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J L Jackson

Publications and source records attributed to J L Jackson.

At least 37 records · Page 2Linked to original sources
PubMed1999

A comparison of outcomes for walk-in clinic patients who see interns and those who see staff physicians.

PURPOSE: To collect pilot data on the effect of interns' involvement on patient care outcomes. METHOD: Between January 1995 and August 1998, 750 patients at a walk-in clinic completed pre-visit questionnaires on symptom-related expectations and functional status. Three follow-up surveys (immediately after the visit, at two weeks, and at three months) assessed symptom outcomes, satisfaction, illness worry, and unmet expectations. Physicians were surveyed about their perceptions of the "difficulty" of each patient encounter. RESULTS: During the study period, 195 patients (26%) were seen by interns and 555 (74%) by staff physicians. The patient groups did not differ in illness worry, unmet expectations, or satisfaction immediately after the visit, at two weeks, or at three months. Patients seen by interns were more satisfied with the time they had spent with their clinicians (p = .007). Interns were more likely to experience their patient encounters as difficult. There was no difference in visit costs, subspecialty referrals, health utilization, or hospitalization rates. CONCLUSION: Patients who are seen by interns in an ambulatory clinic are similar to those who are seen by staff physicians in terms of post-visit satisfaction, residual expectations, symptom resolution, and functional status improvement.

Ambulatory Care Facilities↗
PubMed1999

A comparison of bowel preparations for flexible sigmoidoscopy: oral magnesium citrate combined with oral bisacodyl, one hypertonic phosphate enema, or two hypertonic phosphate enemas.

OBJECTIVE: Magnesium citrate with hypertonic enemas or oral bisacodyl provides superior preparation quality for sigmoidoscopy over enemas alone. We compared three magnesium citrate sigmoidoscopy preparations in a randomized, single-blind, controlled trial. METHODS: Two hundred and ninety-one adults scheduled for routine sigmoidoscopy were randomly assigned to receive one of three preparations containing oral magnesium citrate (296 cc) taken the night before the procedure in combination with the following: 1) oral bisacodyl (10 mg), given with the magnesium citrate the night before the procedure; 2) one hypertonic phosphate enema 1 h before the procedure; or 3) two hypertonic phosphate enemas, given singly at 2 and 1 h before the procedure. Endoscopists rated preparation quality, procedure duration, and depth of endoscopic insertion. Patients assessed preparation comfort and overall satisfaction. RESULTS: Preparation quality was rated as excellent or good for 80.6% in the bisacodyl group, 88.7% in the one-enema group, and 85.1% in the two-enema group (p = 0.30). Patients reported the oral bisacodyl regimen was better tolerated (p = 0.032). Although the three regimens were comparable in most side effects, the bisacodyl preparation was associated with more diarrhea (p = 0.0003). Mean procedure duration, mean insertion depth, and prevalence of diverticula and polyps were similar in all groups. Fewer than 4% of patients required repeat procedures due to poor preparation quality. CONCLUSIONS: There was no statistical difference between the quality of the three bowel preparations. Patients considered an oral bisacodyl and magnesium citrate regimen more easily tolerated, though it was associated with more diarrhea.

Administration, Oral↗
PubMed1999

A psychometric comparison of military and civilian medical practices.

