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Biomedical subjects

J R Hall

Publications and source records attributed to J R Hall.

At least 55 records · Page 3Linked to original sources
PubMed1990

Analysis of residents' performances on the In-Training Examination of the American Board of Anesthesiology-American Society of Anesthesiologists.

An analysis of the results of the In-Training Examination of the American Board of Anesthesiology-American Society of Anesthesiologists has been developed using a new question-categorization method and a new form of calculation, the resident index score. Resident index scores permit comparison of the performance of any program's residents with the performance of all U.S. residents who took the examination. This study analyzed examination results from eight residency programs for a five-year period, 1983-1987. Statistically significant differences in the residents' performances were found both within and among the residency programs during this time. Areas of educational strength and weakness were identified by levels of training for each program. The analyses of the individual programs' results were provided to the respective program directors on a confidential basis, and have been used to change curriculum content, modify lectures for residents, and provide structured review for residents. Similar analyses can be provided as a service to other residency program directors.

Achievement↗
PubMed1990

How to initially manage a pediatric trauma patient.

1. Pediatric trauma care should be organized to assess the airway, breathing, circulation, disability/neurological status, and exposure of the child. 2. Because they have different body proportions, children may present with slightly different injuries than an adult. 3. Children react to trauma differently than adults. They may compensate for an extended period with tachypnea and tachycardia before cardiorespiratory failure occurs.

Adolescent↗
PubMed1990

Critical-care medicine and the acute-care laboratory.

Critical-care medicine today is practiced by anesthesiologists, internists, pediatricians, and surgeons. Outcome from today's management of critically ill patients is very good, yet associated costs are very high. Over one-half of the hospital costs of critically ill patients emanates from the intensive-care unit (ICU), although the ICU stay accounts for less than 20% of their time in the hospital. Outside of the operating room, the ICU is the most expensive location for patient care in the hospital, and laboratory tests are the most expensive single item. Plans for cost containment should incorporate the following: more effective data management, education of practitioners about appropriateness and costs of tests, conversion from laboratory measurements to appropriate in vivo and ex vivo measurements, and real-time utilization assessment. To provide high-quality, cost-effective critical care in the future, laboratorians and clinicians must work together today to meet the challenges of technology, data management, and staff education.

Blood Chemical Analysis↗
PubMed1989

A double-blind comparative study of fluoxetine and dothiepin in the treatment of depression in general practice.

Fluoxetine, a selective inhibitor of 5-HT uptake, was compared to dothiepin in a double-blind study of 6 weeks duration in 100 depressed patients (male and female) drawn from 8 general practices. Only those who scored at least 17 on the first 17 questions of the Hamilton Psychiatric Rating Scale for Depression (HAM-D) were selected. Both groups improved throughout the trial, though the dothiepin treated patients tended to improve quicker. However, by the end of the trial there was no statistically significant difference between the 2 groups. Subset analyses of HAM-D scores associated with anxiety and sleep revealed no statistically significant differences between the 2 treatments though improvement in anxiety scores was marginally greater for those receiving fluoxetine by the end of the trial. Other global assessments by patients and doctors confirmed the changes in HAM-D scores. Statistically significant weight changes occurred between visits 1 and 5. Whereas fluoxetine-treated patients lost weight (p less than 0.05), dothiepin-treated patients gained weight (p = 0.05) over this period. Adverse effects were reported in 27 patients given fluoxetine and 20 dothiepin. Of these, 14 fluoxetine and 7 dothiepin-treated patients withdrew before the end of the trial. The most common adverse effects were nausea, vomiting and diarrhoea in the fluoxetine group and tiredness, drowsiness and diarrhoea in the dothiepin group. There were no haematological or clinical chemistry changes.

Adolescent↗
PubMed1989

The mortality of childhood falls.

Falls accounted for 5.9% of the childhood deaths due to trauma in a review of the medical examiner's files in a large urban county. Falls represented the seventh leading cause of traumatic death in all children 15 years of age or younger, but the third leading cause of death in children 1 to 4 years old. The mean age of those with accidental falls was 2.3 years, which is markedly younger than that seen in hospital admission series, suggesting that infants are much more likely to die from a fall than older children. Forty-one per cent of the deaths occurred from "minor" falls such as falls from furniture or while playing; 50% were falls from a height of one story or greater; the remainder were falls down stairs. Of children falling from less than five stories, death was due to a lethal head injury in 86%. Additionally, 61.3% of the children with head injuries had mass lesions which would have required acute neurosurgical intervention. The need for an organized pediatric trauma system is demonstrated as more than one third of the children were transferred to another hospital, with more than half of these deteriorating during the delay. Of the patients with "minor" falls, 38% had parental delay in seeking medical attention, with deterioration of all. The trauma system must also incorporate the education of parents and medical personnel to the potential lethality of "minor" falls in infants and must legislate injury prevention programs.

Accidental Falls↗
PubMed1989

An in vivo examination of rat brain during sepsis with 31P-NMR spectroscopy.

