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Bolster MB, Kolfenbach J, Poeschla A, Criscione-Schreiber L, Hant F, Ishizawar R, Jonas B, Leverenz D, O'Rourke KS, Wolfe RM, Zickuhr L. Incorporating Telemedicine in Rheumatology Fellowship Training Programs: Needs Assessment, Curricular Intervention, and Evaluation. Arthritis Care Res (Hoboken) 2023; 75:2428-2434. [PMID: 37232060 DOI: 10.1002/acr.25165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To increase the confidence of rheumatology fellows in training (FITs) in delivering virtual care (VC) and prepare them for independent practice, we developed educational materials addressing gaps in their skills. METHODS We identified gaps in telemedicine skills based on FIT performance in a virtual rheumatology objective structured clinical examination (vROSCE) station on VC delivery using video teleconference technology and survey (survey 1) responses. We created educational materials including videos of "mediocre" and "excellent" VC examples, discussion/reflection questions, and a document summarizing key practices. We measured change in the confidence levels of FITs for delivering VC with a post-intervention survey (survey 2). RESULTS Thirty-seven FITs (19 first-year, 18 second- plus third-year fellows) from 7 rheumatology fellowship training programs participated in a vROSCE and demonstrated gaps in skills mapping to several Rheumatology Telehealth Competency domains. Confidence levels of FITs improved significantly from survey 1 to survey 2 for 22 of 34 (65%) questions. All participating FITs found the educational materials helpful for learning and reflecting on their own VC practice; 18 FITs (64%) qualified usefulness as "moderately" or "a lot." Through surveying, 17 FITs (61%) reported implementing skills from the instructional videos into VC visits. CONCLUSION Continually assessing our learners' needs and creating educational materials addressing gaps in training are requisite. Using a vROSCE station, needs assessments, and targeted learning with videos and discussion-guidance materials enhanced the confidence level of FITs in VC delivery. It is imperative to incorporate VC delivery into fellowship training program curricula to ensure breadth in skills, attitudes, and knowledge of new entrants into the rheumatology workforce.
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Affiliation(s)
| | | | | | | | - Faye Hant
- Medical University of South Carolina, Charleston
| | | | - Beth Jonas
- University of North Carolina at Chapel Hill
| | | | | | - Rachel M Wolfe
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Callahan LF, Hawk V, Rudd R, Hackney B, Bhandari S, Prizer LP, Bauer TK, Jonas B, Mendys P, DeWalt D. Adaptation of the health literacy universal precautions toolkit for rheumatology and cardiology - applications for pharmacy professionals to improve self-management and outcomes in patients with chronic disease. Res Social Adm Pharm 2013; 9:597-608. [PMID: 23867753 DOI: 10.1016/j.sapharm.2013.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 02/21/2013] [Accepted: 04/22/2013] [Indexed: 11/25/2022]
Abstract
Over a decade of research in health literacy has provided evidence of strong links between literacy skills of patients and health outcomes. At the same time, numerous studies have yielded insight into efficacious action that health providers can take to mitigate the negative effects of limited literacy. This small study focuses on the adaptation, review and use of two new health literacy toolkits for health professionals who work with patients with two of the most prevalent chronic conditions, arthritis and cardiovascular disease. Pharmacists have a key role in communicating with patients and caregivers about various aspects of disease self-management, which frequently includes appropriate use of medications. Participating pharmacists and staff offered suggestions that helped shape revisions and reported positive experiences with brown bag events, suggestions for approaches with patients managing chronic diseases, and with concrete examples related to several medicines [such as Warfarin(©)] as well as to common problems [such as inability to afford needed medicine]. Although not yet tested in community pharmacy sites, these publically available toolkits can inform professionals and staff and offer insights for communication improvement.