BACKGROUND: Our purpose was to compare the psychometric properties of military and civilian ambulatory internal medicine care. METHODS: Military data came from two cohorts of patients presenting for primary care. Variables collected included mental disorders (the PRIME-MD study), previsit symptom-related concerns and expectations, functional status (Medical Outcomes Study SF-6 and SF-20 scales), postvisit unmet expectations, satisfaction with care (Medical Outcomes Study five-item survey), and physician-perceived "difficulty" (Difficult Doctor-Patient Relationship Questionnaire). This data set was compared with data abstracted from several civilian studies of ambulatory primary care. These studies used the same instruments and took place during the same period. RESULTS: Military and civilian patient populations were equally likely to have mental disorders, with no differences in the prevalence of disorders within the broad categories of mood, anxiety, somatoform, eating, or alcohol disorders. Civilian populations had a slightly higher rate of some specific diagnoses, including major depression, panic disorder, and generalized anxiety disorder. There was a similar distribution of previsit expectations of care and in the types of postvisit unmet patient expectations, with military patients having slightly lower rates of unmet expectations. Patients in both practice settings had similar self-reported ratings in the six domains of functioning (role, social, pain, emotion, physical, general health), with civilian patients reporting slightly worse overall self-rated health. Both settings had high rates of fully satisfied patients (40% "excellent" for both), with patients with unmet expectations in both groups much less likely to be fully satisfied. There was also a similar proportion of encounters rated as difficult by the clinician (military, 11%; civilian, 15%; p = 0.99). The correlates of difficulty in both groups were similar, with mental disorders and multiple symptoms increasing the likelihood of a difficult encounter. CONCLUSIONS: The psychometric properties of patient care in military and civilian internal medicine ambulatory settings are remarkably similar. These data support mutual generalizability of primary care research findings with respect to psychometric properties between military and civilian populations.

Activities of Daily Living↗
PubMed1999

Patients, diagnoses, and procedures in a military internal medicine clinic: comparison with civilian practices.

BACKGROUND: Our goal was to compare the demographic features, diagnoses, and procedures in civilian and military ambulatory internal medicine clinics. METHODS: One year (September 1996 to August 1997) of data from the Ambulatory Data System of the Adult Primary Care Clinic at Madigan Army Medical Center was extracted and compared with the most recent (1995) National Ambulatory Medical Care Survey. RESULTS: A total of 41,374 Madigan patient encounters were compared with civilian data from the National Ambulatory Medical Care Survey. The age distribution was similar, with military patients averaging 53.5 years of age and civilian patients averaging 54.5 years. Military patients were more likely to be female (71 vs. 60%) and were more ethnically diverse (military: 68% white, 17% African American, 7% Hispanic, 7% Asian American, and 1% Native American; civilian: 78% white, 10% African American, 6% Hispanic, 5.9% Asian American, and 0.3% Native American). There were similar rank orderings of the top 189 diagnostic groups seen in each setting (Spearman's rho = 0.87). There were also no differences in the type or rank order of procedures performed between military and civilian internists (p = 0.53). CONCLUSION: The practice content of military and civilian practices appears to be more similar than different.

Age Distribution↗
PubMed1999

Comparison of discharge diagnoses and inpatient procedures between military and civilian health care systems.

BACKGROUND: Our goal was to compare the demographics and discharge diagnoses between civilian and military health care systems. METHODS: One year (1997) of data from the Retrospective Case Mix Adjustment System from the Military Health Services System were compared with the most recent (1994) civilian National Hospital Discharge Survey data. RESULTS: Military and civilian inpatient age (52.5 and 52.9 years), gender (54% and 59% female), and ethnic distributions (military: 71% white, 16% African American, 3% Asian American, 10% other; civilian: 65% white, 12% African American, 2.6% Asian American, 1.2% Native American, 18% unclassified) were similar. There were similar rank orderings of diagnosis-related groupings (Spearman's rank correlation = 0.72) and procedures performed during hospitalization (Spearman's rho = 0.74), although the military inpatients yielded a higher proportion associated with pregnancy and strenuous activity (traumatic joint disorders and hernias) than their civilian counterparts. CONCLUSION: The practice content of military and civilian inpatients appear to be more similar than different.

Diagnosis-Related Groups↗
PubMed1999

Antidepressant therapy for unexplained symptoms and symptom syndromes.

