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PubMed1989

Teaching MEDLINE to non-urban end users.

The University of Oklahoma Health Sciences Center (OUHSC) Library conducted a two-year program, funded by the National Library of Medicine (NLM), to teach Oklahoma's nonurban health professionals to perform searches of NLM's MEDLINE files using microcomputers. The training program included lectures, online demonstrations, and hands-on practice time. The initial target audience of non-urban physicians was later broadended to include other health professionals. Data collected on the 334 seminar participants included professions and specialties, previous microcomputer usage, and the size of their hospitals. On-site evaluation indicated a high degree of satisfaction with the trainers' communication skills, preparation, information imparted, and the visual aids used. The results of a follow-up survey to determine how many trainees subsequently obtained NLM codes, the amount of searching done, and the problems experienced await analysis.

Academic Medical Centers↗
PubMed2003

Fixed precision sequential sampling plans for the greenbug and bird cherry-oat aphid (Homoptera: Aphididae) in winter wheat.

The numbers of greenbugs, Schizaphis graminum (Rondani), and bird cherry-oat aphids, Rhopalosiphum padi L., per wheat tiller (stem) were estimated in 189 production winter wheat (Triticum aestivum L.) fields located throughout Oklahoma. Taylor's power law regressions were calculated from these data and used to construct fixed precision sequential sampling schemes for each species. An evaluation data set was constructed from 240 samples taken during three growing seasons from winter wheat fields at four locations in Oklahoma. Wheat cultivar and growth stage were recorded for each field on the day of sampling. Taylor's power law parameters for evaluation fields differed significantly for both species among growing seasons, locations, and plant growth stages. Median precision achieved using the fixed precision sequential sampling schemes for each species departed <20% from expected precision over the range population intensity in the evaluation data. For the 10% of samples with greatest deviation between observed and expected precision, observed precision was 13.8-81.8% greater than that expected precision depending on aphid species and population intensity. For the greenbug, the distribution of the percentage deviation between observed and expected precision was positively skewed, so that the sampling scheme tended to over-predict precision. For the bird cherry-oat aphid, the distribution was more symmetric. Even though precision observed using the sampling schemes frequently varied from expected precision, because of the inevitable consequence of sampling error and environmental variation, the sampling schemes yielded median observed precision levels close to expected precision levels over a broad range of population intensity.

Agriculture↗
PubMed2007

Disseminated malignancy misdiagnosed as thrombotic thrombocytopenic purpura: A report of 10 patients and a systematic review of published cases.

BACKGROUND: Patients with disseminated malignancy who present with microangiopathic hemolytic anemia and thrombocytopenia may be misdiagnosed as thrombotic thrombocytopenic purpura (TTP), resulting in inappropriate plasma exchange treatment, a procedure with major risk, and delay of appropriate chemotherapy. PURPOSE: To assess clinical features that may distinguish occult disseminated malignancy from TTP. PATIENTS AND METHODS: We report the 17-year experience of The Oklahoma TTP-Hemolytic-Uremic Syndrome (HUS) Registry (1989-2005) and a systematic review of previously published case reports. RESULTS: Ten of 351 patients in the Oklahoma Registry who were initially diagnosed with TTP and treated with plasma exchange were subsequently discovered to have disseminated malignancy. Only one patient had a history of cancer. In these 10 patients, neurologic abnormalities, hematocrit, platelet count, and serum creatinine were not different from the 133 concurrent patients with idiopathic TTP. Patients with disseminated malignancy had a longer duration of symptoms, more frequent presence of respiratory symptoms, higher lactate dehydrogenase levels, and more often failed to respond to plasma exchange treatment. Diagnosis of malignancy was made by bone marrow biopsy in six patients but not until autopsy in two patients. A systematic literature review identified 19 additional patients, reported from 1965 to 2005, in whom TTP or HUS was initially suspected and systemic malignancy was subsequently discovered. Fourteen different malignant disorders were diagnosed in these 29 patients. CONCLUSIONS: Occult disseminated malignancy may mimic TTP. A search for systemic malignancy, including a bone marrow biopsy, is appropriate when patients with TTP have atypical clinical features or fail to respond to plasma exchange.

Adult↗
PubMed1987

Shigellosis outbreak associated with swimming.

