Biomedical subjects

J K Jones

Publications and source records attributed to J K Jones.

At least 19 recordsLinked to original sources

PubMed2004

Mortality of patients following hip fractures in Barbados.

A retrospective study of all patients admitted with hip fractures to the Queen Elizabeth Hospital in Barbados from January 1996 to December 1998 was conducted. There were 110 patients who had sustained either a femoral neck or peri-trochanteric fracture. The mean age was 80.7 years and 71.8% of the patients were women. Mortality at six months in 110 patients was 32.7% and 41.2% at 12 months in 102 patients. Forty-nine patients had open reduction and internal fixation of their fractures, forty-five patients were treated with Austin Moore prostheses and one patient had excisional arthroplasty. Patients with pre-operative cardiac abnormalities had a significantly higher mortality (60%) at 12 months (p = 0.028). There was a linear correlation between age and mortality with mortality increasing with age. The length of time from admission to surgical procedure had no significant influence on mortality. Hip-fracture patients with cardiac abnormalities should be carefully evaluated and stabilized pre-operatively.

Adult↗

PubMed2002

A survey of cutlass ("Collins") injuries seen in the emergency department of the Queen Elizabeth Hospital in Barbados.

For the period March to November 1998 inclusive, a prospective survey was conducted of all patients who sustained injuries with a cutlass or machete and were admitted to the Accident and Emergency Department of the Queen Elizabeth Hospital. Of the 77 patient admissions, 81% (62/77) were male. The average age was 28.8 years (range 8 to 73 years; standard deviation 13.1). Twenty-two per cent of the patients were less than 20 years old. The most common locations of the lacerations were upper extremity (59 lacerations) and scalp (16 lacerations). Thirty-four per cent of the patients (26/77) sustained lacerations to two or more anatomical locations. There were 23 fractures in 21 patients; skull fractures were the most common fractures (11). Of the 63 patients who responded to the question on whether they knew the identity of their assailants, 51 reported that they were attacked by someone known to them; eight were assaulted by a spouse or known family member. Eighty-six per cent of patients (66/77) were treated in the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating theatre. The average length of stay was 3.6 days. There were no amputations or deaths. One patient sustained loss of vision in one eye. In Barbados, most victims of cutlass injuries are males who know their assailants and the morbidity is most often related to head injuries and to short-term physical disability due especially to lacerations of the hand and forearm.

Adolescent↗

PubMed2001

Coprescribing and codispensing of cisapride and contraindicated drugs.

CONTEXT: Cisapride, an oral prokinetic drug indicated for the symptomatic treatment of nocturnal heartburn due to gastroesophageal reflux disease, was approved by the US Food and Drug Administration in July 1993. After reports of serious cardiac arrhythmias and deaths during administration of cisapride, most involving concomitant exposure to another drug, a series of label changes and warnings were issued in February 1995, October 1995, June 1998, and June 1999. Cisapride was removed from general distribution in July 2000. OBJECTIVE: To determine the frequency of contraindicted coprescribing and codispensings, in which cisapride and a contraindicated drug were prescribed or dispensed to the same patient for overlapping periods, and the proportion of contraindicated coprescribing by the same physicians and codispensing by the same pharmacies. DESIGN AND SETTING: Retrospective study of prescription claims from a managed care organization database for all patients with cisapride prescriptions between July 1993 and December 1998. PARTICIPANTS: A total of 38 757 adult and pediatric patients who had a cisapride prescription immediately preceded by at least 60 days of insurance eligibility. MAIN OUTCOME MEASURE: Proportion of cisapride prescriptions or dispensing occurring during the same treatment period as a drug contraindicated at that time prescribed by the same physicians or dispensed by the same pharmacies. RESULTS: Of 131 485 cisapride prescriptions dispensed after the warnings began, 4414 (3.4%) overlapped with at least 1 drug contraindicated in the labeling at the time of the prescription. Of all overlapping prescription pairs, 2190 (50%) were by the same physicians, 3908 (89%) were by the same pharmacies, and 765 (17%) were dispensed on the same day. CONCLUSION: Prescriptions dispensed by the same pharmacies accounted for a far higher proportion of contraindicated medication pairs than prescriptions from the same physicians. The pharmacy may be an important and underutilized intervention point to prevent contraindicated drugs from being used together.

