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Biomedical subjects

F R Jelovsek

Publications and source records attributed to F R Jelovsek.

At least 19 recordsLinked to original sources
PubMed1990

Eliciting principles of hazard identification from experts.

National experts in the field of developmental toxicology were interviewed in order to elicit the principles, or rules-of-thumb, they use in determining if a compound or agent is likely to be a developmental hazard during pregnancy. Several levels of individual and cumulative consensus activity were carried out that resulted in consensus in 71 rules and partial consensus in an additional 24 rules of 145 rules initially elicited. Rules could be divided generically into those affecting the expert's confidence in a piece of scientific evidence and those determining the weight of importance of that evidence in deciding about hazard identification. Topically, the rules also divided into those about the general nature or characteristics of a compound, animal studies testing for an effect of the compound, and human reports about the presence of absence of developmental effects associated with the compound. Several conclusions about the methodology include the following: 1) expert systems must be based on the knowledge of more than one expert; 2) considerable human effort is expended in evaluating the certainty of scientific evidence before combining the evidence for problem solving; 3) how experts use evidence of different degrees of uncertainty in their decisions is a major area that is yet to be determined and that may greatly affect subsequent efforts in artificial intelligence; and 4) knowledge elicitation by interview has limitations but is a workable methodology for medical decision making.

Animal Testing Alternatives↗
PubMed1989

Application of computer technology to reproductive endocrinology.

Data manipulation and information management activities are as central to physicians as writing is to the literary profession. It is not surprising that the computer, as an information tool, has become important and accepted in many aspects of our professional lives. Computer applications can significantly help in daily patient care activities as well as serve as instruments for advancing and managing medical knowledge. Even if the rate of computer technology change slows down from its exponential increase in the last decade, useful software applications will continue at the same or faster rate since they do not now, fully utilize existing hardware features. This presents an exciting future for all information management, decision-rich professions.

Computer Systems↗
PubMed1989

Prediction of risk for human developmental toxicity: how important are animal studies for hazard identification?

To determine how developmental toxicity studies in animals can be used in human risk assessment, a data base was assembled from the literature. It included probable, suspected, unknown, and probably negative teratogenic or embryotoxic drugs and chemical compounds. For each of 175 substances, we recorded the results of any developmental toxicity testing in up to 14 animal species and any reports of mutagenicity or carcinogenicity. Logistic regression and discriminant analysis were used to predict a compound's effect in humans. A measure of the number of positive animal studies and bacterial mutagenicity were important predictors in both models, as were the specific results in hamsters and subhuman primates. The fact that a compound had been tested at all in subhuman primates was more important in predicting human risk than was the result itself. The methods used correctly classified the study compounds 63-91% of the time, depending upon how the suspicious and unknown compounds were treated. The models had a sensitivity of 62-75%, a positive predictive value of 75-100%, and a negative predictive value of 64-91%. These findings imply that studies in laboratory animals carry weight in predicting human developmental toxicity. The more animal species in which a compound is positive, the more likely it is to have a human effect, albeit not the same effect as in the animals. Clinicians should not ignore developmental toxicity tests in animals "because laboratory rats are not like humans."

Abnormalities, Drug-Induced↗
PubMed1989

Information management needs of the obstetrician-gynecologist--a survey.

A random sample survey of members of The American College of Obstetricians and Gynecologists (ACOG) was conducted to ascertain the extent to which computer technology was being used by the members, and what further computer services and applications were needed. Computers were used by 38% of the members, with an additional 13% planning on getting a computer within the year. An average of 48% of the members had no plans for computerization, although this number was lower (29%) for physicians 36-45 years of age. There was no significant variation of use by physician sex or type of practice (office- versus non-office-based). Word processing and financial management were the most frequently used computer applications; clinical patient care tasks were used much less frequently and were presumably less available, because software for these tasks was also highly desirable. The most desired information services were uniform coding and terminology, high-risk patient management, electronic access to full-text obstetric and gynecologic data bases, and online clinical management protocols. Prescription writing, patient recall by drug, and drug inventory computer applications were among the least requested. Several educational, project development, communication, and member service strategies have been formulated to integrate medical information management activities for ACOG members.

