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Biomedical subjects

J Johnson

Publications and source records attributed to J Johnson.

At least 883 records · Page 49Linked to original sources
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Responsibility-centered management: a 10-year nursing assessment.

In 1988-89, Indiana University became the first public university to implement responsibility-centered management (RCM) comprehensively. This article describes and assesses the implementation of RCM on the core campus of Indiana University School of Nursing in Indianapolis. It describes how RCM encouraged an information-rich environment, particularly with the advent of economic modeling; decision making linked to strategic goals/objectives; and a performance-based reward structure (e.g., merit pay increases and incentive plans). It ends with a discussion about the worth of RCM and the changes that frame-work produced, particularly in reconceptualizing the roles of the business officer and dean. The most profound consequence of RCM may be the effect it has in encouraging rethinking of what it means to be a school of nursing at this point in time.

Benchmarking↗
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Use of whole body hyperthermia as a method to heat inaccessible tumours uniformly: a phase III trial in canine brain masses.

In this study, whole body hyperthermia (WBH) was assessed as a means of heating intracranial tumours uniformly. Twenty-five dogs received radiation therapy and 20 the combination of radiation and WBH. Total radiation dose was randomly assigned and was either 44, 48, 52, 56 or 60 Gy. Because of WBH toxicity, intercurrent disease or tumour progression, seven of the 45 dogs received less than the prescribed radiation dose. For WBH, the target rectal temperature was 42 degrees C for 2h and three treatments were planned. In five of the 20 dogs randomized to receive WBH, only one WBH treatment was given because of toxicity. WBH toxicity was severe in six dogs, and resulted in death or interruption in treatment. Most tumours did not undergo a complete response, making it impossible to differentiate tumour recurrence from brain necrosis as a cause of progressive neuropathy. Therefore, survival was the major study endpoint. There was no survival difference between groups. One-year survival probability (95% CI) for dogs receiving radiation therapy alone was 0.44 (0.25, 0.63) versus 0.40 (0.19, 0.63) for dogs receiving radiation and WBH. There was no difference in the incidence of brain necrosis in the two treatment groups. Results suggest that use of WBH alone to increase the temperature of intracranial tumours as a means to improve radiation therapy outcome is not a successful strategy.

Animals↗
PubMedDate not supplied

Perinatal lead exposure alters the expression of neuronal nitric oxide synthase in rat brain.

Environmental exposure to lead (Pb) is known to affect the developing nervous system causing cognitive deficits in children. The diffusible nitric oxide (NO) is a biological messenger known to be involved in brain development. We examined the developmental changes of neuronal nitric oxide synthase (nNOS) in cerebellum and hippocampus of developing rat brain by radiometric assay, Western blot analysis and immunohistochemistry. Pb-exposure (0.2% Pb acetate) was initiated on gestation day 6 through the drinking water of the dam and continued through birth and postnatal days (PNDs) 1 to 21. The pups were never exposed to Pb directly. Pb exposure was stopped on weaning of pups from mothers on PND 21. The changes in nNOS were measured in the offspring on PNDs 7, 14, 21, and 35. The nNOS activity was increased gradually from PNDs 7 to 35 in both cerebellum and hippocampus of control rats when the enzyme activity was determined in the presence of either 0.5 or 6 microM calcium (Ca2+) in the reaction mixture. However, Pb exposure decreased the nNOS activity significantly at PNDs 21 to 35 as compared to respective controls when the enzyme activity was determined in the presence of 6 microM Ca2+. The decrease of nNOS was even greater and evident at all PNDs tested when the enzyme activity was assayed in the presence of physiological concentration of Ca2+ (0.5 microM). These findings were further strengthened by the in vitro studies. The cerebellar nNOS activity was inhibited much more at low Ca2+ (0.5 microM) as compared to 6 microM Ca2+, with IC50 values of 35 and 50 nM Pb, respectively. The nNOS protein levels and immunoreactivity in the cerebellum and hippocampus of rats perinatally exposed to Pb were decreased as compared to controls at PNDs 21 and 35. These data suggest perinatal Pb exposure decreases the nNOS in the developing brain. The decrease of nNOS activity and protein may explain the Pb-mediated cognitive deficits because NO regulates long-term potentiation (LTP) and other neurophysiological events in the developing nervous system.