OBJECTIVE: To determine the efficacy of antidepressant therapy for unexplained symptoms or symptom syndromes. SEARCH STRATEGIES: We identified original studies through searching MEDLINE, EMBASE, PsycLIT, the Federal Research in Progress database, and The Cochrane Library. We also searched the bibliographies of primary and review articles for additional studies. SELECTION CRITERIA: We excluded trials of patients with neuropathic, oncologic, or degenerative joint pain. Independent duplicate review of 392 articles identified 94 relevant reports of randomized trials involving 6595 patients across 6 symptom syndromes. Independent duplicate assessment was made for inclusion and data abstraction. Meta-analysis was performed on extractable placebo-controlled data. MAIN RESULTS: Of 94 included trials, most studied either tricyclic antidepressants, antiserotonin antidepressants, selective serotonin reuptake inhibitors (SSRIs), or multiple agents for the treatment of the following syndromes: headache (50), fibromyalgia (18), functional gastrointestinal syndromes (13), idiopathic pain (11), tinnitus (2), and chronic fatigue (2). The quality of the studies was fair (mean score = 4.8 on a scale of 0 to 8). A majority of the studies (69%) demonstrated benefit for at least one outcome measure. Symptom improvement typically did not correlate with depression response in the few studies where it was assessed. Meta-analysis of all extractable data showed a substantial benefit from antidepressants: For the dichotomous outcome of improvement, the odds ratio was 3.4 (95% confidence interval [CI], 2.6 - 4.5), and for continuous outcomes, the standardized mean difference was 0.87 (95% CI, 0.59-1.14). The absolute percentage difference in improvement between the antidepressant and placebo arms was 32%, yielding a number needed to treat of 3 to improve one person's symptoms. Meta-regression indicated no differential effect across the classes of antidepressants; however, onbivariate tally tricyclic studies were associated with a greater likelihood of efficacy than SSRI studies (P = .02). CONCLUSIONS: Antidepressants can be effective for various physical symptoms and symptom syndromes. The relation of outcome to depression and the efficacy of SSRIs needs further study.

Adult↗
PubMed1998

The value of screening for psychiatric disorders in rheumatology referrals.

BACKGROUND: Musculoskeletal complaints are common and often unexplained and often lead to rheumatology referrals. The prevalence of psychiatric disease in patients with musculoskeletal complaints is unknown. OBJECTIVES: To determine the prevalence of common psychiatric disorders among patients referred to a rheumatology clinic and the likelihood of establishing a rheumatic diagnosis if a psychiatric disorder is present. DESIGN: Prospective diagnostic survey. SETTING: Two hospital-based rheumatology clinics and a general medicine clinic. PARTICIPANTS: A consecutive sample of newly referred patients (n = 185) and their rheumatologists (n = 9). INTERVENTION: Before their visit, all patients filled out a self-administered version of PRIME-MD (Primary Care Evaluation of Mental Disorders), a questionnaire that makes Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: Primary Care Version, diagnoses of depressive, anxiety, and somatoform disorders. After the visit, the study rheumatologists, who were unaware of the PRIME-MD results, completed a questionnaire regarding their diagnostic assessment. These patients were compared with 210 patients with musculoskeletal complaints who were cared for in a general medicine clinic. MAIN OUTCOME MEASURES: Psychiatric and rheumatic disorders. RESULTS: Compared with patients with musculoskeletal complaints in a general medicine clinic, patients referred to a rheumatology clinic had a higher prevalence of psychiatric disease (40% vs 29%; P = .008), had an almost 2-fold higher prevalence of anxiety disorders, and were more likely to have multiple psychiatric disorders (odds ratio = 2.70, 95% confidence interval = 1.50-5.00). The likelihood of a psychiatric disorder differed among patients with connective tissue disease, nonsystemic articular or periarticular disorders, and nonarticular disorders (27%, 38%, 55%, respectively; P = .006). In a best-fitting logistic regression model, psychiatric disorders markedly decreased the likelihood of a connective tissue disease (odds ratio = 0.24, 95% confidence interval = 0.09-0.62). CONCLUSIONS: Forty percent of patients referred to a rheumatology clinic in this study had a psychiatric disorder, and its presence predicted a lower likelihood of a connective tissue disease. Prospective studies are needed to determine if screening for psychiatric disease before referring patients with unexplained musculoskeletal complaints would reduce costs or improve recognition of potentially treatable psychiatric disorders.