Adult↗
PubMed1988

Microcomputer-aided instruction for ob-gyn education.

PC-CAI is a computer program that presents text characters from a word-processed file. The software was created to allow rapid authoring of computer-aided-instruction modules or multiple choice tests that give explanation and feedback to the student about their choice of responses. The program is IBM-PC/XT/AT compatible under MS-DOS. It is used in the Department of Obstetrics and Gynecology for medical students to supplement faculty lectures and also to administer pre- and post-tests to those students. The program is additionally used to create practice tests for our residents to prepare for their in-training exams. The software's main forte is to create multiple choice question modules, with feedback and explanations, that serve as learning tools rather than just as testing tools. Its use has enabled our department to create a comprehensive set of teaching modules in a relatively short period of time. These modules are easily modifiable as medical concepts or teacher emphasis changes.

Arkansas↗
PubMed1987

Computer applications in obstetrics.

The potential impact of the computer on the practice of obstetrics has long been recognized and is slowly being realized. Computers are already essential in many administrative aspects of obstetrics and indispensable in data storage and analysis for clinical research. Emerging applications include computer systems for taking the perinatal history, storage and on-line interpretation of fetal monitor tracings, information retrieval for case management and research purposes, and computer-assisted instruction. Future applications offer possibilities of computerized consulting for support of obstetric decisions and sophisticated case simulations for continuing education.

Computer-Assisted Instruction↗
PubMed1987

Effect of oocyte number and rate of atresia on the age of menopause.

Menopause occurs when oocyte number falls below the threshold required for ovarian function. The age of menopause is decreased by some drugs, some occupational exposures, and cigarette smoke (both active and passive). Using data collected by Block (Acta Anat (Basel) 1954; 14:208), we have constructed four, two parameter models to explore the effect of oocyte number and rate of atresia on age at menopause. The models used are: linear [O(A) = OB + R * A]; natural log [O(A) = R * In (A)]; exponential [O(A) = OB * exp(R * A)], and power [O(A) = OB * Age(R)]. OB = oocyte number at birth, ATR = rate of atresia, and O(A) = number of oocytes at age A. The parameters for the four models are: (formula; see text) Each model has different behavior with respect to alterations in oocyte number and rate of atresia on age at menopause. Animal studies suggest that ovarian failure is only weakly dependent on oocyte number, consistent with the power and exponential models. These suggest that the decrease in age at menopause following xenobiotic exposures results from an increase in the rate of atresia.

Age Factors↗
PubMed1987

Pharmacokinetics and expert systems as aids for risk assessment in reproductive toxicology.

A minimal approach to risk assessment in reproductive toxicology involves four components: hazard identification, hazard characterization, exposure characterization, and risk characterization. In practice, risk assessment in reproductive toxicology has been reduced to arbitrary safety factors or mathematical models of the dose-response relationship. These approaches obscure biological differences across species rather than using this important and frequently accessible information. Two approaches that are formally capable of using biologically relevant information (pharmacokinetics and expert system shells) are explored as aids to risk assessment in reproductive toxicology.

Animals↗
PubMed1987

Family history of diabetes mellitus and oral glucose tolerance testing criteria.

