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Biomedical subjects

J M Overhage

Publications and source records attributed to J M Overhage.

At least 37 records · Page 2Linked to original sources
PubMed1996

Computerizing guidelines: factors for success.

Clinical practice guidelines are being touted as a cure for the tension between health care cost and quality. Rather than being just a means of controlling clinicians, guidelines also offer the chance to improve the quality of care by reducing practice variation and adherence to standards of good care. To be operationalized via computers, guidelines must be accepted by the clinicians, who must fully intend to follow them. They must be timely and use available data with minimal additional data entry by clinicians. Finally, they should have a measurable effect and be shown to improve care processes and/or outcomes.

Medical Informatics Applications↗
PubMed1996

Representing CARE rules in a decision-theoretic formalism.

Improvement in the performance of reminder systems may be facilitated by the use of new representations. A decision-theoretic representation, for example, may enable a reminder system to represent and reason about the probabilities that a reminder will be a true or a false alarm and the relative utilities of these events. We extended a previously described decision-theoretic model to include such events. The model now represents explicitly the uncertainty, costs, and benefits of sending a reminder. We also extended the model to remove an assumption of reminder independence. As a step towards testing a hypothesis that this approach will support better performance than a rule-based approach, we analyzed a set of CARE rules and showed that our representation can represent these rules.

Decision Support Techniques↗
PubMed1995

Multidimensional work sampling in an outpatient pharmacy.

Multidimensional work sampling was performed at a hospital-based outpatient pharmacy. Data were collected from nine full-time and five part-time pharmacists over a 45-day baseline period. Pharmacists wore silent, random-signal generators that permitted continuous work sampling. We introduced the concept of quick codes to allow pharmacists to record their work using a single letter for repetitive activities. Pharmacists recorded 4,687 observations, 90 percent using quick codes. The most common activity was checking prescriptions (36.2 percent). Detection and correction of prescribing errors was the most common reason for their work (39.4 percent). Most work-related activities were performed alone (80 percent) with little time in contact with patients or physicians. These baseline measures will be compared with future measures to assess the effect of the implementation of computerized prospective drug utilization review and clinical treatment guidelines on pharmacists' work. It is expected that these technologic and process changes will increase opportunities for pharmacists to educate patients and consult with physicians.

Classification↗
PubMed1995

Design and implementation of the Indianapolis Network for Patient Care and Research.

We are creating a health care information network that will link a large community medical record system to three hospital emergency departments, fifty community pharmacies, ten clinics, four health-maintenance organization (HMO) offices, and twelve homeless care sites in Indianapolis, Indiana. This project will test the feasibility of linking care providers across organizational boundaries and measure the benefits of such a network. The network will supply three kinds of information services: a "mini-medical library," patient medical record information, and a citywide prescription database incorporating a computer-based prescription-writing system. The use of medical resources, the cost of care, provider time spent giving care, and providers' opinions of the services will be used as outcomes in randomized clinical trials. Through this project, we hope to expand the information base available to the target care sites; reduce unnecessary testing and increase the efficiency of care in emergency departments; improve emergency department, office, and clinic prescribing patterns; enlarge the consortium of health care providers connected by the network; and develop strategies for successfully implementing a comprehensive city medical record resource.

Ambulatory Care Facilities↗
PubMed1995

A tool for provider interaction during patient care: G-CARE.

We have extended the CARE language to facilitate interaction with providers using the Medical Gopher order entry system during patient care to create G-CARE. We have used G-CARE in several randomized controlled trials and for routine clinical applications. The language has evolved and is now able to support nearly all of the decision support. Its flexibility allows G-CARE results to be used at many points throughout the patient care process. Based on actual use of G-CARE, we have found performance issues and lack of dynamically grouped order sets are limitations which need to be addressed.

Decision Making, Computer-Assisted↗
PubMed1994

Medical students' and housestaff's opinions of computerized order-writing.

