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Biomedical subjects

J K Cooper

Publications and source records attributed to J K Cooper.

At least 37 records · Page 2Linked to original sources
PubMed1995

Accountability for clinical preventive services.

Clinical preventive services are important in both the civilian and military health care systems. In the civilian sector, preventive services have been included in the movement for more accountability for health care services. Four civilian accountability models have at least some preventive services evaluation. DEMPAQ is a program developed for Medicare, and collects data both from claims records and from office medical records. PROSPER is an example of another type of model, and uses patient questionnaires to collect information. A third model, HEDIS, produces the popularly-called "report cards." HEDIS relies on administrative data generally available in managed care organizations. "Passports" is yet another model that offers the potential for perhaps the most efficient way to evaluate preventive services, but it is still developmental. None of these civilian models is directly applicable to today's military care system. However, the Composite Health Care System, a computer system widely used in military treatment facilities, offers a possible mechanism to provide local accountability for clinical preventive services that should be easy and efficient.

Ambulatory Care↗
PubMed1994

Endometrial adenocarcinoma presenting as an isolated calcaneal metastasis. A rare entity with good prognosis.

A 59-year-old woman presented with progressive pain, swelling, and erythema of her right foot. Biopsy of a destructive calcaneal lesion revealed a metastatic adenoacanthoma with focal adenosquamous carcinoma consistent with an endometrial origin. This was confirmed on hysterectomy. Postoperative treatment consisted of systemic chemotherapy, hormonal therapy, and local radiotherapy to the foot. She has now experienced 5 years of complete remission. This is a case of an endometrial adenocarcinoma presenting as an isolated calcaneal metastasis with an excellent outcome.

Adenocarcinoma↗
PubMed1992

Stereoselective pharmacokinetics of doxepin isomers.

Commercial preparations of the tricyclic anti-depressant doxepin contain 15% of the more active cis-doxepin and 85% of the trans-isomer. The single dose pharmacokinetics of doxepin and its major metabolite N-desmethyldoxepin were examined in 30 healthy young men. Results for total doxepin showed wide intersubject variation in all pharmacokinetic parameters except tmax and Cmax. Plasma levels of cis-doxepin were extremely low and it was only possible to estimate the stereoselective pharmacokinetics of the parent drug in 3 subjects. The data from those particular subjects resulted in an average ratio of cis- to trans-doxepin isomers in plasma of 15:85. In contrast, the mean plasma levels of cis-N-desmethyldoxepin in 28 subjects exceeded those of the trans-isomer at every time point after 10 h, such that the areas under the plasma concentration versus time curves (AUC) of cis-N-desmethyldoxepin were significantly higher than those of the corresponding trans-isomer. This phenomenon may play an important role in the therapeutic action of doxepin since it has been suggested that cis-N-desmethyldoxepin is pharmacologically active. In 2 subjects, however, the AUC0-inf of trans-N-desmethyldoxepin were respectively 4 and 8 fold higher than those of the cis-isomer.

Adolescent↗
PubMed1992

Serotonin response in sweet-food craving Alzheimer's disease subjects.

Abnormal sweet-food craving may occur in subjects with Alzheimer's disease. This behavior may be due to abnormalities in the brain serotonin system. Fenfluramine stimulates the brain serotonin neurosystem, producing an increase in systemic prolactin. Using the fenfluramine stimulation test, brain serotonin system response was evaluated in 12 subjects with probable Alzheimer's disease. The subjects' caregivers completed questionnaires concerning subject food preferences and behaviors. Alzheimer's disease subjects with sweet-food craving were found to have a significantly higher response to fenfluramine than non sweet-food craving subjects. This preliminary study is limited by small sample size. Allowing for assumptions concerning central nervous system regulatory processes, the data suggest a possible role for the serotonin system in sweet-food craving in Alzheimer's disease.

Aged↗
PubMed1991

A prospective evaluation of plain radiographic signs of chronic obstructive pulmonary disease.

