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Biomedical subjects

C B Jones

Publications and source records attributed to C B Jones.

At least 37 records · Page 2Linked to original sources
PubMed1996

Registered nurse turnover and the changing health care system.

Changes in health care delivery and cyclic fluctuations in the registered nurse (RN) labor market affect health care costs, access, and quality. This study provides insight into one factor central to these issues, the job-change behavior of RNs. The theory of human capital provides the foundation to guide investigation, and econometric modeling is used to explore relationships among study variables. Model results show clear differences in job change behavior of nurses employed in hospital and nonhospital settings. These differences are a reflection, not only of individual nurse preferences, but also of wages, working conditions, and opportunities associated with various health care settings. Understanding these relationships is essential to leaders in the nursing profession as they plan for and respond to changes in health care delivery.

Adult↗
PubMed1995

Ventilator-associated Pseudomonas aeruginosa pneumonia: radiographic findings.

PURPOSE: To characterize the radiographic features of ventilator-associated Pseudomonas aeruginosa pneumonia (PAP). MATERIALS AND METHODS: In 56 patients (40 men and 16 women), PAP was documented with fiberoptic bronchoscopy. All patients underwent mechanical ventilation for at least 48 hours before diagnosis. The findings on chest radiographs were recorded. In eight patients in whom computed tomography (CT) was performed, results were compared with radiographic findings. RESULTS: Twenty-six patients with adult respiratory distress syndrome (ARDS) had diffuse bilateral confluent opacities; 30 patients without ARDS had multifocal opacities. In 13 patients, cavities were detected at chest radiography, CT, or both. Seven of 29 patients with pleural abnormalities had empyema. CT provided important additional information (presence of cavities or effusions) in four cases. CONCLUSION: Findings on chest radiographs are nonspecific for PAP. The frequencies of cavities and empyema are surprisingly low, perhaps owing to prompt diagnosis and therapy.

Bronchoscopy↗
PubMed1994

Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia, a leading cause of sepsis in patients with acute respiratory failure, is difficult to distinguish clinically from other processes affecting patients receiving mechanical ventilation. We conducted a prospective study of patients with suspected ventilator-associated pneumonia to identify the causes of fever and densities on chest radiographs and to evaluate the diagnostic yield and efficiency of tests used alone and in combination. METHODS: The 50 patients entered into the study underwent a systematic diagnostic protocol designed to identify all potential causes of fever and pulmonary densities. Diagnoses responsible for fever were established by strict diagnostic criteria for 45 of the 50 patients. The prevalence of specific conditions and diagnostic yield of individual tests were used to formulate a simplified diagnostic protocol. RESULTS: The diagnostic protocol identified 78 causes of fever (median 2 per patient). Infections were the leading causes of fever and pulmonary densities. Of the 45 patients with fever, 37 had one or more infections identified (67 sources). Most infections (84 percent) were one of four types:pneumonia, sinusitis, catheter-related infection, or urinary tract infection. Ventilator-associated pneumonia occurred in only 42 percent. All but nine infections (87 percent) were directly or indirectly related to insertion of a catheter or a tube. Concomitant infections were frequent (62 percent), particularly in patients with sinusitis (100 percent), catheter-related infections (93 percent), and pneumonia (74 percent). Of concomitant infections, 60 percent were caused by a different pathogen. Noninfectious causes of fever were more common in the 22 patients with adult respiratory distress syndrome. Histologically proved pulmonary fibroproliferation was the only cause of fever in 25 percent of patients with adult respiratory distress syndrome. Radiographic densities were caused by an infection in only 20 patients (19 pneumonia, 1 empyema). In more than 50 percent of the 25 patients without adult respiratory distress syndrome, congestive heart failure, and atelectasis were the sole causes of pulmonary densities, and fever always originated from an extrapulmonary site of infection. Used in combination, bronchoscopy with protected sampling, computed tomographic scan of the sinuses, and cultures of maxillary sinus aspirate, central intravenous or arterial lines, urine, and blood identified 58 of the 78 sources of fever (74 percent). CONCLUSIONS: The observations in this study document the complex nature of acute respiratory failure and fever and underscore the need for accuracy in diagnosis. The frequent occurrence of multiple infectious and noninfectious processes justifies a systematic search for source of fever, using a comprehensive diagnostic protocol. A simplified diagnostic protocol was devised based on the diagnostic value of individual tests.

Adult↗
PubMed1993

What is a reasonable orthopaedic surgical workload? An analysis of elective and trauma workloads using two different complexity scoring systems.

