Search PubMed⌕ Search

Biomedical subjects

V Johnson

Publications and source records attributed to V Johnson.

At least 55 records · Page 3Linked to original sources
PubMed1996

Simplifying the assessment of rural emergency medical services trauma transport.

OBJECTIVES: The authors determine whether assessments of effects of rural emergency medical service (EMS) system characteristics on trauma outcomes (using patient-level data) are significantly biased if the Injury Severity Score (ISS) is not available. METHODS: The data are from ambulance trip reports merged with the trauma registry data for the Georgia EMS region VI trauma center hospital, located in Augusta. All 294 trauma patients for the rural counties surrounding Richmond County for the calendar year 1991 who were not dead at the scene and were treated at the trauma center are included. A 20% random sample of trauma patients from Richmond county from May to September 1991 not dead at the scene and treated at the trauma center yielded an additional 96 cases. Excluding 43 patients with missing data yields 347 trauma cases with 18 trauma deaths. A logistic regression model for trauma mortality is estimated using the Revised Trauma Score (RTS), ISS, type of trauma, and patient age (analogous to the standard Trauma Related Injury Severity Score model). The predicted probability of patient mortality from this model is compared with the predicted probability of mortality when the logistic regression model omits ISS. Correlations between the difference in predicted probability (i.e., the error in predicted probability associated with the omitted ISS variable) and EMS system characteristics are determined. RESULTS: Although ISS adds to the predictive power of the trauma outcome model, the errors in predicted probabilities associated with the omission of ISS generally are small and uncorrelated with patient or EMS system characteristics, with the exception of patient gender. CONCLUSIONS: In rural settings, where a patient's ISS generally is not available, studies of rural EMS system characteristics and trauma outcomes may use RTS, patient age, and type of trauma to control for expected survival. The patient's ISS does not appear to be essential, at least for the rural area analyzed in this study.

Emergency Medical Services↗
PubMed1996

Managed care and physician/hospital integration.

This paper examines the extent to which hospitals and physicians use new organizational structures designed to facilitate contracting with managed care firms and the extent to which this use is associated with managed care revenue. The data come from a nationally representative sample of 1,495 U.S. community hospitals responding to a 1993 survey about different organizational structures. The results indicate that only 23.3 percent of hospitals participate in at least one form. Hospitals with more than 15 percent of revenues from managed care are twice as likely to participate and favor forms that provide tighter linkages with physicians.

Delivery of Health Care, Integrated↗
PubMed1996

Regression of Kayser-Fleischer rings during oral zinc therapy: correlation with systemic manifestations of Wilson's disease.

Fourteen patients presenting with neuropsychiatric manifestations of Wilson's disease were treated with oral tetrathiomolybdate (TM) for 8 weeks followed by oral zinc (Zn) maintenance therapy. The patients were evaluated prospectively at baseline and at yearly intervals for up to 5 years by slit-lamp biomicroscopy and photography, quantitative neurologic and speech pathology examinations, 24-h urine copper collection, and a quantitative scoring of magnetic resonance imaging (MRI) of the brain. Kayser-Fleischer (KF) ring size decreased significantly during the 5-year study period (p < 0.0001). Although results of neurologic examination, speech pathology examination, and 24-h urine copper level analysis in symptomatic Wilson's disease patients improved during the study period, KF ring regression did not correlate with the improvement in these clinical parameters (p > 0.05). However, there was a correlation between MRI scores and KF ring regression (p = 0.02). Anticopper therapy with TM followed by zinc maintenance therapy is a safe and effective treatment for patients with neurologically symptomatic Wilson's disease. This treatment leads to reduction in KF ring size; however, KF ring reduction is not a good predictor of clinical improvement for patients with neuropsychiatric manifestations of Wilson's disease.

Administration, Oral↗
PubMed1995

The relationship between parent and offspring comorbid disorders.

Data concerning alcohol and drug abuse and dependence, depression, and antisocial behaviors, among both subjects and their parents, were obtained from a community sample of 1,201 young adults. Although 35% of the sample exhibited alcohol abuse or dependence, 14% marijuana or cocaine abuse or dependence, and 22% reported a parent positive for alcoholism, evidence of comorbidity with depression or antisocial personality was generally rare among both parents and subjects. Over one third of the subjects were negative both for family history and any disorder of their own and 20% reported a problem in both themselves and in one or both parents. These findings lend only partial support for Winokur's depression spectrum disease hypothesis, in that diagnosed children of depressed-only families have a 30% chance of exhibiting substance abuse or dependence alone, whereas diagnosed children of alcoholic-only families have only a 7% chance of exhibiting depression alone.