Adolescent↗
PubMed1998

Priming and aging: an electrophysiological investigation of N400 and recall.

Twenty young (20.5 years) and 20 middle-aged academics (57.2 years) performed a priming-recall task which was presented in three blocks. In each block, participants read 40 word pairs after which a recall task had to be carried out. Half of the word pairs were highly associated while the others were low associated. Targets showed the N400 of the middle-aged group to be both delayed and smaller in amplitude for low-associated items. N400 of primes, however, showed no age-related latency difference but was smaller for the middle-aged group due to a positive shift. It is argued that this shift possibly indicates age differences in semantic activation or buildup of context. A reanalysis showed individual differences in word pair processing to depend on recall performance. In general, high recallers were found to show a much larger differentiation between low- and high-associated targets. This resulted from a much larger N400 component elicited by low-associated targets and a more positive ERP in the N400-region for the high-associated targets. It is suggested that the middle-aged subjects activated the expected target word to a level at least equivalent to the younger subjects, but that the activated network itself was larger/less selective particularly in subjects showing a low recall.

Adult↗
PubMed1998

The effects of kainic acid lesions on locomotor responses to haloperidol and clozapine.

Spontaneous and amphetamine-elicited locomotor activity in rats is reduced by most clinically effective antipsychotic drugs. We have recently demonstrated that intracerebroventricular infusion of kainic acid (KA), which produces cell loss in the hippocampus and other limbic-cortical brain regions, increases spontaneous and amphetamine-elicited locomotion. The present study determined if KA lesions alter the suppressive effects of the antipsychotic drugs, haloperidol and clozapine, on spontaneous and amphetamine-elicited locomotor behavior. Young adult male rats (70 days of age) received intracerebroventricular infusions of vehicle or KA, which produced hippocampal pyramidal cell loss in each rat and more variable cell loss or gliosis in the amygdala, piriform cortex, and laterodorsal thalamus. Thirty days post-surgery, lesioned and control rats were tested once a week for locomotor responses to drug treatments. As observed previously, spontaneous locomotor activity and hyperactivity elicited by amphetamine (1.50 mg/kg s.c.) were greater in lesioned animals than controls. In addition, the level of spontaneous activity and/or amphetamine-elicited hyperlocomotion observed in lesioned rats after haloperidol treatment (0.13, 0.35, or 1.50 mg/kg s.c.) was greater than that found in controls. Locomotor responses to low (6.30 mg/kg) and moderate doses of clozapine (20 mg/kg) were similar in lesioned and control rats, although lesioned rats were more active than controls following the administration of a high dose of clozapine (30 mg/kg). These data indicate that the hyperactivity associated with limbic-cortical lesions may be insensitive to reversal by haloperidol, yet uniquely sensitive to suppression by clozapine.

Amphetamine↗
PubMed1998

Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up.

BACKGROUND: Although physical complaints account for over half of all ambulatory visits, surprisingly little is known about their natural history and factors affecting prognosis. OBJECTIVES: Our aims were to determine the outcome in general medical patients presenting with physical complaints and to delineate which factors impact upon recovery rates. METHODS: In this cohort study, 500 adults presenting to a general medicine clinic with a chief complaint of a physical symptom were interviewed in order to determine symptom characteristics, the presence of depressive or anxiety disorders, and expectations regarding the visit. Outcomes were assessed immediately post-visit and at 2 weeks and 3 months. The primary outcome was symptomatic improvement, and secondary outcomes included functional status, unmet expectations, satisfaction with care and visit costs. RESULTS: The majority (70%) of patients improved by 2 weeks follow-up and, of those who had not, 60% got better within 3 months. Moreover, relapse in patients initially better at 2 weeks was uncommon (6%) in the ensuing several months. While symptoms of recent onset had the highest improvement rates, half of those patients whose symptom had been present a year or longer also improved within 2 weeks. Improvement rates varied somewhat by symptom type, but no specific symptom had an improvement rate of less than 50%. Patients who had not improved at 2 weeks were more likely to report continuing serious illness worry, unmet expectations, functional impairment and dissatisfaction, even 3 months after the initial visit. CONCLUSION: Most general medical patients with physical complaints improve within 2 weeks of their initial clinic visit. Further attention may best be focused on the minority of patients who fail to improve and experience continuing concerns and impairment.

