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J Eisner

Publications and source records attributed to J Eisner.

At least 19 recordsLinked to original sources
PubMed2001

Does the time of resternotomy for bleeding have any influence on the incidence of sternal infections, septic courses or further complications?

BACKGROUND: Former studies on sternal wound infections indicate predisposing factors like diabetes, obesity, use of bilateral internal mammary grafts, impaired renal function and reoperation. We wanted to evaluate whether the time of resternotomy for postoperative bleeding has any influence on the development of a sternal wound infection and other complications. METHODS: In our department, 12,315 patients underwent median sternotomy for cardiac surgery between 1987 and 1998. We analyzed the clinical data of all patients which were reoperated on for postoperative bleeding, especially patients with subsequent operations caused by sternal wound infections. All data were compared by T-test respectively chi2-test, and p<0.05 was regarded as significant. RESULTS: 406 of the 12,315 patients were re-explored because of postoperative bleeding (3.3%). 57 (14%) of these patients died in the postoperative period of non-infectious complications. The remaining patients were divided into two groups: Group A (286 patients) (70.4%) did not suffer from any sternal wound complications, where as group B patients (n = 63) (15.6%) needed subsequent surgery due to sternal infection. There were no significant differences in either concerning age, clinical data and first operation. All patients had an average blood loss of 223 ml/hr. The time before re-operation for bleeding was 5.3+/-1.7 hours in group A compared to 11.1+/-4.2 hours in group B (p<0.05). A significant delay of reoperation for bleeding could also be found for patients with postoperative septic complications (ø: 5.2+/-1.9 hours, +: 12.9+/-5.2 hours), renal failure, mechanical ventilation >48 hours and a stay in hospital >20 days. CONCLUSIONS: Early reoperation for postoperative bleeding decreases the number of subsequent complications, e.g. sternal wound infections, septic complications and prolonged mechanical ventilation.

Cardiac Surgical Procedures↗
PubMed2000

Problems of older adults living alone after hospitalization.

OBJECTIVE: To describe functional deficits among older adults living alone and receiving home nursing following medical hospitalization, and the association of living alone with lack of functional improvement and nursing home utilization 1 month after hospitalization. DESIGN: Secondary analysis of a prospective cohort study. PARTICIPANTS: Consecutive sample of patients age 65 and over receiving home nursing following medical hospitalization. Patients were excluded for new diagnosis of myocardial infarction or stroke in the previous 2 months, diagnosis of dementia if living alone, or nonambulatory status. Of 613 patients invited to participate, 312 agreed. MEASUREMENTS: One week after hospitalization, patients were assessed in the home for demographic information, medications, cognition, and self-report of prehospital and current mobility and function in activities of daily living (ADLs) and independent activities of daily living (IADLs). One month later, patients were asked about current function and nursing home utilization. The outcomes were lack of improvement in ADL function and nursing home utilization 1 month after hospitalization. RESULTS: One hundred forty-one (45%) patients lived alone. After hospital discharge, 40% of those living alone and 62% of those living with others had at least 1 ADL dependency (P =.0001). Patients who were ADL-dependent and lived alone were 3.3 (95% confidence interval [95% CI], 1.4 to 7. 6) times less likely to improve in ADLs and 3.5 (95% CI, 1.0 to 11. 9) times more likely to be admitted to a nursing home in the month after hospitalization. CONCLUSION: Patients who live alone and receive home nursing after hospitalization are less likely to improve in function and more likely to be admitted to a nursing home, compared with those who live with others. More intensive resources may be required to continue community living and maximize independence.

Activities of Daily Living↗
PubMed1995

Multi-national, multi-lingual, multi-professional CATs: (Curriculum Analysis Tools).

A consortium of dental schools and allied dental programs was established in 1991 with the expressed purpose of creating a curriculum database program that was end-user modifiable [1]. In April of 1994, a beta version (Beta 2.5 written in FoxPro(TM) 2.5) of the software CATs, an acronym for Curriculum Analysis Tools, was released for use by over 30 of the consortium's 60 member institutions, while the remainder either waited for the Macintosh (TM) or Windows (TM) versions of the program or were simply not ready to begin an institutional curriculum analysis project. Shortly after this release, the design specifications were rewritten based on a thorough critique of the Beta 2.5 design and coding structures and user feedback. The result was Beta 3.0 which has been designed to accommodate any health professions curriculum, in any country that uses English or French as one of its languages. Given the program's extensive use of screen generation tools, it was quite easy to offer screen displays in a second language. As more languages become available as part of the Unified Medical Language System, used to document curriculum content, the program's design will allow their incorporation. When the software arrives at a new institution, the choice of language and health profession will have been preselected, leaving the Curriculum Database Manager to identify the country where the member institution is located. With these 'macro' end-user decisions completed, the database manager can turn to a more specific set of end-user questions including: 1) will the curriculum view selected for analysis be created by the course directors (provider entry of structured course outlines) or by the students (consumer entry of class session summaries)?; 2) which elements within the provided course outline or class session modules will be used?; 3) which, if any, internal curriculum validation measures will be included?; and 4) which, if any, external validation measures will be included. External measures can include accreditation standards, entry-level practitioner competencies, an index of learning behaviors, an index of discipline integration, or others defined by the institution. When data entry, which is secure to the course level, is complete users may choose to browse a variety of graphic representations of their curriculum, or either preview or print a variety of reports that offer more detail about the content and adequacy of their curriculum. The progress of all data entry can be monitored by the database manager over the course of an academic year, and all reports contain extensive missing data reports to ensure that the user knows whether they are studying complete or partial data. Institutions using the beta version of the program have reported considerable satisfaction with its functionality and have also offered a variety of design and interface enhancements. The anticipated release date for Curriculum Analysis Tools (CATs) is the first quarter of 1995.

