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Biomedical subjects

R Winslow

Publications and source records attributed to R Winslow.

10 recordsLinked to original sources
PubMed1994

Expert systems.

The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.

Drug Interactions↗
PubMed1993

Personal computer-based expert system for quality assurance of antimicrobial therapy.

A personal computer (PC)-based expert system developed to monitor the appropriateness of antimicrobial therapy is described. Susceptibility test data and antimicrobial therapy data are downloaded daily from the microbiology department and pharmacy department computer systems. Relational database software allows for the indexing, sorting, and manipulation necessary for analysis. The expert system accomplishes its analyses using (1) databases of organisms, antimicrobial drugs, and susceptibility cutoff values, (2) programs for evaluating pathogenicity and therapy, and (3) algorithms that determine the timing and sequence of the analysis. System output consists of discrepant therapy reports that indicate that no therapy is being given despite the presence of pathogens, that the pathogens isolated are resistant to the therapy being given, that the therapy cannot be matched with susceptibility data on the isolates, or that the therapy was discontinued too quickly. The expert system has been in continuous operation at an 800-bed referral hospital since July 1991. During an 11-month period, the system generated 1538 discrepant therapy reports. The percentage of isolates resulting in reports varied substantially with the source of the isolate. Therapy was more likely to be improved when the physician was contacted about the potential problem indicated by the report than when the physician was not contacted. A PC-based expert system using data from unlinked pharmacy and microbiology computer systems automatically evaluated the appropriateness of antimicrobial drug therapy in light of susceptibility test data.

Anti-Bacterial Agents↗
PubMed1979

Oxygen transport in a woman with hemoglobin Hope/beta+ thalassemia.

Because their blood may "unload" oxygen more readily than normal, people with hemoglobin of low oxygen affinity might be expected to be anemic. We have studied a woman with hemoglobin Hope/beta+ thalassemia, whose hemoglobin level was 10.4 to 12.3 gm/dl (normal 14 +/- 2) despite a P50 of 41 mm Hg (normal 26). Her cardiac index was normal, yielding a calculated mixed venous PO2 of 51 mm Hg (normal 34 to 49). Oxygen transport in patients with low oxygen affinity can be maintained by a variety of homeostatic responses, only one of which is altered erythropoiesis.

Adult↗
PubMed1978

Hb Potomac (101 Glu replaced by Asp): speculations on placental oxygen transport in carriers of high-affinity hemoglobins.

Blood from a woman with unexplained erythrocytosis had increased oxygen affinity, but no abnormality could be detected by electrophoresis or chromatography of her hemolysate. Separation of the tryptic peptides of her beta chains disclosed two half-sized peaks in the regions of beta T-11. The faster of these was abnormal, with the structure beta 101 Glu replaced by Asp. The new hemoglobin was called "Potomac." Three of the proband's four surviving siblings and both of her children were carriers. Differences in the ratio of carrier: normal children born to male of female carriers of 23 other high-affinity hemoglobins were not significant. The high proportion of carriers in this kindred was probably due to chance alone, and not because high maternal oxygen affinity interfered with oxygen transport to fetuses with normal hemoglobin.

Adult↗
PubMed1978

Variability of the homeostatic response to altered p50.

Blood from carriers of hemoglobin Osler (Hb Osler) had almost the same oxygen affinity as that of carriers of Hb McKees Rocks (Hb MR) (P50 10-11 mm Hg), but Hb concentrations were higher in male carriers of the former (21.6 versus 17.2 g/dl). Two carriers of each Hb were studied to compare their adaptations to altered oxygen affinity and their responses to phlebotomy. All four were healthy, and all excreted normal amounts of erythropoietin. Carriers of Hb MR had somewhat lower mixed venous pO2 than carriers of Hb Osler. There was no suggestion that phlebotomy impaired ability to exercise in either group of patients.

Adolescent↗
PubMed1977

Postsynthetic deamidation of hemoglobin Providence (beta 82 Lys replaced by Asn, Asp) and its effect on oxygen transport.

Carriers of hemoglobin Providence have three types of beta chain in their hemolysates. The two abnormal chains have asparagine (Providence N, Prov N) or aspartic acid (Providence D) at position beta 82, instead of lysine. In vitro, only two beta chains are synthesized by reticulocytes of carriers, betaA and betaProv N. In vivo studies showed that the specific activity of Providence N was initially 10-fold higher than that of Providence D; the specific activities of the two labeled hemoglobins were approximately equal 5 wk after injection of isotope. Oxygen affinity of carriers' blood was somewhat increased, but they were not polycythemic. The affinity of the purified hemoglobins Providence was decreased. Addition of 2, 3 diphosphoglycerate had little effect on the affinity of either hemoglobin component, and addition of inositol hexaphosphate produced no change in the affinity of Providence D. These studies demonstrate that Providence N is deamidated to Providence D during the life span of the erythrocyte, and suggest this finding may represent only an easily observed prototype of posttranslational modification of proteins in general. Despite and abnormal P50 of the blood, oxygen transport is probably normal in carriers of the abnormal hemoglobins.

Adolescent↗
PubMed1976

Juvenile retinal detachment.

We feel that the management of juvenile retinal detachment can best be improved by earlier diagnosis. School vision-screening tests should be encouraged, and long-term followup of patients with high myopia, aphakia, and retrolental fibroplasia should be practiced. The peripheral retina should be examined in all traumatized eyes since delayed detachment is the rule. When retinal breaks are found in high-risk eyes, in our opinion, prophylactic treatment is indicated.

Adolescent↗