Adolescent↗

PubMed2001

Adverse drug reactions.

Explore the source record for details and available documents.

Adverse Drug Reaction Reporting Systems↗

PubMed2001

Postmarketing surveillance of new food ingredients: design and implementation of the program for the fat replacer olestra.

Following U.S. Food and Drug Administration (FDA) approval for the use of olestra, a noncaloric fat substitute (brand name Olean) in food snacks, the manufacturer agreed to provide safety updates on market experience to the FDA. However, guidelines for food product postmarketing surveillance (PMS) are not available and those typically used with medical products were only partly applicable. In modeling the Olean program, we drew from experience with consumer products and incorporated elements typical of medical product PMS. A cooperative effort was established with Olean snack manufacturers and a two-tiered, multidisciplinary approach enlisting Consumer Relations and Medical Affairs personnel was used to maximize use of specialized skills. The result of this effort was implementation of a reliable PMS system which could handle a high volume of reports from consumers while providing pertinent data required for medical interpretation of these reports. Summaries of data for the Olean snack manufacturers and FDA were generated in timely fashion. In addition to collection of the spontaneous reports from consumers, a clinical studies program was undertaken and an independent medical advisory panel was established. Through these, we gained perspective on the spontaneous reports and additional confirmation of the safety of olestra in savory snacks.

Clinical Trials as Topic↗

PubMed2001

An evaluation of medical school education in musculoskeletal medicine at the University of the West Indies, Barbados.

At the University of the West Indies, Cave Hill campus, the Freedman and Bernstein musculoskeletal competency examination was administered to 22 medical students during the last month of their final year. Eighty-two per cent (82%) of the students failed to score above the passing score of 73.1%. Nineteen of the twenty-two students had taken an orthopaedic elective or rotation during their final two years. The questions were also categorized as Anatomy, Trauma and General Orthopaedics. All students failed to score above the passing score in Anatomy. Sixty-four per cent (64%) failed in Trauma and 45% failed in General Orthopaedics. This study suggests that inadequacies in medical school preparation do exist at this campus of the University of the West Indies and the findings mirror those at medical schools in the United States of America.

Education, Medical↗

PubMed2000

Microspore culture in Corchorus olitorius: effect of growth regulators, temperature and sucrose on callus formation.

Culture of isolated microspores and of anthers on media containing IAA directed free microspore development to an embryogenic pathway in C. olitorius. The first division of microspores on transfer to culture media was symmetrical in contrast to the asymmetrical division seen in normal development in vivo. Initially, 10-30% microspores divided symmetrically, but only 0.2-1% of the dividing microspores continued dividing and produced multicellular microcalli. About 30% of these microcalli produced callus but only on medium with 2.0 mg/L zeatin and 0.1 mg/L IAA. Incubation in the dark at temperatures of 35 degrees C for 1 day and then 25 degrees C was found effective for induction of first embryonic division in Corchorus. The frequency of microspore callus formation was higher on medium containing either 3% or 5% sucrose. Addition of colchicine and addition of activated charcoal to the above medium did not enhance microspore division in Corchorus olitorius. On transfer to different media most calli produced roots but regeneration of shoots and embryos was not induced.

Breeding↗

PubMed1999

Selective serotonin reuptake inhibitors have broadened the utilisation of antidepressant treatment in accordance with recommendations. Findings from a Swedish prescription database.

BACKGROUND: With the advent of the selective serotonin reuptake inhibitors (SSRIs), the use of antidepressants has increased drastically in Sweden. The use of tricyclic antidepressants (TCAs) has, however, decreased. METHODS: We surveyed a prescription database in the Swedish county of Jämtland and compared prescription patterns for patients prescribed SSRIs with those prescribed TCAs. RESULTS: The incidence of treatments of antidepressants increased from 0.76% to 1.33% during the period 1991-1996. There were no significant differences between SSRIs and TCAs with regard to patients having only one prescription dispensed within three months from the index prescription, or patients who switched class of antidepressant. Only a minority of the treatments were continued for at least six months, but significantly more SSRI than TCA treatments (42% and 27%). A second treatment period suggesting recurrence was three-times more common in the TCA group than in the SSRI group. CONCLUSION: Provided that the increased use of SSRIs is mainly for depression, these drugs appear, despite a lower efficacy in severe depression, to have enabled a broader utilisation of antidepressants with regard to incidence, dosage and duration, in accordance with recommendations. Further analyses of this phenomenon relative to diagnostic criteria and outcome measures are required.

