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C K Tse

Publications and source records attributed to C K Tse.

At least 37 records · Page 2Linked to original sources
PubMed1995

Computer-prompted diagnostic codes.

BACKGROUND: The purpose of this study was to develop and evaluate a computer system that would translate patient diagnoses noted by a physician into appropriate International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes and maintain a patient-specific up-to-date problem list. METHODS: The intervention consisted of a computerized list (dictionary) of diagnoses, including practice-specific synonyms and abbreviations, linked to their corresponding ICD-9-CM codes. To record the diagnoses for the office visit before the intervention, physicians used International Classification of Health Problems in Primary Care (ICHPPC-2) codes. After the intervention, physicians used their own words or checked previously identified diagnoses on the computer-generated problem list. The computer then identified the correct ICD-9-CM code. Accuracy of coding was compared before and after the new computerized system was implemented. RESULTS: Visits in which all diagnoses matched increased from 58% to 76% (P < .001) with use of the computer system. Visits in which no computer diagnoses matched the chart decreased from 22% to 8% (P < .001). Errors of omission declined from 38% to 18% (P < .001). Errors of commission decreased from 19% to 11% (P = .006). Overall accuracy increased from 62% to 82% (P < .001). CONCLUSIONS: Outpatient medical diagnosis coding can be simplified and accuracy improved by using a computerized dictionary of practice-specific diagnoses and synonyms linked to appropriate ICD-9-CM codes. Such a system provides a computer-generated problem list that accurately reflects the chart and assists with prompted coding on subsequent visits.

Abstracting and Indexing↗
PubMed1993

The Duke Severity of Illness Checklist (DUSOI) for measurement of severity and comorbidity.

The Duke Severity of Illness Checklist (DUSOI) was evaluated on 414 primary care adult patients using data collected both by medical providers at the time of the patient visit and later by a chart auditor. Severity scores for individual diagnoses were determined by summing the ratings for four non-disease-specific parameters: symptom level, complications, prognosis without treatment, and expected response to treatment. Mean diagnosis severity scores (scale 0-100) among the 21 most prevalent diagnoses varied from a low of 13.9 for menopausal syndrome to a high of 43.0 for sprains and strains. An overall severity score was calculated by combining diagnosis severity scores and giving highest weights to the most severe diagnoses. Provider-generated overall severity scores (mean = 43.3) and auditor-generated overall severity scores (mean = 38.9) were significantly correlated (coefficient of agreement = 0.59, p < 0.0001). Diagnoses varied in their individual contribution to the overall severity score, from 8.9% for lipid disorder to 90.0% for sprains and strains. Separate comorbidity severity scores were calculated to measure the severity of all of each patient's health problems except the diagnosis under study. For example, patients with menopausal syndrome had co-existing health problems which generated a high mean comorbidity severity score of 43.2, while patients with sprains and strains had a low mean comorbidity score of 4.7. The DUSOI Checklist can be used in the clinical setting by both providers and auditors to produce quantitative severity scores (by diagnosis, overall, and for comorbidity) which are based entirely upon clinical judgment. This method should be useful in controlling for severity of illness in clinical studies and indicating the outcome of medical care in terms of reduction in severity of illness following medical interventions.

Adolescent↗
PubMed1993

Disease-specific versus generic measurement of health-related quality of life in insulin-dependent diabetic patients.

The health-related quality of life of 170 adult insulin-dependent diabetic patients was measured cross-sectionally to compare a disease-specific instrument, Diabetes Quality of Life (DQOL) questionnaire, and two generic instruments, the Duke Health Profile (DUKE) and the General Health Perceptions Questionnaire (GHP). The generic measures provided as much or more information about health-related quality of life as the disease-specific instrument. This was demonstrated both by comparison of the DQOL with the DUKE and GHP and by comparison of the disease-specific with the generic components of a modified version of the DQOL. Patients with the diabetic complication of nephropathy had increased worry over their health and lower general health perceptions. Neither the duration of diabetes nor the intensity of insulin therapy, however, was found to have a statistically significant effect on any of the health-related quality of life scores. Nondiabetic factors, such as the comorbidity, nondiabetic medications, marital status, social relationships, and family arguments were found to be predictors of health-related quality of life more often than the diabetic factors duration of diabetes, complications, and intensity of insulin therapy. These analyses suggest the clinical value of using generic questionnaires to measure health-related quality of life and psychosocial factors to identify nondiabetic problems that might respond to intervention, thereby potentially enhancing the effect of diabetes-specific therapy.