District of Columbia↗
PubMed1998

Chronic medications in the perioperative period.

BACKGROUND: While most chronic medications can be safely continued in the perioperative period, decisions regarding certain medications remain controversial. METHODS: We mailed a questionnaire to all 150 anesthesiology program directors in the United States, with 113 (75%) responding. Opinions regarding preoperative discontinuance or modification of selected medications were assessed. RESULTS: Antiplatelet agents are typically discontinued preoperatively, although the number of days varies widely. Few respondents discontinue tricyclic antidepressants, oral contraceptives, diuretics, or oral hypoglycemic agents. For a patient on insulin, the most popular regimen is half the patient's usual dose of neutral protamine Hagedorn insulin (50%) or no preoperative insulin (37%), whereas an insulin infusion for tight control was rarely advised. Respondents varied widely in their approach to steroid coverage, their cancellation of elective operations in patients with inadvertent aspirin ingestion, and the length of time before surgery they would discontinue warfarin. In patients with chronic atrial fibrillation, 72% of respondents favored use of a heparin window preoperatively. CONCLUSIONS: Practice variations regarding insulin regimens, steroid coverage, aspirin, and anticoagulants reflect a lack of firm evidence favoring one approach.

Adult↗
PubMed1998

A randomized trial comparing three methods of bowel preparation for flexible sigmoidoscopy.

OBJECTIVE: The aim of this study was to assess the optimum method of bowel preparation for flexible sigmoidoscopy. METHODS: A total of 164 adults undergoing flexible sigmoidoscopy at an ambulatory clinic were randomized to receive one of three preparations: a single hyperphosphate enema 1 h before the procedure; a hyperphosphate enema given 1 and 2 h before the procedure; or a hyperphosphate enema administered 1 and 2 h before the procedure, preceded by a 296 ml bottle of magnesium citrate taken p.o. the night before. Patients completed surveys on preparation and procedure comfort and satisfaction. The performing endoscopist assessed preparation quality, procedure duration, and depth of sigmoidoscope insertion. RESULTS: All three preparations were equally well tolerated with slightly more diarrhea reported among patients receiving magnesium citrate (p = 0.007). The addition of magnesium citrate resulted in more procedures rated by the endoscopist as excellent or good (RR 1.5, 95% CI: 1.3-1.9), deeper sigmoidoscope insertion (56 vs 51 cm, p = 0.0036), fewer procedures requiring repeat preparation (RR: 0.21, 95% CI: 0.04-0.98) and more procedures rated by patients as discomfort free (RR: 2.2, 95% CI: 1.39-3.60). Excellent and good preparations were associated with shorter procedure duration (19 vs 14 min, p = 0.008) and greater depth of insertion (56 vs 50 cm, p = 0.003). Fewer diverticuli were noted with a single enema than the two enema preparation (p = 0.006) with the remaining outcomes equal between these two groups. CONCLUSION: The addition of bottle of magnesium citrate to a 2-hyperphosphate enema preparation is well tolerated and improves bowel preparation for flexible sigmoidoscopy.

Abdominal Pain↗
PubMed1998

Accuracy of measurements of hemoglobin and potassium in blood samples from peripheral catheters.

