Biomedical subjects

David Berg

Publications and source records attributed to David Berg.

4 recordsLinked to original sources

PubMed2005

Preparedness of hospitals to respond to a radiological terrorism event as assessed by a full-scale exercise.

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Disaster Planning↗

PubMed2004

Executing clinical practice guidelines using the SAGE execution engine.

We report the first successful test of an interoperable guideline execution engine that interprets encoded clinical guideline content and executes that content via functions of a target clinical information system (CIS). For this test, an exemplar immunization guideline was encoded in the SAGE guideline model using standards-based information models and terminologies. This guideline content was subsequently executed using the prototype SAGE guideline execution engine, which interacts through standards-based VMR/Action services to instantiate real-time guideline recommendations via existing functions of the target CIS. In this paper, we describe our test implementation and highlight the significance and implications of each component of our deployment architecture

Decision Making, Computer-Assisted↗

PubMed2003

Effect of a computerized alert on the management of hypokalemia in hospitalized patients.

BACKGROUND: Electrolyte abnormalities, including hypokalemia, are frequently encountered among hospitalized patients. Their management, when carefully audited, reveals major shortcomings. OBJECTIVE: To evaluate the effect of a computerized alert on the management of severe hypokalemia in hospitalized patients. METHODS: All patients who experienced severe hypokalemia (serum potassium levels <3.0 mEq/L) during their hospitalization at Hadassah Medical Center (a 1000-bed teaching institution on 2 campuses in Jerusalem, Israel) were included in the study. The study intervention was a computerized alert consisting of a flashing screen or printed warning for patients with serum potassium levels below 3.0 mEq/L, visible whenever an individual patient's or entire ward's results were accessed on any hospital computer. Using a previously validated computerized audit technique, we analyzed the management of hypokalemia 6 months before and 6 months after implementation of the alert intervention. RESULTS: Comparing outcomes before and after the intervention, nonmeasurement of a subsequent serum potassium level after an initial low value decreased by 36.1% (P =.08). Failure to correct the serum potassium level to above 3.5 mEq/L during the hospitalization decreased by 28.6% (P =.02). Discharge from the hospital with a subnormal serum potassium level decreased by 17.2% (P =.06). CONCLUSIONS: A computerized alert system improved the management of hypokalemia in a tertiary care hospital. This was achieved at minimal cost and with no evidence of harm. The computerized audit based on a laboratory information system is an efficient tool for evaluating this intervention.

Female↗

PubMed2002

Genetic determinants of mammographic density.

BACKGROUND: Changes in breast density are highly correlated with steroid hormone exposure. MATERIALS AND METHODS: In a cross-sectional study of 396 Caucasian and African-American women, we evaluated whether polymorphisms in genes involved in steroid hormone biosynthesis and metabolism, CYP17 (T27C), COMT (Val158Met), 17HSDB1 (Ser312Gly) and 3HSDB1 (Asn367Thr), predict mammographic density. We also evaluated whether associations vary by menopausal and hormone replacement therapy status. RESULTS: We found no strong consistent relationships between polymorphisms in these genes and breast density. African-American women homozygous for the Thr allele of 3HSDB1 had increased density (the absolute difference versus the Asn/Asn genotype was +19.7%; P trend = 0.02), while Caucasian homozygous women had decreased density (-5.1%; P trend = 0.04). Among premenopausal women, carriers of the Ser allele had (not significantly) greater density (versus Gly/Gly genotype: +7.1%; P trend = 0.07). In addition, among current users of hormone replacement therapy, we observed that women with the low-activity Met/Met genotype of COMT had greater breast density (versus the Val/Val genotype: +11.7%; P trend = 0.01). CONCLUSION: Additional large studies evaluating these and other candidate breast cancer genes will be required to determine what proportion, if any, of the interindividual differences in breast density are due to underlying genetic variation in genes involved in steroid hormone biosynthesis or metabolism.

17-Hydroxysteroid Dehydrogenases↗