Placental transfer of theophylline: two case reports.
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Administration, Oral↗
Biomedical subjects
C Friedman
Publications and source records attributed to C Friedman.
Tumors of the head and neck. A 4-year study of a multidisciplinary approach.
A multidisciplinary conference composed of the essential medical, surgical, dental, and allied specialists involved in the region of the head and neck, with resources to call upon other contributors when necessary, was undertaken at a major teaching center in the Northeastern U.S.A. (Long Island Jewish Hillside Medical Center). Meeting on a bimonthly basis with referrals accepted from all sources, but non-publicized, a total of 343 patients were seen over a period of 50 months. The results indicate that optimum patient care can be achieved with a minimum loss of time for treatment initiation and substantial cost savings from these specialists meeting as a group.
Age Factors↗
Pituitary responses to LRH in the postpartum periods.
Pituitary responses to luteinizing-hormone-releasing-hormone (LRH) in the postpartum periods were studied. Following a subcutaneous injection of 100 mug of synthetic LRH to postpartum subjects, no statistically significant changes in the levels of LH and FSH could be demonstrated in five subjects on postpartum day 1 or 3 and the three subjects on postpartum day 8. A normal elevation of LH and FSH following LRH was demonstrated in one subject 36 days post partum. The findings are in agreement with previous studies demonstrating a persistence of pituitary suppression during the early postpartum period. No correlation could be drawn between the pituitary responses to LRH and the plasma levels of estradiol-17 beta and progesterone.
Estradiol↗
The time course of functional and morphological changes of the guinea-pig colon after "a frigore" denervation of the periarterial sympathetic nerves.
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Animals↗
Negative and positive schizophrenic syndromes after the acute phase: a prospective follow-up.
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Acute Disease↗
Prevalence and correlates of skin damage on the hands of nurses.
OBJECTIVE: To describe the prevalence and correlates of skin damage on nurses' hands. DESIGN: Prevalence survey using self-report questionnaire of hand care regimens, problems, and skin condition, and visual examination of the hands at 30X magnification by trained investigators to evaluate degree of skin scaling. SETTING: Four hospitals: two in the Mid-Atlantic and two in the northern United States. PARTICIPANTS: Convenience sample of 410 nurses working 30 hours or more per week in acute care units. OUTCOME MEASURES: Damage to skin of the hands. RESULTS: Approximately one fourth of subjects (n = 106) met the criteria for currently damaged hands; 85.6% (n = 351) reported ever having skin problems. Damage was not correlated with age (p = 0.43), sex (p = 0.14), or skin type (p = 0.25), type of soap used at home (p = 0.58), reported duration of handwashing (p = 0.12), or glove brand (p = 0.90), but was significantly correlated with the type of soap used at work (p = 0.01), number of hand washes per shift (p = 0.0003), number of times gloves were worn (p = 0.008), and study site (p = 0.009). Variables significantly predictive of skin damage in a logistic regression analysis were type of soap used at work and number of times gloves were worn (p = 0.04). Geographic location was not a factor, because both the highest and lowest prevalence of skin damage occurred in the northern study institutions. CONCLUSIONS: Damage to skin of the hands is a common and potentially serious problem among nurses, and is associated with gloving and handwashing practices rather than with geographic or demographic factors. Efforts to improve skin condition must focus on improving products and identifying any interactive effects between hand care products and glove materials and brands.
Adult↗
Restriction of hospital employees with active HSV.
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Cross Infection↗
Automated data entry and retrieval for health-care management.
The development and implementation of a unique system for medical information management are described. An automated, optically scanned data entry system (OpScan) was combined with a generalized, interactive, storage and retrieval system, the Medical Information Management System (MIMS). OpScan-MIMS operates via a time-share system and requires minimal acquisition and maintenance of hardware. The primary advantages of OpScan-MIMS are its efficient and rapid method for data entry, lack of requirement for technical skills, user-generated programs, and cost-effectiveness. OpScan-MIMS has been utilized in a clinic for sexually transmitted diseases for immediate audit of medical records, monitoring of quality-assurance systems, retrieval of data for statistical analysis and clinic management, and as a teaching instrument for medical and paramedical trainees. Further applications to other systems of health-care management are being developed.
Community Health Centers↗
A general natural-language text processor for clinical radiology.