Plain film signs of COPD, spirometric evidence of airflow obstruction, and smoking history were correlated in a group of 182 men aged 32 to 85 years (average, 57.5 years) who presented for evaluation of possible pulmonary disability. There were 148 current or past smokers (range, 0.66 to 150 pack-years; average, 31.89 pack-years) and 34 lifetime nonsmokers. A single observer, who had no knowledge of the other parameters, prospectively evaluated posteroanterior chest radiographs for 11 signs of COPD. Airflow obstruction was defined as a reduction in FEV1/FVC% below the 95% confidence limit of normal. Obstruction was classified on the basis of the reduction in FEV1 as mild (FEV1 greater than 2.5L), moderate (FEV1 greater than 1.0 L and less than 2.5 L), or severe (FEV1 less than 1.0 L). Spirometric evidence of airflow obstruction was present in 67 patients; obstruction was mild in 26, moderate in 36, and severe in 5. We found a statistically significant association between smoking and airflow obstruction on spirometry (P less than 0.001) and an equally significant association between smoking and radiographic signs of COPD on plain chest films (P less than 0.001). Both airflow obstruction and radiologic signs of COPD were generally absent in lifetime nonsmokers. The plain film signs of COPD were only of moderate value in predicting spirometric evidence of airflow obstruction in smokers; spirometric evidence is not the gold standard for the presence of COPD, however, and the strong association between smoking and these radiologic signs may indicate that in smokers the presence of plain film signs of COPD reflects morphologic abnormality in the lungs indicative of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Drug treatment of Alzheimer's disease.

Drugs may be part of the treatment for Alzheimer's disease. Drug treatment can be divided into two categories: treatment to improve cognitive function and treatment to improve abnormal behaviors. There are at least 16 new drugs undergoing evaluation that may improve cognitive function. Some of these drugs are intended to augment acetylcholine neurotransmitter function. Others are nootropics that affect neuron metabolism with little effect elsewhere. A third major category is drugs that affect brain vasculature. A miscellaneous group includes drugs aimed at modifying other defects found in Alzheimer's disease. Drugs to affect behavior have been available for some time. These include neuroleptics, anxiolytics, and antirage drugs. Use of all these drugs has been controversial. Recent federal legislation and guidelines affect their use in nursing homes. Specific indications for neuroleptics are psychotic features and agitation. Dosage for patients with dementia is different than for other psychotic patients. There is no consensus on the use of other psychoactive medications.

Alzheimer Disease↗
PubMed1991

Alzheimer's disease: answering questions commonly asked by patients' families.

Once a diagnosis of Alzheimer's disease is made, the patient's family usually has a number of questions for the physician. These questions range from concerns about genetic aspects of the disease to specific caregiving issues. The primary care physician's role in treating Alzheimer's disease is focused on the family or caregiver and includes support and counseling. Providing answers to common questions is an important part of counseling.

Alzheimer Disease↗
PubMed1990

Comparative bioavailability of two tablet formulations of fluphenazine dihydrochloride in drug-free psychiatric patients.

The comparative bioavailability of a new tablet formulation of fluphenazine dihydrochloride (5 mg) and a reference product (fluphenazine dihydrochloride, Prolixin, 5 mg) was assessed in drug-free psychiatric patients. Twenty-six patients were initially entered in the study, of whom 22 completed the protocol. Each patient received the test (T) and the reference formulation (R) in a balanced two-way crossover design. Plasma concentrations of fluphenazine were monitored over a period of 48 h after drug administration using a sensitive HPLC method. One patient did not show any measurable plasma concentration for one formulation at any sampling time and, therefore, bioavailability was assessed in the remaining 21 patients. All pharmacokinetic parameters showed wide intersubject variation. The maximum plasma concentration (Cmax), time to Cmax, and area under the curve up to the last measurable concentration (AUClast0), infinity (AUCinfinity0), or truncated areas (such as AUC16(0), AUC24(0) were compared by analyses of variance and found not to be significantly different in each case across the formulations. Except for AUC24(0), AUC32(0), and AUC48(0), ANOVA of all other parameters showed a high power (greater than 80%) to detect a 20% difference in the mean value of each bioequivalence parameter between T and R. The two formulations were found to be bioequivalent in that confidence intervals of the mean values of AUCinfinity0, AUClast0, truncated AUCs, or Cmax for T:R ratios were, in each case, well within the acceptable range of 100 +/- 20%.

Biological Availability↗
PubMed1990

Bioequivalence of two thorazine tablet formulations using radioimmunoassay and gas chromatographic-mass spectrometric methods.

