Olfactory neuroblastoma--an unusual presentation.
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Adult↗
Biomedical subjects
C Weir
Publications and source records attributed to C Weir.
Developmental differences in understanding of balance scales in the United States and Zimbabwe.
This cross-cultural, developmental study of understanding of the physics of a balance scale involved 2 age groups (5- and 22-year-olds) in 2 countries (the United States and Zimbabwe). A factorial design was used. Each participant solved 6 types of balance scale problems, and the patterns of errors for these problem types were analyzed to determine which rules and concepts the participant used (e.g., whether number of weights was considered). As expected, on average, older participants were more accurate than younger participants, although significant age differences in the Zimbabwean sample were not found for problems solved by weight or distance cues. One finding differing from earlier research was that problems in which the beam balanced were more difficult for all participants. Generally, understanding of the physics of a balance scale appeared fairly similar in the 2 countries. Some cultural practices may account for the findings--in particular, the availability of preschool and age at time of academic specialization in higher education.
Adolescent↗
An immunoglobulin G1 monoclonal antibody highly specific to the wall of Cryptosporidium oocysts.
The detection of Cryptosporidium oocysts in drinking water is critically dependent on the quality of immunofluorescent reagents. Experiments were performed to develop a method for producing highly specific antibodies to Cryptosporidium oocysts that can be used for water testing. BALB/c mice were immunized with six different antigen preparations and monitored for immunoglobulin G (IgG) and IgM responses to the surface of Cryptosporidium oocysts. One group of mice received purified oocyst walls, a second group received a soluble protein preparation extracted from the outside of the oocyst wall, and the third group received whole inactivated oocysts. Three additional groups were immunized with sequentially prepared oocyst extracts to provide for a comparison of the immune response. Mice injected with the soluble protein extract demonstrated an IgG response to oocysts surface that was not seen in the whole-oocyst group. Mice injected with whole oocysts showed an IgM response only, while mice injected with purified oocyst walls showed little increase in IgM or IgG levels. Of the additional reported preparations only one, BME (2-mercaptoethanol treated), produced a weak IgM response to the oocyst wall. A mouse from the soluble oocyst extract group yielding a high IgG response was utilized to produce a highly specific IgG(1) monoclonal antibody (Cry104) specific to the oocyst surface. Comparative flow cytometric analysis indicated that Cry104 has a higher avidity and specificity to oocysts in water concentrates than other commercially available antibodies.
Animals↗
Computer needs assessment based on nursing tasks.
The purpose of this paper was to validate the Nurse Task Computer Use (NTCU) scale as a measure of the impact of computer use on tasks performed by nurses. It was expected that evaluation of a computer system by tasks is a better measure of nursing satisfaction. We used four strategies to accomplish validation. Initially, we used taxonomy of nursing interventions developed by Susan Grobe as a basis for identifying tasks. Next, using factor analysis, the results of the NTCU was compared to two validated user satisfaction scales. The third validation strategy consisted of comparing responses to the survey with interview findings for similarity, additional responses, and reoccurring patterns. Finally, findings from the results of the NTCU were compared to the Computers in Medical Care values survey. Results generally supported the validity and reliability of this instrument.
Attitude of Health Personnel↗
Assessing the implementation process.
A Computerized Patient Record System (CPRS) has many benefits and could improve health care outcomes. Reaping these benefits, however, is dependent on successful implementation of a provider order entry system. The literature supports substantial evidence that even systems that are usable, effective and reliable have not been adopted by the intended users. A successful implementation may be substantially a function of the degree to which the processes of care have changed to adapt to the new system. To ensure successful implementation we suggest monitoring the implementation process itself. The purpose of this paper is to report the methodology we developed for assessing how successfully a provider order entry system is being implemented. We adopt a model of diffusion of information technology developed by Fichman (1994) and expanded by Ash (1997). In this model, diffusion is characterized be three categories, "breadth" (infusion) and "depth" (diffusion) and "quality" (appropriateness of use). In this paper we discuss the typology of diffusion and describe specific measures designed to measure infusion and diffusion of a hospital information system.
Diffusion of Innovation↗
Myolipoma of the eyelid.
