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Biomedical subjects

John H Holmes

Publications and source records attributed to John H Holmes.

10 recordsLinked to original sources
PubMed2006

Use of the internet to enhance infectious disease surveillance and outbreak investigation.

Modernization of electronic communication systems to facilitate infectious disease surveillance and outbreak investigation became a priority after the 2001 anthrax attacks. However, the extent to which communicable disease investigators are using web-based information resources, e-mail notifications, or secure information exchange systems to facilitate surveillance is unknown. To address this question, we conducted a survey in 2004 of state and local communicable disease investigators responsible for infectious disease surveillance and outbreak investigation in three states. The majority (70.7%) of the 297 respondents accessed the Internet for information regarding infectious disease surveillance and outbreaks at least weekly. Most (74%) respondents who searched for information from the Centers for Disease Control and Prevention (CDC) website reported that they found what they were looking for 75-100% of the time, compared with 54% who found the information from their state health department websites 75-100% of the time. One-third of respondents read e-mail notifications regarding outbreaks under investigation in their state less frequently than monthly; 34% of those enrolled in CDC's Epidemic Information Exchange (Epi-X) read e-mail notifications of new reports less frequently than monthly. Forty-seven (18%) respondents read ProMED-mail at least monthly, while 46% indicated they had never consulted MEDLINE/PubMed. Some progress has been made in use of the Internet to facilitate communication in infectious disease surveillance and outbreak investigation. Addressing barriers to access and usability of new information systems in conjunction with training and technical support could enhance infectious disease surveillance and timely investigation of outbreaks and bioterrorism events.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Pressure ulcers among elderly patients early in the hospital stay.

BACKGROUND: Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence. METHODS: A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Service at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified as either preexisting, possibly hospital-acquired, or definitely hospital-acquired. RESULTS: There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.2% (95% confidence interval, 5.4%-7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status. CONCLUSIONS: A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person's hospital stay.

Aged↗
PubMed2005

CiteSpace II: visualization and knowledge discovery in bibliographic databases.

This article presents a description and case study of CiteSpace II, a Java application which supports visual exploration with knowledge discovery in bibliographic databases. Highly cited and pivotal documents, areas of specialization within a knowledge domain, and emergence of research topics are visually mapped through a progressive knowledge domain visualization approach to detecting and visualizing trends and patterns in scientific literature. The test case in this study is progressive knowledge domain visualization of the field of medical informatics. Datasets based on publications from twelve journals in the medical informatics field covering the time period from 1964-2004 were extracted from PubMed and Web of Science (WOS) and developed as testbeds for evaluation of the CiteSpace system. Two resulting document-term co-citation and MeSH term co-occurrence visualizations are qualitatively evaluated for identification of pivotal documents, areas of specialization, and research trends. Practical applications in bio-medical research settings are discussed.

Algorithms↗
PubMed2005

Visual exploration of landmarks and trends in the medical informatics literature.

This study presents preliminary results from a visual study of a new dataset of forty years of citation data from publications of twelve journals in the medical informatics field covering the time period from 1964-2004. Highly cited and pivotal documents, areas of specialization within medical informatics, and emergence of research topics are visually mapped through a progressive knowledge domain visualization approach to detecting and visualizing trends and patterns in scientific literature.

Bibliometrics↗
PubMed2003

Expert consensus for discharge referral decisions using online delphi.

This paper describes the results of using a modified Delphi approach designed to achieve consensus from eight discharge planning experts regarding the decision to refer hospitalized older adults for post-discharge follow-up. Experts reviewed 150 cases using an online website designed to facilitate their interaction and efforts to reach agreement on the need for a referral for post-discharge care and the appropriate site for such care. In contrast to an average of eight weeks to complete just 50 cases using the traditional mail method, the first online Delphi round for 150 cases were completed in six weeks. Data provided by experts suggest that online Delphi is a time efficient and acceptable methodology for reaching group consensus. Other benefits include instant access to Delphi decision results, live knowledge of the time requirements and progress of each expert, and cost savings in postage, paper, copying, and storage of paper documents. This online Delphi methodology is highly recommended.

Aged↗
PubMed2003

Developing a patient intervention to reduce antibiotic overuse.

The emergence of drug resistance among common community-acquired bacterial infections has been clearly linked to the overuse of antibiotics. To address this problem, guidelines have been developed for the judicious use of antibiotics, particularly with regard to respiratory infection in adults and children. In addition, the CDC has promulgated guidelines for the general public, exhorting patients not to take an antibiotic for viral illnesses, not to pressure practitioners for antibiotic therapy, not to use antibiotics prescribed for another person, and not to use antibiotics left over from a previous illness. Despite some overall decline in antibiotic use, patients continue to engage in antibiotic overuse practices, resulting in increasing antimicrobial resistance. One reasons for antibiotic overuse is "antibiotic expectation," in which patients expect to be treated with an antibiotic for an acute infection, whether it is viral or bacterial.1 This phenomenon points to an underlying system of beliefs held by patients toward antibiotic use that may be alterable by educational interventions.

Anti-Bacterial Agents↗
PubMedDate not supplied

Use of photographs for the identification of pressure ulcers in elderly hospitalized patients: validity and reliability.

To evaluate the ability of research nurses to identify pressure ulcers, the authors assembled digital photographs of the skin of 160 consenting elderly patients (80% African American, 63% women). The series included 39 photos of pressure ulcers, 109 of normal skin, and 12 of other skin conditions, determined by consensus by two experts (D.J.M. and S.H.K.). Photos were packaged electronically into eight blocks of 20, with pressure ulcer prevalence ranging from 20% to 30% per block. The eight blocks were duplicated to create two sets of 160 photos each. Each of six raters (experienced clinical research nurses), working independently, evaluated the 320 photos as if each photo depicted a different patient. For analysis, the ratings were collapsed into binary determinations (any pressure ulcer vs. none). The overall sensitivity and specificity of the ratings were 0.97 (95% confidence interval: 0.94, 0.98) and 0.81 (95% confidence interval: 0.77, 0.86), respectively. Rater-specific prevalence (range: 31.8-47.5%) exceeded the true prevalence (24.4%). Inter- and intrarater reliability coefficients were 0.69 and 0.84, respectively. Trained research nurses can accurately classify pressure ulcers from photographs, even when patients are largely non-White and the photographs depict pressure ulcers spanning all pressure ulcer stages.

Aged↗