Biomedical subjects

D Jarjoura

Publications and source records attributed to D Jarjoura.

At least 19 recordsLinked to original sources

PubMed1999

Assessing the impact of reengineering on nursing.

OBJECTIVES: This study assessed the impact of organizational re-engineering on nursing in a large community teaching hospital in the Midwest, using an observational repeated measures design. Time, clinical unit, and nurse characteristics were incorporated as covariates. A second objective was to compare two sampling approaches for robustness and efficiency. BACKGROUND: Economic and technological changes are having an enormous impact on acute care hospitals, which often attempt to adapt by re-engineering or restructuring their systems. Despite the difficulty of conducting research in a constantly changing setting, it is imperative that nursing evaluate its reactions and contributions to new delivery models. METHODS AND SUBJECTS: During a hospital-wide reorganization, mail surveys were conducted to assess nurses' perceptions of their authority and autonomy in a new nursing model, commitment to a new philosophy (patient-focused care), and satisfaction with their ability to deliver care. To validate the findings, patient satisfaction was evaluated through a survey of 227 hospitalized patients. Over a 1-year period, two sampling approaches were used: three independent samples of nurses were surveyed at three dates, and a panel of nurses were surveyed repeatedly over the same three dates. Response rates were approximately 45% across the independent samples and 67% for the panel. RESULTS: Comparison of nursing units that underwent re-engineering and units in which re-engineering was delayed showed no obvious effects. Data also showed that the estimates of effects of re-engineering were not subject to confounding from nursing unit, date, or nurses' experience, although there was evidence that the measures were sensitive to these covariates. No biases were found due to the two sampling schemes, yet the panel data was three to five times more efficient--that is, they produced more information--than the data from the independent samples. CONCLUSIONS: This study reinforces the need to build evaluation research into organizational activities such as re-engineering. It also argues for the commitment of resources to organizational research so that information valuable to nursing and the healthcare system is not lost.

Adult↗

PubMed1999

Confronting the communication gap between conventional and alternative medicine: a survey of physicians' attitudes.

CONTEXT: An estimated 60 million Americans use some from of complementary and alternative medicine, though approximately 70% do not tell their physicians about this use. Open communication between conventional medical providers and patients in this area is therefore lacking. OBJECTIVE: To explore the dynamics that could potentially contribute to communication breakdown between physicians and patients over the use of alternative therapies. DESIGN: Mail-in, self-administered questionnaire. PARTICIPANTS: 96 practitioners in primary care and medical subspecialties representing the local county medical society, Stark county, Ohio. MAIN OUTCOME MEASURES: Data were obtained on the following: (1) physicians' level of familiarity with 23 different alternative therapies, (2) the question of whether physicians used the therapies themselves, (3) physicians' assessment of the potential benefits and harm of each therapy, and (4) physicians' response to the prospect of their patients using these therapies. RESULTS: Respondents reported the use of myriad alternative therapies. Only 28%, however, referred patients for alternative therapies. The physicians demonstrated clear preferences for specific therapies (i.e., when asked about benefits, familiarity, and reactions to patient use, they responded differently depending on the therapy). Indication that the doctor-patient relationship might be terminated as a result of alternative therapy use was more common among subspecialists than among primary care practitioners. CONCLUSIONS: Overall, physicians demonstrated an open attitude toward alternative therapies. This finding indicates that patients should disclose their use of alternative therapies to their doctors. Increased referral to alternative healthcare providers may require both ongoing peer-reviewed studies of efficacy and increased physician access to information concerning therapies that have undergone definitive study.

Adult↗

PubMed1998

Evaluation of acetaldehyde-modified hemoglobin and other markers of chronic heavy alcohol use: effects of gender and hemoglobin concentration.

