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Biomedical subjects

A Jha

Publications and source records attributed to A Jha.

At least 37 records · Page 2Linked to original sources
PubMed1999

Do Medicare patients with disabilities receive preventive services? A population-based study.

OBJECTIVE: To compare health maintenance procedure rates of Medicare patients with different levels of disability. STUDY DESIGN: Observational study analyzing data from the 1995 Medicare Current Beneficiary Survey (MCBS, n = 15,590). Self-reported Pap smears, mammograms, and influenza and pneumococcal vaccinations were compared between groups with different levels of health-related difficulties in six activities of daily living (ADL). RESULTS: Compared to those without disabilities, the most severely disabled women (limitations in 5 or 6 ADL) reported fewer Pap smears (age < or =70, 23% vs 41%, p < .001) and mammograms (age > or = 50, 13% vs 44%, p < .001). In a controlled analysis, individuals with this high level of disability were 57% (95% confidence interval [CI], 33% to 72%) and 56% (95% CI, 43% to 76%) less likely to report receiving Pap smears and mammograms, respectively, compared with able-bodied women, regardless of their age, whether they were in an HMO, or whether they lived in a long-term care facility. Functional limitations were not a deterrent to receiving vaccinations. In general, patients in HMOs reported more procedures than those in fee-for-service, while those in long-term care facilities reported fewer procedures than those living in the community. CONCLUSIONS: Disability among Medicare patients is a significant, independent risk factor for not receiving mammograms and Pap smears. Efforts should be made to identify the most severely disabled because they are at particular risk.

Bacterial Vaccines↗
PubMed1999

Constituents of the yew trees.

Yew trees, taxonomically classified under the genus Taxus, are sources of a number of physiologically active compounds of different classes. Taxane derivatives with various carbon skeletons, lignans, flavonoids, steroids and sugar derivatives have been isolated from different Taxus species. Compounds isolated from the genus Taxus between 1908 and December 1997 have been comprehensively reviewed.

Molecular Structure↗
PubMed1999

Microstructural analysis of Al alloys dispersed with TiB2 particulate for MMC applications

A dispersion of TiB2 particulates in an Al alloy matrix was formed via the in-situ reaction between mixtures of K2TiF6 (K2ZrF6), KBF4 and molten aluminium. The dispersion of the ceramic phase in the aluminium matrix was also achieved in some experiments by adding exogenous TiB2 particles to the fluoride melt in contact with molten aluminium. In this work, we have examined the microstructure of the as-cast metal matrix composites using analytical electron microscopy and X-ray diffraction techniques. The phases formed as a result of the reaction between the molten fluoride flux and liquid aluminium have been identified. These were (Ti, Zr, Al)B2, Al3Ti and possibly AlB12 in the Al-matrix, and KAlF4 and KMgF3 in the solidified flux. The mechanism of formation of TiB2 and Al3Ti is explained. The role of alloying elements is also explained in the context of interfacial chemistry and dispersion.

Journal Article↗
PubMed1997

Does the computerized display of charges affect inpatient ancillary test utilization?

BACKGROUND: The computerized display of charges for ancillary tests in outpatients has been found to affect physician-ordering behavior, but this issue has not been studied in inpatients. OBJECTIVE: To assess whether the computerized display of charges for clinical laboratory or radiological tests affected physician-ordering behavior. PATIENTS AND METHODS: Two prospective controlled trials, randomized by patient, were performed. Each trial included all medical and surgical inpatients at 1 large teaching hospital during 4 and 7 months: 3536 intervention and 3554 control inpatients in the group with clinical laboratory tests, and 8728 intervention and 8653 control inpatients in the group with radiological tests. The intervention consisted of the computerized display of charges for tests at the time of ordering. MAIN OUTCOME MEASURES: The number of clinical laboratory and radiological tests ordered per admission and the charges for these tests. RESULTS: For the clinical laboratory tests, during a 4-month study period, patients in the intervention group had 4.5% fewer tests ordered, and the total charges for these tests were 4.2% lower, although neither difference was statistically significant. Compared with historical controls from the same 4-month period a year before, the charges for the tests per admission had decreased 13.3%, but the decrease was temporally correlated with a restriction of future ordering of tests, and not with the introduction of the display of charges. For the radiological tests, during a 7-month period, the intervention group had almost identical numbers of tests ordered and charges for these tests. CONCLUSIONS: The computerized display of charges had no statistically significant effect on the number of clinical laboratory tests or radiological procedures ordered or performed, although small trends were present for clinical laboratory tests. More intensive interventions may be needed to affect physician test utilization.

Computer Systems↗
PubMed1997

Does hospital admission affect dependency levels of elderly psychiatric patients?