Curriculum↗
PubMed1994

The computer-based oral health record: an essential tool for cross-provider quality management.

A more efficient and detailed exchange of information between the various professionals who provide healthcare for an individual patient could have a strong positive impact on both quality assurance and patient health. This paper examines many of the issues relevant to cross-provider communication and quality assurance mechanisms in the computer-based oral health record.

American Dental Association↗
PubMed1993

Anticoagulant activity of Hirulog, a direct thrombin inhibitor, in humans.

Hirulog (BG8967) is a direct thrombin inhibitor built by rational design using the protein hirudin as a model (Maraganore et al. [1990]; Biochemistry 29: 7095-101). In order to evaluate the therapeutic potential for hirulog in the management of thrombotic disease, the tolerability and anticoagulant activity of the agent were examined in a study of human volunteers. In a randomized, placebo-controlled study (n = .54), the intravenous infusion of hirulog over 15 min showed a rapid, dose-dependent prolongation of activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). There was a corresponding dose-dependent increase in plasma hirulog levels. The peptide was rapidly cleared with a half-life of 36 min and a total body clearance rate for the peptide of 0.43 l kg-1 h-1. Similar activity was observed following subcutaneous injection but with sustained pharmacodynamic and pharmacokinetic behavior. There was a significant correlation between pharmacokinetic and pharmacodynamic variables for both intravenous (r = 0.8, p < 0.001) and subcutaneous administration (r = 0.7, p = 0.002). To evaluate the possible interactions of aspirin on the tolerability and anticoagulant activity of intravenous hirulog, a cross-over design was employed in eight subjects. Aspirin administration did not modify the peptide's activity. At the administered dose of 0.6 mg kg-1 h-1 for 2 h, hirulog infusion prolonged APTT from 230 to 260% baseline. The infusion of hirulog in subjects who had received aspirin was not associated with any significant changes in the template bleeding time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Curriculum Analysis Tools (CATs): a cooperative approach to the design of curriculum databases.

In 1990, a small group of dental schools agreed to pool their resources and cooperate in the design and programming of curriculum analysis software. After two and one half years, the consortium which was formed has grown to include over 50 institutions. Its efforts have been endorsed by the American Association of Dental Schools and it is now beta testing its first software product, known as CATs, which is an acronym for Curriculum Analysis Tools. The process by which the software has been developed, as well as its current design, offers a unique blend of flexibility and creativity which could perhaps be adopted by other health professions.

Curriculum↗
PubMed1992

DentLE. The dental learning environment: a prototype.

The State University of New York at Buffalo School of Dental Medicine was awarded a 'Model Curriculum' grant through the USPHS Bureau of Health Professions Education. The award was provided in support of the School's ongoing effort to design a 'model electronic curriculum' for the health professions. The project's development is described from its grounding in critical thinking and problem solving to a discussion of its features including the organization of its knowledge base, the layout of its computer-based oral health record, and its navigation features.

Computer-Assisted Instruction↗
PubMed1992

DentLE. The Dental Learning Environment: a prototype demonstration.

DentLE, the Dental Learning Environment is a hypermedia software system being prototyped as part of a research and development project at the State University of New York at Buffalo School of Dental Medicine. The design seeks to reach beyond single discipline software or cases, and integrate a range of patient problems within a comprehensive dental knowledge base. The approach is to use computer and hypermedia technology to weave together the disciplines of dentistry so that learning occurs in relation to patients, as they appear in the real world. The DentLE system prototype allows the learner to explore information in all the disciplines related to patient problems, as well as other information including "blind alleys" and results of curiosity.

Computer-Assisted Instruction↗
PubMed1992

Changes and challenges in Canadian dental faculties.

Canadian dental faculty were surveyed to determine changing career interests, sources of satisfaction, and professional development needs. The respondents indicated a desire to change the proportion of time allocated to their major responsibilities in ways that could create serious problems for dental faculties, i.e. more time on research, with less time on teaching and administration. While most reported teaching as a source of satisfaction and happiness, relatively few reported it as recognized and rewarded. The different status accorded to teachers, clinicians, and researchers, as reflected in the division of workload and rewards have created dissatisfaction among faculty, perhaps contributing to the fact that over 50 percent of respondents reported considering leaving academia. Faculties of Dentistry must determine what is required to reestablish a productive and enjoyable balance among their roles as teacher, researcher, and clinician and to determine what type of environment will best support the development of today's dental academics and tomorrow's dentists.

Canada↗
PubMed1992

Instructional and information technology initiatives: the potential for delivery.

An attempt has been made to discuss some of the issues and opportunities which lie ahead as dental educators, their institutions, and our national associations prepare for the expected growth in the instructional and informational technologies that curriculum reform and technological advances will promote. The issues stem from a perceived need to collectively deliver products, as well as discuss issues, within our associations. While most national professional associations are well equipped to focus on questions of policy rather than the production of specific products, I believe there is a real potential for the successful pursuit of both within dental education.

Canada↗