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Biomedical subjects

R Jackson

Publications and source records attributed to R Jackson.

At least 91 records · Page 5Linked to original sources
PubMed2000

Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients.

BACKGROUND: Health care organizations face pressures from patients to improve the quality of care and clinical outcomes, as well as pressures from managed care to do so more efficiently. Coordination, the management of task interdependencies, is one way that health care organizations have attempted to meet these conflicting demands. OBJECTIVES: The objectives of this study were to introduce the concept of relational coordination and to determine its impact on the quality of care, postoperative pain and functioning, and the length of stay for patients undergoing an elective surgical procedure. Relational coordination comprises frequent, timely, accurate communication, as well as problem-solving, shared goals, shared knowledge, and mutual respect among health care providers. RESEARCH DESIGN: Relational coordination was measured by a cross-sectional questionnaire of health care providers. Quality of care was measured by a cross-sectional postoperative questionnaire of total hip and knee arthroplasty patients. On the same questionnaire, postoperative pain and functioning were measured by the WOMAC osteoarthritis instrument. Length of stay was measured from individual patient hospital records. SUBJECTS: The subjects for this study were 338 care providers and 878 patients who completed questionnaires from 9 hospitals in Boston, MA, New York, NY, and Dallas, TX, between July and December 1997. MEASURES: Quality of care, postoperative pain and functioning, and length of acute hospital stay. RESULTS: Relational coordination varied significantly between sites, ranging from 3.86 to 4.22 (P <0.001). Quality of care was significantly improved by relational coordination (P <0.001) and each of its dimensions. Postoperative pain was significantly reduced by relational coordination (P = 0.041), whereas postoperative functioning was significantly improved by several dimensions of relational coordination, including the frequency of communication (P = 0.044), the strength of shared goals (P = 0.035), and the degree of mutual respect (P = 0.030) among care providers. Length of stay was significantly shortened (53.77%, P <0.001) by relational coordination and each of its dimensions. CONCLUSIONS: Relational coordination across health care providers is associated with improved quality of care, reduced postoperative pain, and decreased lengths of hospital stay for patients undergoing total joint arthroplasty. These findings support the design of formal practices to strengthen communication and relationships among key caregivers on surgical units.

Aged↗
PubMed2000

Increasing age and experience: are both protective against motorcycle injury? A case-control study.

OBJECTIVES: To assess the associations between age, experience, and motorcycle injury. SETTING: Motorcycle riding on non-residential roads between 6 am and midnight over a three year period from February 1993 in Auckland, New Zealand. METHODS: A population based case-control study was conducted. Cases were 490 motorcycle drivers involved in a crash and controls were 1518 drivers identified at random roadside surveys. Crash involvement was defined in terms of a motorcycle crash resulting in either a driver or pillion passenger being killed, hospitalised, or presenting to a public hospital emergency department with an injury severity score > OR =5. RESULTS: There was a strong and consistent relationship between increasing driver age and decreasing risk of moderate to fatal injury. In multivariate analyses, drivers older than 25 years had more than 50% lower risk than those aged from 15-19 years (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.26 to 0.81). In univariate analyses, a protective effect from riding more than five years compared with less than two years was observed. However, this protection was not sustained when driver age and other potential confounding variables were included in the analyses. Familiarity with the specific motorcycle was the only experience measure associated with a strong protective effect (OR (> OR =10,000 km experience) 0.52; 95% Ci 0.35 to 0.79) in multivariate analyses. CONCLUSIONS: Current licensing regulations should continue to emphasise the importance of increased age and might consider restrictions that favour experience with a specific motorcycle.

Accidents, Traffic↗
PubMed2000

John Updike on psoriasis: At war with my skin, from the journal of a leper.

BACKGROUND: In recent years patients have become more involved in the impact, description, diagnosis, and management of their own disease. OBJECTIVE: This article will briefly record the personal observations of John Updike, a highly regarded, perceptive twentieth-century American writer, on how moderately severe psoriasis has affected his life and also his thoughts about his disease and its treatment. CONCLUSION: Updike's description of his psoriasis gives a valid insight into a patient's view of psoriasis.

Attitude to Health↗
PubMed2000

Serum sickness.