Two analytical methods for the analysis of chlorpromazine (CPZ), a radioimmunoassay (RIA) and a GLC-MS method, were compared in a bioequivalence study of two CPZ tablet formulations (Thorazine: film coated and sugar coated). Thirty-six nonsmoking, healthy, male volunteers completed the study. Each subject ingested single doses (2 x 25 mg) of the test (T) and the reference (R) formulations in a two-way crossover design with a two-week drug-free interval between doses. Following each administration, plasma concentrations of CPZ were monitored over a period of 24 h by both RIA and GLC-MS methods. Plasma concentrations and pharmacokinetic parameters determined by either analytical method showed wide intersubject variation, with the GLC-MS data showing relatively higher magnitude of intersubject variation than the RIA data. In general, plasma concentrations measured by RIA were significantly different from those measured by GLC-MS (paired t tests: p less than 0.0001). As indicated by the regression analysis, concentrations determined by RIA were 1.3-1.4 times higher than those determined by GLC-MS. There were strong and significant correlations between the two methods for both T and R (r greater than 0.75: p less than 0.0001). Similar statistical relationships were found between the plasma concentrations of CPZ determined by the two methods at each sampling time and the bioequivalence parameters area under the plasma level versus time curves up to the last measurable concentration (AUCt0) and the maximum plasma concentration (Cmax).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Development and application of a radioimmunoassay for fluphenazine based on monoclonal antibodies and its comparison with alternate assay methods.

The development of a monoclonal antibody towards fluphenazine allows the measurement of plasma concentrations of this highly potent neuroleptic. The method demonstrates sufficient sensitivity to measure 0.02 ng of fluphenazine per milliliter of plasma and employs a 150-microL plasma extract derived from a 2-mL plasma sample. The procedure is linear over the concentration range of 0.02 to 2.5 ng/mL, with a mean overall coefficient of variation of less than 3%. The validity of the described monoclonal-based RIA procedure was confirmed by comparison to alternate assay methods in replicate samples. Comparison to a newly developed HPLC-coulometric procedure in 159 samples showed a strong correlation, with a slope value of close to unity (1.0484) and a coefficient of correlation of 0.8136, while comparison to a previously developed polyclonal-based RIA procedure showed a correlation of 0.95 and a slope of 0.91 (n = 26).

Animals↗
PubMed1990

Dietary preference for sweet foods in patients with dementia.

Using a telephone survey, patients with probable Alzheimer's disease (n = 31) and vascular dementia (n = 14) were compared with elderly normal controls (n = 43) in preferences for different foods. Patients with Alzheimer's disease had a greater preference than normal controls for relatively high-fat, sweet foods and for high-sugar, low-fat foods, but did not significantly differ in preference for other foods, including those high in complex carbohydrates and protein. Vascular dementia patients showed a similar pattern, not significantly different from that for Alzheimer's patients. Results did not consistently support a hypothesis that increased sweet preference is a nonspecific form of disinhibited behavior related to declining mental status, nor was a hypothesis relating sweet preference to serotonin activity within the brain consistently supported. Results provide preliminary evidence that craving for sweet food may be a significant part of the clinical syndrome of dementia, but further research is needed to delineate the psychological and biological mechanisms accounting for it.

Aged↗
PubMed1990

Relation of cognitive status and abnormal behaviors in Alzheimer's disease.

Some studies suggest that abnormal behaviors are associated with increasing cognitive loss in Alzheimer's disease (AD). Other studies do not show this association. We examined the relation of cognitive loss, represented by Folstein Mini-Mental State Examination (MMSE) score, with abnormal behaviors in 680 patients with probable AD. Six behaviors were examined: agitation/anger, personality change, wandering, hallucinations/delusions, insomnia, and depression. All but depression were associated with declining MMSE score. The number of abnormal behaviors present in each patient was also related to declining MMSE score. Several other associations were also found: hallucinations/delusions were associated with age and race; agitation/anger was related to male gender; and wandering was associated with increased age. Although these data support the general notion that five of the six abnormal behaviors studied are more likely to occur with increasing cognitive loss, the correlations are small and it is suggested that other as yet unproven factors may play an as large or greater role than MMSE score in predicting such behaviors.

Age Factors↗
PubMed1990

Exercise capacity in coal workers' pneumoconiosis: an analysis using causal modelling.

