Biomedical subjects
Publications and source records attributed to J Fowler.
We outline recent developments in the delivery of emergency medicine and prehospital care in the Republic of Turkey. Residency training in emergency medicine is in its infancy in Turkey, and the presence of specialists will help define the future of emergency medical care in this country.
STUDY OBJECTIVE: To determine whether immediate treatment with oral activated charcoal (AC) products of differing surface areas prevents clinical toxicity of a lethal oral dose of dichlorvos in mice. DESIGN: An in vivo, prospective, randomized, placebo-controlled study using 75 male albino mice. INTERVENTIONS: Fasting mice were administered 57.5 mg/kg of a 0.55% dichlorvos solution via feeding tube. One minute later, groups of 15 mice each received 1 or 2 g/kg of Actidose-Aqua AC or 1 or 2 g/kg of Sigma AC or sterile water by feeding tube. In this way, all mice received 15 mL/kg of an AC suspension or sterile water. The animals were observed for 24 hours for seizures or death. RESULTS: In all treatment groups, mice were found to have significantly fewer seizures and deaths (P < .05) than the control group when compared by chi 2 and Fisher's exact tests. No statistical difference was found between the death and seizure rates when treatment groups were compared with each other. The group sizes were too small, however, to rule out significant type II error (beta > .2). CONCLUSION: In this in vivo mouse model, all AC products tested decreased the incidence of seizures and death. Further studies should be done to investigate the clinical effects of AC products with different surface areas.
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The feasibility of quality of life (QOL) assessment in a heterogeneous group of gynaecological cancer patients undergoing chemotherapy was determined. All new patients being prescribed cytotoxic chemotherapy were asked to complete a modified QOL assessment tool. The elected assessment tool is the Functional Assessment Cancer Therapy-General (FACT-G) tool, comprising 33 questions under 5 broad categories: physical well-being, social well-being, relationship with doctor, emotional well-being and functional well-being. Raw scores were calculated and then transformed to a 0-100 scale. Twenty eight patients received a total of 75 treatment cycles of chemotherapy. Four patients were not offered the assessment due to language difficulties. All patients offered the test satisfactorily completed the test to allow statistical analysis. The average number of chemotherapy courses received was 2.5 (range: 1-6). Of a total possible 2,475 study items (33 items x 75 cycles), 240 items were not answered (10%). Of these 240 unanswered items, 2 items (#14 and #15) comprised 38%. The mean transformed score for physical well-being was 32 (SE 2.5), for social well-being the mean transformed score was 50 (SE 1.7), relationship with doctor 86 (SE 2.4), emotional well-being 41 (SE 2) and functional well-being was 54 (SE 2.6). The assessment of QOL indices in gynaecological cancer patients undergoing chemotherapy is feasible. Further research needs to determine the optimal QOL tool for this patient population.
Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross-sensitization such as between para-phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the "angry back syndrome". This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.
A 55 year-old female ingested two bulbs of Urginea maritime (squill) plant as a folk remedy for her arthritic pains. Her past history was significant for Hashimoto thyroiditis and she was hypothyroid upon presentation. Subsequent effects resembling those seen with cardiac glycoside intoxication included nausea, vomiting, seizures, hyperkalemia, atrioventricular block and ventricular arrhythmias resembling digitalis toxicity. A serum digoxin level by an enzyme immunoassay method was 1.59 ng/mL. Despite supportive treatment and pacing, the patient expired from ventricular arrhythmias 30 h after ingestion. Squill has been recognized since antiquity for the clinical toxicity of its cardiac glycosides, but this appears to be the first report of a fatality since 1966.
1. The strength of Peplau's work is in giving the practitioner a structure on which to base his or her interactions with the patient. 2. There is no ideal way in which to document the care given when using Peplau's work as a model. Peplau's theory has a holistic perspective that does not adjust easily to a record-keeping system. 3. Staff will need to be trained, supported and supervised by a consultant nurse if the true philosophy of Peplau is followed. 4. The strength of Peplau's model lies in the fact that it encourages the nurse to develop an attitude of mind that gives a framework to practice.
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ASOP is a proposed method for future medical record notation. This permutation of the original POMR-SOAP method is necessary to provide the standardized workflow and medical nomenclature which will be essential for automated medical record systems and forms-based encounter recording. The development of an ASOP system is dependent on tools to map assessment to appropriate terminology within a universal medical dictionary and generate intelligent queries across the World-Wide-Web. In this study we intend to demonstrate the need for change in the POMR system and highlight some of the current tools in development to make the ASOP method the medical record notation system of choice.
Categorization by Reference is a novel text classification technique that examines the existing classifications of the citations found in an as-yet unclassified text to determine what terms should be assigned to that text. The existence of the Medical Subject Headings and MEDLINE make the biomedical domain a prime candidate for application of this technique. We describe our approach and implementation of a prototype, presenting some results of our initial tests. We further discuss refinements that could improve the precision of the technique, and describe its possible use in categorizing portions of the World-Wide Web.