The present study examined whether measurement of hemoglobin-acetaldehyde (HbA1-AcH) using an improved methodology may be useful as a biological marker of alcohol abuse. Red blood cell hemolysates of 182 patients consecutively admitted to the drug and alcohol treatment unit of our institution were analyzed for HbA1-AcH concentration using cation exchange HPLC. Mean HbA1-AcH of those who claimed to drink > or = 6 drinks/day [mean = 0.055 (% total hemoglobin), SD = 0.051] was significantly higher than the mean of those who drank < 6 drinks/day (mean = 0.026, SD = 0.0174). The greatest sum of sensitivity (67%) and specificity (77%) came with a cut-score of 0.030 area% of total hemoglobin. A cut-score of 0.080 produced a 100% specificity, but lowered the sensitivity to 20%. The Pearson product moment correlation (r) between HbA1-AcH and reported drinks per day was r = 0.30 (p < 0.001). There was no significant difference in the association of HbA1-AcH and reported drinking between males and females, and the small difference observed was shown to be entirely associated with differences in hemoglobin levels between the sexes. Cocaine use did not significantly alter the correlation between reported drinking and HbA1-AcH levels. Hemoglobin levels were shown to have a significant correlation with HbA1-AcH independent of drinking. HbA1-AcH was shown to have a better sensitivity and specificity than gamma-glutamyltransferase, ALT, AST, or mean corpuscular volume in this population. The results suggest that HbA1-AcH may be a useful marker to help detect alcohol abuse, especially in populations where other markers have been shown to fail.

Acetaldehyde↗

PubMed1997

Oral contraceptive failure rates and oral antibiotics.

BACKGROUND: Despite anecdotal evidence of a possibility of decreased effectiveness of oral contraceptives (OCs) with some antibiotics, it is not known whether antibiotic use in dermatologic practices engenders any increased risk of accidental pregnancy. OBJECTIVE: Our purpose was to examine the effect of commonly prescribed oral antibiotics (tetracyclines, penicillins, cephalosporins) on the failure rate of OCs. METHODS: The records from three dermatology practices were reviewed, and 356 patients with a history of combined oral antibiotic/OC use were surveyed retrospectively. Of these patients, 263 also provided "control" data (during the times they used OCs alone). An additional 162 patients provided control data only. RESULTS: Five pregnancies occurred in 311 woman-years of combined antibiotic/OC exposure (1.6% per year failure rate) compared with 12 pregnancies in 1245 woman-years of exposure (0.96% per year) for the 425 control patients. This difference was not significant (p = 0.4), and the 95% confidence interval on the difference (-0.81, 2.1) ruled out a substantial difference (> 2.1% per year). There was also no significant difference between OC failure rates for the women who provided data under both conditions, nor between the two control groups. All our data groups had failure rates below the 3% or higher per year, which are typically found in the United States. CONCLUSION: The difference in failure rates of OCs when taken concurrently with antibiotics commonly used in dermatology versus OC use alone suggests that these antibiotics do not increase the risk of pregnancy. Physicians and patients need to recognize that the expected OC failure rate, regardless of antibiotic use, is at least 1% per year and it is not yet possible to predict in whom OCs may fail.

Administration, Oral↗

PubMed1997

Geriatric renal function: estimating glomerular filtration in an ambulatory elderly population.

In elderly individuals, serum creatinine may remain normal as glomerular filtration rate (gfr) declines. Therefore, the estimation of glomerular filtration utilizing mathematical models incorporates age as an important variable. In order to adjust drug dosages and diagnose renal disease earlier in the elderly, a variety of such simplified estimates of gfr have been applied. Unfortunately, no estimator is as accurate as the cumbersome gold standards (e.g. inulin or iothalamate clearance) and the reliability of each may vary with the particular clinical setting. The purpose of this study was to critically evaluate three commonly used estimators of gfr-i.e., creatinine clearance (CC), Cockroft-Gault (CG), and 100 over serum creatinine (100/SC)-comparing them to iothalamate clearance (IC) in a group of healthy ambulatory geriatric subjects (n = 41; ages 65-85). IC declined 1 ml/min per year of age in our sample. CC demonstrated a similar decline, a correlation of 0.83 with IC, and moderate error relative to IC of 17% at the mean (standard error [SE] = 12.3). In contrast, 100/SC correlated only 0.56 with IC, demonstrated a large positive bias (41 ml/min), and showed no age-related decline. An age correction to 100/SC similar to that utilized in the CG formula was clearly necessary. Despite the age and weight correction used in the CG formula, we found the estimates from it to be inaccurate (correlation = 0.5; SE = 23.8). A simpler age-corrected formula (Est. IC = 1/2 [100/SC] + 88-age) was derived and proved significantly superior to CG in our ambulatory geriatric sample, but still exhibited enough error (SE = 16.4) to question its clinical utility. It appears that serum creatinine based estimates of gfr in the elderly may not provide accurate results.