Adult↗

PubMed1998

Presence of laminin fragments in cyst fluid from patients with autosomal dominant polycystic kidney disease (ADPKD): role in proliferation of tubular epithelial cells.

Cyst fluid samples obtained from eight patients with autosomal dominant polycystic kidney disease (ADPKD) were analysed for the presence of the basement membrane component laminin and its breakdown products, using ELISA and immunoblotting techniques. Whole laminin was not detected, whereas laminin fragments of 270, 155, 87, 56, and 14 kDa were detected at a mean total value of approximately 0.5 microgram/ml. The laminin fragments were assessed for their effect on cultured normal and ADPKD epithelial cells. Both cell types showed accelerated growth under these conditions. These findings suggest that basement membrane degradative fragments present in cyst fluid may contribute to cystic epithelial cell proliferation and may therefore be important in the pathogenesis of ADPKD.

Adult↗

PubMed1998

Antidepressant use and resource utilization in the general practitioner setting in The Netherlands.

OBJECTIVE: To assess antidepressant use and resource utilization in the general practitioner (GP) setting in the Netherlands following initiation of antidepressant therapy. DESIGN: Longitudinal study in a retrospective database. PARTICIPANTS: Sample of 869 patients from a new database in the Netherlands who initiated therapy on a selective serotonin re-uptake inhibitor (SSRI) or a tricyclic antidepressant (TCA). MAIN OUTCOME MEASURES: Mean length of antidepressant therapy within the first 90 days and resource utilization in the GP setting in the first 180 days following therapy initiation. RESULTS: (1) patients who initiated therapy on an SSRI were younger (48.6 years old versus 54.1 years old, p<0.01) and more likely to have a depression diagnosis (58% versus 30%, p<0.01) than patients who initiated therapy on a TCA; (2) patients who initiated therapy on an SSRI were more likely than patients who initiated therapy on a TCA (65% versus 52%, p<0.01) to have more than 30 days of therapy within the first 90 days and to receive antidepressant doses consistent with Dutch guidelines; (3) patients with greater than 30 days of antidepressant therapy within the first 90 days had more general practitioner visits than patients with 30 days of therapy or less (TCA patients: 9.6 versus 7.0; SSRI patients: 8.8 versus 6.9, p<0.01). CONCLUSIONS: Patients in the GP setting in the Netherlands who initiate therapy on SSRIs are more likely than patients who initiate therapy on TCAs to receive recommended doses and duration of therapy consistent with Dutch antidepressant treatment guidelines.

Journal Article↗

PubMed1997

Value of epidemiologic studies in determining the true incidence of adverse events. The nonsteroidal anti-inflammatory drug story.

BACKGROUND: Evidence supporting differential toxic effects of nonsteroidal anti-inflammatory drugs (NSAIDs) often is derived from spontaneous reports of adverse events to the US Food and Drug Administration (FDA). These reports represent observations from an undefined, exposed population that are not collected in a standardized manner and therefore are subject to reporting biases. Epidemiologic studies, in which the numbers of patients experiencing an adverse event and exposed to the drug are known, provide more reliable measures of risk and can place spontaneous reports in perspective. OBJECTIVE: To compare both data sources with regard to NSAID-associated gastrointestinal, liver, and skin events. METHODS: We obtained spontaneous reports of these adverse events for diclofenac, nabumetone, naproxen, and piroxicam. Published epidemiologic studies of these events were reviewed. RESULTS: Spontaneous reports did not mirror reliably the results of epidemiologic studies. Spontaneous reports showed higher associations of gastrointestinal and skin events with nabumetone and piroxicam and hepatic events with diclofenac. Epidemiologic studies generally did not show differential risk among these NSAIDs. CONCLUSIONS: When the 4 NSAIDs are compared in epidemiologic studies, there is no quantitative basis for identifying 1 as more or less toxic than the others, underlining the hazard of deriving quantitative conclusions from spontaneous reports. Spontaneous reports are an unreliable measure of risk; rather, they may provide evidence of the relative awareness of specific toxic effects among physicians.