A 1-year prospective study of all surgical activity was undertaken by the Orthopaedic Unit using two weighting systems for operative complexity: the Intermediate Equivalent (IE) and the Operative Complexity Score (OCS). The objectives were to define the difference between caseload and workload, and to formulate a reasonable workload for an operating session and a reasonable annual workload for a consultant team. In both elective and trauma surgery the BUPA complex, major+ and major operations represented 50 per cent of the caseload but accounted for approximately 68 per cent of the workload. The BUPA minor and intermediate procedures representing the remaining 50 per cent of the caseload accounted for only 32 per cent of the workload. The number of hours required to undertake all the complex, major+ and major operations was approximately twice that required for the number of minor and intermediate procedures. Despite the marked variation in case mix, the workload achieved by the six teams in the same number of sessions was remarkably similar. On the basis of two consultant and one registrar elective lists per week, a total of 705 IEs (1795 OCS units) could be undertaken by each team in 1 year. An average of 458 IEs (1086 OCS units) of trauma surgery were undertaken by each team. Caseload is a poor performance indicator of surgical activity. This study supports the concept of 3.5-4.0 IEs as reasonable workload for an orthopaedic elective operating session, and 900 IEs (2200 OCS units) as a reasonable annual workload for an orthopaedic team.

England↗
PubMed1992

Heavy metals and lipofuscinogenesis. A study on myocardial cells cultured under varying oxidative stress.

The aim of this study was to examine the influence on lipofuscinogenesis of a number of transition and non-transition heavy metals in cultured post-mitotic cells (neonatal rat myocytes) at varying oxidative stress. The effects of Al, Cd, Cr, Cu, Hg, Pb and Zn, added to the medium as chlorides, were examined after 14 days in culture under 5, 20 and 40% ambient oxygen. Lipofuscin was quantified by microspectrofluorometry of individual cells. The addition of Al (40 microM), Cd (40 nM), Hg (30 microM) and Pb (40 microM) to the culture growth medium markedly increased the amount of intracellular lipofuscin, whereas Cr (40 microM), Cu (40 microM) and Zn (40 microM) had the opposite effect. Transmission electron microscopic examination of the myocytes showed greatly increased numbers of autophagic vacuoles in cells exposed to those heavy metals that increased lipofuscin formation. This effect was most pronounced when cells were grown at high (40%) oxygen tension. Possible explanations for the metal augmented pigment formation may be (i) inhibition of lysosomal enzymes, (ii) catalytic interference with peroxidative reactions, or (iii) general toxicity with unspecifically increased autophagocytosis. The decreased pigment accumulation after the addition of Zn, Cr and Cu may, at least partly, be related to the replacement of iron, which has catalytic activity in Fenton reactions.

Aging↗
PubMed1992

A novel hypothesis of lipofuscinogenesis and cellular aging based on interactions between oxidative stress and autophagocytosis.

Based on a series of experiments, using cultured postmitotic neonatal rat cardiac myocytes as a model system, we present a novel hypothesis of lipofuscin formation. This hypothesis proposes that lipofuscin is formed within secondary lysosomes due to an interplay of two processes, the production of partially reduced oxygen species by mitochondria and the autophagocytotic degradation within secondary lysosomes. Specifically, it is proposed that H2O2 generated by mitochondria and other organelles permeates into the lumen of secondary lysosomes, which contain iron derived from cellular structures undergoing intralysosomal degradation. The interaction between reactive ferrous iron and H2O2 results, via Fenton-type mechanisms, in the generation of hydroxyl free radicals (OH), inducing lipid peroxidation and eventually leading to intermolecular cross-linking and lipofuscin formation. Additionally, mitochondria undergoing intralysosomal decomposition might continue for a certain period to produce superoxide anion radicals (O2-) and thus also H2O2. This model of lipofuscinogenesis could satisfactorily explain the variations observed in the rates of lipofuscinogenesis among different postmitotic cell types in various species. Such variations might arise from a variety of factors including differences in the efficiency of the 'anti-oxidative shield', rate of H2O2 generation, amount of chain-breaking antioxidants, mode of intralysosomal iron chelation, rate of autophagocytosis as well as degree of efficiency of the intralysosomal hydrolytic enzymes.

Animals↗
PubMed1991

A combined intra- and extra-articular reconstruction using a carbon-dacron composite prosthesis for chronic anterior cruciate instability. A two to six-year follow-up study.

Fifty patients with chronic symptomatic anterior cruciate insufficiency underwent ligamentous reconstruction using the "Westminster Composite Prosthesis" which consists of a central core of carbon fibre with an external weave of polyester. In 42 patients, the prosthesis was used as an augmentation within a tube of ilio-tibial tract, combined with a MacIntosh's extraarticular reconstruction. The prosthetic replacement alone was used in eight patients where there had been a previous extraarticular reconstruction and was associated with only fair results. The average age of the patients at operation was 28.5 years (range 18 to 50 years); instability of the knee had been present for a mean of 5.3 years and the average follow-up was 3.8 years (range 2 to 6 years). Assessment included subjective functional rating (Lysholm knee score) and clinical examination for instability. Thirty-seven patients (74%) had a good or excellent result, 11 (22%) had a fair result and two (4%) had a poor result. The Lachman test was grade I or less in 35 patients and the pivot shift sign was eliminated in 37 patients. Clinical signs of instability correlated well with the Lysholm knee score (p less than 0.001). Twenty-two unselected patients (44%) underwent an arthroscopic assessment and biopsy of the "neoligament" at an average of 10.4 months post-operatively. The prosthesis was found to be stable and well covered by a thick fibrous sheath ("neoligament") in 19 patients. The prosthesis was partially ruptured in two patients and completely disrupted in one. Thirty-two patients (64%) returned to their previous sports and 13 of them (26%) achieved their pre-injury level of performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure.

Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a face mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in PCO2 (greater than 16 percent decrease) and in pH (from less than 7.30 to greater than 7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the face mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency.

Acidosis, Respiratory↗
PubMed1990

Staff nurse turnover costs: Part I, A conceptual model.

The impact of turnover is a major concern for the chief nurse executive. This study provides nurse administrators with information necessary to more fully understand the impact of turnover and assists them in developing and defending retention strategies. Part 1 addresses the conceptual model used to guide the study; Part 2 (May 1990) will discuss the application of the methodology to measure nursing turnover costs and the study's findings.

Administrative Personnel↗
PubMed1990

Staff nurse turnover costs: Part II, Measurements and results.

This study demonstrated that the costs of nursing turnover can be high (over +10,000 per RN turnover), and that the potential for adverse impact on the nursing department, the hospital environment, and the healthcare environment exists. The results of this study are important, particularly in the midst of a national nursing shortage, for several reasons. CNEs are responsible for obtaining, allocating, and managing nursing department resources; knowledge of nursing turnover costs will allow them to make more informed decisions about how best to allocate scarce resources. The findings of this study are also important to hospital administrators because they demonstrate the financial impact of high rates of nursing turnover on healthcare delivery. Finally, these findings provide nurse researchers direction for future research into the costs and benefits of nursing turnover and retention activities, so that cost-effective methods of minimizing organizational costs can be determined.

Advertising↗
PubMed1989

Epiphyseal distraction monitored by strain gauges. Results in seven children.

Ten epiphyses in seven children underwent fixed-rate distraction of 0.25 mm twice daily in an attempt to achieve percutaneous leg lengthening by chondrodiatasis. The forces generated across the growth plate were recorded by means of strain gauges incorporated into the distractors. All epiphyses fractured before 33 days of lengthening. An average gain of 6.75 cm was achieved. Epiphyseal distraction at the lower femur produced many complications, but at the upper tibial epiphysis planned lengthening was achieved, with excellent bone production and few complications.

Adolescent↗
PubMed1987

Prosthetic anterior cruciate ligaments in the rabbit. A comparison of four types of replacement.

Four types of prosthetic replacement for the anterior cruciate ligament (carbon fibre, carbon fibre and Dacron composite, Dacron alone and bovine xenograft) were assessed at three, six and 12 months after implantation in the knees of New Zealand white rabbits. The synovium and both intra-articular and intra-osseous portions of the ligaments were examined macroscopically, by light microscopy and by scanning electron microscopy. All the knees showed mild synovitis, and there was no significant growth into the intra-articular part of any ligament. Carbon fibre and xenograft did not appear to be suitable materials in this animal model. The composite ligament showed short-term ingrowth of fibrous tissue only into the periphery of the sheath in its intra-osseous portion, whereas the Dacron ligament showed progressive fibrous tissue ingrowth with some bony incorporation of its outer fibres.

Animals↗
PubMed1987

Characterization of a murine tumor of spontaneous origin with selective hepatic metastasis.

The primary objective of this study was to establish the identity and characteristics of a murine uterine tumor of spontaneous origin in a C57Bl/6 Ros mouse that selectively metastasized to the liver. The primary tumor contained a minimum of two different cell types. One cell type was elongated and spindly and readily adhered to a plastic coated surface. From it, a permanent cell line, termed RCS-1 was established. The RCS-1 cell line was poorly tumorigenic in normal C57Bl/6 Ros mice. The other cell type, designated RCS-2, was more rounded in structure. It was maintained in vivo, enzymatically dissociated and used after short-term in vitro cell culture. The RCS-2 cells had phagocytic vacuoles, Fc, and C3 receptors. These cells phagocytosed antibody coated SRBCs and opsonized zymosan. Furthermore, these cells generated the superoxide anion. Thus, the RCS-2 cells are of macrophage origin. The spontaneous and experimental pattern of metastasis of the RCS-2 tumor cells was established. The RCS-2 tumor cells selectively metastasized to the liver by the hematogenous route. Metastatic RCS-2 tumor cells obtained from the liver (RCS-2M) retained their macrophage characteristics. These studies indicate that this murine uterine tumor of spontaneous origin consists of two cell types. One cell type is a reticulum cell sarcoma.

Animals↗
PubMed1985

Tumours of the cauda equina. The problem of differential diagnosis.

A retrospective study of 32 patients with primary tumours of the cauda equina is presented. Most of the patients were initially diagnosed as having prolapsed intervertebral discs and treated accordingly. The correct diagnosis was eventually made, usually after a long delay, and confirmed by myelography. Treatment consisted of laminectomy and excision of the tumour. Only one tumour was frankly malignant; all the remaining patients were relieved of their pain and the majority recovered completely. The exceptions were those patients with long-standing neurological deficits; this highlights the importance of early diagnosis and correct treatment before irreparable damage occurs.

Adolescent↗
PubMed1984

A modified bone clamp.

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Fracture Fixation, Intramedullary↗