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Biomedical subjects

R Jackson

Publications and source records attributed to R Jackson.

At least 523 records · Page 29Linked to original sources
PubMedDate not supplied

Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: a multi-center study.

OBJECTIVE: To assess whether socioeconomic status (SES) or race is associated with adverse outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: A convenience sample of OHCA of presumed cardiac origin from seven suburban cities in Michigan, 1991-1996. Median household income (HHI), utilizing patient home address and 1990 census tract data, was dichotomized above and below 1990 state median income. Patient race was dichotomized as black or white. Outcome was defined as survival to hospital discharge (DC). Multiple logistic regression and Pearson's chi2 values were used for analysis. RESULTS: Of 1317 cases with complete data for analysis, the average age was 67.3 +/- 16.0, 939 (71.1%) were white, 587 (44.4%) arrests were witnessed (WIT), and 65 (4.9%) were DC alive. There was no significant difference between races with respect to WIT arrests, V(T)/V(F) arrest rhythms, and a small difference in EMS response interval. Whites were more likely to be above median HHI (57.1 vs. 26.2%, P < 0.001). Adjusted odds ratios for predictors of survival were WIT arrest (OR = 3.76, 95% CI (1.7, 8.2)), V(T)/V(F) (OR = 8.74, 95% CI (3.7, 10.8), but not race (OR = 0.68, 95% CI (0.3, 1.4)) or SES (OR = 1.51, 95% C1 0.8, 2.8). CONCLUSION: In this population, neither race nor SES was independently associated with a worse outcome after OHCA.

Black or African American↗
PubMedDate not supplied

Domoic acid: neurobehavioral and neurohistological effects of low-dose exposure in adult rats.

Adult rats treated IP with domoic acid at 0, 0.22, 0.65, or 1.32 mg/kg were tested for passive avoidance (PA), auditory startle (AS), or conditioned avoidance (CAR) behaviors. Clinical signs were observed only at the 1.32 mg/kg dose level. Within 24 h of dosing, rats surviving a dose of 1.32 mg/kg exhibited transient decreased body weight and exaggerated AS responding. Startle latency and habituation, PA, and CAR were not affected. Examination of brains from six rats per group revealed a subset (2/6) of animals receiving 1.32 mg/kg domoic acid with degenerating neurons in the hippocampal CA1/CA3 subregions and gliosis. The decreased body weight and increased startle suggest a hyperreactivity syndrome possibly related to neuronal degeneration in the hippocampus. In a separate experiment, domoic acid at an IP dose of 0.93 mg/kg was found to produce hypomotility in addition to a decrease in body weight. Both effects were reduced by pretreatment with scopolamine (2 mg/kg), but not with caffeine (30 mg/kg), indicating a possible cholinergic involvement in domoate's toxicity.

Acoustic Stimulation↗
PubMedDate not supplied

Effects of EMS transportation on time to diagnosis and treatment of acute myocardial infarction in the emergency department.

INTRODUCTION: Recent studies have documented decreased time to emergency department (ED) thrombolytic therapy with the use of prehospital electrocardiography. PURPOSE: Is the time to ED diagnosis and treatment of acute myocardial infarction (AMI) patients with thrombolytic agents decreased by emergency medical services (EMS) transport when compared with those transported by other means (non-EMS)? DESIGN: Retrospective, case-control study. POPULATION: The AMI patients treated with thrombolytic agents at a 34,000-visit, community hospital ED during 1992. METHODS: Review of records of patients who received thrombolytic therapy for AMI. Statistical analysis was performed using "Student's" t-test and Yates corrected Chi-square (chi 2). RESULTS: Eighty-seven patients received thrombolytic agents for AMI during 1992; 33 arrived by ambulance, 54 arrived by other methods. There were no differences in age, gender, or time of ED arrival among these groups. Ambulance patients received standard advanced life support (ALS) care, but not a 12-lead electrocardiogram (ECG) or thrombolytic agents. Ambulance patients experienced a significantly shorter time to first ECG (12.9 +/- 9.1 min. versus 20.8 +/- 25.3 min.; p = .028) and received thrombolytic therapy sooner than did controls (56.0 +/- 31.5 min. versus 78.0 +/- 63.4 min.; p = .018). There was no difference in time from diagnosis to treatment between these groups. CONCLUSION: Emergency medical services transport of AMI patients in this study decreased time to diagnosis and treatment and may be a confounder in studies that assess the value of field EMS interventions. Non-EMS AMI patients did not receive as rapid diagnosis and treatment, and emergency physicians should evaluate and address this issue in their departments.

Ambulances↗
PubMedDate not supplied

Outcomes of cardiac arrest in the nursing home: destiny or futility? [see comment].

