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Biomedical subjects

J Holbrook

Publications and source records attributed to J Holbrook.

At least 19 recordsLinked to original sources
PubMed2002

Bioinformatics and type II G-protein-coupled receptors.

The best known family B, or Type II, G-protein-coupled receptors (GPCRs) recognize peptides as ligands. The receptors for corticotrophin-releasing factor, parathyroid hormone and secretin typify this group. However, there are only 15 such GPCRs. Many other receptors share sequence homology and have been assigned to this family. The ten 'Frizzled' and one 'Smoothened' receptors show the lowest sequence homology and are not necessarily G-protein coupled. Drosophila genetics have enabled our understanding of their biology. In contrast, relatively little is known about the largest group with family B, the 33 'large amino termini' or large N-terminal family B seven-transmembrane (LNB 7TM) receptors. This review highlights the similarities found between family B receptors and provides a classification of LNB 7TM receptors.

Animals↗
PubMed2001

Mining free-text medical records.

Text mining projects can be characterized along four parameters: 1) the demands of the market in terms of target domain and specificity and depth of queries; 2) the volume and quality of text in the target domain; 3) the text mining process requirements; and 4) the quality assurance process that validates the extracted data. In this paper, we provide lessons learned and results from a large-scale commercial project using Natural Language Processing (NLP) for mining the transcriptions of dictated clinical records in a variety of medical specialties. We conclude that the current state-of-the-art in NLP is suitable for mining information of moderate content depth across a diverse collection of medical settings and specialties.

Acute Disease↗
PubMed2000

Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect.

BACKGROUND: Pneumococcal disease kills more people in the United States than any other vaccine-preventable bacterial disease, and a national health objective for the year 2000 is that at least 60% of eligible persons be immunized with pneumococcal vaccine. METHODS: An electronic care monitoring system was used to track immunization of patients with diabetes in a managed care plan who were receiving their care through a staff-model primary care clinic in Guam. In November 1998 a letter was sent to all patients not known to be immunized. The letter invited these patients to attend immunization clinics and waived usual copayment. Standing orders were also created for the clinic nurses to administer pneumococcal vaccines. In addition, a diabetes care status report was placed on each patient's medical record. RESULTS: The immunization rate for the 1,278 actively enrolled patients with diagnosed diabetes increased from 42% in October 1998 to 62% in January 1999. Compared to November 1995, 1996, and 1997, the number of pneumococcal immunizations increased more than 15-fold in November 1998. DISCUSSION: The combined use of patient outreach letters, special immunization clinics, standing orders, and practitioner reminders on medical records resulted in a rapid, marked increase in the pneumococcal immunization rate for patients with diabetes. The electronic care monitoring system is being used to target get interventions for improvement opportunities for an array of diabetes care measures, including regular foot care and eye exams.

Adult↗
PubMed1996

Measuring visual function and quality of life in patients with cytomegalovirus retinitis. Development of a questionnaire. Studies of Ocular Complication of AIDS Research Group.

OBJECTIVE: To develop and test a brief questionnaire designed to assess visual symptoms, visual function in daily activities, and impact of treatment administration in patients with cytomegalovirus retinitis related to acquired immunodeficiency syndrome. DESIGN: Observational cross-sectional study. Patients were recruited in June and July 1992. SETTING: Seven university-based sites participating in the Studies of Ocular Complications of AIDS. PATIENTS: Twenty-six subjects enrolled in a randomized trial that compared foscarnet and ganciclovir for the treatment of cytomegalovirus retinitis. MAIN OUTCOME MEASURES AND ANALYSIS: Distributions of scores, reliability, and validity of newly developed scales to assess visual function, visual symptoms, and global vision. Spearman rank correlations with 95% confidence intervals were used to test hypothesized relationships between scale scores, visual acuity, visual field, and findings from visual examination. RESULTS: The final 18-item self-administered questionnaire required 5 minutes to complete. The new scales had high internal consistency (Cronbach alpha = .81 to .94). As hypothesized, patient-reported vision scores decreased with greater abnormalities found on ophthalmologic examination. Visual symptoms were most strongly related to findings in the worse eye. Visual function and global vision scores were moderately correlated with findings from visual testing and examination, and less strongly related to general health perceptions. Patients reported considerable impairment: 42% reported blurred vision; 40%, difficulty reading; 44%, difficulty driving; and 40%, that treatment interfered with social activities; 50% reported substantial trouble with their vision. CONCLUSIONS: The brief questionnaire developed to assess patient-reported visual function in cytomegalovirus retinitis appears reliable and valid as a measure of performance of vision-related activities, visual symptoms, and the impact of treatment administration. Further research is needed to test its utility as an outcome measure in longitudinal studies of cytomegalovirus retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1993

Massachusetts emergency medicine closed malpractice claims: 1988-1990.

