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J Kirby

Publications and source records attributed to J Kirby.

At least 55 records · Page 3Linked to original sources
PubMed1995

A clerking tool for the patient record system.

1. BACKGROUND. The goal of the PEN&PAD (Elderly Care) project is to develop a patient record system to assist the many different professionals that care for patients in a hospital setting. At the core of the project is the use of structured data which can be reused in a variety of ways--both within the system for further manipulation and display, and externally for auditing and statistical purposes. To accommodate these needs, a compositional method of data entry called Structured Data Entry (SDE) was used in this application. SDE was developed in an earlier project PEN&PAD (GP)(1). Our application utilizes a network representation of the medical semantics that can be queried to obtain what is sensible to "say" about a particular concept. This functionality is contained within a separate application known as the Terminology Server (TeS), which has been developed within the GALEN project (2). The client application (the patient record system) requests information from the TeS which can then be used to produce compositional data entry forms that require the user to choose values for given attributes (e.g., if information pertaining to chest pain were being recorded, the attribute 'location' and a choice of possible values i.e., 'left' 'right' and 'bilateral' might appear on the form). Given the importance of capturing clinical information in a highly structured format, SDE is a valuable tool. However, its long term success depends on a very comprehensive model of the medical terminology corpus. This component is currently being studied by the GALEN team. 2. CURRENT WORK. We are developing a clerking tool to be used to create records for the newly admitted patient. The clinician seeks to identify a patient's problems based on physical examination and information obtained through conversation with the patient. Patients are usually admitted with a presenting complaint and obtaining more information about this complaint is an important part of the clerking process. While the physician may be able to use the clerking data to consider possible diagnoses right away, he/she often needs to review relevant body systems before a diagnosis is made. In traditional paper based clerking systems, notes are highly formalized but still subject to variation between clinicians. A typical clerking records information such as: 1) history of the presenting complaint; 2) previous medical history; 3) review of body systems; 4) medication; 5) social history; and 6) investigations. We have attempted to retain this clerking outline as much as possible, focusing primarily on the presenting complaint and review of body systems sections. To begin the clerking process, the user chooses a presenting complaint (from the list provided) to launch the 'clerking' window. Access buttons for the different clerking sections are positioned above a data entry window. This window contains a form for collecting information on the presenting complaint. The form is divided into sections to allow the user to record the absence or presence of an associated symptoms and other details. Free text comments can be added to the window, and a data display area shows information entered so far. The user can query the body system database by choosing a system from a menu. At this point the presenting complaint window is replaced by one on the body system in question. The user is free to switch back and forth between the presenting complaint and body system screens. On returning to a previously visited window, the user may pick up where he/she left off when exiting the window. Once the clerking is completed, the information is entered as a unit into the patient record with the date and clinicians name attached. Thereafter, the file becomes read-only. We are currently putting a prototype clerking system through field trials with clinicians from of a local hospital. In our demonstration, we hope to elaborate on these trials and their outcomes.

Admitting Department, Hospital↗
PubMed1994

A comparison of amethocaine cream with lignocaine-prilocaine cream (EMLA) for reducing pain during retrobulbar injection.

A prospective, randomised, double-masked, placebo-controlled study was carried out on 169 patients undergoing cataract extraction to compare the topical anaesthetic cream amethocaine with EMLA (eutetic mixture of local anaesthetic, lignocaine and prilocaine) and placebo in reducing pain during retrobulbar injection. Fifty-eight patients received EMLA, 55 amethocaine and 56 the placebo. The pain was assessed objectively by the anaesthetist and subjectively by the patient. Significantly lower pain scores were observed in those patients who had amethocaine (p < 0.001) or EMLA (p < 0.005) in comparison with those who had placebo, but there was no statistical difference between amethocaine and EMLA (p > 0.1; t-test). No systemic or local side-effects were encountered in any group.

Aged↗
PubMed1994

Developmental expression of testis messenger ribonucleic acids in the rat following propylthiouracil-induced neonatal hypothyroidism.

Propylthiouracil- (PTU) induced transient neonatal hypothyroidism increases adult rat testis weight 80-100%; this effect involves prolongation of Sertoli cell proliferation. To gain insight into developmental effects of PTU on the testis, we used Northern analysis to examine chronological expression of Sertoli cell mRNA in postnatal rat testes from rats that were untreated (controls) or were given PTU from birth to Day 25. Treated rats showed prolonged early expression of genes associated with dividing Sertoli cells such as MIS (Müllerian inhibiting substance) and c-erbA alpha (thyroid hormone receptor). Expression of several other Sertoli cell mRNAs (androgen-binding protein [ABP], clusterin, and inhibin-beta B) was delayed, as was that of hemiferrin, a spermatid-specific mRNA. Temporal expression patterns for other mRNAs (sulfated glycoprotein [SGP]-1, transferrin, and inhibin-alpha) were similar in control and treated animals. Additionally, thyroid hormone replacement in PTU-treated animals decreased MIS and c-erbA alpha mRNA expression to control levels. The altered developmental pattern of expression of a number of major Sertoli cell genes reflects a prolonged mitogenesis and delayed maturation of Sertoli cells in neonatally hypothyroid animals. Furthermore, our results suggest that thyroid hormone may directly potentiate molecular events associated with cessation of Sertoli cell proliferation and maturation during early testis development.