Adolescent↗
PubMed1993

Increasing compliance with mammography recommendations: health assessment forms.

BACKGROUND: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. METHODS: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. RESULTS: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). CONCLUSIONS: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Adolescent↗
PubMed1992

Quality of life and functional health of primary care patients.

Quality of life and functional health were measured cross-sectionally for 314 adult ambulatory primary care patients in a rural clinic and found to be much better for patients with low severity of illness who required no confinement to home because of health problems, than for patients with high severity of illness who required confinement. Severity of illness was the strongest predictor for patient-reported physical health function and for patient quality of life when assessed by the health provider. Confinement was the strongest predictor for patient quality of life when assessed by the patient. There was very little agreement between patient-assessed and provider-assessed quality of life. Family stress was the strongest predictor of function in terms of mental health, social health, general health, self-esteem, anxiety, and depression. These data suggest that clinicians should direct increased attention to patient-assessed quality of life, patient-reported functional health status, and psychosocial factors such as family stress in an effort to improve medical outcomes.

Activities of Daily Living↗
PubMed1991

Development of the 17-item Duke Health Profile.

The 17-item Duke Health Profile (DUKE) was developed as a refined version of the 63-item Duke-UNC Health Profile (DUHP) using a methodology based upon a balanced clinical and statistical rationale. The result is a brief, valid functional health measure with 10 scales that compares well with the MOS Short-form and the COOP Charts. In addition to the five constructs (ambulation, emotional symptoms, activities with friends or relatives, health perception, and pain) which are measured by all three of the instruments, the DUKE quantitates cognition, social self-esteem, confinement, and somatic symptoms other than pain.

Adult↗
PubMed1991

Validation of the Duke Social Support and Stress Scale.

The Duke Social Support and Stress Scale (DUSOCS) was validated in 249 adult family practice patients using the Family Strengths, the Family Inventory of Life Events, and the Duke Health Profile (DUKE) as comparison instruments. Validity was supported in that the DUSOCS family support measure had the clinically expected positive associations with DUKE health measures (regression coefficients of +7.4 to +18.7) and negative associations with DUKE anxiety and depression measures (-2.0 to -17.2). DUSOCS family stress had negative associations with the health measures (-11.6 to -34.5) and positive associations with anxiety and depression (+18.9 to +32.1). Family and non-family stress contributed more than severity of illness to elevated levels of anxiety and depression and lowered levels of mental health, social health, and self-esteem, while these same stresses contributed only half as much as severity of illness to lowered physical health.

Adolescent↗
PubMed1991

Tricyclic antidepressant prescribing for nonpsychiatric disorders. An analysis based on data from the 1985 National Ambulatory Medical Care Survey.

BACKGROUND: Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon). METHODS: Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties. RESULTS: Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,892,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists. CONCLUSIONS: When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An understanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS:

Adolescent↗
PubMed1990

Depression, disability days, and days lost from work in a prospective epidemiologic survey.

We describe the relationship of depression and depressive symptoms to disability days and days lost from work in 2980 participants in the Epidemiologic Catchment Area Study in North Carolina after 1 year of follow-up. Compared with asymptomatic individuals, persons with major depression had a 4.78 times greater risk of disability (95% confidence interval, 1.64 to 13.88), and persons with minor depression with mood disturbance, but not major depression, had a 1.55 times greater risk (95% confidence interval, 1.00 to 2.40). Because of its prevalence, individuals with minor depression were associated with 51% more disability days in the community than persons with major depression. This group was also at increased risk of having a concomitant anxiety disorder or developing major depression within 1 year. We conclude that the threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity. Only by changing our nosology can the societal impact of depression be adequately addressed.

Absenteeism↗
PubMed1990

The health status and life satisfaction of first-year medical students.