Age Factors↗

PubMed1997

Nephrologists' subjective attitudes towards end-of-life issues and the conduct of terminal care.

Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy. Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible for selected aspects of terminal care independent of patient choice. To study how nephrologists' perceptions toward end-of-life issues may affect decision-making, we anonymously surveyed 125 of them. The study employed the straightforward terminology of "hastening death" rather than adopting the ambiguous term "euthanasia" or the narrow term "assisted suicide." Subjective physician profiles demonstrated that nephrologists who are less comfortable with dying patients were significantly less likely to report that they omitted life-prolonging measures (p = 0.02) and more likely to report that they would not initiate measures in order to hasten death even were it legal (p = 0.04). Ninety-eight percent of nephrologists reported omissions in terminal care with patient knowledge and 80% without patient knowledge. In contrast, forty-three percent of the nephrologists said that were it to become legal to initiate measures in order to hasten death, they would "never" do so. The ethical framework utilized for discontinuation of dialysis decisions incorporated medical benefit (cancer as criterion, 48%; multisystem complications, 84%; dementia 79%) and quality of life criteria. Twenty-five percent of nephrologists admitted difficulty with advance directives if the directives clashed with heir beliefs. ESRD end-of-life decision-making in the USA may be altered by the subjective characteristics of nephrologists. In particular, nephrologists' level of discomfort with patient mortality is linked with their reported management of terminal patients.

Adult↗

PubMed1996

Prospective comparison of dual-phase technetium-99m-sestamibi scintigraphy and high resolution ultrasonography in the evaluation of abnormal parathyroid glands.

Technetium-99m-sestamibi (MIBI) is a new radionuclide for imaging parathyroid tissue. The purpose of this study was to evaluate parathyroid localization using single radiotracer, dual-phase MIBI scintigraphy and to compare the results to ultrasonography. Twenty-one patients with hyperparathyroidism underwent dual-phase scintigraphy using 25 mCi MIBI and high resolution ultrasonography before parathyroidectomy. Scan results were correlated with size, weight, location, and histopathology of excised parathyroid glands, thyroid abnormalities, and cost. Seventeen patients were female, five had secondary or tertiary hyperparathyroidism, and three had a previous parathyroid exploration. Twenty patients (95%) were cured, 14 with a single and 1 with a double adenoma, and 5 of 6 patients with generalized hyperplasia. There were no false positive MIBI scans and one false positive ultrasound study, despite associated thyroid nodules in 29 per cent of patients. The sensitivity of MIBI and ultrasound in the identification of adenomas was 87 per cent versus 57 per cent (P = 0.046), and the rate of detection of hyperplastic glands was 44 per cent versus 24 per cent (P = 0.19), respectively. There was no correlation between scan results and size, weight, or location of adenomatous glands. The cost of dual-phase MIBI was comparable to that of ultrasound. Dual-phase MIBI is more sensitive than ultrasound in the localization of adenomas and is the preferable modality for preoperative parathyroid localization. Neither MIBI nor ultrasound is effective in localization of hyperplastic glands, underscoring the importance of routine bilateral neck exploration.

Adenoma↗

PubMed1994

Ventricular tachycardia in acute myocardial infarction: the role of hypophosphatemia.

The relationship between serum concentration of certain electrolytes and the pathogenesis of ventricular arrhythmia in myocardial infarction has been the subject of frequent review. The role of hypophosphatemia in the pathogenesis of arrhythmia in patients with acute myocardial infarction has not been as well studied. In our study group of 325 consecutive patients admitted to the coronary care unit of a community hospital, 111 were confirmed to have had a myocardial infarction. Patients were continuously monitored for ventricular arrhythmia during the first 24 hours, and the electrocardiographic records were reviewed for documentation of arrhythmia. From an admission blood sample, measurement of electrolytes included serum phosphate, calcium, bicarbonate, potassium, and magnesium. Associations between ventricular tachycardia and serum electrolyte abnormalities including magnesium, potassium, phosphate, calcium, and bicarbonate were studied. Low phosphate (less than 2.6 mg/dL) was a significant predictor of ventricular tachycardia in the myocardial infarction group. In the entire group of 325 patients prior to the confirmation of myocardial infarction, both low bicarbonate and low phosphate were significant predictors of ventricular tachycardia during the first 24 hours of hospitalization. Although management of acidosis is considered early in the hospital course, phosphate replacement therapy is usually not as often considered. We recommend further study on the effectiveness of replacement therapy in hypophosphatemic patients with chest pain to reduce the risk of ventricular tachycardia.