To facilitate networked discovery and information retrieval in the biomedical domain, we have designed a system for automatic assignment of Medical Subject Headings to documents retrieved from the World-Wide Web. Our prototype implementations show significant promise. We describe our methods and discuss the further development of a completely automated indexing tool called the "Web-MeSH Medibot."
Exploiting high-speed computer networks to provide a national medical information infrastructure is a goal for medical informatics. The Distributed Medical Dictionary under development at Baylor College of Medicine is a model for an architecture that supports collaborative development of a distributed online medical terminology knowledge-base. A prototype is described that illustrates the concept. Issues that must be addressed by such a system include high availability, acceptable response time, support for local idiom, and control of vocabulary.
Baylor College of Medicine is developing the Collaborative Social and Medical Services System (CSMSS) to provide a computerized patient record (CPR) system for the Teen Health Clinics (THC) [1]. The THCs consist of five geographically distributed clinics providing health care and social services to teenagers in the Harris County Hospital District. The CSMSS is the first application built upon the Ambulatory Systems Architecture (ASA) [2]. The ASA is aimed at providing an architecture and application framework for the development and deployment of CPR systems in ambulatory care settings. This paper describes the ASA server architecture.
We have developed an architecture and application framework known as the Ambulatory Services Architecture (ASA) for computerized management of patient records for ambulatory care. Our primary design goals included the development of an architecture that will be readily adaptable to advances in technology needed to enhance computerized patient record systems (e.g., multimedia, human-computer interfaces such as voice-to-text, and a fully distributed objects, etc.) and a data model and database implementation capable of providing the flexibility and extensibility needed to support a broad spectrum of specialty medical practices. This report describes the data model, access control, and the client/server components of the Ambulatory Services Architecture.
Baylor College of Medicine has five Teen Health Clinics (THC) dispersed throughout Harris county. The population served by the clinics includes inner-city adolescent boys and girls 19 years of age and under. Patients receive services such as family planning, sexually transmitted disease screening and treatment, perinatal care, counseling, and support services. Adolescents may receive services at any one of the clinics at no cost to the adolescent or their dependents. Given the geographical distribution of the clinics and the reliance on paper-based records, client services cannot be provided efficiently or expeditiously. According to the statistics developed by Clinic staff, ineffective coordination of service needs and client schedules undermine the follow-up needed for effective care. For example, a counselor will often need to balance a school schedule, clinic visits, well baby follow-up, and the Best Friends Program for a new mother. In addition, the lack of ready access to patient information impairs the ability of clinical and social service staff to provide continuity of care. In fact, some cases of client dropout are attributable to these difficulties. We have developed the Collaborative Social and Medical Service Application (CSMSA) to facilitate the provision of social and medical services to this population. The CSMSA is a domain-specific application based on a robust infrastructure known as the Ambulatory Services Architecture (ASA). This system is designed to support integrated social and ambulatory care. The ASA is a Baylor developed application framework and architecture for the computerization of the patient medical record in the ambulatory care setting. The working environment for the CSMSA user is an integrated desktop which provides an operating environment for both third-party applications and the CSMSA, as well as a fundamental set of services. The integrated desktop services include a mechanism for object organization or grouping, a facility for the management of desktop objects including disposal and storage, and an embedded search utility to assist in the location of desktop objects as well as other application objects. The access control mechanism will provide the security for the desktop environment by requiring the user to log into and out of the environment. This security mechanism will also enable/disable CSMSA tools based on the user's role at the clinic. The CSMSA is designed to provide work process, functionality and data access appropriate to the responsibilities of the user, e.g., a THC clerk may have permission to view a patient's orders but does not have the facility to create an order. Patient context is defined through a patient browser containing the master patient index or a user defined patient list. Patient encounters are managed using forms based on the process for each encounter type (e.g., initial visit). Forms are used for data entry and for queries. Data entry forms are only committed to the patient database (i.e., making the patient data available to other users who have permission to access the data) when the user approves the data. The CSMSA provides a means to suspend an entry into a chart by saving incomplete or non-committed data entry forms as part of the desktop state which is restored when the user logs into the system. CSMSA was designed to provide a robust, expandable application capable of accommodating the changes in health care and social services delivery while encompassing evolving software standards and new technology. This goal was achieved using object-oriented methodologies and technologies, combined with an object-oriented database management system as the foundation of our server to facilitate the evolution of our data model.
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This paper explores the technique known as 'sculpting' and examines its application to the education of nurses. It identifies the therapeutic origins of sculpting, the processes and techniques involved and other requirements necessary for its application to nurse education. The experiences of both facilitator and participant are also described. It is argued that experiential learning methods in many cases continue to be met with anxiety and distrust often being carried out by facilitators who lack the skill and expertise to provide for the psychological safety of participants. The neglect or improper use of experiential learning methods denies students a valuable 'educational experience'.