An unusual tattoo.
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Fibrinolytic Agents↗
Biomedical subjects
M O'Neil
Publications and source records attributed to M O'Neil.
Cardiac pacemakers and implantable cardioverter defibrillators are unaffected by operation of an extremity MR imaging system.
OBJECTIVE: The objective of our investigation was to determine whether an MR imaging system designed to obtain images of the extremities affects the safety and functionality of pacemakers or that of implantable cardioverter defibrillators (ICDs). MATERIALS AND METHODS: Ex vivo experiments were conducted in which seven pacemakers and seven ICDs were exposed to a 0.2-T extremity MR imaging system. Magnetic field attraction was assessed at three positions relative to the MR imaging system. In addition, the devices were placed into a test apparatus that was oriented parallel and perpendicular relative to the MR imaging system while imaging was performed on a phantom using T1-weighted spin-echo and gradient-echo sequences. Various functional aspects of the pacemakers and ICDs were evaluated before, during (pacemakers only), and after MR imaging. RESULTS: Magnetic field attraction was relatively minor for all devices. The quality of the MR images was unaffected by the devices. Operation of this MR system did not alter any of the functional aspects of the pacemakers or ICDs evaluated in this study. CONCLUSION: According to these data and in consideration of how patients are positioned during examinations--that is, positioned so that the thorax (where the pacemaker or ICD and the corresponding leads are located) does not enter the magnet bore--the results suggest that it should be safe to perform MR imaging in patients with the pacemakers and ICDs evaluated in this study.
Arm↗
Semantic definition of disorders in version 3 of the Read Codes.
The disorder chapter of Version 3 of the Read codes is a rich source of clinically derived terminology. The file structure has been designed to meet a clinical need to support both enumerated and compositional taxonomy. This requirement coupled with the maintenance of multiple classification necessitates a mechanism to identify consistent hierarchical placement and equivalence between concepts. The early work on the semantic definition of the disorder chapter, to support these requirements, is outlined and the attributes that have been found to be important are presented. We also describe different categories of completeness of definition that have been identified, and the scope of those that are likely to remain incompletely characterised.
Artificial Intelligence↗
Exploring the ontology of surgical procedures in the Read Thesaurus.
The Read Thesaurus is a comprehensive user-led clinical vocabulary developed from earlier, and structurally simpler, versions of the Read Codes, with substantial input from United Kingdom health care professionals. A constituent template table underpins a range of functions, including semantic definition of concepts using object-attribute-value triples. Concept representation for surgical procedures has been investigated by a number of groups and a standard European structure has been proposed. Over 50% of the surgical procedures in the Read Thesaurus have been fully characterised using a number of attributes each with a defined concept field. We report progress to date and, based on our large-scale experience, examine the applicability of the European model to a user-defined terminology.
Europe↗
The Read Thesaurus--creation and beyond.
The creation of the Read Thesaurus was a unique undertaking, involving over 2000 clinicians. This clinically-led, multidisciplinary enterprise posed many organisational and professional challenges. The process of term collection and integration and the problems encountered are described. A brief account is given of the large task of maintenance and refinement. This paper looks at the practical and cultural aspects and describes how problems were tackled by good organisation, clear guidelines and much goodwill.
Disease↗
Anatomical characterisation of surgical procedures in the Read Thesaurus.
Each concept in the surgical operations chapter of the Read Thesaurus has been analysed to determine its anatomical site component. The underlying structure of this chapter and its relationship to the anatomy chapter are explored. The defined anatomical sites have been included as atomic maps in the Read Code template table, one of the key component files of the Thesaurus, relevant features of which are described. The analysis methodology is outlined and the value of an anatomically characterised surgical procedure terminology is discussed together with the implications of semantically defining a wider range of characteristics of surgical procedures.
Anatomy↗
Aneurysm of a congenitally persistent sciatic artery presenting as a soft-tissue mass of the buttock. A case report.
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Aneurysm↗
Read Codes Version 3: a user led terminology.
Version 3 of the Read Codes was designed in response to a new set of requirements generated by three new terming initiatives in the UK, the Clinical Terms Project, the Professions Allied to Medicine Terms Project and the Nursing Terms Project. The challenge was to cope with the detail required by clinical specialists for maintaining a computerised record, to capture the natural language used by clinicians in their everyday work, and to support efficient analysis across medical records required to extract information from clinicians' individual patient data. The structure of Version 3 allows a directed acyclic graph to replace the traditional hierarchy; permits multiple such graphs if necessary; introduces qualifiers, embedding these in an information model to support analysis; introduces one-to-many mapping to external classifications where this is necessary; and maintains the tradition of a dynamic terminology that stresses the inclusion of natural clinical terms.
Artificial Intelligence↗
CEO summit. Building the new health care delivery alliance, Part III. Roundtable discussion.
In cooperation with McManis Associates, Hospitals & Health Networks recently convened a CEO summit on physician/hospital integration activities. In the third report of a three-part series on the summit, leading health care executives discuss investor capital needs, strategic information management needs, and the management competencies required for capitated managed care success.
Comprehensive Health Care↗
CEO Summit. Building the new health care delivery alliance, Part II. Roundtable discussion.
In cooperation with McManis Associates, Hospitals & Health Networks recently convened a CEO summit on physician/hospital integration activities. The summit was designed and facilitated by the senior staff of McManis Associates. Part I, which appeared in the May 5 issue, focused on the lessons being learned by those providers on the front lines of integration. This report focuses on aligning incentives and achieving cost-effectiveness.
Chief Executive Officers, Hospital↗
CEO summit. Building the new health care delivery alliance, Part I. Roundtable discussion.
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Continuity of Patient Care↗
The option to withdraw from chronic dialysis treatment.