A review of 185 obstetrical patients, having a family history of diabetes mellitus without medical history of glucose intolerance in the non-pregnant state was conducted. A 3-hour 100-g oral glucose tolerance test was performed on all patients between 20 and 34 weeks of gestation. According to O'Sullivan's criteria for glucose tolerance testing, normal glucose tolerance occurred in 89.7%, while Class A diabetes was identified in 10.3% of patients tested. 3.8% of the study population fulfilled the O'Sullivan criteria for abnormal glucose intolerance and required insulin treatment during pregnancy. The Division of Perinatal Medicine at Duke University has traditionally defined the abnormal glucose tolerance test at glucose values lower than O'Sullivan's internationally accepted criteria. An intermediate group, having abnormal glucose values according to the Duke criteria, was classified as "Carbohydrate Intolerance", comprised 32.4% of the patients tested and were managed identically to O'Sullivan Class A Diabetes. Analysis or perinatal outcome, including macrosomia, birth trauma and neonatal morbidity, revealed that Carbohydrate Intolerance patients fulfilling O'Sullivan criteria, being similar to patients with 'normal' GTT test results. Patients having a family history of diabetes mellitus, appeared as a group to be at increased risk for macrosomia, fetal distress and cesarean delivery, compared with the general population.

Blood Glucose↗
PubMed1986

Learning resources for medical computing.

For medical professionals to acquire computer literacy can be an arduous task. Resources for learning medical computing fall into four major categories: learning technical microcomputer use, computerizing an office practice, tracking patient care experience and integrating medical information systems. Both microcomputer use and tracking patient care experience are technical skills similar to learning any medical procedure with which physicians are already familiar. These skills can be acquired by consulting general, commercial resources such as computer stores, popular computer magazines or software manuals. Computerizing an office practice involves diagnosing office information problems by thoroughly analyzing how data flow during outpatient care. Medical information system design and management is a cognitive specialty in which principles of computer science and medical information management are applied to patient care experience.

Computer Literacy↗
PubMed1979

Effects of long-term estrogen replacement therapy. I. Metabolic effects.

Two groups of hypoestrogenic women are analyzed by retrospective comparisons. Patients were observed by a single group of physicians for at least five years; 301 patients were treated with replacement estrogen and 309 patients were untreated. Incidence figures for various metabolic diseases present at entry and both during and after estrogen therapy were compared by the usual statistical analysis and by statistical adjustments for certain group differences (Mantel-Haenszel statistic). The long-term administration of estrogen to these relatively young women with hypoestrogenism was associated with significantly lower rates of development of cardiovascular disease, hypertension, osteoporosis, and fractures. Detrimental effects were a higher rate of abnormal uterine bleeding and an increase in the likelihood of developing adenocarcinoma of the endometrium. Effects of estrogen preparation, dosage, method of therapy, duration of therapy, and the addition of synthetic progestins are presented.

Adenocarcinoma↗
PubMed1979

Effects of long-term estrogen replacement therapy. II. Neoplasia.

Two groups of hypoestrogenic women are analyzed by retrospective comparison. Patients were observed by a single group of physicians for at least five years -- 301 patients treated with replacement estrogen and 309 untreated patients. Of each group, 207 women had uteri in situ. Incidence figures for neoplasia (gynecologic, breast, and all sites) were compared between the two groups and with the Third National Cancer Survey, yielding a risk ratio for the development of adenocarcinoma of the endometrium among estrogen-treated women of 3.8 and 9.3, respectively. There was no increase among any other malignancies. The addition of synthetic progestin to estrogen therapy provided significant protection against the likelihood of developing endometrial cancer and did not reduce previously reported metabolic benefits of estrogen treatment. Data pertaining to estrogen use and details of the patients with endometrial carcinoma are presented.

Adenocarcinoma↗
PubMed1977

A computerized obstetric medical record.

Duke University has utilized computerized obstetric medical records since 1971. System evolution is described. Deficiencies in the current system appear to evolve from the computer/human interface rather than from basic system design. Critical elements in system success are physician acceptance of the appearance of data collection sheets and printed notes and continual rapid response in programing modification to allow for physician individuality and changes in medical practice. The limiting factor in the potential usefulness of such a system is the rate of incomplete data collection. It is suggested that if the physician were to enter data directly into the computer through a terminal, data collection would be more accurate and complete.

Computers↗