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Biomedical subjects

K R Jones

Publications and source records attributed to K R Jones.

At least 55 records · Page 3Linked to original sources
PubMed1998

Surgical correction of primary hyperparathyroidism improves quality of life.

BACKGROUND: The SF-36 health status assessment tool is well suited for measuring the morbidity associated with primary hyperparathyroidism (HPT). The purpose of this study was to test the hypothesis that surgical correction of primary HPT leads to measurable improvement in patient reported functional health status and well-being. METHODS: For the past 4 years patients with primary HPT have been asked to complete the SF-36 and to provide additional demographic and condition-specific information for study before operation. They then completed the SF-36 again by mail 2 months and 6 months after operation. RESULTS: One hundred forty patients entered the study through March 1998; 110 patients completed follow-up at 2 months and 82 at 6 months. Marked impairment compared to population norms occurred before operation in 7 of 8 domains of health status. Substantial improvement occurred in 5 of 8 domains of health status at 2 months and in 6 of 8 domains at 6 months. Statistically significant improvement was demonstrated in limitations caused by physical and emotional role function, social function, bodily pain, and vitality. CONCLUSIONS: Successful operation to correct primary HPT significantly improves patient reported functional health status and quality of life. Most improvement is seen within 2 months, but additional improvement in both physical and mental function is seen at 6 months.

Adult↗
PubMed1998

Measuring health-status improvement after surgery: experience with the SF-36.

The outcomes of care delivery are increasingly being measured and managed by health care providers and clinicians. The authors describe an outcomes monitoring program implemented in one tertiary care center that uses both generic and condition-specific instruments to monitor patient recovery after routine surgery. The SF-36 Health Survey was shown to be a useful tool for measuring changes in functional status and well-being after inguinal hernia repair, cholecystectomy, and parathyroidectomy. Recommendations for its successful adoption in a clinical setting are presented.

Activities of Daily Living↗
PubMed1997

Core outcomes measures for inguinal hernia repair.

BACKGROUND: Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes. METHODS: Beginning in March 1994, a convenience sample of patients scheduled for IH repair completed a series of questionnaires addressing a range of patient case mix and outcomes dimensions, including demographics, comorbid conditions, SF-36 health status (Medical Outcomes Study 36-item short-form health survey), and condition-specific questions, expectations, and responses to the surgical experience before and after operation. Surgical data were abstracted from the medical records. RESULTS: One hundred three patients were entered in the study; 63 completed 2-month reports and 44 completed 6-month reports. Acceptance of the study and response rates were excellent. Differences in health status associated with IH have been identified in two SF-36 domains, and changes in function after repair noted in several others, supporting the applicability of this measure. Outcomes may also differ by type of hernia and type of repair performed. CONCLUSIONS: A core outcomes measurement set for IH that encompasses demographics, comorbidities, health status, expectations, utilization, and condition-specific data provides a portrait of patient outcomes that is useful to providers and patients, and combined with cost and satisfaction data, it can be used for benchmarking and improving surgical care.

Adult↗
PubMed1997

Policy issues associated with analyzing outcomes of care.

Policy questions associated with the conduct of outcomes studies are addressed and outcomes management and outcomes research are differentiated. Multiple outcomes initiatives are being undertaken in the United States, from the institutional to national and international levels. Nurses have had limited involvement, thus far-although the array of outcomes being examined is considerable. Members of an American Academy of Nursing expert panel on quality health care discuss the environmental context and multiple focuses of outcomes analysis. They provide an overview of current activities, present the challenges confronting nursing in its pursuit of a quality assessment agenda, and make recommendations for increasing nurses' participation in quality initiatives.

Health Planning Guidelines↗
PubMed1996

Characterization of IS199 from Streptococcus mutans V403.

The complete nucleotide sequence of the insertion sequence IS199 has been determined. This novel element was found in Streptococcus mutans V403 where DNA hybridization studies suggested that it was present in multiple copies on the genome. IS199 is 1220 bp and appears unique to the mutans streptococci. A limited epidemiological survey revealed this element to occur infrequently in this group (4/50 strains examined). IS199 belongs to the IS3 family of procaryotic insertion sequence elements. It contained tandem open reading frames (ORFs) reminiscent of the structure of the IS3 class. Additionally, the larger of the two ORF products (ORFB) exhibited amino acid sequence similarities to comparable proteins from IS3 and other elements of this family. Transposition of IS199 gave rise to a 3-bp target site duplication. We were able to insert an antibiotic resistance gene into IS199 enabling us to follow the transposition of this element in S. mutans V403.

Amino Acid Sequence↗
PubMed1996

Assessment of patient outcomes after operation for primary hyperparathyroidism.