OBJECTIVE: To compare EMS system characteristics and outcomes between nursing home (NH) patients and out-of-hospital cardiac arrest (OHCA) patients whose arrests occurred in a residence (home). DESIGN: Prospective cohort study reviewing OHCA from July 1989 to December 1993. Variables were age, witnessed arrest, response intervals, automated external defibrillator (AED) use, and arrest rhythms. Outcomes were hospital admission and discharge. Pearson chi-square was used for analysis. SETTING: Suburban EMS system. SUBJECTS: Patients > or = 19 years old with arrest of presumed cardiac cause, with locations at home or at a NH. RESULTS: 2,348 total arrests were complete for analysis, 182 at a NH and 2,166 at home. BLS and ALS response intervals were shorter for the NH patients. The NH patients were more likely to receive CPR on collapse, were older (73.1 vs 67.5 years, p < 0.001), were less likely to have had an AED used (9.9% vs 30.0%, p < 0.001), and were more likely to have an arrest bradyasystolic rhythm (74.7% vs 51.5%, p < 0.001). They were less likely to survive to hospital admission (10.4% vs 18.5%, p < 0.006) and discharge (0.0% vs 5.6%, p < 0.001). CONCLUSION: During this four-and-a-half-year study period, no NH patient survived, even though % CPR was increased. Arrest rhythm is an important factor in this finding. EMS initial care for ventricular tachycardia/fibrillation NH patients, with less application of AEDs, was identified. This different response may adversely contribute to dismal NH outcome.

Adult↗
PubMedDate not supplied

A preliminary study of the reliability of immediate vs. delayed interviews of cardiac arrest witnesses.

INTRODUCTION: Methods to characterize the interval between a collapse from cardiac arrest until a 911 call is made have not yet been developed. OBJECTIVE: To determine the concordance of cardiac arrest data obtained by two methods: an immediate nurse interview of out-of-hospital cardiac arrest (OHCA) witnesses, and a follow-up phone interview performed two weeks later. METHODS: This was a prospective study of OHCA witnesses dating from January 1997 to May 1998. Witnesses were briefly interviewed at the time of emergency department presentation, and two weeks later a more lengthy structured phone interview was performed. The authors identified key data elements: 1) was the arrest witnessed? (Wit); 2) was CPR administered prior to EMS arrival? (BCPR); 3) was the first call placed to 911? (c911); and 4) was the estimated collapse to call interval <4 minutes? (ECCI). The analysis utilized Cohen's kappa statistic and Spearman's correlation coefficient. RESULTS: A convenience sample of 42 matched pairs of OHCA cases was analyzed. Kappa statistics for agreement between methods were: 1) Wit(kappa = 0.750), 2) BCPR(kappa = 0.892), 3) c911 (kappa = 0.892), and 4) ECCI(kappa = 0.571, Spearman's 0.528). CONCLUSION: There is good to excellent agreement between immediate and phone interview data retrieval methods. Phone interviews appear to yield data comparable to that with the more difficult and expensive, direct interview method.

Aged↗
PubMedDate not supplied

Immunological concept for Bell's palsy: further experimental study.

This report concerns itself with additional experimental evidence to support the immunologic concept for the pathogenesis of Bell's palsy, using the mast cell as an index of immunological activity. In a previous experimental study, we postulated that degranulation of mast cells activated by complement or specific allergens with release of histamine and other substances may be the mechanism leading to nerve edema, ischemia, and paralysis. In this study we observed a loss of granulated mast cells in the more severely damaged facial nerves of immunized dogs after the intrafallopian canal injection of various substances, in contrast with the relative abundance of these cells in nerves that showed little or no evidence of injury. In addition, we demonstrated that cromolyn sodium, a mast cell degranulation inhibitor, when infused intravenously at the time of the intrafacial canal injection of horse serum, very effectively lessened the degree of experimental paralysis and histologic nerve injury.

Animals↗
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Treatment of symptomatic foot and ankle deformities in the nonambulatory neuromuscular patient.

Thirteen nonambulatory patients, aged 7 to 15 years and with neuromuscular disease, had residual foot and ankle deformities secondary to persistent and continued muscular imbalance around the ankle and foot. Surgical procedures were done to correct these fixed contractures so that the ankle was neutral and the foot plantigrade at the conclusion of the procedures. Despite successful attainment of the preoperative objectives, surgery should not be performed unless the following indications are present: severe pain, skin breakdown and/or ulceration, and the inability for the foot and ankle to accept reasonably costing and available shoe wear. Recurrence occurs if AFOs (ankle-foot orthoses) are not used after the surgical releases.

Achilles Tendon↗