Adolescent↗
PubMed1995

Pharmacotherapy of depression in children.

Depression can interfere with the overall functioning of children and adolescents. It can impair normal cognitive and social development. The use of antidepressant medications in children and adolescents has grown in the past decade. Newer antidepressant agents, the selective serotonin reuptake inhibitors, appear very promising, but their safety and efficacy have not been established for children. This review focuses on depression and the design of studies for its treatment with newer antidepressant drugs in children.

Adolescent↗
PubMed1995

Rural emergency medical services: patients, destinations, times, and services.

This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams.

Adolescent↗
PubMed1995

Assessing and tracking family histories of alcoholism.

OBJECTIVE: This study sought to (1) determine the rates of family history of alcoholism among a community sample, using both specific questions and structured interviews, (2) document conversions from negative (FH-) to positive (FH+) alcoholism diagnoses among parents and grandparents of subjects, and (3) investigate the concordance between interview and questionnaire methods in assessing alcoholism in family members. METHOD: Information concerning alcoholism among relatives of a sample of 1,201 (620 female) probands was gathered longitudinally over a 13-year period, spanning adolescence into adulthood. At Times 1 through 3 of the study, information was gleaned from personal interviews with subjects, medical health forms and information from subjects' parents, which was used to determine a "best estimate diagnosis." At Time 4, the Family History Research Diagnostic Criteria (FH-RDC) interview was used. RESULTS: The number of subjects having an alcoholic relative increased at each test time with the largest rise occurring at Time 4. Over 80% of subjects whose parent converted to FH+ at Time 4 had previously described that parent as a heavy or problem drinker. CONCLUSIONS: The higher than previously seen escalation in FH+ status occurring at Time 4 is speculated to be the result of one or more of the following: an actual increase in the number of relatives becoming alcoholic, a newfound awareness on the part of probands about alcohol-related problems, the fact that a global judgment or single behavior observation provides an inadequate indication of familial alcoholism, or that the FH-RDC may include a more global measure of "alcohol-related problems" or "problem drinking."

Adolescent↗
PubMed1994

Treatment of Wilson's disease with ammonium tetrathiomolybdate. I. Initial therapy in 17 neurologically affected patients.

OBJECTIVE: To test the efficacy and toxicity of a new drug, ammonium tetrathiomolybdate, in the initial treatment of a relatively large series of patients presenting with neurologic signs and symptoms caused by Wilson's disease. The key aspect of efficacy was to preserve the neurologic function present at the onset of therapy. DESIGN: An open study of 17 patients treated for 8 weeks each. Neurologic function was evaluated by frequent quantitative neurologic and speech examinations. Several copper-related variables were studied to evaluate the effect of the drug on copper, and a large number of biochemical and clinical variables were studied to evaluate potential toxicity. Patients were then followed up at yearly intervals, with follow-up periods of 1 to 5 years reported. SETTING: A university hospital referral setting INTERVENTION: Patients were generally treated for 8 weeks with tetrathiomolybdate, followed by zinc maintenance therapy. MAIN OUTCOME MEASURES: Neurologic function was evaluated by quantitative neurologic and speech examinations. RESULTS: None of the patients suffered a loss of neurologic function. Copper status and potential further toxic effects were generally well controlled quickly. No toxic effects resulted from administration of tetrathiomolybdate. During the ensuing period of follow-up of 1 to 5 years, neurologic recovery in most patients was good to excellent. CONCLUSIONS: Tetrathiomolybdate appears to be an excellent form of initial treatment in patients with Wilson's disease presenting with neurologic signs and symptoms. In contrast to penicillamine therapy, initial treatment with tetrathiomolybdate does not result in further, often irreversible neurologic deterioration.

Adolescent↗
PubMed1994

Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy.