OBJECTIVE: Development of a general natural-language processor that identifies clinical information in narrative reports and maps that information into a structured representation containing clinical terms. DESIGN: The natural-language processor provides three phases of processing, all of which are driven by different knowledge sources. The first phase performs the parsing. It identifies the structure of the text through use of a grammar that defines semantic patterns and a target form. The second phase, regularization, standardizes the terms in the initial target structure via a compositional mapping of multi-word phrases. The third phase, encoding, maps the terms to a controlled vocabulary. Radiology is the test domain for the processor and the target structure is a formal model for representing clinical information in that domain. MEASUREMENTS: The impression sections of 230 radiology reports were encoded by the processor. Results of an automated query of the resultant database for the occurrences of four diseases were compared with the analysis of a panel of three physicians to determine recall and precision. RESULTS: Without training specific to the four diseases, recall and precision of the system (combined effect of the processor and query generator) were 70% and 87%. Training of the query component increased recall to 85% without changing precision.
Diagnosis, Computer-Assisted↗
A schema for representing medical language applied to clinical radiology.
OBJECTIVE: Develop a representational schema for clinical concepts and apply it to the task of encoding radiology reports of the chest. DESIGN: The schema was developed following a manual analysis of sample reports from the domain. The schema has two main components: the Medical Entities Dictionary (MED), which specifies the formal representation of the concepts in the domain and of their structures, and the natural-language processor, which specifies the linguistic expressions of the concepts. The schema was evaluated by applying it to a test set of 7,500 reports. Two-hundred reports from the test set were manually analyzed by a medical expert to determine the accuracy and success rate of the system. RESULTS: 82% of the 7,500 reports that contained relevant clinical information were successfully structured automatically. For the smaller set of 200 reports, 80% were structured successfully with an accuracy rate of 97%. CONCLUSIONS: The schema is a formal representation for clinical concepts in radiology reports, and provides domain coverage that is particularly well-suited for natural-language processing of radiology for use in a decision support system.
Decision Support Systems, Management↗
The Canon Group's effort: working toward a merged model.
OBJECTIVE: To develop a representational schema for clinical data for use in exchanging data and applications, using a collaborative approach. DESIGN: Representational models for clinical radiology were independently developed manually by several Canon Group members who had diverse application interests, using sample reports. These models were merged into one common model through an iterative process by means of workshops, meetings, and electronic mail. RESULTS: A core merged model for radiologic findings present in a set of reports that subsumed the models that were developed independently. CONCLUSIONS: The Canon Group's modeling effort focused on a collaborative approach to developing a representational schema for clinical concepts, using chest radiography reports as the initial experiment. This effort resulted in a core model that represents a consensus. Further efforts in modeling will extend the representational coverage and will also address issues such as scalability, automation, evaluation, and support of the collaborative effort.
Artificial Intelligence↗
Representing information in patient reports using natural language processing and the extensible markup language.
OBJECTIVE: To design a document model that provides reliable and efficient access to clinical information in patient reports for a broad range of clinical applications, and to implement an automated method using natural language processing that maps textual reports to a form consistent with the model. METHODS: A document model that encodes structured clinical information in patient reports while retaining the original contents was designed using the extensible markup language (XML), and a document type definition (DTD) was created. An existing natural language processor (NLP) was modified to generate output consistent with the model. Two hundred reports were processed using the modified NLP system, and the XML output that was generated was validated using an XML validating parser. RESULTS: The modified NLP system successfully processed all 200 reports. The output of one report was invalid, and 199 reports were valid XML forms consistent with the DTD. CONCLUSIONS: Natural language processing can be used to automatically create an enriched document that contains a structured component whose elements are linked to portions of the original textual report. This integrated document model provides a representation where documents containing specific information can be accurately and efficiently retrieved by querying the structured components. If manual review of the documents is desired, the salient information in the original reports can also be identified and highlighted. Using an XML model of tagging provides an additional benefit in that software tools that manipulate XML documents are readily available.
Humans↗
A reliability study for evaluating information extraction from radiology reports.