Animals↗
PubMed1994

Lichen sclerosus and the Köbner phenomenon.

Two patients with lichen sclerosus (et atrophicus) are described in whom there was conspicuous localization of lesions to sites subjected to friction from tight clothing. This was highly suggestive of the Köbner phenomenon. Both patients experienced symptomatic improvement following avoidance of pressure on the skin from tight clothing.

Clothing↗
PubMed1994

Daily exposure to a nonphotic stimulus can alter photoperiodic response to short days in hamsters.

The ability of mammals to measure seasonal changes in daylength depends upon a circadian clock and the phase-relationship between this clock and the light: dark cycle. Recently, a number of pharmacological and nonpharmacological stimuli have been shown to have pronounced effects on the phase of the circadian clock of rodents. The objective of the present study was to determine if a drug-induced change in the phase-relationship between a measurable circadian rhythm (i.e., wheel running behavior) and the light:dark cycle would alter the effects of the light cycle on the neuroendocrine-gonadal axis. Adult male hamsters with regressed testes due to exposure to an inhibitory 10:14-hr light:dark cycle were daily injected with vehicle or the short-acting benzodiazepine, triazolam, while remaining on short days, while a control group of hamsters was transferred to a photostimulatory 14:10-hr light:dark cycle. Two other groups of hamsters with regressed testes were blinded and daily injected with vehicle or triazolam. The injections were timed to occur about 4 hr before activity onset because previous studies had demonstrated that injections of triazolam at this time can lead to a phase advance in the activity rhythm. The circadian rhythm of wheel running behavior was measured in all the animals maintained on the 10:14-hr light:dark cycle in order to monitor circadian phase. While no testicular growth was observed after 25 days of vehicle injections, growth was observed in the triazolam-treated animals that was comparable to that observed in control animals transferred to long days. Testicular growth in triazolam-treated animals was associated with an earlier onset of locomotor activity, when compared with the vehicle-treated animals. Importantly, triazolam had no effect on the testicular size of blind animals. These results indicate that daily injections of triazolam can stimulate neuroendocrine-gonadal activity by altering the phase-relationship between the cycle and the circadian clock involved in photoperiodic time measurement, and that agents which can affect the clock may be useful in altering seasonal cycles.

Animals↗
PubMed1994

The PEN & PAD medical record model: development of a nursing record for hospital-based care of the elderly.

The PEN & PAD Medical Record model describes a framework for an information model, designed to meet the requirements of an electronic medical record. This model has been successfully tested in a computer-based record system for General Practitioners as part of the PEN & PAD (GP) Project. Experiences of using the model for developing computer-based nursing records are reported. Results show that there are some problems with directly applying the model to the nursing domain. Whilst the main purpose of the nursing record is to document and communicate a patient's care, it has several other, possibly incompatible, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical frameworks underlying their work. By providing new insights into the professional background of nursing records, this work had highlighted the need for nurses to clarify and make explicit their uses of information, and also provided them with some tools to assist in this task.

Aged↗
PubMed1994

Using the PEN&PAD information model to support hospital-based clinical care.

The PEN&PAD model for clinical record systems has been successfully used for medical records in both General Practice and hospital-based care. This paper describes experiences of using the model for developing computer-based nursing records. Results from this work show that there are some problems with directly applying the model to the nursing domain. Whilst the main purpose of the nursing record is to document and communicate a patient's care, it has several other, possibly incompatible, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical frameworks underlying their work. By providing new insights into the professional background of nursing records, this work has highlighted the need for nurses to clarify and make explicit, their uses of information, and also provided them with some tools to assist in this task.

Computer Systems↗
PubMed1993

PEN&PAD (Elderly Care): designing a patient record system for elderly care.

Practical experiences in the work analysis and design of a computer-based patient record system for use by doctors on an elderly care ward are discussed. A diagrammatic technique named "Task Oriented Flow Diagrams" is briefly described. This technique enables designers to formalise their understanding of users work tasks in manner that is comprehensible to users, and thus can form the basis of a dialogue between designer and users. A prototype patient record system is described and the results of its evaluation with users presented.

Aged↗
PubMed1992

PEN&PAD (Geriatrics): a Collaborative Patient Record System for the shared care of the elderly.