STUDY PURPOSE: To describe the characteristics of malpractice claims against emergency physicians and to identify causes and potential preventability of such claims. POPULATION: Malpractice claims closed in 1988, 1989, and 1990 against emergency physicians insured by the Massachusetts Joint Underwriters Association were compared with claims closed from 1980 to 1987 as investigated in our previous study. METHODS: Retrospective review of malpractice claim files by board-certified emergency physicians. RESULTS: The average indemnity and expense per claim were higher in the current study population than in our previous study population (P = .05). Claims in eight high-risk diagnostic areas (chest pain, abdominal pain, fractures, wounds, pediatric fever/meningitis, subarachnoid hemorrhage, aortic aneurysm, and epiglottitis) accounted for 50.8% of claims in this study and 55.5% of total monetary losses. Four claims in this study were related to two instances of failure of an emergency department radiograph follow-up system. The evaluation of patients who were intoxicated contributed to major monetary losses, especially in cases of fractures and head injury. CONCLUSION: Emergency physicians must have a particular awareness of their great risk exposure for missed myocardial infarction. Addition of dictation or voice-activated record generation systems, departmental protocols for radiograph follow-ups, and holding and re-evaluation of the intoxicated patient will help provide systems supports for reducing the liability of individual emergency physicians.

Costs and Cost Analysis↗
PubMed1992

Cystic degeneration of a leiomyoma masquerading as a postoperative abscess.

Leiomyomas are common tumors that usually have a typical sonographic appearance. With degeneration, however, the sonographic findings may be completely uncharacteristic. We report a case of a multicystic anterior uterine wall mass detected at antenatal sonography in an asymptomatic patient. Differential diagnosis included myoma, varicosity, hematoma, abscess, uterine anomaly, and pelvic neoplasm. At cesarean section, the mass was confirmed to be a myoma. Postoperatively, an ultrasound was performed by the radiology service during evaluation of suspected endometritis and the mass was interpreted as an endometrial abscess. This case illustrates that myomas can present with sonographic features consistent with a number of pathologic disorders. This variable pattern of echogenicity may sometimes create difficulty in establishing a correct diagnosis. The case also demonstrates the importance of communication between services and the need for not only antenatal but also postpartum and gynecologic ultrasound studies to be performed by physicians trained in sonographic findings of the abnormal uterus.

Abscess↗
PubMed1992

Emergency department applications of digital dictation and natural language processing.

The emergency physician has a number of challenges that must be addressed in providing high quality emergency health care delivery. One of these is the need to develop accurate documentation of the patient's health status and the patient's response to treatment in the ED. Digital dictation when combined with natural language processing is an evolving technology that is very user-friendly, fast, flexible, and cost-effective. Together, they can potentially improve risk management, reimbursement, and ultimately patient care. All the specialties of medicine are facing tremendous challenges of quality in the coming decade. In the past, an ED would wait for an incident or maloccurrence to happen. The director would analyze the cause, educate the staff, and write a new policy. Quality assurance meant searching for deviance and promoting compliance. The approach of "quality as a process of continuous improvement" suggests that the old ways don't work. We must have access to the detailed information about our clinical practice in order to assess outcomes, evaluate procedures, and undergo any meaningful change. It is said, "We cannot change what we cannot measure". Certainly tens of thousands of handwritten illegible ED reports represent an effective barrier to any substantive insight into our clinical process, and that constitutes an absolute barrier to any effective change. Digital dictation represents one gateway into the electronic record. Combined with NLP and appropriate information management, this technology holds tremendous potential for growth and provides for quality in the coming decade.

Efficiency↗
PubMed1991

The Massachusetts Emergency Medicine Risk Management Program. Massachusetts Chapter of the American College of Emergency Physicians.

Reducing malpractice claims incidence and improving the quality of patient care are the goals of the Massachusetts Emergency Physician Risk Management Program. This innovative program entails computer audit of records in high-risk diagnostic categories. The program focuses on increasing physician awareness of high-risk diagnoses and on medical record documentation of a few critical actions pertinent to each diagnostic area.

Algorithms↗
PubMed1990

Preventability of malpractice claims in emergency medicine: a closed claims study.

We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. One hundred eighty-four of these cases were included in the following eight diagnostic categories: chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, aortic aneurysm, central nervous system bleeding, and epiglottitis. These eight categories accounted for 66.44% of the total dollars spent for the 262 claims. Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.

Chest Pain↗
PubMed1990

A computerized audit of 15,009 emergency department records.

The text of 15,009 emergency department medical records was reviewed with the use of a computer program that detected the presence or absence of key words and phrases. The search focused on "trigger diagnoses," that is, any diagnoses associated with an above-average risk for an undetected but more serious condition. Included were the trigger diagnoses from the five high-risk areas of extremity laceration, epiglottitis, abdominal pain, meningitis, and myocardial infarction. The three kinds of medical records that were compared were handwritten records, records dictated and transcribed, and records created by a voice-activated word processor. From a risk management perspective, inclusion of critical pertinent positives and negatives was taken as an index of quality from a risk management perspective, and records created by a voice-activated word processor using real-time risk management prompts were superior to handwritten and dictated records. The computer holds promise as a vehicle to reduce the cost and frequency of malpractice risk in the ED and as a teaching tool to improve the quality of care.

Computers↗
PubMed1987

Effect of heparin and citrate on measured concentrations of various analytes in plasma.