OBJECTIVE: To study effect of hospital admission on dependency levels of psychogeriatric patients. DESIGN: A cohort was formed comprising consecutive admissions. This was subdivided into organic and functional cases and the dependency levels of the two groups compared on admission and discharge. SETTING: An acute psychogeriatic ward at a psychiatric hospital near London. PATIENTS: One hundred consecutive acute elderly psychiatric inpatients. MEASURES: The Stockton Geriatric Rating Scale was used to assess dependency levels, the Hamilton Rating Scale for Depression and the Mini-Mental State Examination for cognitive impairment. RESULTS: Patients with functional illness showed a significant reduction in dependency levels compared to organic cases during admission. CONCLUSION: Admission to hospital has a significant effect in reducing dependency levels of elderly patients with functional illness.

Aged↗
PubMed1997

Predicting bacteremia in patients with sepsis syndrome. Academic Medical Center Consortium Sepsis Project Working Group.

The goal of this study was to develop and validate clinical prediction rules for bacteremia and subtypes of bacteremia in patients with sepsis syndrome. Thus, a prospective cohort study, including a stratified random sample of 1342 episodes of sepsis syndrome, was done in eight academic tertiary care hospitals. The derivation set included 881 episodes, and the validation set included 461. Main outcome measures were bacteremia caused by any organism, gram-negative rods, gram-positive cocci, and fungal bloodstream infection. The spread in probability between low- and high-risk groups in the derivation sets was from 14.5% to 60.6% for bacteremia of any type, from 9.8% to 32.8% for gram-positive bacteremia, from 5.3% to 41.9% for gram-negative bacteremia, and from 0.6% to 26.1% for fungemia. Because the model for gram-positive bacteremia performed poorly, a model predicting Staphylococcus aureus bacteremia was developed; it performed better, with a low- to high-risk spread of from 2.6% to 21.0%. The prediction models allow stratification of patients according to risk of bloodstream infections; their clinical utility remains to be demonstrated.

Adult↗
PubMed1997

Increased levels of protein kinase C in lymphocytes in asthma: possible mechanism of regulation.

Asthma is an inflammatory disease of the airways. Activation of lymphocytes leads to elaboration of inflammatory mediators which are likely to initiate and perpetuate the asthmatic response. During activation of lymphocytes, the role of protein kinase C (PKC) has been emphasized. Therefore, changes in PKC activity in peripheral blood lymphocytes in bronchial asthma can be expected, which may be due to alterations in the regulatory mechanisms of the enzyme molecule. To understand the mechanism of regulation of PKC activity the effects of drugs, such as carbachol, histamine, sphingosine and disodium cromoglycate (DSCG), on the lymphocytes of healthy subjects were studied. The study included 27 asthmatic patients and 14 healthy volunteers. Disease was classified as mild, moderate-to-severe, and cases in remission. PKC activity was determined in peripheral blood lymphocytes by [3H] phorbol 12,13-dibutyrate ([3H]PDBu)-binding assay. A highly significant (p < 0.001) increase was observed in total, cytosolic and membrane PKC activity in all of the asthmatic patients as compared to the healthy group. There was an increased translocation of PKC from cytosol to membrane in all of the groups, and the extent of translocation of the enzyme indicates physiological activation of the cells. A highly significant (p < 0.001) reciprocal relationship (r = -0.47) existed between forced expiratory volume in one second (FEV1) as percentage predicted and total PKC activity in bronchial asthma. Carbachol and histamine significantly (p < 0.001) increased PKC activity in lymphocytes, the increase being dose-dependent for histamine. Sphingosine or disodium cromoglycate (DSCG) brought about complete inhibition of PKC activity at 100 nM. We conclude that protein kinase C activity is increased in lymphocytes in bronchial asthma. Our findings suggest that the mediators (carbachol and histamine), and drugs (sphingosine and disodium cromoglycate) possibly exert their action on protein kinase C by influencing the regulatory domain of the enzyme.

Adolescent↗
PubMed1996

Chemoprevention of carcinogen-DNA binding: the relative role of different oxygenated substituents on 4-methylcoumarins in the inhibition of aflatoxin B1-DNA binding in vitro.

Eighteen 4-methylcoumarins bearing methoxy/hydroxy/acetoxy functionalities have been reported to effectively inhibit the rat liver microsome-mediated aflatoxin B1-DNA binding in vitro. The contribution of functionality on coumarin nucleus towards the inhibition of AFB1-DNA binding is in the order acetoxy > hydroxy > methoxy. The results illustrate the structure-activity relationship.

Aflatoxin B1↗
PubMed1996

Decreased efficacy of combined benzodiazepines and unilateral ECT in treatment of depression.

In a retrospective study, 124 patients with depression who were concomitantly receiving ECT and benzodiazepines were compared with patients (matched for age, sex, diagnosis, and laterality of ECT) receiving ECT without benzodiazepines in order to investigate the efficacy of ECT in terms of therapeutic response and length of stay in hospital. Most of the subjects (84% of cases and 89% of controls) improved on ECT, but the benzodiazepine group of patients receiving unilateral ECT showed a significantly poorer response and a longer stay in hospital. No such difference was detected with the bilateral ECT. It is therefore concluded that prescription of benzodiazepines with ECT does compromise the therapeutic effect of unilateral ECT for depression.