The PEN&PAD (Geriatrics) project seeks to develop a Collaborative Patient Record System for the hospital based shared care of the elderly. The goal of the project is to produce a single, integrated information system which is both useful and usable by the different practitioner groups involved in geriatric care. A User Centred Design methodology is proposed which makes users and human issues central to the design and development process. Preliminary results indicate that the specification of a Minimum Basic Data Set as the basis of a shared record system is infeasible and undesirable. An architecture is presented which illustrates how the diversity between the different disciplines may be preserved in a Collaborative Patient Record System.

Geriatrics↗
PubMed1991

Wound instillation for postoperative pain relief: a comparison between bupivacaine and saline in patients undergoing aortic surgery.

In a double blind trial 72 patients having elective aortic surgery were randomized to receive either 40 ml of 0.25% bupivacaine or 40 ml of saline through one or two indwelling wound irrigation catheters every four hours over a total of 48 hours. In transverse incisions the two catheters were randomly placed either subcutaneously or in the rectus sheath; in vertical incisions one catheter was placed subcutaneously. Analgesia was assessed by visual analogue score on Postoperative Days 1 and 2 and the number of doses of intramuscular morphine given during the instillation period. Pulmonary function was monitored by forced expiratory volume and peak flow on Postoperative Days 1 to 5; arterial blood gases were monitored preoperatively and Postoperative Day 2. In all parameters evaluated there was no statistically significant difference between the saline (n = 33) or the bupivacaine (n = 37) groups. Site of the catheter in the transverse groups made no difference. Comparing vertical (n = 21) and transverse (n = 49) incisions, the mean visual analogue scores on the first postoperative day were 40 and 29, respectively (p less than 0.05). Wound instillation with bupivacaine neither improves pulmonary function nor reduces morphine requirements when compared to saline. Transverse incisions may be less painful than vertical ones.

Adult↗
PubMed1991

Effects of NMDA modulation in scopolamine dementia.

D-Cycloserine is a partial agonist at the strychnine-insensitive neuronal glycine receptor and positively modulates the N-methyl-D-aspartate (NMDA) excitatory amino acid receptor. NMDA receptors appear to be important in learning and memory, and D-cycloserine facilitates learning in rats. In man, central cholinergic blockade due to scopolamine administration impairs attention, information processing, and memory for new information, the latter secondary memory impairments resembling those shown in patients with Alzheimer's disease (AD). D-Cycloserine has been studied for its ability to counteract the cognitive decrements produced by scopolamine in young and elderly healthy volunteers. D-Cycloserine specifically antagonized the memory impairments produced by scopolamine. These findings provide evidence of NMDA receptor involvement in human memory and suggest a novel mechanism for alleviation of memory loss associated with aging and dementia.

Adolescent↗
PubMed1991

A double-masked evaluation of lignocaine-prilocaine cream (EMLA) used to alleviate the pain of retrobulbar injection.

A randomised, placebo controlled, double-masked study was undertaken in 115 patients undergoing cataract surgery to assess the efficacy of the anaesthetic cream EMLA (eutetic mixture of local anaesthetic, lignocaine-prilocaine) in alleviating the pain of retrobulbar injection. Sixty three patients received the EMLA cream and 52 the placebo cream. The pain was assessed objectively by the anaesthetist, who observed the reaction of the patient on needle insertion, and subjectively by the patient. Significantly lower pain scores were recorded in patients treated with EMLA cream (anaesthetist's observation: p less than 0.01, patient's assessment: p less than 0.006). No patients experienced serious side effects in either treatment group.

Aged↗
PubMed1989

Platelet MAO activity and personality variations in normals.

The authors examined platelet MAO activity and several personality variables in 58 non-clinic-referred healthy adult males. The psychological tests administered consisted of the Minnesota Multiphasic Personality Inventory, the Personality Research Form-E, and the Zuckerman Sensation Seeking Scale. The findings replicated previous findings in the literature.

Adult↗
PubMed1989

Patterns of maxillofacial injuries in restrained and unrestrained motor vehicle crash victims.

Safety belts reduce the frequency and severity of injuries sustained in motor vehicle crashes. Since the head and face are the most frequently injured anatomic regions in motor vehicle crash victims, the use of active restraints should lessen these injuries. This study was undertaken to examine the ability of safety belts to prevent and alter the pattern of maxillofacial injuries. During a 6-month period beginning February 1, 1987, 613 motor vehicle crash victims presented alive to the Trauma Center at the University of Tennessee Medical Center at Knoxville and were entered into this study. There were 254 restrained victims (R), 290 unrestrained (UR), and 69 who were excluded for lack of sufficient data regarding restraint usage. Unrestrained victims tended to be younger (mean age: UR = 27.9, R = 31.7; p less than 0.03), and more often male (UR = 65% vs. R = 51%; p less than 0.03). Irrespective of position within the vehicle, the mean number of facial lacerations per person was less in the restrained group (R = 0.31, UR = 0.76; p less than 0.03). This injury reduction was more pronounced in front seat occupants (R = 0.27, UR = 0.82; p less than 0.03). Furthermore, a smaller proportion of the lacerations in the restrained group were categorized as complex, i.e., involving more than skin and subcutaneous tissue (R = 5.0%, UR = 15.9%; p less than 0.03). The pattern of skeletal injuries was also significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1989

Injury and cost comparison of restrained and unrestrained motor vehicle crash victims.