BACKGROUND: Greater use of computers has been touted as one way in which health care quality can be enhanced while reducing costs. The authors assessed factors associated with acceptance of computerized order-writing. METHOD: From April 1990 through October 1991 a survey was administered to 275 medical students and housestaff who used computer workstations to write all their orders on the general medicine wards at Wishard Memorial Hospital. The survey assessed computer literacy, ease of workstation use, effects on practice and time management, and usefulness of information provided. RESULTS: A total of 212 (77%) of the computer-workstation users responded. Opinions were generally positive. Those of junior students were the most positive, with opinions declining progressively for senior students, interns, and residents. The housestaff were most critical of time spent using the workstations, although they required less time to write orders than the students did. CONCLUSION: The favorableness of the respondents' opinions declined as the level of training increased, a trend that was independent of computer literacy. Hence, increasing computer use by physicians will probably require modification of the educational and socialization process rather than mere reliance on increasing computer literacy.

Analysis of Variance↗
PubMed1993

Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.

OBJECTIVE: To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. DESIGN: Randomized controlled clinical trial. SETTING: Inpatient internal medicine service of an urban public hospital. SUBJECTS: A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. INTERVENTION: Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. MAIN OUTCOME MEASURES: Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. RESULTS: Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P = .02). Significant reductions (P < .05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P = .11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P < .0001). CONCLUSIONS: A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Computer Communication Networks↗
PubMed1991

Standards for the electronic transfer of clinical data: progress and promises.

Data exchange standards have two components: the message format or syntax and the dictionary of codes (semantics). For many applications, message standards already have been developed. For a few kinds of clinical entities, such as drugs, these code systems (e.g., the National Drug Code) are virtually complete, but a few gaps must be filled and an agreement must be reached about the level of granularity needed. The available codes for clinical descriptors are inadequate but the National Library of Medicine's Universal Medical Language (UML) project will do much to redress this deficiency. Codes for clinical variables such as blood pressure and blood glucose which have methods, units, normal ranges, and physiologic correlates are very inadequate. CPT4 provides some of the needed codes but has huge gaps. An early effort to extend CPT4 is included in ASTM 1238. Work being done by ASTM E31.12 and the Euclides project will offer robust codes for clinical laboratory measurements. If we want to pool data from different institutions for clinical and policy research, universal codes for observations are prerequisite. And agreement of an international coding system for observation-bearing variables should be a major agenda item for standards groups in the next year. Our goal has been to standardize the communication of clinical data between clinical systems, not the systems themselves or their internal operation. In fact, standardizing the internals of clinical application could be counterproductive at the present. It would deflect energy from, and delay the spread of, CDI standards. Moreover, it gives undue attention to computer systems, rather than the data they contain. The data are the most expensive part of any data system. They are the raison d'être for such systems. Computer systems come and go. The data last forever. Yet we have been mesmerized by the computer system while ignoring its contents. As a result, most computer-stored clinical data must live like the tragic boy in the bubble. They cannot "live" outside of the computer system in which they were born. So, we find at every hospital the bizarre rituals of humans reading computer-generated reports so they can type this information in another computer. Electronic (e.g., stored clinical) data should not depend upon the internals of a particular program, language, or machine for its interpretation. The clinical data entered into one computer system should be directly available to any other computer system that now receives them through manual transcription. Data interchange standards give life to our data--independent of the source system.

Abstracting and Indexing↗
PubMed1990

Developing renal innervation in the spontaneously hypertensive rat: evidence for a role of the sympathetic nervous system in renal damage.