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Affiliation(s)
- Leigh F Callahan
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
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Desai RJ, Hansen RA, Rao JK, Wilkins TM, Harden EA, Yuen A, Jonas DE, Roubey R, Jonas B, Gartlehner G, Lux L, Donahue KE. Mixed treatment comparison of the treatment discontinuations of biologic disease-modifying antirheumatic drugs in adults with rheumatoid arthritis. Ann Pharmacother 2012; 46:1491-505. [PMID: 23092868 DOI: 10.1345/aph.1r203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Introduction of biologic disease-modifying antirheumatic drugs (DMARDs) has considerably changed treatment options for rheumatoid arthritis (RA) over the past decade. Very little information is available on comparative discontinuation rates of the biologics. OBJECTIVE To compare treatment discontinuations for 9 biologic DMARDs in adults with RA. METHODS We searched electronic databases through May 2012 to retrieve randomized controlled trials (RCTs) of patients with RA that compared biologic DMARDs with placebo or another biologic DMARD. The primary outcome was treatment discontinuation during the blinded phase of the trials, measured as overall withdrawals, withdrawals resulting from lack of efficacy, and withdrawals resulting from adverse events. Random-effects meta-analysis estimated the effect size for individual agents, and adjusted indirect comparisons were made between biologics using mixed treatment comparisons (MTC) meta-analysis. RESULTS Forty-four trials were included in the analysis. In comparison with placebo, biologics were less likely to be withdrawn because of lack of efficacy (OR 0.22, 95% CI 0.17 to 0.27) and more likely to be withdrawn because of an adverse event (OR 1.41, 95% CI 1.16 to 1.70). Based on the MTC, certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates resulting from lack of efficacy than adalimumab, anakinra, and infliximab. Anakinra had higher relative withdrawal rates resulting from lack of efficacy than most other biologics. Certolizumab and infliximab had more, while etanercept had fewer, withdrawals because of adverse events than most other drugs. CONCLUSIONS Based on MTC using data from RCTs, differences in discontinuation rates were observed, generally favoring certolizumab, etanercept, and rituximab over other biologic DMARDs. These potential differences need to be further explored in head-to-head trials or well-conducted observational studies.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Craig SM, Yu F, Curtis JR, Alarcón GS, Conn DL, Jonas B, Callahan LF, Smith EA, Moreland LW, Bridges SL, Mikuls TR. Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol 2009; 37:275-81. [PMID: 20032100 DOI: 10.3899/jrheum.090705] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the prevalence of vitamin D insufficiency and the associations of vitamin D concentration with disease status in African Americans with rheumatoid arthritis (RA). METHODS Study participants (n = 266) were enrolled in the Consortium for the Longitudinal Evaluation of African Americans with Early RA (CLEAR) Registry. The vitamin 25(OH)-D was measured on baseline plasma, and associations of 25(OH)-D with disease status (baseline and at 3 years' disease duration) were examined using univariate and multivariate regression. RESULTS The prevalence of 25(OH)-D insufficiency (<or= 37.5 nmol/l or 15 ng/ml) was 50%, with the highest prevalence in winter. In unadjusted analyses, vitamin D concentrations were inversely associated with baseline pain (p = 0.04), swollen joints (p = 0.04), and Disease Activity Score (DAS28, p = 0.05) but not with measures at 3 years' disease duration. There were no multivariate associations of 25(OH)-D with any disease measures at baseline or at 3 years, with the exception of a positive borderline association with rheumatoid factor positivity at enrollment (p = 0.05). CONCLUSION Vitamin D insufficiency is common in African Americans with recent-onset RA. Unadjusted associations of circulating vitamin D with baseline pain, swollen joints, and DAS28 were explained by differences in season, age, and gender and were not significant in multivariate analyses. In contrast to reports of Northern Europeans with early inflammatory arthritis, there are not strong associations of 25(OH)-D concentration with symptoms or disease severity in African Americans with RA.