OBJECTIVE: To compare measurements of hemoglobin and potassium in blood samples obtained from peripheral venous catheters with measurements in samples obtained via venipuncture. SUBJECTS: 53 adult volunteer patients admitted to a medical ward. METHODS: For each patient, a 10-mL blood sample was obtained from a 20-gauge or larger peripheral venous catheter after a 3-mL volume of fluid was discarded. Immediately afterward, additional samples were obtained by venipuncture, and all samples were sent to the laboratory for measurement of hemoglobin and potassium levels. Separate venipuncture samples were obtained from both extremities in another 10 subjects to assess intratechnique variation. Results were analyzed by using limits-of-agreement analysis. RESULTS: Blood samples were successfully obtained from a peripheral catheter in 32 (60%) of the 53 patients. The success rate was 78% with 18-gauge catheters and 42% with 20-gauge catheters (P = .021). The 95% agreement interval in the set of differences between values for samples obtained via catheter and samples obtained via venipuncture was +/- 0.37 mmol/L for potassium and +/- 7.6 g/L for hemoglobin. The 95% agreement interval for the venipuncture control group was +/- 0.21 mmol/L for potassium and +/- 7.3 g/L for hemoglobin. The preset acceptable interval for potassium measurements was +/- 0.3 mmol/L, and that for hemoglobin measurements was +/- 10 g/L. CONCLUSIONS: Obtaining blood samples from peripheral catheters is an acceptable alternative to venipuncture for hemoglobin measurements but not for potassium measurements. Larger gauge catheters are better than small-gauge catheters for obtaining blood samples.

Adult↗
PubMed1997

A meta-analysis of zinc salts lozenges and the common cold.

BACKGROUND: In the United States, the common cold has been estimated to cost more than $3.5 billion a year. Despite several randomized clinical trials, the effect of treating colds with zinc salts lozenges remains uncertain because of conflicting results. OBJECTIVE: To conduct a meta-analysis of published randomized clinical trials on the use of zinc salts lozenges in colds using a random effects model. RESULTS: Eight clinical trials of treating adults with zinc salts lozenges were identified. After excluding 2 studies that used nasal inoculation of rhinovirus, 6 trials were combined and analyzed. The summary odds ratio for the presence of any cold symptoms at 7 days was 0.50 (95% confidence interval, 0.19-1.29). CONCLUSION: Despite numerous randomized trials, the evidence for effectiveness of zinc salts lozenges in reducing the duration of common colds is still lacking.

Administration, Oral↗
PubMed1997

The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis.

BACKGROUND: Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results. METHODS: Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto. RESULTS: Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81). CONCLUSION: Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.

Acyclovir↗
PubMed1997

The effects of kainic acid lesions on dopaminergic responses to haloperidol and clozapine.

The antipsychotic drugs haloperidol and clozapine have the common action of increasing dopamine metabolism in the striatum (nucleus accumbens, caudate-putamen) of the rat. Intracerebroventricular administration of kainic acid (KA) produces neuronal loss in limbic-cortical brain regions which project directly or indirectly to the striatum. In the present study, dopamine metabolism in subregions of the striatum was examined in rats with KA lesions after acute and chronic haloperidol or clozapine administration. The main findings was that the elevating effect of acute haloperidol treatment on the dopamine metabolite, DOPAC, was blocked in the nucleus accumbens shell and diminished in medial and laterodorsal caudate-putamen of the KA-lesioned rats. In addition, the elevating effects of both acute and chronic haloperidol treatment on dopamine turnover were attenuated in the laterodorsal caudate-putamen of KA-lesioned rats. The levels of dopamine, DOPAC, and HVA after chronic clozapine treatment were greater in KA-lesioned than control rats. These results indicate that dopaminergic responses to haloperidol may be diminished by limbic-cortical neuropathology, while such pathology does not significantly alter dopaminergic responses to clozapine.

Animals↗