Neurological symptoms including lethargy, obtundation, and confusion are early and common findings in patients with sepsis. The etiology of the mental status changes that occur during severe infection is not known. We investigated the effects of sepsis on the levels of high-energy phosphates to determine whether decreased energy metabolism was a factor in the depressed neurological state. The time course of changes in brain pH and brain high-energy phosphate metabolites during an Escherichia coli infusion was determined from sequential phosphorus-31 nuclear magnetic resonance (31P-NMR) spectra of ketamine-xylazine-anesthetized rats. A second group of rats received 0.9% saline infusion and served as a control group. Despite severe obtundation and near loss of righting reflex, the rats in the septic group had no significant differences in the brain pH, the ratio of phosphocreatine (PCr) to beta-adenosine 5'-triphosphate (beta-ATP), or in the ratio of PCr to Pi. The only significant decrease in brain high-energy phosphates or pH occurred terminally in the septic rat group and corresponded with a rapidly falling arterial blood pressure. We conclude that the severe neurological depression that is characteristic of sepsis is not due to decreased levels of brain high-energy phosphates or brain acidosis.

Adenosine Triphosphate↗
PubMed1988

A highly conserved amino-acid sequence in thrombospondin, properdin and in proteins from sporozoites and blood stages of a human malaria parasite.

As a consequence of gene cloning and DNA sequencing several gene families are emerging in the field of cell-cell recognition. These include immunoglobulins, integrins, certain extracellular glycoproteins and a family of functionally unrelated proteins which include factor B. We report here the cloning and sequencing of a gene from Plasmodium falciparum, coding for a protein we call thrombospondin related anonymous protein (TRAP), which shares certain sequence motifs common to other well-characterized proteins. The most significant homology is based around the sequence Trp-Ser-Pro-Cys-Ser-Val-Thr-Cys-Gly (WSPCSVTCG), present in three copies in region I of thrombospondin (TSP), six copies in properdin (P) and one copy in all the circumsporozoite (CS) proteins sequenced so far. TRAP also shares with certain extracellular glycoproteins, including TSP, the cell-recognition signal Arg-Gly-Asp (RGD), which has been shown to be crucial in the interaction of several extracellular glycoproteins with members of the integrin superfamily. Unlike the CS protein, TRAP is expressed during the erythrocytic stage of the parasite life cycle.

Amino Acid Sequence↗
PubMed1988

Percutaneous drainage in emphysematous pyelonephritis--an alternative to major surgery.

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney associated with the production of gas, usually found in diabetic patients. Experience of this condition reported in the literature suggests that vigorous medical treatment and early nephrectomy are advisable. We report a case in which percutaneous renal drainage combined with medical therapy produced not only complete recovery of the patient, but also preservation of renal function on the affected side.

Aged↗
PubMed1987

Effects of wound exudates on in vitro immune parameters.

Although local failure of antibacterial host defenses in the surgical wound may contribute to the development of wound infections, little attention has been focused on this problem. The goals of the current study were to determine the biological activity of postsurgical wound exudates (seroma fluids) on normal neutrophil and lymphocyte function and to quantitate the levels of complement and plasma fibronectin in these wound exudates. The wound exudates did not support the opsonophagocytosis and killing of Staphylococcus aureus or Pseudomonas aeruginosa by control neutrophils as well as serum (P less than 0.01) and was inferior to serum as a neutrophil chemoattractant (P less than 0.01). Similarly, the wound exudates did not support mitogen-induced lymphocyte blastogenesis as well as normal serum (P less than 0.01). The impaired function of both neutrophils and lymphocytes incubated in the wound exudates appeared to be due to a lack of normal humoral factors, rather than to the presence of inhibitory factors, since the addition of normal serum to the wound exudates restored cellular activity to normal. The findings of decreased levels of plasma fibronectin and decreased complement hemolytic activity in the wound exudates were consistent with the concept of a local deficiency of immune-related humoral factors. Thus, this study supports the clinical concept that local collections of wound fluids may predispose to wound infections by hampering effective local host defenses.

Adult↗
PubMed1987

Familial dyskeratotic comedones. A report of three cases and review of the literature.

Three family members, at initial evaluation, had generalized comedonal lesions with histologic changes of acantholysis and dyskeratosis. A total of nine cases of this entity, termed familial dyskeratotic comedones, have been documented in the literature. It appears to have autosomal dominant inheritance and onset in childhood or adolescence. Lesions are asymptomatic except for occasional pruritus or inflammation, and general health is undisturbed. A history of acne vulgaris is seen in four of nine patients and is the only associated skin disease. Treatment with oral isotretinoin produced no improvement in two patients. Electron microscopy revealed changes similar to those seen in Darier's disease.

Acantholysis↗
PubMed1985

Comparison of venous digital subtraction angiography and aortography in patients with peripheral vascular disease of the lower limbs.

Twenty-eight patients referred for peripheral vascular imaging were investigated by both venous digital subtraction angiography and conventional aortography. A comparison of the two techniques revealed that, in the femoral region, venous digital subtraction angiography demonstrated all the abnormalities shown by aortography but missed three major and eight minor stenoses in the iliac region, due largely to bowel artefacts.

Angiography↗