BACKGROUND: We have used the SF-36, an accepted health status assessment tool, in conjunction with condition-specific clinical information, to assess patient-reported health status before and after operation for primary hyperparathyroidism (1 degree HPT). METHODS: Beginning in March, 1994, a convenience sample of patients has been asked to complete the SF-36 and provide additional demographic and condition-specific information for study. The SF-36, which measures eight components of functional status and well-being, is completed in person before operation and again by mail at 2 and 6 months after operation. Clinical and condition-specific data are gathered at the same times. RESULTS: Fifty-nine patients have entered the study; 56 had abnormal parathyroid tissue removed. Patients with 1 degree HPT have lower SF-36 scores in all health domains at baseline than do healthy patients. At 2 months, scale scores for emotional role limitations and bodily pain improved by more than 10 points. At 6 months all eight scale scores showed improvement, seven of eight by 10 points or more. Commensurate improvements in HPT-specific measures were also seen. CONCLUSIONS: Patient-reported measurements of health outcomes after parathyroidectomy for 1 degree HPT show improvement in all aspects of health status 6 months after operation. Most dramatic improvements were reported in reduction of bodily pain and in improved vitality and emotional and physical function. Surgical correction of 1 degree HPT improves patient health status and quality of life.

Adult↗
PubMed1996

Using elements of the nursing minimum data set for determining outcomes.

To measure the contribution of nursing activities to patient outcome achievement requires a standardized language for documentation and retrieval of critical data elements. This pilot study explored the utilization of elements of the Nursing Minimum Data Set (NMDS) in a sample of patients undergoing parathyroidectomy. Results support the importance of nursing management's role in creating reliable systems that capture the critical elements of care delivery. The successful use of any system for documentation and for research will be dependent on education of the staff in the various taxonomies being used.

Adult↗
PubMed1996

Immunologic characteristics of a Streptococcus mutans glucosyltransferase B sucrose-binding site peptide-cholera toxin B-subunit chimeric protein.

Glucosyltranferases (Gtfs) produced by the mutans streptococci are recognized as virulence factors in dental caries, and the inhibition of Gtfs by secretory immunoglobulin A is predicted to provide protection against this disease. The basis of such mucosal immunity is linked to the ability to reliably stimulate production of secretory immunoglobulin A against Gtfs. In this regard, we are exploring the immunogenicities of various Gtf peptides genetically fused to the B subunit of cholera toxin (CTB), a known mucosal adjuvant. In this work, we have created a gene fusion linking the GtfB active-site (AS) peptide DANFDSIRVDAVDNVDADLLQIA to the amino terminus of CTB. This sequence, deduced from the nucleotide sequence of gtfB from Streptococcus mutans GS5, has been found to be strongly conserved in Gtfs from several mutans streptococci. We have purified this recombinant protein (AS:CTB) from Escherichia coli carrying the fusion gene under the control of the lactose operon promoter. This protein was immunogenic in rabbits and produced specific serum antibodies against both the Gtf peptide and the CTB moiety. The antiserum was tested for its ability to inhibit GtfB activity obtained from a mutant of S. mutans able to make only this enzyme and none of the other usual Gtfs or fructosyltransferase. Approximately 50% of the GtfB activity was inhibited in such assays. These results suggest that the AS of this enzyme is accessible to antibody binding and that this region of the protein may be considered a vulnerable target for vaccine design and development. The AS:CTB was able to bind GM1, ganglioside in enzyme-linked immunosorbent assays, indicating that the recombinant protein retained this property, which is though to be critical to the mucosal immunoadjuvant properties of CTB. Thus, this protein may be promising as a candidate anticaries vaccinogen alone or in combination with other Gtf peptides or conjugates.

Adjuvants, Immunologic↗
PubMed1996

Systemic adenovirus infection associated with high mortality in mule deer (Odocoileus hemionus) in California.

Seventeen counties in northern California experienced epizootics of high mortality in the mule deer (Odocoileus hemionus) population during the latter half of 1993. Thirteen deer submitted to the California Veterinary Diagnostic Laboratory System as part of this natural die-off had systemic adenovirus infection. Pulmonary edema was present in all 13 deer. Erosions, ulceration, and abscessation of the upper alimentary tract occurred in 7/13 deer. Four of 13 deer had hemorrhagic enteritis. All 13 deer had widespread systemic vasculitis with endothelial intranuclear inclusions. Fluorescein isothiocyanate-labeled antibody directed against bovine adenovirus type 5 bound to antigen in endothelial cells. Adenovirus was identified by transmission electron microscopy within the nuclei of endothelial cells in 6/6 deer examined. An adenovirus was isolated from lung homogenates of one deer that were cultured on black-tailed deer pulmonary artery endothelial cells. With the exception of the intranuclear inclusions evident on histologic evaluation, gross and histologic changes were similar to those described for bluetongue virus infection and epizootic hemorrhagic disease virus infection in white-tailed deer. Nine additional deer were emaciated and had pharyngeal abscesses with focal vasculitis, which may represent the chronic affects of previous nonfatal adenovirus infection.

Adenoviridae↗
PubMed1996

Inventory management.

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Financial Management, Hospital↗