Adult↗

PubMed1997

An investigation of the safety of midazolam use in hospital.

OBJECTIVE: To investigate whether an association exists between midazolam use and serious cardiorespiratory events or death. DESIGN: Retrospective analysis of data in an inpatient record linkage database, collected between March 1986 and October 1987 from 14 hospitals in the United States. PATIENTS: A cohort of 19,112 patients who received injectable midazolam or diazepam on the same day that a medical procedure was performed. MAIN OUTCOME MEASURES: An attempt was made to identify suspected serious cardiorespiratory adverse events and deaths that occurred within 24 h of study-drug administration. Death rates within 24 h following study-drug administration were compared between patients who received injectable midazolam and those who received injectable diazepam. RESULTS: Validation analysis of the information in the computerized record linkage database indicated that serious cardiac and respiratory adverse events that occurred within 24 h of study-drug administration could not be reliably identified. Therefore, a comparison of the serious cardiorespiratory adverse event rates following administration of midazolam versus diazepam could not be made. Death rates within 24 h of study-drug administration could be evaluated. For the cohort as a whole, the death rate was significantly lower among patients who received midazolam than among those who received diazepam (0.76% versus 1.93%, p<0.01). This difference remained statistically significant, after adjusting for age, sex, comorbidity diagnosis, concomitant drug use, type of medical procedure, and hospital size and teaching capability. CONCLUSIONS: The results suggest that there is no increased risk of death associated with midazolam administration when compared to diazepam administration for endoscopic, conscious sedative, and general anesthetic procedures in hospitals.

Journal Article↗

PubMed1996

Isolation of pepsin-resistant laminin fragments from human placenta: effect on epithelial cells cultured from the kidneys of patients with autosomal dominant polycystic kidney disease (ADPKD).

Laminin isolated from human placenta was subjected to prolonged pepsin digestion. Seven peptide fragments (designated N1 to N7) were separated by ion-exchange chromatography and gel filtration and characterised by SDS-polyacrylamide gel electrophoresis and immunoblotting. The molecular size of the laminin fragments varied from approx. 900,000 (N1) to 28,000 (N7). Epithelial cells obtained from normal kidneys and patients with autosomal dominant polycystic kidney disease (ADPKD) were cultured. The incorporation of [3H]thymidine was measured over 96 h to determine the effect of the addition of the different fragments and whole laminin from EHS tumour to the cells. The rate of growth of both normal and polycystic cells was increased in the presence of the laminin fragments but this effect was more pronounced in the ADPKD cells.

Cell Division↗

PubMed1996

Congenital heterotopic gastrointestinal cyst of the oral cavity in a neonate: case report and review of literature.

Heterotopic gastrointestinal cysts of the oral cavity are rare benign lesions which may mimic both benign and malignant neoplasms. These cysts are usually discovered during infancy, but may not appear until well into adulthood. This lesion involves the tongue and floor of the mouth in 97% of cases and has a male predilection. The cyst may range in size from less than 1 cm to 9 cm, with most lesions being 1-3 cm in size. About 30% of affected individuals have symptoms related to difficulties with feeding, swallowing and respiration. The epithelial lining is quite variable, but all cysts have an enteric lining. The histogenesis is related to entrapment of undifferentiated, noncommitted endoderm within the oral cavity during the 3rd-4th week of fetal life. The purpose of this paper is to report a congenital heterotopic gastrointestinal cyst of the oral cavity presenting in a neonate. The clinical and histopathologic features of this cyst are reviewed, as well as the histogenesis of this lesion.

Choristoma↗

PubMed1996

Investigation of an outbreak of Aleutian disease on a commercial mink ranch.