Adult↗
PubMed1994

Anti-invasive activity of 3,7-dimethoxyflavone in vitro.

Invasion of MCF-7/6 human mammary carcinoma cells into embryonic chick heart fragments was studied in organ culture during 8 days. The effect of 31 polyphenolic compounds, belonging to the flavonoids, chalcones, or coumarins, was tested in this assay for invasion. The anti-invasive activity of 3,7-dimethoxyflavone was found at concentrations ranging from 1 to 100 microM. At these anti-invasive concentrations, no cytotoxic effects could be detected: the anti-invasive effect was reversible upon omission of the molecule from the medium, and treatment of MCF-7/6 cells or heart fragments did not affect subsequent outgrowth from explants on tissue culture plastic. The molecule did not inhibit growth of MCF-7/6 cell aggregates nor of heart fragments kept in suspension culture. The action mechanism of 3,7-dimethoxyflavone is the subject of our ongoing research.

Animals↗
PubMed1993

Tetralogy of Fallot: intracardiac repair in 840 subjects.

Since 1967, when the first intracardiac repair was performed in this centre, until 1991, 840 symptomatic subjects with tetralogy of Fallot have undergone corrective surgery. Cardiac catheterization and angiocardiography were carried out in all patients. Cardinal findings on the clinical status of these subjects are outlined. A substantial number of patients (244; 29.0%) were > 15 years of age. Historically, a transannular pericardial gusset has been utilized in 578 (68.8%), and in 423 (93.0%) during the past decade. The incidence of residual interventricular septal defects has been 0.68% and occurrence of complete heart block after surgery 0.4%. Death occurred in 86 patients (10.2%) within 30 days of operation and later in 40 subjects (4.8%). Long-term results have been excellent with good haemodynamic status in > 90% of subjects in the follow-up period. Associated features including absent pulmonary valve, absent left pulmonary artery, and previous palliative shunts did not alter the outcome; however, a raised haematocrit (> 0.65) was associated with an increased mortality rate.

Adolescent↗
PubMed1993

What decides: high mortality in paediatric acute renal failure?

Forty paediatric cases of A.R.F. (Acute Renal Failure) of various aetiology were included in the study. 60% of patients were less than 4 years of age with male predominance. 80% cases reported to us very late with oligoanuria of more than 24 hours (2-7 days). Diarrhoea, vomiting and fever were other dominant symptoms. Maximum cases were severely anaemic (87.5%) with mean Hb 7.73 +/- 1.9 gm%. 40% cases were of underweight while only one case (2.5%) was of over weight, inspite of volume excess in 40% cases. All 24 cases, who were estimated for serum albumin, found to have marked hypoalbuminemia. Mortality was found to be as high as 65% inspite of effective peritoneal dialysis in all cases. High mortality seems to be due to profound anuria of many days (because of marked delay in reaching the hospital), fever and malnutrition besides other factors as aetiology.

Acute Kidney Injury↗
PubMedDate not supplied

How promptly are inpatients treated for critical laboratory results?

OBJECTIVE: The purpose of the study is to determine how frequently critical laboratory results (CLRs) occur and how rapidly they are acted upon. A CLR was defined as a result that met either the critical reporting criteria used by the laboratory at Brigham and Women's Hospital or other, more complex criteria. DESIGN: This is a retrospective cohort study in a large academic tertiary-care hospital. MEASUREMENTS: The proportion of chemistry and hematology results obtained in a 13-day period that met the hospital laboratory's critical reporting criteria were calculated. The charts of a stratified random sample of patients with CLRs due to sodium, potassium, and glucose were reviewed to determine the time interval until an appropriate treatment was ordered and the time interval until the critical condition was resolved. RESULTS: In 13 days, 1938 of 201,037 laboratory results (0.96%, or 0.44 per patient-day) met the hospital's critical reporting criteria. In the chart review, 222 CLRs were included in the stratified random sample, and 99 of these met the inclusion criteria. Among these 99 CLRs, the median time interval until an appropriate treatment was ordered was 2.5 hours. This interval was 1.8 hours when the CLR met the laboratory's criteria and a phone call was made, and 2.8 hours when the CLR met more complex criteria not requiring a phone call (p = 0.07). For 27 (27%) of the CLRs, an appropriate treatment was ordered only after five or more hours. The median time until the condition resolved was 14.3 hours: 12.0 hours for CLRs that met the hospital's criteria and 20.9 hours for the CLRs that met the more complex criteria (p = 0.006). CONCLUSION: Although CLRs meeting the hospital's criteria were reported promptly by the laboratory, treatment delays were still common. Results that did not meet the hospital's critical criteria but still represented serious clinical situations were more often associated with treatment delays. Difficulty communicating critical results directly to the responsible caregiver is the likely cause of some delays in treatment. New communications methods, including computer-based technologies, should be explored and tested for their potential to reduce treatment delays and improve clinical care.

Academic Medical Centers↗