BACKGROUND: This report describes the pathology of a myolipoma which occurred in the eyelid. Myolipoma is a benign hamartomatous tumour in which smooth muscle cells are interspersed with adipocytes. PATIENT DETAILS: An irregular yellowish tumour (30 x 25 mm) with illdefined borders had been present for 50 years in the medial part of the left lower eyelid of a 67-year-old woman. The tumour was excised and studied by conventional histology, immunohistochemistry and transmission electron microscopy. RESULTS: The tumour was formed by bundles of spindle-shaped cells with cigarshaped nuclei intermingled with multiloculated clear cells containing small eccentric nuclei. By immunohistochemistry, positive staining of the spindle cells was restricted to smooth muscle actin and desmin; the clear cells were non-reactive with the immunohistochemical panel, but fat was identified within the cytoplasm. The ultrastructural features of the spindle cells were those of a leiomyoma, while the clear cells were classified as adipocytes. CONCLUSION: This tumour was considered to originate from the media of blood vessels within the tumour.
Actins↗
The role of problem definitions in understanding age and context effects on strategies for solving everyday problems.
The participants (107 preadolescents, 124 college students, 118 middle-aged adults, and 131 older adults) described 2 everyday problems (1 unconstrained, the other constrained to 1 of 6 domains) that they experienced and their goals and strategies. Problem definitions reflected interpersonal or competence components or both; strategies reflected altering cognitions, actions, or regulating and including others. Age differences in problem definitions were found. For unconstrained-domain problems, age and problem definition were related to strategies; for unconstrained-domain problems age differences in strategies were not found. For constrained-domain problems, strategies related to problem domain and problem definition, with problem definition the better predictor of strategies. The results illustrate the value of individuals' problem definitions for addressing age and context effects on strategies used.
Activities of Daily Living↗
The need for a thoughtful deployment strategy: evaluating clinicians' perceptions of critical deployment issues.
This paper presents data collected from 899 clinicians across three Department of Veterans Affairs (VA) medical centers where existing terminal-based architecture was being replaced with client-server architecture. Surveys were conducted with physicians (n = 184), nurses (n = 355) and other clinicians (n = 360) gathering user characteristics and their perceptions of five deployment issues (e.g. adequacy of technical and institutional support and perceptions of the soon-to-be-implemented clinical workstation). Mean scores for the five deployment issues for all clinicians indicates perceptions are somewhat neutral. However, when data is analyzed according to job classification, significant (p = 0.05) differences in perceptions were noted among groups of clinicians (e.g., physicians and registered nurses). Results of analyzing data grouped by VA site (n = 3) indicates significant (p = 0.05) differences exist among sites in clinicians' perceptions of the deployment issues. A thoughtful deployment strategy including an in-depth assessment of clinician users by job classification and by location may produce important information, critical to the successful deployment of new technologies, in very large health management institutions.
Attitude to Computers↗
Prospective study on factors delaying surgery in ruptured abdominal aortic aneurysms.
Delays between rupture, eventual diagnosis and the repair of abdominal aortic aneurysms (AAAs) can significantly affect outcome, but the reasons for such delays in management are not always clear. A prospective study was, therefore, performed on 30 patients with ruptured AAAs. Twenty-three male and seven female patients, mean age 71.3 years, were studied. The general practitioner had made the correct diagnosis in only 38% of cases and the most common misdiagnosis was renal colic (24%). Non-vascular hospital doctors made the correct diagnosis in 55% of cases, but patients with back pain were the most frequently misdiagnosed by both types of doctor. The performance of an ultrasound scan significantly delayed referral to the vascular unit from a median of 0.75 to 2.50 hours and was of little benefit in aiding the diagnosis. In conclusion, the most striking delay factors in the management of ruptured AAAs are the high incidence of misdiagnosis and the lack of benefit of ultrasound scanning.
Aged↗
Are backward words special for older adults?
Two experiments comparing older and young adults confirmed that Stroop interference from lists of incongruent color words was greater for older adults. Similar age effects were observed when the lists of words were presented in 2 unusual print orientations (upside-down; backward and upside-down). In contrast, no age effect was observed, when participants named colors on backward-word lists, as measured with a percentage interference score that corrected for individual differences in baseline (color patches) naming times. Reading speed failed to account for all the interference effects in these data.
Adolescent↗
The effects of neonatal jaundice and respiratory complications on learning and habituation in 5- to 11-month-old infants.
The influences of neonatal hyperbilirubinemia and respiratory complications were examined in 5- to 11-month-old infants in two studies. One study focused on habituation performance and the other on contingency learning. In both experiments, three neonatal jaundice conditions (no jaundice history, measured bilirubin, phototherapy) were crossed with two levels of neonatal respiratory risk (no oxygen intervention, oxygen intervention). For low respiratory risk subjects there were increasingly adverse effects for both habituation and learning the more severe the jaundice history. A complex pattern emerged for the high respiratory risk groups. Only for the learning task were the results consistent with a summative effect of neonatal jaundice and respiratory risk factors.
Arousal↗
Use of Iliad to improve diagnostic performance of nurse practitioner students.