The self-reported health status and life satisfaction of 286 first-year Duke University medical students in four consecutive classes were measured at the beginning and end of the school year and compared statistically with relevant sociodemographic and behavioral factors. Health status, quantitated in terms of Duke Health Profile scores, was generally lower for women than for men. Although there was a definite trend of worsening along all parameters of health and satisfaction during the year for both women and men, the most marked change was the increase in depressive symptoms. The students who were very satisfied with life had fewer symptoms of depression and anxiety; higher self-esteem, better physical, mental, and social health; stronger social ties; more physical activity; more sleep; and fewer stressful life events. Strong social ties was the factor most positively related to better health and life satisfaction.

Depressive Disorder↗
PubMed1990

The Duke Health Profile. A 17-item measure of health and dysfunction.

The Duke Health Profile (DUKE) is a 17-item generic self-report instrument containing six health measures (physical, mental, social, general, perceived health, and self-esteem), and four dysfunction measures (anxiety, depression, pain, and disability). Items were derived from the 63-item Duke-UNC Health Profile, based upon face validity and item-remainder correlations. The study population included 683 primary care adult patients. Reliability was supported by Cronbach's alphas (0.55 to 0.78) and test-retest correlations (0.30 to 0.78). Convergent and discriminant validity were demonstrated by score correlations between the DUKE and the Sickness Impact Profile, the Tennessee Self-Concept Scale, and the Zung Self-Rating Depression Scale. Clinical validity was supported by differences between the health scores of patients with clinically different health problems. Patients with painful physical problems had a DUKE physical health mean score of 58.1, while patients with only health maintenance problems had a mean score of 83.9 (scale: 0.0 = poorest health and 100.0 = best health). Patients with mental health problems had a DUKE mental health mean score of 49.2, in contrast to 75.7 for patients with painful physical problems and 79.2 for those with health maintenance. The DUKE is presented as a brief technique for measuring health as an outcome of medical intervention and health promotion.

Adolescent↗
PubMed1988

Acetylcholinesterase antibodies and thyroid autoimmunity.

It has been suggested that anti-thyroglobulin antibodies cross-react with acetylcholinesterase (AChE) and that this may explain the pathogenesis of Graves' ophthalmopathy. We have tested this hypothesis using an ELISA. Antibodies to human red blood cell AChE were found in 21% of 47 patients with thyroid autoimmunity. However antibodies to AChE were also detected in one of 25 normal subjects and two of 16 patients with non-organ specific autoimmunity. The anti-AChE antibodies showed no correlation with anti-thyroglobulin antibody levels and they were not associated with the presence of severe ophthalmopathy. Inhibition studies suggested only limited cross reactivity, if any, between anti-Tg and anti-AChE antibodies. Immunoblotting demonstrated antibody binding to at least four human AChE determinants at 130, 55, 32 and 22 kD. Our results demonstrate quite frequent anti-AChE reactivity in sera but no relationship with the development of orbital pathology.

Acetylcholinesterase↗
PubMed1986

Actions of beta-bungarotoxin on spontaneous release of transmitter at muscle end-plates treated with botulinum toxin.

Rat leg muscles were injected subcutaneously with sublethal doses of type A botulinum neurotoxin, and the extensor digitorum longus muscle removed three days later. Intracellular microelectrode recordings were then made of miniature end-plate potentials (mepps). The mepp frequency was reduced by botulinum toxin, while mepp rise times were slowed. Mepp amplitude distributions became characteristically skew. beta-Bungarotoxin (140 nM) was applied to normal muscles in vitro and recordings were made 10-30 min later. The main effect was an increase in mepp frequency during this period. Mepp rise times were unaffected. When beta-bungarotoxin was applied in vitro to muscles treated with botulinum toxin there was also an increase in mepp frequency, although to a value less than in normal muscles. The mepp rise times were speeded up to normal values. The mepp amplitude and rise time distributions showed no obvious evidence for the addition of a second component to the distribution. The data appear to support the hypothesis that the sites for spontaneous release in botulinised muscle may be located at or near the usual release sites at the active zones.

Animals↗
PubMed1982

Preparation and characterisation of homogeneous neurotoxin type A from Clostridium botulinum. Its inhibitory action on neuronal release of acetylcholine in the absence and presence of beta-bungarotoxin.

