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Biomedical subjects

R E Johnson

Publications and source records attributed to R E Johnson.

At least 199 records · Page 11Linked to original sources

Denominator definition by the utilization correction factor method.

Most clinical research in the United States has been carried out in atypical populations. This study, done in a network of primary care populations in Virginia, calculates the denominator by the utilization correction factor method and compares the demography with that of the population of the state. The demographic characteristics of the patients in the network are very similar to those of the underlying populations and on the same order of state-of-the-art sampling methods in current use.

Adolescent↗

Comparing HMO physicians' attitudes towards NPs and PAs.

This study examined the attitudes of physicians working in health maintenance organizations toward the use of nurse practitioners and physician assistants. It also explored some of the underlying reasons for these attitudes: effect upon quality of care, risk of malpractice, role threat and gender bias. The setting was a health maintenance organization serving 270,000 members. The data were derived from a survey of physicians' attitudes and behavior. Physicians from internal medicine, pediatrics and obstetrics-gynecology were the study population. Internists and pediatricians had favorable attitudes toward both nurse practitioners and physician assistants. Obstetrician-gynecologists had somewhat less favorable attitudes. Physicians in all three specialties favored nurse practitioners more than physician assistants. Physicians felt that nurse practitioners were more likely to increase the quality of care and less likely to increase the risk of malpractice. Nurse practitioners were not seen as a greater role threat. Some gender bias appeared to be present, but it did not appear to constrain the use of nurse practitioners. Large, multi-specialty, prepaid group practice health maintenance organizations may be favorable settings for nurse practitioners and physician assistants to practice primary care.

Attitude of Health Personnel↗

Human psychopharmacology of ketocyclazocine as compared with cyclazocine, morphine and placebo.

The activity of ketocyclazocine, a putative kappa opioid receptor agonist, was studied and compared with that of morphine, a mu opioid receptor agonist, and cyclazocine, a putative kappa and sigma opioid receptor agonist, vs. placebo in 10 drug abusers. The measures included vital signs and pupil measurements, established and new observer- and subject-completed psychopharmacologic questionnaires and several methods of drug discrimination. The results indicate that ketocyclazocine is different from morphine-like agonists in that it produces only minimal miosis and lacks euphoriant action. It causes a dysphoric state and was clearly discriminated from morphine. The dysphoria and pattern of responses was similar to cyclazocine though ketocyclazocine was discriminated from cyclazocine. This is consistent with the concept that morphine and ketocyclazocine have separate modes of primary activity. The similarity between ketocyclazocine and cyclazocine obscures the assignment of particular drug effects to activity at the kappa receptor.

Adult↗

Erythromycin in the treatment of acute bronchitis in a community practice.

To assess the efficacy of erythromycin in treating acute bronchitis, 52 adults were enrolled in a randomized trial comparing a one-week course of erythromycin with placebo. Among smokers, no difference in outcome was noted. Among nonsmokers, trends favored more rapid resolution of key symptoms in the erythromycin group, but these trends did not generally achieve statistical significance. These results suggest a trial with a larger sample size.

Acute Disease↗

Genital herpes and pregnancy.

In addition to the morbidity of genital herpes, there is also significant morbidity and mortality in neonatal herpes. A woman with a history of herpes infection should be counseled about the risks in pregnancy and advised to discuss this information with her physician during future pregnancies. Neonatal morbidity and mortality can be reduced by prenatal screening of women in high-risk groups and by appropriate use of cesarean section in women with active genital herpes at term.

Cesarean Section↗

Clonidine in morphine withdrawal. Differential effects on signs and symptoms.

Reports of an antiwithdrawal effect for clonidine hydrochloride in acute opioid withdrawal are inconsonant with experimental findings that other nonopioids are ineffective. In the present investigation the antiwithdrawal effects of clonidine, morphine sulfate, and placebo were compared in volunteer addicts whose dependence was maintained by 15 mg of morphine sulfate given subcutaneously four times daily. Clonidine was effective but had a differential effect on the signs and symptoms of morphine abstinence. Compared with morphine, clonidine was more effective in suppressing autonomic signs of abstinence but less effective in reducing subject-reported symptoms and discomfort. It is concluded that the perception of the clinical usefulness of clonidine depends on whether objective measures or subjects' reports are treated.

Clonidine↗

Does the surgeon's annual case load make a difference in the quality of peripheral vascular surgery? A report of the mortality, morbidity, and long-term results of 101 procedures performed over 93 months.