BACKGROUND: In the late 19th and early 20th century there was much interest in understanding the reactions to diphtheria antitoxin and the horse serum in which it was produced and administered. OBJECTIVE: Pirquet and Schick reported on their studies of these reactions; particularly the differences in the reaction of those patients who had only one injection, and those who had a re-injection. CONCLUSION: Pirquet and Schick concluded that "due to a single injection of horse serum a change takes place in the reaction of the human organism to the re-introduction of the same substance." This change, Pirquet in a 1906 article, called allergy.

Allergy and Immunology↗
PubMed2000

The archives of the Canadian Dermatology Association.

This article describes some details of the archival material of the Canadian Dermatology Association (CDA). Covering its 75 years of existence, these archives consist of seven items: (1) 38 volumes of bound archives; (2) tri-annual issues since 1975 of the CDA Journal/Bulletin (a socio-political historical newsletter); (3) members' files containing extensive biographical material; (4) a collection of 150 books and other pamphlets; (5) since 1995, the scientific peer-reviewed official journal of the CDA (Journal of Cutaneous Medicine and Surgery); (6) a sporadic collection of photographs, meeting tape recordings, and protocols of patient presentations at the annual meetings; and (7) a miscellany of historical articles on Canadian dermatologists, dermatology published in older medical Journals, and two books published separately.

Archives↗
PubMed2000

Population of households in England to 2021.

This article outlines the methodology and results of the Department of the Environment, Transport and the Regions (DETR) 1996-based household projections for England, and its regions. It examines differences between this round of projections and the previous 1992-based round. The 1996-based projections indicate that between 1996 and 2021 a growth of 3.8 million households can be expected in England, if recent trends continue. Both the national and subnational methodology and results are covered.

Adolescent↗
PubMed2000

Interaction of chemical defense clothing and high terrestrial altitudes on lift/carry and marksmanship performance.

BACKGROUND: The increased metabolic energy requirement imposed by a chemical defense uniform (CDU) and the lower maximal aerobic capacity associated with increased altitude should produce greater demands on the cardiopulmonary system during the performance of a given work task at increasing altitudes. We hypothesized that: a) relative to sea level, the decrements in physical work performance caused by ascending to high terrestrial altitudes would be greater in a CDU compared with a standard fatigue uniform (U.S. Army, BDU); b) the aversive subjective reactions to the CDU would be accentuated with increasing altitude; and c) that staging at moderate altitude, to induce acclimatization, would restore work performance at higher altitudes to sea level norms. METHODS: The physiological and subjective responses of 8 male soldiers to work (10-min lift-and-carry task and rifle marksmanship) were measured. Subjects wore the BDU and a CDU ensemble (U.S. Army, BDO) at sea level, intermediate (2743 m) and high (4,300 m) altitudes following rapid and staged (3 d at 1,830 m) ascents to the higher altitudes. RESULTS: Lift/carry task performance tended to be lower (p = 0.076) in the CDU vs. the BDU at altitude. The cardiopulmonary responses to the lift/carry task increased at altitude and were greater in the CDU. The subjects' perception of their ability to perform the lift/carry task at altitude was adversely impacted more in the CDU than the BDU. Rapid ascent to intermediate altitude degraded marksmanship in both uniforms. Following staged ascent, lift/carry task and marksmanship performance was restored to sea level norms. CONCLUSIONS: Personnel wearing CDU or equivalent protective clothing at intermediate to high terrestrial elevations should anticipate proportionally larger CDU-induced decrements of work performance and lower tolerance to working in a CDU than experienced near sea level. Staging at moderate altitude is an effective strategy for restoring work performance to sea level norms at higher altitudes.

Activities of Daily Living↗
PubMed2000

A comparison of primary and proxy respondent reports of habitual physical activity, using kappa statistics and log-linear models.

BACKGROUND: Many epidemiological studies rely in part on proxy informants. There is little published information on the reliability of proxy-respondent reports of physical activity. METHODS: Self-reported data on vigorous and moderate physical activity, from a representative sub-sample of participants in a community-based case-control study of coronary heart disease, were compared with information collected from their next-of-kin. RESULTS: Relative to primary respondents, proxy respondents under-reported activity by approximately 10 percentage points, for both leisure and work-time activity. On a simple three point scale (inactivity/moderate activity/physical activity), 70% of primary-proxy pairs were in exact agreement with regard to leisure time activity and 67% of pairs were in exact agreement on work-time activity. The corresponding values for the weighted kappa statistic were 0.66 [95% confidence interval (CI) 0.59-0.72] and 0.62 (0.54-0.72). Log-linear modelling provided evidence for superior agreement on worktime activity when the proxy was not the primary respondent's spouse. DISCUSSION: Overall levels of primary-proxy respondent agreement on physical activity seem somewhat lower than has been reported for smoking and alcohol-drinking frequency. There seems little reason to prefer spouse proxies when endeavouring to elicit information on work-time physical activity. Log-linear modelling provides an efficient means of exploring covariate effects in observer-agreement studies.

