubMed1985

Physician reimbursement for services to HMO-sponsored patients. An academic model.

When the University of California, San Diego (UCSD) School of Medicine faculty and UCSD Medical Center became participants in a capitated health care program, it became necessary to reevaluate the method of reimbursement for physicians' services. In developing a new formula, the faculty established specific objectives for the program and agreed to a plan that was not fixed to predetermined unit value for physicians' services but rather was a function of residual capitated income after program expenses. The formula prescribed that 50% of capitation income available for physicians' reimbursement would go to primary care physicians who were paid based on the number of patients in their panels and 50% to specialty physicians based on their clinical activity. This scheme and an aggressive utilization review process were associated with a rate of hospitalization and physicians' reimbursement that met or exceeded anticipated results during the first 2 years of operation.

Academic Medical Centers↗
PubMed1983

The immediate effects of cortisol on pulmonary function in normals and asthmatics.

We investigated short-term effects of corticosteroids on airway caliber, measured by spirometry and body plethysmography, over a period of 6 hr after an intravenous bolus of cortisol (8 mg/kg) or saline placebo was administered in a double-blind crossover format comparing 10 normal and nine asymptomatic unmedicated asthmatics. After 6 hrs isoproterenol (240 micrograms) was administered to compare the effects of cortisol with a beta-agonist bronchodilator. Serum cortisol levels remained greater than 100 micrograms/dl after cortisol and normal after placebo. Cortisol had no effect on pulmonary function except for a trend of improved flows and decreasing ratios of residual volume to total lung capacity in asthmatics that was not significant at 6 hr. Isoproterenol resulted in immediate improvement in specific conductance and flows in both groups; no interaction with cortisol was seen. We conclude that cortisol had no short-term effect on airway caliber in normals, at best a slowly evolving effect in asymptomatic unmedicated asthmatics, and no interaction with the bronchodilator effects of a maximal dose of isoproterenol in these groups.

Adult↗
PubMed1983

The timing of career decisions in internal medicine.

The creation of new residencies in primary care internal medicine is aimed at increasing the number of individuals entering careers as general internists. This strategy assumes that final career decisions are made prior to application for residency training. A survey of all graduates of internal medicine residencies at the University of California, San Diego, during 1969-1979 resulted in 155 respondents (an 86 percent response rate) and revealed that only 30 percent had no change in career plans regarding general versus subspecialty practice since medical school and 41 percent had made final decisions during residency training. Inpatient care experiences, peer interactions, and faculty role models were the training factors which most influenced final career choice. The goal of increasing the number of general internists may be better served by strengthening the role of generalist faculty members in traditional internal medicine residencies rather than creating new programs which force trainees to make premature career choices.

California↗
PubMed1983

Evaluation of general and traditional internal medicine residencies utilizing a medical records audit based on educational objectives.

Residency programs in general internal medicine must ensure that skills relevant to the care of both ambulatory and hospitalized patients are taught effectively. The authors evaluated both a general and a traditional internal medicine training program at the same institution. They employed a medical records audit technique based on educational objectives that assessed the approach of residents in each program in dealing with five inpatient and five outpatient problems. Inpatient performance also was assessed by subjective faculty evaluations. Resident physicians in the general program more closely reflected the educational objectives in two of five outpatient audits. There were no differences between the programs for inpatient audits or subjective evaluations. These findings support the argument that the emphasis on teaching ambulatory medicine need not jeopardize inpatient training, and they demonstrate the feasibility of a medical records audit based on educational objectives for program evaluation.

Ambulatory Care↗
PubMed1983

Preparation and handling of methacholine chloride testing solutions. Effect of the hygroscopic properties of methacholine.

Persons with hyperreactive airways differ quantitatively from normal persons in their response to bronchial provocation testing with methacholine chloride (Mch). Methacholine chloride has strong hygroscopic properties that necessitate careful dessication, preparation, and handling if accurate results are to be achieved. The rate of hydration of Mch was determined by exposing the drug to various levels of relative humidity. The rate of water uptake was directly related to the availability of water in the atmosphere. At 49% relative humidity, a 0.125%/min gain in weight was noted, which increased to 0.489%/min at 80% relative humidity. Adequate dessication time and technique were determined by noting the time required to return the drug from a hydrated to a dry state. With proper technique, dessication was virtually complete by 4 to 6 h, and 20 to 24 h assured a return to the dry state. From these data, guidelines for preparation and handling of Mch test solutions can be formulated.

Bronchial Provocation Tests↗
PubMed1982

Bronchial hyperreactivity in chronic obstructive bronchitis.

Patients with chronic obstructive bronchitis commonly suffer acute, transient exacerbations, which suggests that episodic bronchoconstriction may play a role in this disease. We studied 22 patients with chronic obstructive bronchitis and no acute improvement in pulmonary function after inhaled sympathomimetics, using methacholine bronchial provocation tests to evaluate the incidence of bronchial hyperreactivity. Patients with clinical or laboratory findings indicative of asthma were excluded. The group demonstrated significant baseline airway obstruction (mean +/- SD forced expiratory volume in one second, 0.96 +/- 0.44) and no improvement after inhalation of isoproterenol (1.68 +/- 8.54% baseline change). All patients were very sensitive to inhaled methacholine, reacting at a dose of 4.29 +/- 5.49 cumulative units. There were no normal responses. These data suggest that airway hyperreactivity may contribute to acute, transient exacerbations experienced by patients with chronic obstructive bronchitis, even in the absence of acute improvement in pulmonary function after the administration of sympathomimetics, and may warrant chronic prophylactic bronchodilator therapy.

Aged↗