Physicians were interviewed about their routines in everyday use of the medical record. From the interviews, we conclude that the medical record is a well functioning working instrument for the experienced physician. Using the medical record as a basis for decision making involves interpretation of format, layout and other textural features of the type-written data. Interpretation of these features provides effective guidance in the process of searching, reading and assessing the relevance of different items of information in the record. It seems that this is a skill which is an integrated part of diagnostic expertise. This skill plays an important role in decision making based on the large amount of information about a patient, which is exhibited to the reader in the medical record. This finding has implications for the design of user interfaces for reading computerized medical records.

Decision Support Techniques↗

PubMedDate not supplied

Reading the medical record. II. Design of a human-computer interface for basic reading of computerized medical records.

A user interface for reading the medical record was designed and implemented on a workstation with a 19-inch colour screen. The text is presented on imitations of paper-pages. The pages are organized in bundles which are dynamically connected to scrollable index lists. The turning of pages on the screen is the fundamental concept of the interface. A page can be turned by a mouse-click or by a circular mouse-movement. Elaborated feedback is given to the user in order to provide effortless orientation and navigation. The interface supports the basic ways of use identified in our analyses of reading habits. It also enables human perceptual and cognitive skills to be used. It seems very easy to learn and efficient in use.

Cues↗

PubMedDate not supplied

Aspirin and myocardial infarction.

Explore the source record for details and available documents.

Acetylation↗

PubMedDate not supplied

The antioxidant butylated hydroxytoluene protects against atherosclerosis.

Rabbits fed a 1% cholesterol diet with or without the antioxidant butylated hydroxytoluene (BHT) developed typical atherosclerotic lesions. The addition of BHT gave higher levels of total cholesterol (+40%), triglycerides (+250%), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) in plasma. Despite the lower plasma lipid levels, the degree of atherosclerosis of the aortic surface was considerably higher in rabbits fed cholesterol than in the group treated with cholesterol and BHT. The mean atherosclerotic involvement was 18.6 +/- 4.4% in the former group and 5.9 +/- 1.7% in the latter group (p = 0.02). In all animals, there was a high correlation between the area of the arterial lesion and cholesterol content (r = 0.96). Serum levels of cholesterol autooxidation products (7-ketocholesterol and cholesterol 5 alpha,6 alpha-epoxide) were lower in the group of rabbits treated with BHT (p less than 0.005). Serum levels of vitamin E were slightly higher in the BHT group. There was no significant difference in the clearance of beta-VLDL between the two treatment groups after using either beta-VLDL from cholesterol-fed animals or beta-VLDL from BHT-fed animals. The results are in accord with the contention that oxidative modification of lipoproteins is important for the development of atherosclerosis and that antioxidants may have a protective effect. At present, however, other explanations cannot be completely excluded, for example, effects of antioxidants on immunologic factors or monocyte adhesion.

Animals↗

PubMedDate not supplied

Metabolism of lipoprotein remnants in humans. Studies during intestinal infusion of fat and cholesterol in subjects with varying expression of the low density lipoprotein receptor.

To study the possible importance of the low density lipoprotein (LDL) receptor in regulating the degree of postprandial lipemia, a cholesterol-rich fat emulsion was infused into the duodenum of subjects who were divided into four groups based on the expected variation in the expression of the LDL receptor: young men (n = 11), elderly men (n = 7), male patients on estrogen therapy (n = 5), and patients with familial hypercholesterolemia (n = 9). In familial hypercholesterolemia, fasting plasma levels of lipoproteins of d less than 1.006 g/ml, intermediate density lipoproteins, and LDLs were increased. During the fat infusion, the cholesterol and triglyceride contents in the d less than 1.006 g/ml fraction increased to a similar extent in all groups, whereas a concomitant reduction of LDL cholesterol levels was observed. The degree of the decrease in LDL cholesterol was positively correlated with the observed increase in triglycerides in the d less than 1.006 g/ml fraction. There were no signs of accumulation of intermediate density lipoproteins during infusion in any of the groups studied. The results indicate that the capacity for clearance of chylomicrons and chylomicron remnants is not affected by variation in LDL receptor expression.

Adult↗

PubMedDate not supplied

Estrogen in patients with prostatic cancer. An assessment of the risks and benefits.

Estrogen therapy of patients with prostatic carcinoma appears to be at least as effective in antitumour activity as surgical castration: the recent therapeutic alternative of gonadorelin (gonadotrophin-releasing hormone) analogues has not to date been shown to improve patient outcome. Oral estrogen therapy in these patients increases the incidence of arterial ischaemic events, thromboembolic events and congestive heart failure. A plausible mechanism behind the enhanced cardiovascular morbidity is an increase in the formation of proteins synthesised by the liver, including coagulation factors. Oral estrogens induce a 'hypercoagulable state' which can be expected to have an adverse influence on the cardiovascular system. The effect of estrogen on cholesterol metabolism is likely to be beneficial for the cardiovascular system, with decreased levels of the atherogenic low density lipoprotein (LDL) cholesterol and increased levels of the putatively beneficial high density lipoprotein (HDL) cholesterol. The effects of estrogen on platelets and cardiovascular prostanoids are difficult to evaluate at present. A possible approach to reduce its impact on the liver, and thereby possibly to minimise the risk of cardiovascular side effects, is parenteral administration. The promising results obtained in a pilot study of parenteral estrogen therapy in patients with prostatic carcinoma await confirmation in a randomised study, but where treatment with estrogen is considered for these patients, it may be that parenteral administration would be preferable.

Administration, Oral↗