Very little has been published about the characteristics and sequelae of dysphagia in children with neurological impairment. The swallowing difficulties encountered by children with spastic cerebral palsy are particularly debilitating and potentially lethal. However, aggressive evaluation and management of their feeding is typically deferred until they are medically or nutritionally compromised. Reports of the use of videofluoroscopy to analyze the swallowing patterns and presence or absence of aspiration in such children are rare. This paper describes the histories and analyzes the videofluorographic swallow studies of 22 patients with the primary diagnosis of severe spastic cerebral palsy. The ages of the subjects ranged from 7 months to 19 years. All had severe dysphagia and were slow, inefficient eaters. Fifteen patients (68.2%) demonstrated significant silent aspiration during their swallow study. Analysis of specific features of their swallowing patterns indicated that decreased or poorly coordinated pharyngeal motility was predictive of silent aspiration. Moderately to severely impaired oral-motor coordination was indicative of severity of feeding complications. Our data suggest that early diagnostic workup, including baseline and comparative videofluoroscopic swallow studies, could be helpful in managing the feeding difficulties in these children and preventing chronic aspiration, malnutrition, and unpleasant lengthy mealtimes.

Adolescent↗
PubMed1994

Structure-activity studies of allatostatin 4 on the inhibition of juvenile hormone biosynthesis by corpora allata: the importance of individual side chains and stereochemistry.

The production of juvenile hormone III (JH III) by the corpora allata of the cockroach Diploptera punctata is regulated in part by peptides originating from the brain. One group of these peptides, termed allatostatins, reversibly inhibits the biosynthesis of JH in vitro. Allatostatin 4 (AST4: Asp-Arg-Leu-Tyr-Ser-Phe-Gly-Leu-amide) is the smallest member of the AST family yet defined and was used as the benchmark peptide for these initial structure-activity studies. Two initial analog series of AST4 were examined for the ability of each analog to inhibit JH biosynthesis by corpora allata in vitro. Each analog series consisted of analogs that contained a single amino acid change from the native AST4 sequence. The first series contained Ala replacement analogs and the second contained analogs with D-amino acid replacements. The first analog series used Ala replacements to help indicate which amino acid side chains were most important for inhibition of JH biosynthesis. The most important side chain appeared to be Leu8 followed by Phe6 and Tyr4. Additionally, the D-amino acid series suggested that a secondary structural element(s) at the C-terminus of AST4 could be important to the biological activity.

Amino Acid Sequence↗
PubMed1994

Prevention of mercuric chloride induced histopathological changes in the small intestine of mice with LIV-52.

Mercuric chloride was administered in drinking water to mice at 1 mM and 5 mM for 100 and 30 days respectively. Lower concentration caused mild pathological changes in the small intestine while higher concentration caused severe pathological changes. Pathological symptoms were less pronounced when Liv52 was administered along with 5 mM mercuric chloric and Hg-induced changes were totally absent when drug was used along with 1 mM HgCl2 solution. After Hg-exposure at both concentrations mice were allowed to recover naturally or with drug (Post-therapy). Again, use of drug appeared useful. At least under laboratory conditions this herbal drug seems to reduce Hg-induced pathological changes in small intestine of mice.

Animals↗
PubMed1994

Treatment of Wilson's disease with zinc. XIII: Therapy with zinc in presymptomatic patients from the time of diagnosis.

The siblings of patients with newly diagnosed Wilson's disease are each at 25% risk of also having this autosomal recessive disease. Screening these siblings allows their detection and institution of prophylactic therapy before they become clinically ill. Herein we report the successful treatment of 13 presymptomatic patients with zinc acetate. These patients who received zinc have been followed for 3 to 9 years. In well-complying patients, 24-hour urine copper and non-ceruloplasmin plasma copper levels have decreased over years of follow-up, consistent with the elimination of the excess easily mobilized copper (the potentially toxic copper) of the body. Effect of therapy and compliance are easily monitored by following 24-hour urine zinc and copper levels. The urine copper level is a good reflection of the body's excess load of easily mobilizable copper. It will increase if control is not adequate. A decrease in urine zinc is an early signal that the patient's compliance is not optimal. The levels of hepatic copper in response to several years of zinc therapy may remain the same, go down, or go up temporarily. This is a reflection of zinc induction of hepatic metallothionein, which sequesters copper in a non-toxic pool. Hepatic copper levels should not be used to manage therapy. Liver function is well preserved by zinc therapy, and no zinc toxicity occurred in these 13 patients. No patient developed symptoms related to Wilson's disease. We conclude that zinc acetate is a fully effective and non-toxic therapy for the prophylactic treatment of the presymptomatic Wilson's disease patient.

Adolescent↗