OBJECTIVE: To determine the modes of transmission of Aleutian mink disease in a natural outbreak. ANIMALS: 5,580 black and 9,087 brown mink from a ranch with an outbreak of Aleutian mink disease. PROCEDURE: Each mink had serum tested by counter-electrophoresis for Aleutian disease antibody. If a mink was seropositive for Aleutian disease virus by counter-electrophoresis, it was considered to be infected. Correlation of prevalence of the disease in kits and parents was determined. Spatial arrangement of infected and un-infected mink also was studied. RESULTS: Infected black dams were more likely to produce infected kits than were uninfected dams. In contrast, infected black sires were less likely to produce infected kits than were uninfected sires. In brown mink, in which prevalence of Aleutian disease was lower, transmission from infected dams and sires to kits was apparent. Infected black mink appeared to be more efficient in transmitting the disease horizontally than were infected brown mink. Although the spatial arrangement of infected mink indicated that mechanical transmission of the disease may be the most efficient mode of horizontal transmission, airborne transmission also occurred. CONCLUSIONS AND CLINICAL RELEVANCE: Infected sires with nonprogressive Aleutian disease may confer protection to their kits in the face of a severe outbreak. Brown mink may be less able to transmit the virus horizontally than are black mink. Airborne transmission is substantial, but may not be as efficient as mechanical transmission.

Aleutian Mink Disease↗

PubMed1995

Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population.

OBJECTIVE: To evaluate the incidence of discontinuation of and changes in treatment after newly prescribed courses of antihypertensive drugs of the four primary therapeutic classes: beta blocker, calcium channel blocker, and angiotensin converting enzyme inhibitor. DESIGN: A retrospective analysis of patients on an automated database of 1.2 million patients was conducted on visits between 1 October 1992 and 30 September 1993. SETTING: General practices in the United Kingdom. SUBJECTS: 37,643 patients with hypertension receiving a relevant drug in the time period were identified. A new course of treatment in at least one of the four therapeutic classes, defined as a drug not prescribed in the previous four months, was observed in 10,222 patients aged > or = 40 years. MAIN OUTCOME MEASURES: Patients changing to other treatment or discontinuing after initiating a new course of treatment, defined as the absence of a refill prescription for the new drug or another in its category within a six month observation period. RESULTS: Changes in or discontinuation of treatment were frequently observed, and by month six continuation rates ranged between 40% to 50% for all four classes of drugs. CONCLUSION: Low rates of continuation with a newly prescribed antihypertensive drug exist regardless of which drug is prescribed.

Adolescent↗

PubMed1994

Radiocontrast media. Regulatory aspects.

The FDA regulates the development, manufacturing, marketing, and postmarketing surveillance of radiocontrast and medical imaging agents, which it defines as drugs. In the current environment, the trend by many institutions toward cost consciousness and quantitative evaluation of all aspects of health care indicates that FDA regulations will represent only one of several regulatory forces that will affect the development and use of all drugs.

Clinical Trials as Topic↗

PubMed1993

Medication use by the elderly.

Medication use is correlated with the age-associated onset of chronic diseases for which drug therapy offers symptomatic relief, and assists in preventing the onset of disabling and life-threatening complications. However, high rates of medication use by older people raise a number of issues, ranging from concerns with rising expenditures for individuals and third-party insurers; increased risk of adverse drug reactions; toxic or interaction effects from concomitant use of multiple pharmaceutical agents, both physician and self-prescribed; and poor compliance with complex medication regimens by the more physically and mentally impaired. Although existing data do not support the theory of age as an independent predictor of drug-specific adverse reactions, older people have typically been excluded from clinical trials in the dynamic and changing field of pharmacotherapy. Furthermore, ingestion of a greater number of different agents clearly exposes individuals to higher risk of adverse reactions and interactions. Recent advances in information technology have facilitated multicenter clinical trials and post-marketing epidemiological surveillance studies of specific and concomitant medication use by individuals of all ages. The employment of such technology by insurers to determine appropriate prescribing or to control costs in the present limited state of knowledge is, however, premature. Furthermore, such techniques will not replace the need for careful clinical review of symptoms and total drug therapy by prescribing physicians, with modification of regimens and provision of appropriate information and instructions to older individuals and their caregivers.

Aged↗