Adult↗

PubMed1994

Likelihood ratios for deoxyribonucleic acid (DNA) typing in criminal cases.

The likelihood ratio approach for DNA typing in criminal cases is described. It is shown how this approach uses both the sizes and pattern of discrepancies between the crime scene profile of fragment lengths and the suspect profile for quantifying the strength of the evidence. In contrast to the current match-binning approach, it avoids an initial decision about whether the two profiles match. Likelihood ratios for pairs of profiles that meet the published statistical criteria for a match show a wide range of values including some that indicate the evidence is strongly against identity.

Criminology↗

PubMed1994

Eosinophils in urine revisited.

The finding of eosinophils in the urine has been suggested to be useful in establishing the diagnosis of acute interstitial nephritis (AIN). The diagnostic accuracy of this test has not yet been defined. It is the purpose of this study to define the specificity, sensitivity, and the predictive positive and negative values for the presence of eosinophils in the urine. One hundred forty-eight patients with pyuria were tested for the presence or absence of urinary eosinophils. In this group consecutively admitted to the hospital with WBC in the urine, 4% of patients had urinary eosinophilia of greater than 1 eosinophil per 100 cells. Since none of this group had the diagnosis of AIN, the false positive rate was 4% and the specificity was 96%. In a selected group of patients in which the diagnosis of AIN was suspected by a nephrology consultant, urinary eosinophils were found in 6 of 15 patients with a confirmed diagnosis of AIN but were also found in 10 of 36 patients with another renal diagnosis. The sensitivity for eosinophiluria was 40% and the specificity was 72% with a positive predictive value of only 38%. We conclude that eosinophiluria is not an accurate test for the diagnosis of AIN. The false positive and negative rates are too high to confirm an AIN diagnosis.

Acute Disease↗

PubMed1993

Wharton's jelly in the umbilical cord. A study of its quantitative variations and clinical correlates.

A frozen segment was prepared from each of 398 consecutively collected umbilical cords after stripping them of blood. Three cross-sections were obtained from each cord, and dye imprints were made. Their surface area was measured by placing a transparency with a grid of squares over the imprint and counting the number of squares it occupied. An average of these three cross-sectional areas was taken to estimate the quantity of Wharton's jelly at any point along the umbilical cord. Of the 14 maternal and fetal variables studied, those that were found to be independently related to the estimated quantity of Wharton's jelly in the umbilical cord were male gender (P = < .01), weight of the fetus (P = .05) and maternal prepregnancy weight (P = < .01). These variables, however, explained only 7% of the observed variation in quantity. A further 3.3% was explained by measurement error, leaving 89.7% of the observed variation unexplained.

Adult↗

PubMed1992

Recognition of depression by internal medicine residents.

We studied the ability of internal medicine residents to recognize depressive symptoms in a population of lower socio-economic primary care patients. Four hundred twenty patients completed the short form of the Beck Depression Inventory (BDI). Simultaneously, the resident caring for the patient estimated the degree of depression for each patient. One-fourth of the patients scored at or above the moderately depressed level on the BDI and the residents rated 23 percent of their patients as at least moderately depressed. However, the accuracy of the residents' assessment of his or her individual patient was poor (correlation = 0.42, sensitivity = 0.46, specificity = 0.84). Patients with a prior history of psychiatric disorder scored higher on the BDI and were given higher ratings of depression. No other pre-existing medical condition was significantly associated with a higher or lower BDI score. The amount of alcohol consumed and the amount smoked, were both associated with higher BDI scores. Residents varied in their sensitivity to their patients' BDI scores. Some showed high agreement with BDI scores, others low. There were no specific resident characteristics (e.g. year of training, resident gender) that could explain this variability. Patients with a history of depression were given lower resident ratings compared to other patients and patients with a history of depression were given lower resident ratings than predicted by their BDI scores. Residents' ability to accurately diagnose and treat depression in the underprivileged primary care patient can be facilitated by the institution of depression screening in the ambulatory clinic.

Adolescent↗

PubMed1992

Searching for a pattern: repeat suicide attempts.