In June 1982, an outbreak of gastrointestinal illness caused by Shigella sonnei occurred among residents of two counties in Oklahoma. A case-control study of cases and age and sex-matched controls showed an association with attendance at a southern Oklahoma lake (14/17 cases vs 3/17 controls, matched pair odds ratio [OR] 9/0, confidence interval [CI] 2.4-infinity). A survey of 85 persons who had visited the lake area showed that persons who had swum were more likely to have been ill with a gastrointestinal illness (50 per cent) than persons who had not swum (0 per cent); among those who had swum, illness was more frequent among those who reported having water in their mouths while swimming (62 per cent) than those who did not (19 per cent) (OR = 6.9, 95% CI = 2.2-21.5). No further primary lake-associated cases had onset of symptoms beyond two days of closing the reservoir. Swimming should be considered as a potential source of enteric infections.

Child↗
PubMed2005

Soil characteristics and phosphorus level effect on phosphorus loss in runoff.

The loss of phosphorus (P) in runoff from agricultural soils may accelerate eutrophication in lakes and streams as well as degrade surface water quality. Limited soil specific data exist on the relationship between runoff P and soil P. This study investigated the relationship between runoff dissolved reactive phosphorus (DRP) and soil P for three Oklahoma benchmark soils: Richfield (fine, smectitic, mesic Aridic Argiustoll), Dennis (fine, mixed, active, thermic Aquic Argiudoll), and Kirkland (fine, mixed, superactive, thermic Udertic Paleustoll) series. These soils were selected to represent the most important agricultural soils in Oklahoma across three major land resource areas. Surface soil (0-15 cm) was collected from three designated locations, treated with diammonium phosphate (18-46-0) to establish a wide range of water-soluble phosphorus (WSP) (3.15-230 mg kg(-1)) and Mehlich-3 phosphorus (M3P) (27.8-925 mg kg(-1)). Amended soils were allowed to reach a steady state 210 d before simulated rainfall (75 mm h(-1)). Runoff was collected for 30 min from bare soil boxes (1.0 x 0.42 m and 5% slope) and analyzed for DRP and total P. Soil samples collected immediately before rainfall simulation were analyzed for the following: M3P, WSP, ammonium oxalate P saturation index (PSI(ox)), water-soluble phosphorus saturation index (PSI(WSP)), and phosphorus saturation index calculated from M3P and phosphorus sorption maxima (P(sat)). The DRP in runoff was highly related (p < 0.001) to M3P for individual soil series (r2 > 0.92). Highly significant relationships (p < 0.001) were found between runoff DRP and soil WSP for the individual soil series (r2 > 0.88). Highly significant relationships (p < 0.001) existed between DRP and different P saturation indexes. Significant differences (p < 0.05) among the slopes of the regressions for the DRP-M3P, DRP-WSP, DRP-PSI(ox), DRP-PSI(WSP), and DRP-P(sat) relationships indicate that the relationships are soil specific and phosphorus management decisions should consider soil characteristics.

Agriculture↗
PubMed1999

Use of the Semmes-Weinstein monofilament in the strong heart study. Risk factors for clinical neuropathy.

OBJECTIVE: We used the Semmes-Weinstein 5.07 monofilament to assess the prevalence of foot insensitivity and its relationship to potential risk factors. RESEARCH DESIGN AND METHODS: There were 3,638 American Indian participants from Arizona, North and South Dakota, and Oklahoma who attended a study clinic on two occasions: baseline and follow-up, 4 years later. Oral glucose tolerance tests were performed at the visits for those who had not previously been diagnosed as having diabetes. A total of 2,051 participants were diagnosed with diabetes before the study or at the subsequent study visits. At the follow-up visit, participants were tested for their ability to sense the 5.07 (10 g) monofilament at 10 sites of the foot. The prevalence of foot insensitivity was ascertained, and its relation to characteristics of participants was assessed in both univariate and logistic regression analyses. RESULTS: Diabetic participants had a much higher prevalence of foot insensitivity (defined as greater than or equal to five incorrect responses) than nondiabetic participants (14 vs. 5%, respectively). However, marked foot insensitivity was uncommon within the first few years of diagnosis of diabetes. Among the diabetic participants, those diagnosed before study entry had the highest prevalence of foot insensitivity. The prevalence of foot insensitivity was highest in the Arizona Indians (22 vs. 9% in the Dakotas and 8% in Oklahoma). In a logistic regression analysis, foot insensitivity was significantly and independently related to center (Arizona versus others), age, duration of diabetes, and height. CONCLUSIONS: Marked foot insensitivity is prevalent in the diabetic American Indian population, especially in Indians in Arizona; however, this insensitivity is apparently uncommon for several years after the diagnosis of diabetes. The data show that Indians with diabetes are particularly vulnerable to the risk of foot ulceration and that the diagnostic screening of diabetes may lead to better prevention of sensory neuropathy and subsequent foot ulceration.