This multidisciplinary discussion focuses on the case of a young diabetic woman who chose to stop chronic hemodialysis during a long and complicated illness. The perspective presented here include an academic lawyer's view of such medical decisions; a hospital chaplain's view of the religious framework for end-of-life situations; a clinical psychiatrist's considerations when consulted to evaluate patients in such straits; a transplant nurse's view of the opportunities for personal interaction that such clinical situations present; and a renal social worker's approach to chronic illness, advance directives, and death in the dialysis patient population. The discussion is intended to address objectively some important issues associated with death in this population, aimed at increasing our willingness to discuss these issues more openly with patients and with our colleagues.
Adult↗
Administering code drugs confidently.
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Drug Therapy↗
Age-related changes in oxygen saturation over the first year of life: a longitudinal study.
Stability of oxygen saturation depends on maturation and function of individual components of the respiratory system. The aim of this study was to record and analyse comprehensive oxygen saturation data in a longitudinal study over the first year of life. Detailed sleep studies were performed on 15 normal infants eight times in the first year of life. The accrued oxygen saturation data were analysed on a computerized oximetry data analysis system. Results show the mean sleep saturation levels trending upwards and stabilizing by 185 days. There was an inverse curvilinear relationship between mean age and median desaturation time and the median number of desaturations at < or = 95, < or = 92 and < or = 90% saturation. The mean cumulative desaturation time < or = 90% in the first 4 months was 11.08 min (range 2.5-36.57 min). This study demonstrates monotonic patterns of increasing saturation and decreasing number and time of desaturations < or = 95% and < or = 90% but a random pattern of desaturations < or = 85% occurs across the first 6 months of life. Cumulative desaturation times over the first 4 months of life were high and could be important to the development of maturity of the respiratory system. After 6 months, all indices of saturation and desaturation point to a stable and mature respiratory system.
Aging↗
Coagulation abnormalities in chronic peritoneal dialysis.
To determine whether children treated with chronic peritoneal dialysis have a hypercoagulable state, various coagulation and fibrinolytic factor concentrations or activities were measured in 17 children undergoing chronic peritoneal dialysis. The patients had significantly increased activities of factors VII and VIII, and increased concentrations of von Willebrand factor (vWF), fibrinogen, factor XIIIA and factor XIIIS compared to reference values (P less than 0.001 in each case). The activated partial thromboplastin time was prolonged (P less than 0.001) and the thrombin clotting time was decreased (P less than 0.05) in these children. The prothrombin time and activities of factors XII, XI, IX, X, V and II were not significantly different from control values. Protein C concentrations were similar to normal, but antithrombin III concentrations were increased (P less than 0.05). Within the fibrinolytic pathway, decreased concentrations of plasminogen were found (P less than 0.001) and the concentrations of alpha-2-antiplasmin were increased (P less than 0.001). The plasma albumin concentration was below 33 g/l in 13 of the 17 children. The duration of treatment with peritoneal dialysis was directly correlated with vWF concentrations (P less than 0.001) and inversely correlated with factor VII concentrations (P less than 0.01). Of these patients 2 have since had clinical thrombotic episodes. The coagulation abnormalities found may have a role in the occurrence of thrombosis complicating renal transplantation.
Adolescent↗
Management of foreign-body bronchial obstruction using endoscopic laser therapy.
A case is presented in which the Nd:YAG laser obviated the need for a major thoracic procedure. A 7-year-old boy presented with an 18-month history of persistent nonproductive cough, preceded by a choking spell while eating pistachio nuts. High-grade left mainstem bronchial obstruction was caused by friable granulation tissue secondary to an underlying foreign body. By advancing a laser fiber through the working channel of a 5-mm Storz ventilating bronchoscope, the granulation tissue was vaporized, showing an irregular piece of pistachio nut shell embedded within the bronchial wall. After retrieval of the foreign body, bronchial patency was restored. Recovery was complete and uneventful. The bronchoscopic laser permits the delivery of precise and effective treatment to lesions within confined areas, and has a useful role in the management of some central airway lesions in children.
Airway Obstruction↗
Schizophrenia and the perception of emotions. How accurately do schizophrenics judge the emotional states of others?
Audiovisual tapes of emotional situations were shown to 34 schizophrenics and 15 controls who were asked to rate the emotional content of the scenes using an adjective check-list. The schizophrenic patients failed to detect the dominant character of the scenes, and perceived the opposite emotions to those perceived by the controls. Such deviant responses were not related to paranoid symptoms, flattened affect, formal thought disorder, general level of morbidity, or duration of in-patient stay.
Adult↗
Murine cytomegalovirus infection of reaggregate cultures of fetal mouse brain.
We used cultures of reaggregate embryonic mouse brain cells to study murine cytomegalovirus (MCMV) infection of neural tissues. After 21 to 28 days in culture, aggregates were infected with MCMV and studied sequentially for 14 days using virus assay, electron microscopy and indirect immunofluorescence. Infectious virus could be recovered from aggregate cultures beginning three days after infection, and peak virus titers were observed on day 7 in aggregate tissues and on day 14 in culture fluids. By transmission electron microscopy, intranuclear viral nucleocapsids were identified in neural cells at the periphery of the aggregates on day 3. Infection then spread centripetally into aggregate tissues so that by day 14 the majority of neural cells contained intranuclear inclusions, numerous nucleocapsids, and mature virus particles. Virion production in neural cells was the result of a sequence of events that included budding of nucleocapsids from the nucleus and envelopment of cytoplasmic virus particles by membranes of the Golgi apparatus. These studies indicate that MCMV infection of murine brain aggregate cultures is a potentially useful in vitro system for the study of CMV infections of neural tissue.
Animals↗