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Biomedical subjects

J Brock

Publications and source records attributed to J Brock.

177 records · Page 10Linked to original sources
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Process of care and outcomes for elderly patients hospitalized with peptic ulcer disease: results from a quality improvement project.

CONTEXT: Since publication in 1994 of guidelines for management of peptic ulcer disease (PUD), trends in physician practice and outcomes related to guideline application have not been evaluated. OBJECTIVES: To describe changes in process of care that occurred in a quality improvement program for patients hospitalized with PUD and to evaluate associations between in-hospital treatment of PUD and 1-year rehospitalization for PUD and mortality in a subset of these patients. DESIGN, SETTING, AND PATIENTS: Cohort study of 4292 sequential Medicare beneficiaries hospitalized at acute care hospitals with a principal diagnosis of PUD in 5 states (Colorado, Georgia, Connecticut, Oklahoma, and Virginia) in 1995 (baseline) and 1997 (remeasurement); outcomes were evaluated for 752 patients in Colorado. MAIN OUTCOME MEASURES: Changes in rates of screening for Helicobacter pylori infection, treatment for H pylori infection, screening for nonsteroidal anti-inflammatory drug (NSAID) use, counseling about NSAID use; outcomes included rehospitalization for PUD and all-cause mortality within 1 year of discharge in Colorado. RESULTS: Screening for H pylori infection increased significantly (12%-19% increase; P<.001) in each of the 5 states. Treatment of H pylori infection increased in each state and was significantly increased for the entire group of hospitalizations examined (8% increase overall; P =.001). Despite increased screening, detection of H pylori infection was less frequent than expected in every state, (13%-24%) and did not increase in any state. Screening for and counseling about NSAIDs did not significantly increase overall or in any state. In the Colorado cohort, the proportion of patients rehospitalized was unchanged in 1995 (8.9%) and 1997 (6.8%), and 124 patients (16%) in the combined 1995 and 1997 cohorts died within 1 year. Treatment for H pylori was not associated with a reduction in rehospitalization within 1 year (adjusted odds ratio [OR], 1.24; 95% confidence interval [CI], 0.65-2.36) or with a reduction in mortality (adjusted OR, 1.08; 95% CI, 0.68-1.71). Counseling about NSAID use was associated with a decrease in risk of 1-year rehospitalization for PUD (adjusted OR, 0.47; 95% CI, 0.22-0.99) and risk of all-cause mortality (adjusted OR, 0.44; 95% CI, 0.26-0.75). CONCLUSIONS: This quality improvement program for elderly patients with PUD resulted in increased screening for H pylori and increased treatment of H pylori infection but no change in counseling about NSAID use. However, with the low prevalence of H pylori detected, treatment of H pylori infection was not associated with a reduction in repeat hospitalization for PUD or subsequent mortality, whereas counseling about the risks of using NSAIDs was associated with a reduction in the risk of both outcomes.

Aged↗
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Nurses' knowledge of pain management: implications for staff education.

Among the 217 nurses responding (one third of those queried), average scores on the NKAS were slightly higher (68%) than that reported in the literature but still inadequate. Nurses' greatest knowledge deficits were related to pharmacotherapeutics. Knowledge scores were uncorrelated with self-assessed level of knowledge about pain. Strategies for re-dressing these nurses' knowledge through Department of Nursing Education interventions are explored.

Adult↗
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Watanabe hyperlipidemic rabbit as a model of aortic degeneration of the medial lamellar elastin unit.

At age 3 years, WHHL rabbits are near the end of their lifespan, frequently dying from the progression of their hyperlipidemic disease from events such as myocardial infarction. Out of a colony of 20 three-year-old WHHL rabbits raised as part of a NIH breeding project, 2 rabbits actually died of a ruptured thoracic aortic aneurysm. The need for a model to study abdominal aortic aneurysm formation led us to explore further the abdominal aortic pathology in aged WHHL rabbits. Six rabbit abdominal aortas from 3-year-old WHHL rabbits were preserved in formalin, sectioned, and stained for elastin. These were compared to the same sections of six normolipidemic age matched New Zealand white (NZW) rabbits. There was significant (P less than or equal to .001) destruction of the medial lamellar elastin unit in the aorta of the WHHL rabbits compared with the control NZW rabbits. Severe cholesterol deposits appeared to destroy the medial lamellae from the inside out. No definite aneurysm formation was seen in the abdominal aorta despite the significant changes in the medial lamellar elastin units. Thus, this model could be used to study the elastin degeneration of the media, but not necessarily abdominal aortic aneurysm formation.

Animals↗
PubMedDate not supplied

Mechanisms of natural resistance to mouse typhoid.

The early, innate resistance phase in mouse typhoid is largely controlled by a single gene (unlike the later, polygenic immune phase), designated Ity, which may be identical to those controlling resistance to Leishmania (Lsh) and mycobacteria (Bcg). The gene product and its function are unknown. Athymic (nu/nu) mice showed greater early resistance to salmonella infection than euthymic littermates, but only if they were already naturally resistant CBA (Ityr). Athymic susceptible Balb/c (Itys) were not different from the controls. The Ity mechanism is highly radio-resistant: 800 R whole body irradiation does not modify the early Ity phenotype in Balb/c and A/J mice, as measured by early in vivo net bacterial growth; this, however, increases sharply on day 3-4, when growth curves plateau in controls (immune response). Bone marrow radiation chimeras infected 3 months after the transfer confirm that, while the donor genotype determines the Ity recipient phenotype in single chimeras, double chimeras (Itys + Ityr) leads to Ityr are susceptible or intermediate in both semiallogeneic and syngeneic models. The typhoid relapse following cessation of antibiotic therapy was greater in susceptible than in resistant mice. In lethally infected mice, ampicillin decreased the bacterial load twice as fast in susceptible Balb/c than in resistant (B10 X A/J)F1 mice, but they required much more prolonged treatment to develop effective immunity. Considered collectively, the present data is consistent with the view that early resistance is thymus independent and relies on innate mechanisms present in radioresistant bone marrow derived cells that in some way provide an environment which favours a more rapid in vivo division rate of the organism in susceptible mice.

Animals↗