Age Factors↗
PubMedDate not supplied

The benefits of inpatient diabetes care: improving quality of care and the bottom line.

OBJECTIVE: To analyze the impact of a hospital-wide inpatient diabetes management program on quality of care, length of stay, and cost. METHODS: A retrospective review was conducted for diabetes identification and treatment in a large tertiary care hospital in Oklahoma City, Oklahoma. Cultural change was accomplished by educating the healthcare professionals and medical staff. Systems were implemented to better identify patients with diabetes and to focus on quality improvement. Protocols were developed and implemented as tools for improving care. Results were monitored, and quality of care was assessed by examining lengths of stay and financial outcomes. RESULTS: Hospital-wide training, earlier identification of patients with diabetes, and the implementation of inpatient protocols had positive results on both quality of care and the hospital's bottom line. More patients with diabetes were identified earlier in their stays, care was managed effectively to reduce blood glucose levels, lengths of stay were reduced, and coding was improved to more accurately reflect the complexity of care provided. CONCLUSION: By increasing diabetes awareness hospital-wide and implementing effective identification and management systems, hospitals are well positioned to provide higher-quality diabetes care, which also translates into a positive impact on the bottom line.

Diabetes Mellitus↗
PubMedDate not supplied

Pharmacy formularies in integrated health systems.

Formulary management implications are described for an Oklahoma integrated health system comprising 14 acute care facilities, numerous owned medical practices, and a fledgling HMO. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations management for the Oklahoma City area has been created. A physician group has been formed that is expected to address system-wide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, including a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information system. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Ambulatory Care↗
PubMed1991

Patient goal setting as a method for program improvement/development in partial hospitalization programs.

Data were collected from a study of 49 patients in 1990 and 106 patients in 1991 admitted into Country View Treatment Center and Green Country Counseling Center. Country View is a 30-bed chemical dependency residential center operating under St. John Medical Center in Tulsa, Oklahoma. Green Country is an evening partial hospital chemical dependency program operating under St. John Medical Center in Tulsa, Oklahoma, The tools used in this study were the Country View Patient Self-Reporting Questionnaire, the global Rating Scale, and the Model of Recovering Alcoholics Behavior Stages and Goal Setting (Wing, 1990). These assessments were specifically designed to measure the patient's perceptions of goal setting and the patient's perspective on treatment outcome. The study outcome resulted in program improvement (Green Country evening partial hospital program) and the development of the Country View Substance Abuse Intermediate Link (SAIL) Program (day partial hospital).

Day Care, Medical↗
PubMed1989

Designation of medically underserved populations including areas recommended by the chief executive officer and local officials of a state--HHS. Notice.

Under the provisions of section 330(b)(6) of the Public Health Service (PHS) Act, 42 U.S.C. 254c(b)(6), as amended by Public Law 99-280, the Governor of the State of Oklahoma has asked the Secretary of Health and Human Services (HHS) to designate a specific population within the State as a medically underserved population (MUP). Also, under section 330(b)(3) of the PHS Act, areas in the States of Michigan, California and Ohio have been proposed for MUP designation. This notice provides an opportunity for local officials and appropriate Community Health Center organizations of States of Oklahoma, Michigan, California and Ohio to provide recommendations and to comment on the proposal to designate as MUPs the populations described in this notice.

California↗
PubMed2000

Gravidity and parity in postmenopausal American Indian women: the Strong Heart Study.

The fertility of a large sample of American Indian women participating in the Strong Heart Study was examined to determine which factors are associated with variation in completed fertility among women in this population. The Strong Heart Study (SHS) is a study of cardiovascular disease (CVD) and its risk factors in American Indians living in Arizona, Oklahoma, and the Dakotas. Data were derived from a baseline examination between 1989 and 1992 of approximately 1,500 men and women, aged 45-74, from each of the 3 SHS centers. A personal interview elicited demographic information, family health history, and information on several life-style variables. A total of 1,955 ever-married, postmenopausal women were considered in these analyses. Women were considered to be postmenopausal if their menstrual cycles had stopped completely for at least 12 months, either because of natural or surgical processes. The average number of pregnancies (gravidity) for all women was 5.9, whereas the mean number of live births (parity) was 5.3. Women living in Arizona (5.6) and the Dakotas (5.8) had higher parity than those in Oklahoma (4.6). Furthermore, there was lower completed fertility in younger women: When American Indian women from all 3 centers were considered together, women born between 1910 and 1919 had a mean parity of 5.3, whereas women born between 1940 and 1949 had a mean parity of 4.0. Although previous research has suggested a relationship between parity and CVD risk factors, no linear associations between CVD risk factors and fertility were indicated in this population. We also examined the relationship of contraception, level of education, and income to fertility. While no significant relationship between contraception and the level of fertility was identified, there was a significant inverse linear relationship of both education and income with fertility. In summary, fertility rates in American Indian women are high, but appear to be decreasing in younger generations. Fertility is higher in those with less education and lower incomes.