The use of active motor vehicle restraints is a topic of current public and legislative debate. To better define the effects of restraint systems on injury severity, the following study was undertaken. Parametric statistical tests were used for data analyses. For a 6-month period beginning February 1, 1987, all motor vehicle crash victims treated in the emergency unit were entered into the study (n = 613). There were 290 unrestrained subjects (UR), 254 restrained subjects (R), and 69 were excluded because restraint usage information was unobtainable. Unrestrained victims were younger (mean age, UR = 28, R = 32; p less than 0.05), and were more often male (UR = 65%, R = 51%; p less than 0.05). Hospitalization was more frequently required for unrestrained crash victims (UR = 59%, R = 26%; p less than 0.05). Length of hospital stay (LOS), including ICU confinement, was also extended (mean LOS, UR = 13, R = 10), but this difference did not reach statistical significance. Injury Severity Scores (ISS) and Abbreviated Injury Scales (AIS) were tabulated and compared. Mean ISS was significantly higher for unrestrained victims (UR = 8.28, R = 4.44; p less than 0.05), and a higher proportion of unrestrained victims had scores greater than 15 (UR = 20%, R = 7%; p less than 0.05). Mean AIS was higher in all regions, although the difference did not consistently reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1987

Prediction of airway responsiveness to allergen from skin sensitivity to allergen and airway responsiveness to histamine.

Previous data have indicated that airway responsiveness to allergen, expressed as the provocation concentration causing a 20% FEV1 fall (PC20), was dependent on nonallergic airway responsiveness (histamine PC20) and sensitivity to allergen (skin sensitivity or end-point titration). From retrospective data in 24 subjects, we developed a formula to predict allergen PC20 and examined its accuracy prospectively in 26 new subjects undergoing allergen inhalation test with doubling allergen concentrations. Allergen PC20 (APC20) was predicted from histamine PC20 (HPC20) and skin sensitivity (SS) by the formula: Log10 (APC20) = 0.69 Log10 (HPC20 X SS) + 0.11 (r = 0.85). Allergen PC20 was accurately predicted in 6, and overestimated or underestimated by 1 doubling concentration in 11, by 2 concentrations in 6, by 3 concentrations in 3, and by greater than 3 concentrations in none. From the total of 50 subjects, a new relationship was developed: Log10 (APC10) = 0.68 log10 (HPC20 X SS) (r = 0.82) from which 46 of 50 (92%) of allergen PC20 values fall within 2 doubling concentrations of the regression line (and all within 3). Early airway responsiveness to a given allergen can be predicted within a +/- 8-fold range, which is better than some investigator's test reproducibility of +/- 1 log (10-fold). Allergen inhalation tests to determine early asthmatic responsiveness to different IgE-mediated allergens can probably be replaced by the simpler and safer determinations of allergen sensitivity (SS, RAST) and histamine or methacholine airway responsiveness.

Allergens↗
PubMed1986

Neuroblastoma and nutritional support: influence on the host-tumor relationship.

The nutritional sequelae of neuroblastoma are secondary to tumor burden, tumor-host influenced metabolism, and antitumor operative, pharmacologic, and radiation therapy. Nutritional support and its influence on the outcome of clinical cancer is confusing; but in a defined murine system, we hypothesized that whether or not nutritional repletion favors the host-tumor relationship is dependent on a nutritional augmentation of host antitumor immunity. C1300 murine neuroblastoma (NB) elicits a host antitumor immune response as determined by in vivo and in vitro testing; but the TBJ clone of the same tumor is nonimmunogenic. After receiving two weeks of either regular 24% protein or protein restricted 2.5% protein chow, normal and malnourished mice received either C1300-NB or TBJ-NB and were serially followed to animal death. The median survival time (MST) of TBJ recipients was shorter in this more aggressive tumor, but the MST of 27.5 days was equal for normal and malnourished mice. Contrasting with these data were an MST of 38 days for malnourished C1300 NB recipients and an MST of 64.5 days for normally nourished C1300 NB recipients, values that are significantly different (P less than 0.02). These data suggest that nutritional support influencing host antitumor immunity may be of benefit only in that circumstance where the tumor elicits an antitumor immune response.

Animals↗