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Biomedical subjects

B Johnson

Publications and source records attributed to B Johnson.

At least 289 records · Page 16Linked to original sources
PubMed1986

Analysis of an industry in transition.

The health care industry is undergoing major structural changes. The significance of these changes for individual competitors moving toward the 1990s is not yet clear. This article assesses the implications of the current changes by applying Porter's industry structure and generic strategy frameworks to the health care industry. Present trends are compared to this analysis to highlight areas where individual hospitals might improve their competitive positioning.

Delivery of Health Care↗
PubMed1986

Acuity and staffing under prospective payment.

Nursing administrators are debating the desirable mix of professional (RN) and paraprofessional (LPN) nursing staff under the prospective payment system (DRGs). The staffing mix reflects the cost and quality of nursing care provided by an acute care hospital. Based on a reliable and valid acuity/care plan system, standards of care and nursing diagnoses, several DRGs were analyzed on an eight-bed medical/surgical intensive care unit with regard to intensity of care and staffing mix. This study showed nursing administrators that the staffing mix on an intensive care unit varies according to the acuity/care plan rather than DRGs or nursing diagnoses.

Diagnosis-Related Groups↗
PubMed1986

The effect of vegetarian diets on plasma lipid and platelet levels.

Vegetarians have an apparent diminished risk for the development of ischemic coronary heart disease. This may be secondary to dietary effects of plasma lipids and lipoproteins, but platelets, which may also play a role, have also been observed to have aberrant functions in vegetarians. We measured plasma lipid and lipoprotein levels, platelet function, platelet fatty acid levels, and platelet active prostaglandins in ten strict vegetarians (vegans), 15 lactovegetarians, and 25 age- and sex-matched omnivorous controls. The most striking observations were a highly significant rise in platelet linoleic acid concentration and a decline in platelet arachidonic acid concentration in both vegetarian subgroups as compared with omnivorous controls. Serum thromboxane and prostacyclin levels as well as results of platelet aggregation studies did not differ among the groups tested. Cholesterol levels were significantly lower in both vegetarian groups as compared with controls, but plasma high- and low-density lipoprotein levels were lower only in the vegan subgroup as compared with omnivores. If diet produces these changes in platelet fatty acid and plasma lipid levels it may contribute to the decreased risk of coronary heart disease and possibly atherosclerosis in vegetarians.

Adult↗
PubMed1986

The effectiveness of optometric aid to Fiji, South Pacific.

During 1983, a volunteer vision care delivery team provided glasses to a population of rural Fijians. To determine the fate of these glasses, an 8-month follow-up study was conducted on a random sample of 80 Fijians. Of the 40 who received lenses for full-time wear, 28% had discontinued lens use and 35% wore their lenses for reading only. Of the 40 who received lenses for reading only, 25% had discontinued use. A significant proportion of the discontinued lenses had low plus powers and/or were dispensed to non-presbyopic Fijians on the basis of asthenopic complaints.

Adolescent↗
PubMed1986

The relationship between depression and the dexamethasone suppression test following alcohol withdrawal in a psychiatric population.

The authors administered at least one dexamethasone suppression test (DST) and Hamilton Rating Scale for Depression (HRSD) simultaneously to 30 psychiatric inpatients following detoxification from alcohol. Twenty-five of these were also interviewed using the NIMH Diagnostic Interview Schedule (DIS). Fifteen patients had two or three sequential DSTs at weekly intervals. Seven of the patients were clinically diagnosed as having a major depressive episode based on close observation over 2 to 4 inpatient weeks free of psychotropic medications. Fifty-eight percent of the initial cortisol determinations with the first 2 weeks showed nonsuppression, as did 60% after 2 weeks. While the level of depressive symptoms was initially high (HRSD score greater than 20) for 48% of the 27 patients interviewed within 2 weeks of abstinence, depressive symptoms cleared within 2 weeks in half of these cases. There were no associations between DST results and the presence of DSM-III major depressive disorder (lifetime or current) as assessed by the NIMH DIS, scores on the HRSD, or the presence of liver disease (elevated admission SGOT or SGPT). By the 15th-day of abstinence an examination of the clinical course of depressive symptoms differentiated those patients with a persistent major depressive episode from those with transient, alcohol-related depressive symptoms. An early positive DST had a positive predictive value of 20% for a clinical diagnosis of a major depressive episode, and a negative predictive value of 73%. After 2 weeks the positive and negative predictive values were each 50%.