Nurse practitioners (NPs) have dual goals as primary care providers, combining the traditional goals of nursing with extended goals as diagnosticians. Diagnostic reasoning, therefore, is a critical component of NP education. Iliad, a computerized diagnostic reasoning expert system, has been used effectively to teach diagnostic skills to medical students. A pilot study was undertaken to determine the effects of Iliad training on NP students' diagnostic skill performance and to identify technical and instructional issues of implementation. The study found that the use of Iliad improved NP students' diagnostic reasoning, and that the training effects were modified by prior nursing experience. Successful use of Iliad required planning, faculty commitment, and technical support.
Clinical Competence↗
Facial swelling in giant cell (temporal) arteritis.
Giant cell (temporal) arteritis is a systemic vasculitis of the elderly. Facial swelling is a rare manifestation of the arteritic process. Delay in recognition of the condition can result in profound loss of vision. This report describes a biopsy-proven arteritic patient who developed anterior ischaemic optic neuropathy (AION) following facial swelling. Both arteritic AION and facial swelling responded to high-dose steroid treatment. Facial swelling in giant cell (temporal) arteritis could be an indicator of risk of AION. Intravenous steroid treatment can lead to salvation of useful vision.
Aged↗
Overutilization of acute-care beds in Veterans Affairs hospitals.
The authors tested the hypothesis that the Department of Veterans Affairs (VA) hospitals would have substantial overutilization of acute care beds and services because of policies that emphasize inpatient care over ambulatory care. Reviewers from 24 randomly selected VA hospitals applied the InterQual ISD* (Intensity, Severity, Discharge) criteria for appropriateness concurrently to a random sample of 2,432 admissions to acute medical, surgical, and psychiatry services. Reliability of hospital reviewers in applying the ISD* criteria was tested by comparing their reviews with those of a small group of expert reviewers. Validity of the ISD* criteria was tested by comparing the assessments of master reviewers with the implicit judgments of panels of nine physicians. The physician panels validated the ISD* admission criteria for medicine and surgery (74% agreement with master reviewers, kappa > 0.4), whereas the psychiatry criteria were not validated (66% agreement, kappa 0.29). Hospital reviewers reliably used all three criteria sets (> 83% agreement with master reviewers, kappa > 0.6). Rates of nonacute admissions to acute medical and surgical services were > 38% as determined by the hospital and master reviewers and by the physician panels. Nonacute rates of continued stay were > 32% for both medicine and surgery services. Similar rates of nonacute admissions and continued stay were found for all 24 hospitals. Reasons for nonacute admissions and continued stay included lack of an ambulatory care alternative, conservative physician practices, delays in discharge planning, and social factors such as homelessness and long travel distances to the hospital. Using criteria that the authors showed to be reliable and valid, substantial overutilization of acute medicine and surgical beds was found in a representative sample of VA hospitals. Correcting this situation will require changes in physician practice patterns, development of ambulatory care alternatives to inpatient care, and modification of current VA policies determining eligibility for care.
Acute Disease↗
The impact of physician order entry on nursing roles.
This study examines the impact of physician order entry (POE) on nurses perceptions of work, quality of care, and nurse/physician communication. Four hospitals that have implemented a computerized order-entry system with POE were compared with four similar hospitals using the same computerized system with clerk order entry only. Three factors were extracted from the 29 item survey using principal component extraction with varimax rotation that accounted for 16.5%, 12.4% and 8.7% of the variance respectively. Three scales were constructed from these factors measuring perceptions of impact of the information system on the quality of care, job, control, and nurse/physician communication. Nurses working in the POE environment rated their computer system as having greater impact on the quality of care and lower ratings of perceived control than those working in non-POE environments. No differences were found between nurses working in POE environments and those working in POE in terms of their ratings of frequency of contact and ease of access to physicians.
Attitude of Health Personnel↗
Successful implementation of an integrated physician order entry application: a systems perspective.
Direct physician order entry is required for effective implementation of an integrated electronic medical record. This effort involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the findings of a follow-up study that quantified dimensions associated with successful implementation identified in a previous study. Results identified several implementation strategies associated with success. These include an interdisciplinary implementation group, involvement of large numbers of regular staff, early and intensive training and support, and 24 hour available assistance as important to success. In addition, attitudes of physicians and their level of involvement were found to be associated with success.
Attitude of Health Personnel↗
The reliability of endotoxin and cytokine measurements in polytrauma patient and their relationship to the development of sepsis.
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Case-Control Studies↗
Creating and evaluating the Department of Veterans Affairs electronic medical record and national clinical lexicon.
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Computer Systems↗