Frequently it is assumed that concentrations of biochemical analytes are similar for serum and plasma, without regard to the anticoagulant. Recently it has been hypothesized that use of certain anticoagulants results in an osmotic redistribution of fluid between blood cells and plasma, causing some dilution of the plasma. We sought to determine the effect of two commonly used anticoagulants, heparin and citrate, on the measured concentrations of 13 clinical-chemical analytes, including selected trace elements, vitamins, lipids, and proteins. The data demonstrate that hyperosmolar citrate causes a significant dilution of all indices measured. In contrast, heparin had no osmotic effect; concentrations of most of the analytes measured in the heparinized plasma were statistically no different from those measured in the corresponding serum. Therefore, anticoagulants must be chosen carefully, especially if concentrations in plasma and serum are to be compared.

Blood Chemical Analysis↗
PubMed1986

Stability of teacher temperament ratings over 6 and 12 months.

Six and 12-month stability of teacher ratings of temperament was studied in four samples. For the two samples retested after a 6-month interval, the same teacher provided the original and retest ratings. For the two samples retested after a 12-month interval, different teachers provided the retest ratings than provided the original ratings. Four indices of stability were investigated for each sample: cross-rank stability, within-person stability , absolute score stability, and factorial stability. Factorial stability was demonstrated for all samples. For the other three indices of stability, 6-month stability was moderate to high, and significantly higher than the 12-month stability. The general pattern of results is comparable to temperament rating data from parents, with specific coefficients being somewhat higher.

Child↗
PubMed1986

Contrasting effects of the stomach and small intestine of rats on copper absorption.

Since the severity of copper deficiency has been shown to be enhanced by feeding diets containing fructose but ameliorated by diets containing starch, we decided to investigate the effect of fructose or starch on copper absorption. As copper transport has been reported to occur also from the stomach, it was possible that copper absorption is inhibited by fructose already from that tissue. Under anesthesia, stomachs of 72 rats fed copper-deficient or supplemented diets containing fructose or starch were ligated prior to the oral administration of 64Cu. Gastric absorption of 64Cu was studied when the isotope was administered by gastric tube either in diet containing fructose or starch or in water. 64Cu was not absorbed from the stomach regardless of the type of dietary treatment, copper status or whether the copper was administered either in diet or in water. In addition, the absorption of 64Cu from a diet containing either fructose or starch or from a saline solution was studied using the isolated ligated duodenal loop. When 64Cu was administered with dietary fructose 64Cu retention and absorption were impaired when compared to starch. When 64Cu was administered in saline solution, differences in retention and absorption between the four dietary groups disappeared. It is suggested that the requirements for copper rather than the decreased absorption of copper are responsible at least in part for the more pronounced severity of copper deficiency in rats fed fructose compared to those fed starch.

Absorption↗
PubMed1986

Effect of fructose or starch on copper-67 absorption and excretion by the rat.

Studies with 67Cu were conducted with copper-deficient or supplemented rats fed fructose or starch in an effort to investigate the effects of different dietary carbohydrates and inadequate copper intake on the absorption, tissue distribution and excretion of copper. After being fed their diets for 5 wk, they were killed at 8, 24, 48 and 96 h following the intubation of their respective copper-supplemented diets extrinsically labeled with 67Cu. Only at 48 and 96 h following the intubation of 67Cu, the gastrointestinal (GI) contents of rats fed the copper-deficient fructose diet exhibited higher radioactivity than rats fed the copper-deficient starch diet. Although not always significant, this apparent retention of copper in GI contents was accompanied by decreased whole-body radioactivity and depressed urinary excretion. The cumulative excretion of 67Cu via feces over the 96-h period of collection was similar for both groups of copper-deficient rats, regardless of whether the dietary carbohydrate was fructose or starch. The data suggest that the more severe copper deficiency is related to the sustained higher level of radioactivity in the GI contents. This increased retention of 67Cu in GI contents suggests impaired absorption of copper.

Animals↗
PubMed1986

Tissue distribution and excretion of copper-67 intraperitoneally administered to rats fed fructose or starch.

It has been suggested that impaired gut absorption of copper is the cause of the exacerbated copper deficiency signs in rats fed fructose when compared to rats fed starch. The present study was designed to examine how rats fed fructose or starch diets, either copper-deficient or supplemented, distributed and excreted 67Cu when the isotope was administered i.p. Intraperitoneal administration was chosen in an effort to circumvent primary gut absorption as a factor in the metabolism of 67Cu. After 7 wk of dietary treatment, rats received an i.p. injection of 67Cu and were placed in metabolic cages for 4 d. Regardless of dietary carbohydrate, copper-deficient rats retained similar levels of radioactivity in various tissues and excreted similar amounts of 67Cu in feces and urine. This similarity in copper metabolism in copper-deficient rats fed either fructose or starch when the gut was circumvented for isotope administration suggests that the gut could be responsible, at least in part, for the exacerbated signs associated with the copper deficiency in rats fed fructose. The possibility is discussed that alterations in metabolism may increase the requirement for copper when fructose is the main dietary carbohydrate.

Administration, Oral↗