Age Distribution↗
PubMed2000

Improving the health of Oklahomans through clinical prevention, Part III: Immunizations and chemoprophylaxis.

Vaccines are one of the greatest achievements of biomedical science and public health and are clearly one of the most effective tools of clinical prevention. Diseases that once caused significant morbidity and mortality in Americans--particularly children--have been virtually eliminated from the population through effective immunization programs. But until these diseases have been eradicated globally we must continue to maintain high immunization levels to prevent their return; a 90% coverage rate has been set as the national goal for recommended vaccines in preschool age children. In Oklahoma we have only achieved that goal for two vaccines (measles and polio) and for the last several years we have ranked near the bottom in vaccine coverage rates compared to other states. Although achieving high vaccination rates in children involves numerous partners, private physicians must play a major role in that effort since they are the primary vaccine providers in the state. Physicians should also be alert to the vaccine needs of their adolescent and adult patients, particularly for pneumococcal disease, influenza, hepatitis A and B, and tetanus. This article describes current vaccination levels in Oklahoma children and adults for several routine and newly recommended vaccines and discusses the role of private physicians in maintaining and improving immunization coverage.

Adult↗
PubMed2001

Impact of the 1999 AAP/USPHS joint statement on thimerosal in vaccines on infant hepatitis B vaccination practices.

On July 8,1999, the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (PHS) jointly recommended reducing infant exposure to thimerosal, a commonly used vaccine preservative that contains mercury. Specific recommendations were made to postpone the first hepatitis B vaccine dose until 2-6 months of age for infants born to hepatitis B surface antigen (HBsAg)-negative (i.e., not hepatitis B virus [HBV]-infected) women. Infants born to HBsAg-positive (i.e., HBV-infected) women, or to women whose HBsAg status was unknown, were recommended to receive postexposure prophylaxis with the first dose of hepatitis B vaccine administered within 12 hours of birth. By mid-September 1999, when adequate supplies of preservative-free hepatitis B vaccine became available, PHS advocated a return to previous infant hepatitis B vaccination practices, including administering the first dose of hepatitis B vaccine to newborns in hospitals that had discontinued the practice. In 2000, preliminary assessments of the impact of these policy changes on routine hepatitis B vaccination practices were conducted by public health officials in Wisconsin, Oklahoma, Oregon, and Michigan. This report summarizes the results of these analyses, which indicate that many hospitals in Wisconsin have not reinstated policies to ensure routine administration of hepatitis B vaccine to newborns despite the availability of preservative-free hepatitis B vaccine, that the number of hepatitis B vaccine doses given to newborns in Oklahoma and Oregon has declined, and that an unvaccinated Michigan infant died from fulminant hepatitis B. Restoring routine newborn hepatitis B vaccination practices may require active advocacy by professional and government groups.

Hepatitis B↗
PubMed1996

No evidence of adverse effects on germination, emergence, and fruit yield due to space exposure of tomato seeds.

Seeds of 'Rutgers California Supreme' tomato (Lycopersicon esculentum Mill.) were exposed to outer space conditions aboard the long duration exposure facility (LDEF) satellite in the space exposed experiment developed for students (SEEDS) project of the National Aeronautics and Space Administration (NASA). Seeds aboard the LDEF were packed in dacron bags forming four layers per sealed canister. Some of these seeds were used in Oklahoma and Florida for studies of germination, emergence, and fruit yield. Among all measured variables in three experiments, there was only one significant main effect of canister 2 versus canister 7 (for mean time to germination) and only one main effect of layer (for seedling shoot dry weight). There also were only two inconsistent canister x layer interactions in the germination tests. The contrast of Earth-based control seed versus space-exposed seed was significant four times: in Oklahoma in 1991 the mean time to germination of space-exposed seeds and the days to 50% of final germination were 0.7 days less than for Earth-based seeds, and in Florida in 1992 seedling percent emergence and shoot dry weight were increased by space exposure. Fruit yield and marketability were unaffected in plants grown from space-exposed seeds. These results support student findings from the SEEDS project, and provide evidence that tomato seeds can survive in space for several years without adverse effects on germination, emergence, and fruit yield.