The spontaneously hypertensive rat (SHR) exhibits increased renal sympathetic nerve activity and neurotransmitter levels compared with the control Wistar-Kyoto rat (WKY). These renal nerve abnormalities have been implicated as the cause of hypertension in the SHR. The aims of the present study were to characterize the ontogeny of renal sympathetic innervation in SHR in order to determine any functional implications. Glyoxylic acid histofluorescent and radio-enzymatic norepinephrine assays demonstrated an accelerated development of renal innervation in newborn and 1-, 2-, 3- and 6-week-old SHR compared with WKY. Sympathetic nervous system function was blocked in developing male SHR by treating pups from days 0 to 14 with: (1) guanethidine, (2) combined alpha- and beta-receptor antagonists (prazosin and timolol), or (3) vehicle (5% sucrose). Blood pressure (mean), renal function (plasma creatinine) and histologic renal damage were assessed at 42 weeks of age. Although the blood pressure of the drug-treated rats remained elevated, renal damage was reduced and renal function was improved compared with control (sucrose-treated) SHR. The data demonstrate that the SHR kidney develops a precocious sympathetic innervation and that inhibition of the development of sympathetic function ameliorates renal damage independently of systemic hypertension.

Animals↗
PubMed1986

Morphological evaluation of vascular smooth muscle cell: length and width from a single scanning electron micrograph of microvessels.

Accurate three-dimensional data on the structure of vascular smooth muscle cells is essential for understanding the microvascular system in both normal or disease conditions. The laborious serial reconstruction methods have limited the amount of data collected on the structure of individual vascular smooth muscle (VSM) cells. The circumferential viewing of whole vessel segments via scanning electron microscopy provides an alternative approach, but even this technique is highly specialized and tedious. This study presents a simplified method to determine the average cell length and width of individual VSM cells by using only one view of a microvessel (single view). The vessels do not have to be isolated for circumferential viewing and can be left in their host tissue if desired. Values for the average VSM cell length and width were obtained by both circumferential- and single-view approach on the same vessels. The average cell length and width obtained from the single-view method (using one-third circumference) duplicated the mean length and width measurements obtained by circumferential viewing.

Animals↗
PubMed1985

Hypertrophy of arteriolar smooth muscle cells in the rat small intestine during maturation.

The purpose of this study was to define structural characteristics for vascular smooth muscle (VSM) cells from the submucosal arteriolar system of the rat small intestine during maturation. Arterioles from 6- to 8-week-old and 10- to 12-week-old male WKY animals were selected from tissue prepared for scanning electron microscopy and mounted on end so that the entire circumference of each vessel could be observed by serial photography using scanning electron microscopy. From each vessel segment, the following measurements were made: outer vessel diameter, number of VSM cells occupying a length of vessel, the number of resolutions each VSM cell makes around the vessel, length of individual VSM cells, and width of lateral processes along their length. At a given age, the length and width of the VSM cell was statistically similar for all types of arterioles. However, the VSM cell increased substantially in length and width from the 6-8- to 10-12-week time periods. The outer diameter for a particular arteriolar type also increased with age. These data suggest that the intestinal vasculature as a common population of smooth muscle cells at a given age in terms of their length, size, and process morphology for the various types of arterioles. Furthermore, maturation of the microvessels is associated with a uniform hypertrophy of the VSM cells from the majority of arterioles such that cells of young adult rats and those of juvenile animals represent distinctly different populations.

Aging↗
PubMed1984

Effect of denervation on the afferent arteriole in the SHR.

To study the role the renal nerves may play in the hypertension of the SHR, we conducted a morphometric study of the afferent arteriole of spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY) which were subjected to renal denervation (or sham-operation). Methacrylate casts were made of the renal vasculature after perfusion fixation with glutaraldehyde. These vascular casts were then examined and measurements made with the scanning electron microscope (SEM). Afferent arterioles of the denervated SHR were dilated in comparison to the sham-operated SHR, but there was no difference between the afferent arteriolar diameters of the 2 groups of WKYs. However, the afferent arteriolar diameters of the SHR (either group) were smaller than those of the WKY. Renal denervation caused a reduction in systolic blood pressure compared to sham-operated in both strains of rat. We concluded that the dilation changes of afferent arterioles of denervated SHRs may be related to renal autoregulation resulting from the decreased blood pressure. However, the effect of the loss of sympathetic innervation of the arterioles cannot be ruled out.

Animals↗