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Biomedical subjects

R Johnson

Publications and source records attributed to R Johnson.

At least 721 records · Page 40Linked to original sources
PubMedDate not supplied

Air medical response for illness revisited.

INTRODUCTION: A previous study (1988-1990) suggested that the majority of air medical scene transports for illness in the Columbus, Ohio, service area were inappropriate. The current study followed an aggressive prehospital educational program (1991-1993) that continued during the study. The question asked: Did this educational program make a difference? METHODS: A descriptive, retrospective review of all patients transported from the scene of illness to tertiary care by air. SETTING: A single air medical transport service with a rural service area encompassing most of central and southeastern Ohio. RESULTS: In the 27 months ending September 1993, there were 3,669 completed missions and 1,039 scene missions. Twenty-seven patients transported for illness included 11 males and 16 females, with an average age of 22.3 years. Significant differences between 1988-90 and 1991-93 included: Number--10% vs. 2.6% (2,414 vs. 3,669), diagnosis arrest--29.4% vs. 3.7%, diagnosis seizure--14.7% vs. 48.1%, tertiary care needed--20.6% vs. 70.4%, helicopter needed--0.0% vs. 29.6%. Total mission volume increased (2,414 vs. 3,669) while the percent scene total volume remained constant (28.3%). CONCLUSION: An aggressive educational program led to a significant decrease in inappropriate helicopter use in the service area studied.

Adult↗
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Quality of life and pain in patients with recurrent breast and gynecologic cancer.

Pain is a central factor affecting quality of life for the cancer patient. This descriptive study was designed to explore the relationship between pain and several factors affecting quality of life. The factors explored included physical and social functioning, emotional health, and spiritual commitment in women with recurrent breast or gynecologic cancer. Pain frequency, amount, and interference with activities were found to correlate more strongly with objective measures of quality of life (i.e., physical and social functioning) than subjective measures (i.e., psychological or spiritual dimensions).

Adult↗
PubMedDate not supplied

Trauma and nontrauma cardiopulmonary arrest: a national survey.

INTRODUCTION: This survey attempts to identify the current standard of care for the air medical transport of the patient in cardiopulmonary arrest. METHOD: An Association of Air Medical Services/National Flight Nurses Association-approved survey by a single mailing with an anonymous response. SETTING: All rotor-craft programs with current memberships in AAMS. RESULTS: Fifty-three of the 178 questionnaires mailed were returned. Program demographics, crew composition and transport volumes were typical of other reported national experiences. The majority of programs (84%) had standing operational protocols for trauma and non-trauma cardiopulmonary arrests. The indications for not initiating or discontinuing CPR, the transport of the patient in cardiopulmonary arrest, triage and financial considerations varied widely between air medical programs. CONCLUSIONS: This study provides some insight on the current air medical management of the patient in cardiopulmonary arrest. National practice guidelines should be developed and tested prospectively in future studies.

Air Ambulances↗
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Storage of platelet concentrates after high-dose ultraviolet B irradiation.

Ultraviolet B (UVB) irradiation of platelet concentrates (PCs) may prevent the development of posttransfusion HLA alloimmunization. As irradiation performed in a blood center or a hospital will probably be associated with a variable postirradiation delay before transfusion, the ability to store PCs after UVB irradiation becomes important. The effects have been studied of a UVB dose of 10,000 mJ per cm2, the dose used in our institution for UVB clinical trials, on PCs pooled and stored for up to 96 hours after irradiation. Results showed that after 96 hours of storage, though there were no changes in pH, platelet count, white cell count, percent discharge of lactate dehydrogenase, or beta-thromboglobulin, there were significant decreases in morphology score and osmotic recovery. These changes, however, were not evident after 24 hours of storage. Similarly, there was a 60-percent decrease in immunoreactive membrane glycoprotein (GP) Ib after 96 hours of storage, but these changes were not seen after 48 hours of storage. No changes were seen in levels of GPIIb/IIIa in either group during the 96 hours of storage. On computer-analyzed two-dimensional polyacrylamide gel electrophoresis, PCs irradiated at 10,000 mJ per cm2 and stored for 72 hours had changes in over 50 platelet proteins as compared to those proteins in nonirradiated age-matched control PCs. It can be concluded that UVB irradiation of PCs at 10,000 mJ per cm2 does not lead to significant platelet deterioration after short-term storage (24-48 hours) but is likely to be deleterious after long-term (72-96 hours) storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Banks↗
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Cognitive and mood-state changes in patients with chronic fatigue syndrome.

In this paper the cognitive and psychiatric impairments associated with chronic fatigue syndrome (CFS) and related disorders are reviewed. It is concluded that while acute mononucleosis and infection with Epstein-Barr virus occasionally result in impaired cognition, such changes have not yet been objectively verified in patients with CFS. However, when patients with CFS are carefully studied, concurrent or premorbid psychiatric disorders are revealed at a greater than chance level. Finally, some suggestions are offered regarding improved neuropsychological assessment of fatigue, concentration, and attention for patients with CFS. The findings to date, while suggesting that psychological predisposition may play a role in the expression of CFS, are still inconclusive regarding the etiology of CFS.

Cognition Disorders↗
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Reducing patient restraint use.

This assessment tool can help nurses identify the reasons a patient may require restraint, and find alternative or less-restrictive measures. After using it for 13 months, the staff from one hospital reduced restraint use by 95%--to less than 1% of total patient days.

Humans↗
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A strategy for service--Disney style.

The organization's customer service philosophy was established over 35 years ago by its founder. Today, every aspect of the resorts and theme parks is geared to serve--and satisfy--its "guests."

Commerce↗
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Custody and caring: clinical placement of student nurses in a forensic setting.

TOPIC: Clinical placement of student nurses in a forensic setting during their psychiatric nursing course. SOURCE: Curriculum at the College of Nursing, University of Saskatchewan. GOAL: To describe a unique setting for learning psychiatric nursing. CONCLUSION: Forensic settings provide an opportunity for students nurses, educators, and clinicians to work together to learn and to provide excellent care.

Clinical Competence↗
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Relation between mouth and haematogenous infection in total joint replacements.

OBJECTIVE: To investigate the source of infections associated with orthopaedic prostheses. DESIGN: Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries. SUBJECTS: Four adults (three men) aged 58-83. RESULTS: For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries. CONCLUSIONS: The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

Aged↗
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Teleradiology as a foundation for an enterprise-wide health care delivery system.

An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.

Appointments and Schedules↗