Cosmic Radiation↗
PubMed2000

An elementary question. Why would a health care system run a school?

INTEGRIS Health System in Oklahoma may be in a class by itself when it comes to improving community health. Its latest effort--a collaboration with the Oklahoma City school system to co-manage a struggling elementary school--has begun a dramatic turnaround for the school and for the health and well-being of its students.

Child↗
PubMed2002

Impact of a tornado on a community hospital.

A significant tornado passed through the Oklahoma City metropolitan area on May 3,1999. This study was undertaken at St Michael Hospital (Oklahoma City, Okla) to describe the impact on a community hospital's emergency department close to the tornado strike zone. Cases were defined as patients receiving diagnostic procedures, care, and interventions at the study hospital's emergency department for injuries related to the tornado. Medical records were abstracted and entered into a custom database; descriptive analysis was done using Microsoft Excel 97. A total of 147 patients met the study criteria, with an admission rate of 31 (21%) [corrected] of 147 patients (6 [19.4%] of 31 to the operating room, 4 [12.9%] of 31 to the intensive care unit, and 21 [67.7%] [corrected] of 31 to ward beds). In addition, 4 (2.7%) of the 147 patients were transferred to tertiary-care facilities (3 pediatric patients with head injuries and 1 adult patient with spinal cord injury). Complex soft tissue wounds, head injuries, and fractures were the most common diagnoses. The number of head-injured patients arriving alive to the emergency department was higher than expected. Most soft tissue wounds were closed primarily in the emergency department. The authors recommend that preexisting referral patterns for trauma and specialty care should be a part of the overall disaster plans for community hospitals.

Adolescent↗
PubMed2002

Medium chain acyl coenzyme A dehydrogenase (MCAD) deficiency: the case for screening all newborns.

Medium chain acyl coenzyme A dehydrogenase (MCAD) deficiency is the most common inborn error of fatty acid oxidation with a frequency of 1 in 12,000, an estimated four new cases in the state of Oklahoma each year. The first clinical manifestation is a hypoglycemic episode any time between the newborn period to adulthood. Largely due to failure of diagnosis, the first episode can be lethal, with a frequency of early mortality of 25%. We report a child with MCAD deficiency admitted to the OU Medical Center-Children's Hospital to illustrate the molecular basis, clinical features, and management of the disorder and to present the pros and cons of instituting newborn screening in our state. Such screening is already part of routine newborn metabolic screening in four states. In Oklahoma and elsewhere, there is current discussion, which we summarize, on whether or not to include MCAD deficiency in the routine neonatal screening program. We suggest the evidence says, "Start now."

Acyl-CoA Dehydrogenase↗
PubMed1987

Smith v. Gore, 13 April 1987.

After undergoing a failed tubal ligation and giving birth to a healthy child, the plaintiff brought a wrongful pregnancy suit against physicians, a university hospital, and a manufacturer of a sterilization technique seeking damages for emotional distress, loss of income, expenses of rearing a child to the age of majority, and punitive damages. The Supreme Court of Tennessee held that all damages were recoverable except those for the expenses of rearing the child. It ruled that the costs of rearing a normal, healthy child lay with the parents under both statutory and common law. It also held that there was no duty to mitigate damages by having an abortion or placing the child for adoption. In 1987 the Supreme Courts of Kansas and Oklahoma also rejected claims for the expenses of raising a healthy child whose birth resulted from a failed sterilization. (Johnston v. Elkins, 1 May 1987 [736 P.2d 935]; Morris v. Sanchez, 10 November 1987, corrected 17 November 1987 [746 P.2d 184]). In making its ruling, the Supreme Court of Oklahoma also held that there was no duty to mitigate damages in such a case. In addition, the Appellate Court of Illinois, First District, Second Division, held that a woman who became pregnant after being sterilized could not recover because she did not show that, had she been informed that there was a 1 percent chance of the sterilization failing, she would not have chosen to be sterilized anyway (Marshall v. University of Chicago Hospitals and Clinics, 29 December 1987 [520 N.E.2d 740]).

Americas↗