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Affiliation(s)
- Steven M Craig
- University of Nebraska Medical Center, Nebraska Arthritis Outcomes Research Center (NAORC), Omaha Veterans Affairs Medical Center, Omaha, Nebraska 68198-6270, USA
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Jonas B, Tossmann P, Lang P, Strüber E, Tensil M. Konsummuster von Cannabis unter Nutzern eines internetbasierten Selbsttests zur Suchtprävention. Suchttherapie 2009. [DOI: 10.1055/s-0029-1242741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tensil MD, Jonas B, Lang P, Strunk M, Tossmann P. Evaluation eines vollautomatischen internetbasierten Rauchausstiegsprogramms für Jugendliche und junge Erwachsene. Suchttherapie 2009. [DOI: 10.1055/s-0029-1240358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mikuls TR, Hughes LB, Westfall AO, Holers VM, Parrish L, van der Heijde D, van Everdingen M, Alarcón GS, Conn DL, Jonas B, Callahan LF, Smith EA, Gilkeson G, Howard G, Moreland LW, Bridges SL. Cigarette smoking, disease severity and autoantibody expression in African Americans with recent-onset rheumatoid arthritis. Ann Rheum Dis 2008; 67:1529-34. [PMID: 18198196 PMCID: PMC2731992 DOI: 10.1136/ard.2007.082669] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association of smoking with clinical and serological features in African Americans with recent-onset rheumatoid arthritis (RA) and to explore whether this association is dependent on the presence of the HLA-DRB1 shared epitope (SE). METHODS In African Americans with recent-onset RA (n = 300), we examined the association of cigarette smoking (current versus past versus never and pack-years of exposure) with anti-cyclic citrullinated peptide antibody, rheumatoid factor (RF) (IgM and IgA), rheumatoid nodules and baseline radiographic erosions using logistic and cumulative logistic regression (adjusting for SE status). We also examined for evidence of interaction between smoking status and SE for all outcomes. RESULTS Although there was no association with RF-IgA seropositivity, current smokers were approximately twice as likely as never smokers to have higher IgA-RF concentrations (based on tertiles; OR = 1.74; 95% CI 1.05 to 2.88) and nodules (OR = 2.43; 95% CI 1.13 to 5.22). These associations were most pronounced in those with more than 20 pack-years of exposure. There was no association of smoking status or cumulative tobacco exposure with anti-cyclic citrullinated peptide antibody, IgM-RF or radiographic erosions. There was also no evidence of a biological or statistical SE-smoking interaction for any of the outcomes examined. CONCLUSIONS This is the first study to systematically examine the association of cigarette smoking with RA-related features in African Americans. Cigarette smoking is associated with both subcutaneous nodules and higher serum concentrations of IgA-RF in African Americans with RA, associations that may have important implications for long-term outcomes in this population.
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Affiliation(s)
- T R Mikuls
- Department of Medicine, University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, NE 68198-6270, USA.
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Wendland KL, Jonas B, Gundel A. Einfluß der Tageszeit auf das EEG bei zerebraler Arteriosklerose. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alcorta DA, Barnes DA, Dooley MA, Sullivan P, Jonas B, Liu Y, Lionaki S, Reddy CB, Chin H, Dempsey AA, Jennette JC, Falk RJ. Leukocyte gene expression signatures in antineutrophil cytoplasmic autoantibody and lupus glomerulonephritis. Kidney Int 2007; 72:853-64. [PMID: 17667990 DOI: 10.1038/sj.ki.5002371] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Leukocytes play a major role in the development and progression of autoimmune diseases. We measured gene expression differences in leukocytes from patients that were antineutrophil cytoplasmic autoantibody (ANCA) positive, patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), and healthy donors to explore potential pathways for clinical intervention. Leukocyte gene expression profiles were determined on Affymetrix U133A/B chips in 88 autoimmune patients, 28 healthy donors, and healthy donor leukocyte cell subtypes that were activated in vitro. Comparison of gene expression in leukocytes identified differentially expressed signature genes that distinguish each donor source. The microarray expression levels for many signature genes correlated with the clinical activity of small vessel vasculitis in the ANCA patients; a result confirmed by quantitative real time-polymerase chain reaction for 16 relevant genes. Comparison with in vitro-activated leukocyte subtypes from healthy donors revealed that the ANCA signature genes were expressed by neutrophils while the SLE signature genes were expressed in activated monocytes and T cells. We have found that leukocyte gene expression data can differentiate patients with RA, SLE, and ANCA-related small vessel vasculitis. Monitoring changes in the expression of specific genes may be a tool to help quantify disease activity during treatment.