1. Although there is a large population of unsuccessful suicide attempts and the same patients are often admitted repeatedly, little investigation has been done to understand this group. 2. Prescription drugs were almost always used in overdose attempts. There was no indication that physicians successfully intervened in preventing abuse of prescribed medication among patients with a history of overdose suicide attempt. 3. Most people choose a method for suicide and repeatedly use the same method (physical versus overdose). The majority of repeat attempts occurred among young people, and alcohol use was especially high when physical methods were used. Identification of these trends could lead to effective intervention.

Alcohol Drinking↗

PubMed1991

Elapsed time from symptom onset and acute myocardial infarction in a community hospital.

STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.

Aged↗

PubMed1990

Variation in heart disease mortality across census tracts as a function of overdispersion and social class mixture.

Variation in heart disease (HD) mortality rates across census tracts is greater than expected given binomial error and available explanatory variables. We extended an extra-binomial variation model for rates standardized by the direct method. The overdispersion parameter accounted for 36 per cent of the observed variation in standardized rates. Ignoring overdispersion resulted in a change in an estimate of the effect of social class on HD mortality and substantial underestimation of the error of the estimates of such effects. Ecologic regression on the proportional mixture of social classes within tracts provided an appealing approach to the problem of estimating fixed effects with aggregated data.

Adolescent↗

PubMed1990

Modeling heart disease mortality with census tract rates and social class mixtures.

The relationship between social class and 1980 heart disease (HD) mortality in eight urban U.S. counties was examined by regressing age and sex adjusted census tract specific HD rates (N = 1211) on tract social class characteristics. The regression model indicated that lower middle class residents experienced a HD mortality rate 1.9 (95% CI = 1.3, 2.8) times the rate in the upper middle/middle class, while the working poor experienced a HD rate 4.4 (95% CI = 3.5, 5.7) times the rate in the referent class. Similar class effects were seen for both black and nonblack residents. The crude race effect (1.3 with 95% CI = 1.2, 1.4) was explainable by the concentration of blacks in the lower classes. The methods illustrate the ecologic regression of mixtures of mortality rates on mixtures of exposure in the presence of random tract effects which eliminates some of the problems associated with small denominators or zero rates in some tracts.

Coronary Disease↗

PubMed1990

Cardiomyocyte aging and hypertrophy: atrial and ventricular changes in normal and myopathic Syrian hamsters.

Cardiac eccentric hypertrophy is associated with complex architectural and metabolic alterations. Atrial and ventricular myocyte diameters in cardiomyopathic (Bio 14.6) and age-matched control (F1b) Syrian hamsters were compared and histopathology was examined by electron microscopy. The mean diameter of ventricular myocyte diameters increased with age in both F1b and Bio 14.6 hamsters. Significantly greater hypertrophy was noted in the Bio 14.6 left ventricle myocytes than the F1b. Histo- and cytopathologic findings included amitotic myocardial divisions and focal myocyte necrosis in Bio hearts. Sarcomere length appeared to be similar across age and strain; however, wider sarcomeres were found in conjunction with wider diameters of myopathic left ventricle myocytes. Moreover, F1b hamsters' atrial myocytes maintained a static diameter, while those of the Bio 14.6 showed hypertrophy even preceding ventricular changes. These findings indicated that the cardiomyopathic heart is characterized by a continued fiber hypertrophy despite cardiac decompensation. Other histopathological findings included amitotic myocardial divisions, focal necrosis and sarcoplasmic widening of Z-lines. In addition, vascular smooth muscles of Bio 14.6 demonstrated vacuolization.

Aging↗

PubMed1989

Risk of imbalance in elderly people with impaired hearing or vision.

We evaluated the effect of impaired hearing and vision on balance in a sample of 977 elderly people residing in the community. Of the sample, 21% reported balance problems, 27% vision problems, and 30% hearing problems. The increased relative risk for balance problems was 1.7 for each 10-year age increment. Women were 1.7 times more likely to report balance problems than were men. The relative risk of imbalance with impaired vision decreased with age from 2.8 in those aged 65-69 years to 1.0 in those over 85 years. There was no age-hearing interaction, the relative risk for impaired hearing is 1.6. It appears that impaired vision and hearing are important risk factors for imbalance and perhaps falls and injury.

Accidental Falls↗