Miners disabled from black lung disease (coal workers' pneumoconiosis, CWP) are entitled to disability benefits under United States federal and state laws. The determination of disability currently involves several scientific controversies. The Federal Department of Labor states that one second forced vital capacity (FEV1) is an important marker of disability from CWP. The Department of Labor also states that disability may occur in simple CWP, in the absence of progressive massive fibrosis (PMF). Both these contentions may reasonably be challenged. To investigate these issues, and to investigate the relation between exercise tolerance and several other variables, including age, weight, radiographic findings, and exposure to mining and smoking, we studied 690 miners. Simple correlation analysis was not helpful because many variables were correlated with each other. Linear regression analysis led to conclusions that were thought to be misleading. Causal modelling provided an analysis that appeared to be most explanatory. In the model tested years of coal mining did not affect FEV1; if this conclusion is substantiated by others FEV1 should be eliminated as an indicator of disability from CWP as it is not related to mining experience. On the other hand, the Department of Labor's position that disability may occur in simple CWP seems reasonable, as years of underground coal mining does affect forced vital capacity (FVC), which in turn impairs exercise capacity, even in the absence of PMF. FVC should be the major spirometric value used in determining disability from CWP because it alone is seen to decrease in relation to mining, and a decrease in FVC does affect exercise capacity. Thus this analysis addresses issues in determining black lung disability and shows the value of casual modelling.

Age Factors↗
PubMed1990

Investigation of death clusters in a nursing home.

The number of elderly residing in, and dying in, nursing homes is steadily increasing. In 1985, an investigation by the California attorney general's office was undertaken concerning a cluster of deaths in a single rural nursing home. The purpose of this study was to provide information for the investigation. The objectives of the study were to determine if there were excess deaths in the nursing home, and if so, to describe the circumstances surrounding the deaths and the policy implications for the quality of care in nursing homes. All the medical records for patients who died in a single nursing home between January 1, 1983 and April 30, 1985 were examined by the research team. Medical care was compared to desirable standards of care. A majority of the deaths, 52.5%, had major discrepancies from standard care that may have contributed to the patient's death. There were also major discrepancies in the cause of death between the death certificate and evidence from examination of the medical records. The data substantiated an unusual occurrence of deaths in the nursing home at the end of 1983 and again in early 1985, but no single factor or person could be identified as the major cause of the deaths. Although this is an isolated study of one nursing home, it is likely that these problems are not unique and the evaluation approach may be useful in other settings. It is recommended that nursing home deaths be routinely monitored, and that an unusual number of deaths should trigger an extensive investigation.

Aged↗
PubMed1989

Interconversion between haloperidol and reduced haloperidol in healthy volunteers.

The interconversion between haloperidol (HAL) and reduced haloperidol (RHAL) was examined following their separate administration in low (5 mg) single oral doses to 15 young healthy male volunteers in a crossover design. Using an ultrasensitive HPLC method plasma concentrations of HAL and RHAL were monitored over a period of one week following each administration. Except in one case, both the analytes were found in the plasma of all the volunteers following each administration, thereby indicating interconversion of the two compounds. Comparison of the AUC(0-t) ratios of RHAL/HAL and HAL/RHAL following administration of HAL and RHAL, respectively, revealed that the interconversion favours the reduction of HAL to RHAL. The disposition of HAL following administration of RHAL appears to be limited by its rate of formation and the disposition of RHAL following administration of HAL, on the other hand, is much slower than that of the parent compound.

Adult↗
PubMed1989

An ultrasensitive method for the measurement of fluphenazine in plasma by high-performance liquid chromatography with coulometric detection.

A new sensitive analytical method is described for the quantitation of fluphenazine in 1 ml plasma samples after low oral doses of this antipsychotic agent. The drug is isolated by a simple one step extraction technique and analyzed by high-performance liquid chromatography (HPLC) with coulometric detection. The limit of detection for fluphenazine was 10 pg/ml of plasma and standard curves from 25 to 1,000 pg/ml were linear with an overall coefficient of variation (CV) of less than 5%. The lowest quantifiable concentration of 25 pg/ml could be determined with a CV of 4.7%. The sensitivity of the HPLC assay was such that plasma concentrations of fluphenazine could be followed for 2 days following administration of a single 10 mg oral dose of fluphenazine dihydrochloride to healthy volunteers. Known metabolites of fluphenazine did not interfere in the assay as they eluted with retention times different from that of fluphenazine.

Adult↗
PubMed1989

Effect of aging on serum albumin.

Some studies have shown a negative association between age and serum albumin. Several of these studies included older people with known disease. Disease may reduce albumin in any age group. Other studies have shown no association between age and albumin. To investigate the association of age and albumin, albumin levels were determined in 241 apparently healthy subjects aged 55 to 101. A small but consistent negative regression slope of about 4% per decade was found for those aged over 70. Because the relationship to age was small, the finding of hypoalbuminemia in an elderly patient generally should be attributed to disease rather than age alone.

Aged↗