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Affiliation(s)
- D A Alcorta
- CB #7155, Division of Nephrology and Hypertension, Department of Medicine, UNC Kidney Center, University Of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Hughes LB, Alarcón GS, Conn D, McNicholl J, Jonas B, Callahan L, Smith E, Gilkeson G, Howard G, Moreland LW, Bridges SL. 361 HLA DRB1 ALLELES IN AFRICAN-AMERICANS WITH EARLY RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS FROM 207 SUBJECTS IN THE CLEAR STUDY. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Eskdale J, McNicholl J, Wordsworth P, Jonas B, Huizinga T, Field M, Gallagher G. Interleukin-10 microsatellite polymorphisms and IL-10 locus alleles in rheumatoid arthritis susceptibility. Lancet 1998; 352:1282-3. [PMID: 9788463 DOI: 10.1016/s0140-6736(05)70489-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Seitz F, Jonas B. Operational definitions for year 2000 objectives: Priority Area 6, Mental Health and Mental Disorders. Healthy People 2000 Stat Notes 1998:1-19. [PMID: 10620825 DOI: 10.1037/e583812012-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grafman J, Jonas B, Salazar A. Wisconsin Card Sorting Test performance based on location and size of neuroanatomical lesion in Vietnam veterans with penetrating head injury. Percept Mot Skills 1990; 71:1120-2. [PMID: 2087366 DOI: 10.2466/pms.1990.71.3f.1120] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We examined Wisconsin Card Sorting Test performance in a large group of brain-damaged patients and controls. No differences were found between patients with frontal lesions only and those with nonfrontal lesions. Patients with left dorsofrontal and anterior temporal lobe lesions committed the most perseverative errors. More analyses regarding requirements for information processing on the Wisconsin Card Sorting Test are needed.
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Affiliation(s)
- J Grafman
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. 20892
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Jabbari B, Geyer C, Gunderson C, Chu A, Brophy J, McBurney JW, Jonas B. Somatosensory evoked potentials and magnetic resonance imaging in syringomyelia. Electroencephalogr Clin Neurophysiol 1990; 77:277-85. [PMID: 1695139 DOI: 10.1016/0168-5597(90)90066-m] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Somatosensory evoked potentials (SEPs) to median and posterior tibial stimulation were obtained in 22 patients with syringomyelia. All patients had magnetic resonance imaging (MR) which defined the maximum transverse diameter of the syrinx as well as its longitudinal extension. SEP was abnormal in 16 (72%) patients. Median and posterior tibial SEPs were abnormal in 11 and 15 patients respectively. Both tests were abnormal in 10 patients. Ten patients showed absence of one or more central potentials (P/N13, N20, N22) and 7 patients demonstrated increased conduction times (N9-N20, P/N13-N20, N22-P40). The mean maximum transverse diameter of the syrinx was 7.5 mm in patients with normal SEPs and 16.2 mm in patients with abnormal SEPs. Abnormal SEP was observed in all 5 patients with loss of position sense, in 9 of 13 (69%) with loss of superficial pain and temperature, and 1 of 2 patients with motor deficit only. Central SEP abnormalities were observed in 3 of 5 patients with sensory deficits indistinguishable from a peripheral neuropathy and in 2 patients in the asymptomatic extremity. Three of 4 patients with syringomyelia and Chiari malformation had a normal SEP.
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Affiliation(s)
- B Jabbari
- Department of Neurology, Walter Reed Army Medical Center, Washington, DC 20307-5001
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Wendland KL, Ruttkowski EF, Gundel A, Jonas B. [Circadian-dependent changes in the EEG of vital elderly humans]. Z Gerontol 1987; 20:230-5. [PMID: 3660921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
UNLABELLED The study was conducted with six women and four men, 70-84 years old, without any psychopathologic signs of organic brain syndrome. Every experiment ran for five days during which closed-eye-EEGs were registered at 8 a.m., at 12 noon, at 4 p.m., and at 8 p.m. of the alert but relaxed patients and recorded on tape for computer processing. Simultaneously with every EEG registration the body temperature was measured. RESULTS As in younger persons the power of the alpha frequency band occipital exceeds the activity of the other frequency bands. But though the frequency of the dominant alpha rhythm comes with 9.5 Hz occipital on an average clearly under the normal range, there was a slight slowing down in sporadic cases. Probably old age leads to a decrease of alpha frequency, even in a state of unaffected sanity. The increase of peak frequency and body temperature during the day, well known from experiments with younger people, comes to the fore in the healthy aged as well. Of striking intensity, especially in the evening, is the beta power at the parietal and the central parts of the scalp, caused possibly by a transitory decline of vigilance. Circadian variations of the different band powers, ascertained in younger persons, are absent in the present collective.