Adult↗
PubMed2000

HPV testing.

Explore the source record for details and available documents.

Female↗
PubMed1999

Xenotransplantation of cells using biodegradable microcapsules.

BACKGROUND: The use of immunoisolation to protect transplanted cells from the immune system of the host has broad application to the treatment of major diseases such as diabetes and a wide range of other disorders resulting from functional defects of native cell systems. In most cases, limitations in functional cell longevity will necessitate periodic replenishment of the cells. We describe a hydrogel-based microcapsule that breaks down at a rate that can be adjusted to correspond to the functional longevity of the encapsulated cells. These injectable capsules can be engineered to degrade over several weeks to months for short-term drug delivery, or to remain intact and immunoprotective for more extended periods. When the supply of cells needs to be replenished, no surgery will be required to localize and remove the old capsules. METHODS: Porcine and bovine islets were immobilized in "composite" microcapsules fabricated from alginate and low-relative molecular mass (Mr) poly (L-lysine[PLL]) (Mr exclusion <120 Kd) and implanted into the peritoneum of normal and streptozotocin-induced diabetic rats. In addition to demonstrating long-term islet viability and function, a series of in vitro studies were carried out to determine the permeability and biodegradability of the microcapsules used in the present system. RESULTS: Xenogeneic islets implanted in nonimmunosuppressed rats remained in excellent condition indefinitely (>40 weeks)(viability was comparable to that of preimplant control specimens). In contrast, no islets survived in uncoated alginate spheres after 2 weeks postimplantation. By changing the concentration of the alginate, it was possible to vary the rate of capsule breakdown in rats from mechanically unstable (outer matrix <0.5-0.75% alginate) to stable for >1 year (> or =1.5% alginate). In addition to in vivo breakdown studies, the biodegradability of the capsular components was verified in vitro using a mixture of tritosomes (enzymes isolated from animal cells). CONCLUSIONS: We have designed a microcapsule system with controllable biodegradability which allows breakdown and absorption of implants when the cells die or become functionally inactive. These results may have application to other alginate-PLL encapsulation systems. The ability to cross species lines using these biodegradable microcapsules has the potential to expand dramatically the number of patients and the scope of diseases that can be successfully treated with cellular therapy.

Absorbable Implants↗
PubMed1999

A study of repeated lateral pinch grip in myotonic dystrophy.

BACKGROUND AND PURPOSE: Subjects with myotonic dystrophy present with progressive muscle weakness, myotonia and fatigue. The aim of this study was to determine whether there was a difference in response to fatiguing exercise in myotonic dystrophy individuals compared to normal subjects. If no difference was found, a similar response to a physiotherapy exercise programme as seen in normal subjects might be expected. METHOD: Ten individuals with myotonic dystrophy were compared to eight normal subjects in their response to ten repetitions of maximal lateral pinch grip efforts each five seconds in duration and separated by a ten-second rest. The root mean square (RMS) values, initial median frequency (Fmed) and slope of the median frequencies were recorded by electromyography (EMG) for the first dorsal interosseus, flexor pollicis brevis, flexor digitorum profundus and extensor digitorum communis muscles in the forearm and hand. Simultaneously, the rate of grip development, rate of grip release and work done during each grip effort were recorded by dynamometer. The RMS values for all muscles from subjects with myotonic dystrophy increased over the ten repetitions. RESULTS: The initial Fmed for all myotonic dystrophy muscles was lower than for the normal subjects. The Fmed slopes for the first and last repetition showed no significant difference to the normal subjects. Rate of grip development was no different between groups over ten repetitions. Rate of grip release was slower and work done less for the individuals with myotonic dystrophy. CONCLUSION: Results suggest the main difference between muscles affected by myotonic dystrophy and normal ones was the smaller size of muscle fibres. The increase in rate of grip release that was found is supportive of the 'warm-up' phenomenon. This appears to indicate that muscles affected by myotonic dystrophy could benefit from standard physiotherapeutic exercise methods.

Adult↗