GOAL: To assess the reliability of a reference standard for an information extraction task. SETTING: Twenty-four physician raters from two sites and two specialties judged whether clinical conditions were present based on reading chest radiograph reports. METHODS: Variance components, generalizability (reliability) coefficients, and the number of expert raters needed to generate a reliable reference standard were estimated. RESULTS: Per-rater reliability averaged across conditions was 0.80 (95% CI, 0.79-0.81). Reliability for the nine individual conditions varied from 0.67 to 0.97, with central line presence and pneumothorax the most reliable, and pleural effusion (excluding CHF) and pneumonia the least reliable. One to two raters were needed to achieve a reliability of 0.70, and six raters, on average, were required to achieve a reliability of 0.95. This was far more reliable than a previously published per-rater reliability of 0.19 for a more complex task. Differences between sites were attributable to changes to the condition definitions. CONCLUSION: In these evaluations, physician raters were able to judge very reliably the presence of clinical conditions based on text reports. Once the reliability of a specific rater is confirmed, it would be possible for that rater to create a reference standard reliable enough to assess aggregate measures on a system. Six raters would be needed to create a reference standard sufficient to assess a system on a case-by-case basis. These results should help evaluators design future information extraction studies for natural language processors and other knowledge-based systems.
Evaluation Studies as Topic↗
Adverse events of Kytril Injection questioned.
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Arrhythmias, Cardiac↗
Oblique osteotomy of the fifth metatarsal: a five year review.
A 5-year retrospective review of a nonfixated oblique osteotomy of the fifth metatarsal for repair of tailor's bunion was performed at the Podiatry Hospital of Pittsburgh. Subjective and objective analysis of 38 osteotomies were evaluated in 22 patients. Incidence of complications, transfer of lesions, and recurrence of the deformity were determined. Preoperative and 5-year postoperative radiographs were analyzed as to the effectiveness of this procedure in changing the intermetatarsal angle, lateral deviation angle, and the sagittal plane elevation of the fifth metatarsal head. While patient acceptance is high, the authors derive new conclusions regarding the overall effectiveness of this common podiatric procedure.
Hallux Valgus↗
Physician advice to reduce chronic disease risk factors.
The U.S. Preventive Services Task Force recommends that physicians advise their patients regarding smoking cessation, weight loss, and physical inactivity. Few studies, however, have assessed the extent to which persons with these risk factors receive advice from their physicians. Using data from the 1990-1991 Missouri Behavioral Risk Factor Surveillance System (BRFSS), a random digit-dialed telephone survey of adults, we identified Missouri residents with one or more of these modifiable risk factors. We examined whether these persons reported being advised by their physicians to modify their behavior(s) within the past year. Of the 2,791 respondents, 764 (26%) smoked, 1,720 (59%) were sedentary, and 686 (23%) were overweight. Five hundred and thirty-five smokers reported having a routine checkup within the past year, but only 224 (42%) reported being advised by their physicians to stop smoking. Of the 1,246 sedentary persons who had a routine checkup within the past year, 192 (15%) reported being told by their physicians to exercise more. Of the 521 overweight respondents who had a routine checkup within the past year, 225 (43%) reported being advised to lose weight. Physician advice for these risk factors was less frequently reported among men, blacks, younger persons, and persons from rural areas. Although most Missouri residents with these modifiable risk factors reported seeing their physicians within the past year, less than half reported that they received advice from their physicians to alter their risk behavior(s). Further efforts are necessary to increase the effectiveness of physician advice for at-risk patients about quitting smoking, losing weight, and increasing physical activity.
Adult↗
Efficacy and safety of oral granisetron versus oral prochlorperazine in preventing nausea and emesis in patients receiving moderately emetogenic chemotherapy.