1. Large-scale production and purification of complexes between Clostridium botulinum neurotoxin and haemagglutinin have been achieved. 2. Haemagglutinin-free neurotoxic protein of the complexes was purified to high specific neurotoxicity by affinity chromatography, on p-aminophenyl beta-D-thiogalactopyranoside coupled to Sepharose 4B, followed by chromatography on DEAE-Sephacel. 3. The resultant neurotoxin was homogeneous on isoelectric focussing (pI = 6.3) and on dodecylsulphate/polyacrylamide gel electrophoresis under non-reducing conditions when its Mr was 1.4 X 10(5); after reduction two polypeptides (Mr = 9.9 and 5.5 X 10(4) were present. 4. On double-immunodiffusion gels, using antiserum against neurotoxin-haemagglutinin complex, the neurotoxin showed a single, sharp precipitin line that was immunologically distinct from a relatively non-toxic protein (Mr = 1.3 X 10(5), which co-purifies with the neurotoxin but is removed by the ion-exchange chromatography step. 5. Application of the neurotoxin to animals in vitro or in vivo produced near complete and irreversible blockade of neurotransmission. Botulinisation of rat leg muscles reduced spontaneous transmitter release; the amplitude of miniature end-plate potentials was altered from the normal 'bell-shaped" to a skewed distribution. 6. In normal muscle, a large transient increase in frequency of the miniatures was produced by beta-bungarotoxin. In contrast, with botulinised muscle the latter induced a much smaller increase in the absolute frequency; in addition, the mean amplitude was increased somewhat but the distribution remained skewed. The results show botulinisation of muscle modifies the action of beta-bungarotoxin.

Acetylcholine↗
PubMed1982

Localization of sites for 125I-labelled botulinum neurotoxin at murine neuromuscular junction and its binding to rat brain synaptosomes.

Botulinum neurotoxin, purified to homogeneity from Clostridium botulinum (Type A), was found to be highly neurotoxic (greater than 8 X 10(7) mouse LD50/mg protein). Labelling of this pure neurotoxin with 125I-iodine to high specific radioactivity was achieved without appreciable loss of biological activity. This was used to demonstrate saturable binding sites for this toxin at the neuromuscular junction, following in vivo administration into mice. A demonstrable inhibitory effect of the neurotoxin on release of acetylcholine from rat cerebrocortical synaptosomes indicates that it affects synapses in the central nervous system. Kinetic studies on the binding of 125I-labelled neurotoxin to brain synaptosomes yielded an association rate constant of 2.3 x 10(5)M-1s-1; dissociation plots were biphasic and the predominant species showed a rate constant of 1.2 X 10(-4)s-1. The saturable binding component is heat-sensitive and inactivated by trypsin. Preliminary studies showed that botulinum neurotoxin associates with plasma membrane fractions of synaptosomes and that binding does not result in any gross structural changes, at least in the majority of the toxin molecules.

Animals↗
PubMed1982

Biochemical and electrophysiological demonstrations of the actions of beta-bungarotoxin on synapses in brain.

Homogeneous beta-bungarotoxin interacts irreversibly with rat olfactory cortex and produced permanent inhibition of neurotransmission (half-time of blockade for 230 nM toxin in 25 min). Binding occurs in the absence of divalent cations, but the rate of synaptic blockade is increased by Ca2+, which activates the intrinsic phospholipase A2 activity of the toxin. Other observable actions of the toxin, seen with rat cerebrocortical synaptosomes, are an increase in the release of acetylcholine, glutamate and gamma-aminobutyrate and impairment of transmitter uptake, which are all insensitive to tetrodotoxin. Inactivation of the toxin's phospholipase activity by chemical modification with p-bromophenacyl bromide diminishes the observed concomitant efflux of the neurotransmitters and lactate dehydrogenase. Collectively, the results support the idea that the toxin binds specifically and irreversibly to component(s) on nerve terminals and this together with the resultant phospholipolysis leads eventually to synaptic blockade. Such a proposal would account for the unique toxicity of the protein relative to phospholipase A2 enzymes.

Acetylcholine↗