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Affiliation(s)
- K L Wendland
- Abteilung Psychiatrie im Zentrum Nervenheilkunde der Universität Kiel
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Wendland KL, Jonas B, Gundel A. [Effect of the time of day on the EEG in cerebral arteriosclerosis]. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1987; 18:82-7. [PMID: 3111832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED The study was conducted with three men and seven women, 72-84 years old, characterized by psychopathological and clinical signs of cerebral arteriosclerosis (A). All patients suffered from disorder of sleep-waking rhythm. With one exception every experiment ran for five days during which closed-eye-EEGs were registered at 8 a.m., 12 noon, 4 p.m., and 8 p.m. of the alert but relaxed patients and recorded on tape for computer processing. Simultaneously with every EEG registration the body temperature was measured. The findings were compared statistically with corresponding data of a former study conducted with ten healthy aged volunteers (G). RESULTS The dominant peak-frequency of the patients turned out significantly slower than that of the volunteers.--While in healthy persons the peak frequency increased corresponding with the body temperature from the morning to the late afternoon or the early evening respectively, the patients lacked such a correlation, although their temperatures rose gradually in the normal way. In most of the patients the peak-frequency had a remarkable small variety from day to day as well as from scalp-position, and its circadian shift was poor. Psychopathologically these subjects manifested primarily memory loss, general intellectual decline, and in four cases disorientation. On the other hand the EEGs of three women showed substantial greater variety of the peak-frequency from day to day and from scalp-position to scalp-position. Besides the alterations during the day were rather excessive, but lacking any appreciable correspondence with the undisturbed circadian variations of the body temperature. In these three cases psychopathologically personality changes preponderated.
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Lytle RR, Feinstein C, Jonas B. Social and emotional adjustment in deaf adolescents after transfer to a residential school for the deaf. J Am Acad Child Adolesc Psychiatry 1987; 26:237-41. [PMID: 3584025 DOI: 10.1097/00004583-198703000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lindenau KF, Goos H, David H, Krause EG, Jonas B, Liebetruth J, Schubel B, Nöhring J, Warnke H. [Improved protection of the myocardium with a combination of intra-aortic balloon counter-pulsation and aimed substrate administration in acute myocardial infarct--a comparative study]. Z Exp Chir 1982; 15:24-37. [PMID: 7043924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In comparative studies in 36 mongrel dogs it was tried to find out how far intraaortic balloon pumping (IABP) applied solely and in combination with glucose-insulin-potassium (GIK) might influence the degree of acute myocardial ischemia. The ischemia lasted 3 hours. After 60 min myocardial ischemia IABP, the isolated GIK infusion, or the combination of IABP plus GIK were used. The directed GIK application into the aortic root was carried out by electronic triggering during the diastolic augmentation via a precoronary catheter. In the ischemic and in the non-ischemic myocardium of the left ventricle, ATP, creatine phosphate, and lactate were determined. Electronmicroscopical studies were carried out qualitatively as well as quantitatively. The isolated use of IABP suggested no protection of the energy-rich phosphates. The most significant morphological changes were found when exclusively the coronary ligature was applied and when only IABP was used, respectively. The best protective effect was achieved by our technique of the triggered GIK infusion via the precoronary catheter in combination with IABP. The ATP value (n mol/mg w.w.) in the ischemic area was 3.06 and in the non-ischemic one 4.96 in comparison to 1.96 and 3.99, respectively, in the control group. The creatine phosphate (n mol/mg w.w.) was 4.18 in the ischemic and 9.38 in the non-ischemic area in contrast to 2.36 and 6.99, respectively, in the control group. The technique of the triggered drug supply in combination with IABP offers the following advantages: --additive summation of IABP and substrate supply directed to the myocardium --high drug concentration in the myocardium --smaller drug load of the whole organism --clinical use of instable substances.
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Szawlowski K, Przeździak B, Pielowska E, Nyka W, Olszewska J, Lawicki T, Jonas B, Groth K. [Importance of early rehabilitation in infantile cerebral palsy]. Pediatr Pol 1973; 48:997-1004. [PMID: 4753963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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