Administration, Oral↗
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Compliance with pressure garment use in burn rehabilitation.

Pressure garment use is recommended 23 to 24 hours a day for hypertrophic scar control after a burn injury. Compliance with this treatment has not been documented. A 52-question survey was administered to 101 adult outpatient burn survivors to rate compliance with this program. The average compliance of each patient was assessed. The framework of the Health Belief Model was used to identify the patients' beliefs and factors reported to interfere with compliance. Strategies patients believed to enhance garment use were identified. Forty-one percent of the patients reported total compliance. The difficulties with garment use such as discomfort and activity limitations appeared to promote low compliance. The primary strategies patients believed would enhance compliance were seeing outcome pictures of scars and having contact with other survivors. This step toward identifying compliance rates and factors that affect them will guide the health care worker in techniques to facilitate adherence to the scar management program.

Adult↗
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A survey of the prevalence and application of chest physical therapy in U.S. burn centers.

The purpose of this study was to determine the prevalence and application of chest physical therapy (CPT) in burn centers. Respiratory therapists primarily administered CPT, and suctioning and coughing were the most frequently used modalities. Further study of the efficacy of treatment techniques is needed to develop congruous standards for CPT after a burn injury.

Aged↗
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Rehabilitation of the burned hand: questionnaire results.

Burns to the hand can cause anatomical and functional limitations due to burn sequelae and treatment obstacles that arise during the rehabilitation process. A questionnaire consisting of four open-ended questions was distributed at the 1993 American Burn Association Breakfast Session, "Rehabilitation of the Burned Hand." The questionnaire was designed to gather information regarding common postburn deformities and treatment obstacles that occur in the acute and postacute phase of burn rehabilitation. Information was collected from 38 respondents and frequency distributions were compiled. The deformities and treatment obstacles are discussed in relation to the current literature and clinical management of hand burns.

Burns↗
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The effects of soft tissue mobilization on the immature burn scar: results of a pilot study.

The purpose of this pilot study was determine the effects of soft tissue mobilization (STM) on range of motion (ROM), scar pliability, and vascularity. Patients received either one treatment session of standard physical therapy or standard physical therapy plus 10 to 15 minutes of STM. Before and after ROM, scar pliability and vascularity measurements were obtained. The student's t test was used to compare measurements and revealed the STM group (n = 5) had significant (p < 0.10) gains in wrist extension and radial deviation, and the control group (n = 5) had significant gains in wrist extension and ulnar deviation. No significant difference was found in ROM, scar pliability, and vascularity when the STM group was compared to the control group. Further study of a larger sample over multiple treatment sessions is necessary to determine the true efficacy of STM.

Adult↗
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Roller traction: mobilizing patients with acetabular fractures.

Patients with acetabular fractures unamenable to open reduction and internal fixation are subject to 6-12 weeks of traction and, traditionally, bed rest. Using roller traction allows the patient to be mobilized to a bedside chair and to stand without disrupting the traction. This is accomplished by slightly modifying a standard lower extremity skeletal traction setup. Roller pulleys and stopper clamps are substituted for the usual pulleys. These are attached to extra-long horizontal bars that expand the lateral space that the patient can now use around the bed. Roller traction helps prevent the common complications of prolonged bed rest, particularly deep vein thrombosis, skin breakdown, pulmonary stasis and boredom.

Acetabulum↗
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Rotavirus RNA variation during chronic infection of immunocompromised children.

Polyacrylamide gel electrophoresis was performed on RNA from rotaviruses isolated from two immunocompromised patients with prolonged rotavirus diarrhea. Extensive variations were observed in the genomes of rotaviruses isolated from each patient during a 16-week period of their illness. An animal model of rotavirus infection was used to help evaluate the results found in our patients. Individual mouse rotavirus strains were found to be stable during serial passage, but individual animals could be coinfected with more than one viral strain. The changes found in the rotavirus RNA from our patients possibly represented reinfection by different viral strains. Appropriate precautions should be observed to prevent such reinfections in immunocompromised patients.