Adult↗
PubMed1985

Decay of the activating signal after platelet stimulation with 1-0-alkyl-2-acetyl-SN-glycero-3-phosphorylcholine: changes in calcium permeability.

The decay of the platelet-activating signal after platelet stimulation with the platelet-activating factor 1-0-alkyl-2-acetyl-SN-glycero-3-phosphorylcholine (AGEPC) was examined. Washed human platelets in calcium-poor buffer were stimulated with AGEPC followed 0.25 to 10 min later by reconstitution with 1.8 mM calcium. AGEPC did not induce platelet aggregation in calcium-poor buffer but aggregation occurred upon addition of calcium. The capacity of calcium-reconstitution to elicit platelet aggregation decayed rapidly after platelet exposure to AGEPC (T 1/2 = 1 min). A parallel decay of AGEPC-induced increased calcium permeability (R = 0.93) was demonstrated using the fluorescent probe Quin 2. Studies with calcium channel blockers suggest that AGEPC opens a calcium channel which is distinct from those present in unstimulated platelets.

Adult↗
PubMed1985

T-cell receptor gene rearrangements as clinical markers of human T-cell lymphomas.

The ability to detect immunoglobulin-gene rearrangements has proved useful in confirming diagnoses of suspected B-cell lymphomas and in establishing their monoclonality. By analogy, we employed a cloned DNA probe for the beta chain of the T-cell receptor gene to determine whether gene rearrangements were present in human T-cell neoplasms representing various stages of T-cell development. Gene rearrangements were present in all cases of T-cell disorders except a single case of T gamma lymphocytosis, a disorder that has not been proved to be a clonal T-cell neoplasm. A germline gene configuration was present in all patients with non-T-cell neoplasms and in normal tissues from patients with T-cell lymphoma. The probe promises to be useful for confirming the pathological an immunologic diagnosis in difficult cases of T-cell disorders and for assessing the extent of disease.

B-Lymphocytes↗
PubMed1985

Antihypertensive effectiveness of terazosin: a new long-acting alpha-adrenergic inhibitor.

Eighteen patients ages 35-70 years (mean +/- SEM 58 +/- 2) with poorly controlled hypertension on various regimens, participated in the present studies. After a 4-week placebo-controlled lead-in period, 12 patients were randomized to terazosin treatment and 6 to placebo. They were followed in the clinic every 2 weeks for 13 weeks, where their supine (5 min) and the upright (2 min) arterial pressure and heart rate were measured. In addition, all patients had a complete laboratory evaluation at the beginning and end of the study. Depending on pressure response, the experimental drug was increased at each visit from 1.0 mg/day to 2.0, 5.0, 15.0, and 20.0 mg/day, if the supine diastolic pressure was greater than 90 mmHg. Terazosin decreased the systolic and diastolic pressure in both the supine and upright positions, and had no significant effect on heart rate. Placebo did not exert any effects on either arterial pressure or heart rate. No adverse clinical or metabolic effects were observed with the administration of either terazosin or placebo. We conclude that: Terazosin is a new effective long-acting alpha blocker given in combination with other antihypertensive drugs, and it is safe and well tolerated by the patients.

Adrenergic alpha-Antagonists↗
PubMed1985

A comparative study of captopril and enalapril in patients with severe hypertension.