PURPOSE: To compare the efficacy and safety of oral granisetron hydrochloride tablets with that of oral prochlorperazine sustained-release capsules in preventing nausea and emesis induced by moderately emetogenic chemotherapeutic agents. PATIENTS AND METHODS: In this multicenter, double-blind, randomized, parallel group study, oral granisetron and oral prochlorperazine were compared in 230 chemotherapy-naive, adult cancer patients who received moderately emetogenic chemotherapy. Patients were stratified by gender and randomized to receive either 1.0 mg oral granisetron HCI twice a day for 7 days, or 10 mg oral prochlorperazine sustained-release capsules twice a day for 7 days. The first dose was given 1 hour before initiation of chemotherapy and the second dose 12 hours after the first dose. Patients were evaluated for emetic episodes, extent of nausea, and adverse events for 7 days after the start of chemotherapy. Primary efficacy parameters were complete response (no emetic episodes, no greater than mild nausea, no antiemetic rescue) and total control (no emetic episodes, no nausea, no antiemetic rescue) in the 24 hours after the start of chemotherapy. RESULTS: Granisetron was significantly more effective than prochlorperazine in achieving a complete response (74% vs. 41%, respectively) and total control of nausea and vomiting (58% vs. 33%, respectively) at the 24-hour assessment. Complete response at 24 hours was significantly higher in the granisetron-treated patients than in prochlorperazine-treated patients. In women, granisetron showed a complete response rate of 69% versus 38% with prochlorperazine; in men, granisetron showed a complete response rate of 92% versus 61% with prochlorperazine. Both regimens were well tolerated, with headache (36% for granisetron, 29% for prochlorperazine) and constipation (31% for granisetron, 6% for prochlorperazine) the most common adverse events. CONCLUSIONS: : Oral granisetron 1 mg twice a day was significantly more effective than oral prochlorperazine sustained release capsules 10 mg twice a day in complete response and total control of nausea and vomiting at 24 hours after chemotherapy. Both agents were well tolerated.
Administration, Oral↗
Comparable safety and antiemetic efficacy of a brief (30-second bolus) intravenous granisetron infusion and a standard (15-minute) intravenous ondansetron infusion in breast cancer patients receiving moderately emetogenic chemotherapy.
PURPOSE: For patients receiving chemotherapy, optimization of antiemetic therapy in terms of safety of administration, efficacy, cost, and convenience remains a subject of intense clinical research. In this study, we evaluated and compared the safety and antiemetic efficacy of a single 30-second intravenous bolus infusion of granisetron which those of a standard 15-minute intravenous infusion of ondansetron in chemotherapy-naive breast cancer patients receiving moderately emetogenic chemotherapy. PATIENTS AND MATERIALS: This was a randomized, double-blind, double-dummy, multicenter crossover study of 623 chemotherapy-naive patients (two male, 621 female) receiving moderately emetogenic chemotherapy (cyclophosphamide plus doxorubicin, with or without 5-fluorouracil) for breast cancer. Patients were assigned randomly to receive either granisetron or ondansetron in cycle 1 and the other agent in cycle 2. Granisetron (10 micrograms/kg) was administered as a 30-second intravenous bolus infusion within 5 minutes before the start of chemotherapy, and ondansetron (32 mg) was administered as a 15-minute intravenous infusion beginning 30 minutes before the start of chemotherapy. A total of 573 patients received the two planned chemotherapy cycles. Safety assessment was based on the type and frequency of adverse experiences reported by the patient at 24 and 48 hours after chemotherapy began. Efficacy assessments included the occurrence of nausea or emesis and the proportion of patients who achieved total emetic control at 24 and 48 hours after chemotherapy. RESULTS: Similar proportions of patients in both treatment groups remained free of emesis at the 24-hour assessment period (58.6% and 62.7% of granisetron- and ondansetron-treated patients, respectively) and at 48 hours (42.2% and 45.0% for granisetron vs ondansetron) in both cycles. The proportions of granisetron- and ondansetron-treated patients who remained nausea-free for the first 24 hours after treatment in both cycles were 44.0% and 48.5%, respectively, and at 48 hours were 26.7% and 31.0%, respectively. Statistical analysis demonstrated no significant treatment-by-cycle interaction. The 30-second granisetron infusion and the 15-minute ondansetron infusion were well tolerated. However, administration of ondansetron as a 15-minute intravenous infusion produced abnormal vision (6.28%) in significantly more patients than granisetron (0.35%). DISCUSSION: These two intravenous 5-hydroxytryptamine3-receptor antagonist antiemetics were similarly effective in controlling acute nausea and emesis during two cycles of moderately emetogenic chemotherapy. Granisetron (30 seconds) and the longer infusion of ondansetron (15 minutes) were well tolerated; however, ondansetron was associated with a greater proportion of patients reporting abnormal vision. Granisetron administered as a 30-second bolus infusion allows a considerably shorter waiting time between the end of the antiemetic infusion and the initiation of chemotherapy. This shorter administration time may enhance patient convenience and provider efficiency.
Adult↗