The outcome of 101 peripheral vascular procedures performed during 93 months was reviewed to determine the quality of the results. Quality was defined as the following: series mortality rate, frequency and significance of complications, cumulative patency rate for bypass grafts, amputation rate, survival following abdominal aneurysm surgery, and neurologic events associated with carotid procedures. The series mortality rate was 4%; 44 procedures were free of complications; patency rates were not significantly different from published reports; the initial amputation rate was 7.4%; and only one out of ten patients was known to have died following aneurysm surgery. Neither of the two carotid procedures included neurologic complications. These data suggest that factors other than a surgeon's annual case load may influence the quality of the results and point out the need to further study this question in light of current admission criteria for the vascular surgery examination.

Adolescent↗

Course and prognosis of sarcoidosis in a nonreferral setting. Analysis of 86 patients observed for 10 years.

Analysis of the course and prognosis of 86 patients with sarcoidosis over a 10-year period of observation in a nonreferral setting (Kaiser-Permanente Medical Care Program), a prepaid health maintenance organization, revealed no deaths or severe disability due to respiratory failure or cor pulmonale among 12 patients in whom pulmonary fibrosis either was present or developed during the period of observation. The prognosis by stage and overall was not influenced by race. Because of the method of disease identification that was chosen, it is believed the favorable outcome observed more closely approximates the course and prognosis of sarcoidosis as it occurs in the population in general than do series emanating from institutional settings.

Adult↗

Plasticity in the 904-day-old male rat cerebral cortex.

Ten pairs of male Long-Evans rats living in nonenriched environments (3 rats per small cage) were transferred to either enriched environments (10 rats per large cage plus "toys") or nonenriched environments (2 rats per small cage) at 766 days of age. One hundred and thirty-eight days later, at 904 days of age, the cerebral cortical thickness from these animals was measured on projected, 10-micron, thionine-stained, transverse sections. Although the thickness in the enriched rats was greater than in the nonenriched rats in all sections through the frontal, parietal, and occipital cortices, the 4 to 10% differences were statistically significantly different in only the frontal and occipital cortices. Right greater than left cortical thickness differences were not statistically significant in either the enriched or the nonenriched animals by 904 days of age. Neuron and glial counts were made on enlarged photographs of area 18 in the occipital cortex on 6-micron-thick, luxol fast blue-stained sections. No significant differences in cell counts were noted between the enriched and nonenriched animals. No significant differences in neuronal counts were found among 108-, 650- (from previous experiments), and the 904-day-old nonenriched rats. The notable findings were the plasticity of the extremely old, enriched rats' occipital cortex and the lack of the loss of neurons in cerebral cortical area 18, whether or not the environments were enriched. These results showed that the cerebral cortex remained structurally plastic throughout the lifetime of the organism.

Age Factors↗

Acquired immunodeficiency syndrome among patients attending hemophilia treatment centers and mortality experience of hemophiliacs in the United States.

The acquired immunodeficiency syndrome (AIDS) was first recognized among hemophiliacs in 1982. The authors have conducted investigations to determine the onset and incidence of AIDS among hemophiliacs and to determine trends in hemophilia mortality since the introduction of clotting-factor concentrates in the late 1960s. A survey of United States hemophilia treatment centers, supported by the Centers for Disease Control and the National Hemophilia Foundation, defined a population of hemophiliacs which was monitored for AIDS cases through June 1984. Death reports from the United States Vital Statistics System and from the hemophilia treatment center survey provided mortality trends for 1968-1979 and for 1978-1982, respectively. The results of these investigations demonstrate the following points. 1) The AIDS epidemic is a new and important cause of illness and mortality among hemophiliacs, although a very low incidence of AIDS among hemophiliacs prior to 1982 cannot be ruled out. 2) The AIDS cases who attended the surveyed hemophilia treatment centers were distributed throughout the United States and were older than hemophilia treatment center patients without AIDS. AIDS cases also used more lyophilized clotting-factor concentrate, but only a small number of cases were reported with this information. 3) Improved care for hemophilia, including the use of clotting-factor concentrates, dramatically reduced hemophilia mortality rates during the 1970s. 4) In 1982, hemorrhage was the major cause of death among hemophiliacs. Deaths from non-alcoholic liver disease were also increased. AIDS incidence among hemophilia treatment center attendees was stable at 0.6 cases per 1,000 hemophilia treatment center attendees per year during 1982 and 1983 but increased sharply to 5.4 cases per 1,000 during the first quarter of 1984.

Acquired Immunodeficiency Syndrome↗

Colonic angiodysplasia and blood loss.

Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy.

Angiography↗