Twenty patients with moderate to severe essential hypertension were randomized in a paralleled, double-blind, 22-week study of captopril (ten) and enalapril (ten) following four weeks of hydrochlorothiazide (50 mg/d) baseline treatment. The captopril group was administered 25 mg tid and increased to 100 mg tid, while the enalapril group began with 5 mg bid and increased to 20 mg bid, depending on the patient's blood pressure (BP) response. Methyldopa, 250 mg to 500 mg bid and 1,000 mg bid, was administered to patients in both groups if BP was not adequately controlled. Patients were seen every two weeks for BP monitoring and metabolic evaluation. Each group showed a significant and equal decrease in BP, with the effect being the greatest on the diastolic pressure, supine and upright. Of the 20 patients, ten (four whites and six blacks) required methyldopa for adequate BP control. Four patients, two from each group, developed reversible prerenal azotemia (BUN [blood urea nitrogen] congruent to 50 mg/dL). No other clinical or metabolic side effects were noted. We concluded that captopril and enalapril were equally effective in lowering BP in the dosages given; no racial differences in BP response were noted, although more black patients required the addition of methyldopa for adequate BP control; and both drugs were safe and well tolerated.

Antihypertensive Agents↗
PubMed1985

The effects of acute hypertriglyceridemia and high levels of free fatty acids on left ventricular function.

The effects of acute hypertriglyceridemia and of high levels of free fatty acids on the left ventricular ejection fraction were studied by radionuclide ventriculography in 20 subjects with and without coronary artery disease. An infusion of approximately 125 ml of a 20% fat emulsion over 25 minutes resulted in an increase of plasma triglycerides to the mean of 820 mg/dl and a fall of the left ventricular ejection fraction from the baseline mean of 62% to 58% (p less than 0.05). Ninety minutes after the intravenous administration of 5000 units of heparin, plasma free fatty acids rose to the mean of 4.6 mmol/L and the mean left ventricular ejection fraction increased to 69% (p less than 0.001). The observed changes in blood lipids were not associated with clinical or ECG evidence of myocardial ischemia. We conclude that acute hypertriglyceridemia causes slight depression of left ventricular performance, while high levels of free fatty acids augment it. However, neither hypertriglyceridemia per se nor its rapid conversion to free fatty acids are likely to cause angina in stable patients with coronary artery disease.

Aged↗
PubMed1985

Carpal tunnel syndrome in paraplegic patients.

Median nerve compression at the wrist (Carpal Tunnel Syndrome) is commonly associated with local trauma around the flexor retinaculum. Repeated manual activity also exacerbates the disease severity. We undertook a prospective study of the incidence of Carpal Tunnel Syndrome (CTS) in 47 paraplegic patients who have used their hands extensively for daily activity. Since surgical decompression generally provides excellent relief of symptoms, early detection of CTS will be particularly important in these patients. Of the 47 patients studied, 19 had clinical CTS (40%). A total of 91 hands (nerves) were tested with motor and sensory nerve conduction of the median and ulnar nerves. Electrophysiological evidence of CTS was noted in 57 hands (63%). The incidence of CTS appears to be related to the duration of Spinal Cord Injury. Concurrent ulnar neuropathy at the elbow was noted in 19 patients (40%). There was no predisposing factor such as diabetes mellitus in any of these patients, and the compressive neuropathy appears to be purely mechanical.

Activities of Daily Living↗
PubMed1985

Health, health risks and inequalities: an exploratory study of women's perceptions.

Recent theoretical and empirical research has highlighted the importance of understanding the relationship between social structure and health beliefs. The empirical study described here explores the relationships between occupational social class and two dimensions of health beliefs which were concepts of health and perception of vulnerability to disease. Both the dimensions are claimed to be associated with decisions to carry out health behaviour and thus one of the aims was to shed some light on the social class gradient in patterns of preventive health behaviour and risk-taking behaviour. The findings showed a more marked social class differentiation in concepts of health when they were defined in the abstract compared with when they were defined in relation to personal health. The concept of personal vulnerability itself was shown to be problematic and theories about vulnerability were similar for both classes. Explanations for the findings are discussed.

Attitude to Health↗
PubMed1985

Hospital "hotels": the time has come.

One of the newest trends in health care that the 1980s has ushered in is customer-oriented management. It recognizes the reality that hospitals are a service industry that must compete by providing the best services to their "customers."

Consumer Behavior↗