Animals↗
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COAD (clinical outcome assessment documentation) charting: using the quality improvement process to meet the new JCAHO nursing standards.

The shortage of nurses has prompted departments across the nation to examine nursing practices in individual healthcare facilities and to initiate changes where relevant. Saint Thomas Hospital, a 571-bed tertiary-care facility, developed a number of strategies designed to allow nurses to focus on skills consistent with professional practice and to reassign technical and clerical duties to other members of the healthcare team. One of the changes implemented was the clinical outcome assessment documentation (COAD) system, which communicates the plan of care without the use of a separate form, expedites charting times, and eliminates duplication. This system also facilitates the documentation of the patient's progress toward outcome-oriented goals. Evaluation of the COAD system after implementation showed improvement in documentation of the nursing process, staff satisfaction with the system, and compliance with the Joint Commission's 1991 nursing standards.

Hospital Bed Capacity, 500 and over↗
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Identifying and recognizing delirium.

Clinicians frequently under-recognize delirium. Physicians and nurses can be taught to recognize delirium by focusing on each of the components of the criteria for delirium. Teachers of physicians and nurses should emphasize the ability to recognize acuteness of onset, fluctuation of course, and attention deficits. Attention deficits in the clinical setting can be recognized by digit span testing, spelling words backwards, or assessing accessibility during the clinical interview. Attention can be scored by assigning a score from 0-10, or ranking as mild, moderate or severe, the patients ability to engage in the medical interview.

Behavioral Symptoms↗
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The early amniocentesis study: a randomized clinical trial of early amniocentesis and midtrimester amniocentesis. II. Evaluation of procedure details and neonatal congenital anomalies.

The present study provides detailed neonatal and congenital malformation follow-up from 695 women enrolled in a prospective randomized multicenter study comparing the safety and accuracy of early (11-12 weeks of gestation) and midtrimester amniocentesis (15-16 weeks of gestation). No differences were found for total pregnancy loss (difference 0.4%; CI -3.6 to 4.4%), obstetrical or neonatal outcome. The incidence of congenital anomalies was 2.4 and 2.6% for the early amniocentesis and midtrimester amniocentesis groups, respectively. Respiratory problems were present in 2.1 and 1.6%, respectively. Musculoskeletal problems were present in 0.9 and 2.4%, respectively. It must be emphasized that before early amniocentesis can be considered as an alternative to midtrimester amniocentesis or chorionic villus sampling, careful evaluation of any fetal effects must be considered and further large randomized trials are necessary.

Amniocentesis↗
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Complications of laryngectomy and neck dissection following planned preoperative radiotherapy.

One hundred sixty-nine patients with carcinoma involving the larynx treated with surgery, combined preoperative radiotherapy plus surgery, or failed curative radiotherapy with surgical salvage have been evaluated with respect to complications. Major complications occurred at approximately the same rate with all three modes of therapy. Major complications had generally a later onset and healed less rapidly in the preoperative radiotherapy group. Minor complications occurred more frequently in irradiated patients than in nonirradiated patients. When evaluating postoperative complications in irradiated patients the time interval must be extended beyond the immediate span because of delayed onset.

Fistula↗
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Quantification of standards for length-of-stay based upon optimal patient care and standard medical practice.

Length-of-stay criteria are being developed by the Allegheny Professional Standards Review Organization (APSRO) in western Pennsylvania. In order to statistically document the standard of practice at the Eye and Ear Hospital of Pittsburgh, a retrospective review of patients who underwent laryngectomy with or without radical neck dissection was performed. Results demonstrated that routinely allowing only one day preoperative assessment deviates significantly from optimal medical practice and may place some patients at increased risk, especially for postoperative complications. From a cost-effective health care delivery point of view, abbreviated preoperative preparation contributes negatively to postoperative length-of-stay which was the most costly component of hospital health care for this group of patients. The development of appropriate standards of medical practice criteria using preexisting HEW mechanisms and scientifically designed prospective studies should be encouraged.

Age Factors↗