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Biomedical subjects

J D Burke

Publications and source records attributed to J D Burke.

At least 19 recordsLinked to original sources
PubMed2001

Development and utilization of paperless medical records: a unique approach.

The purpose of this article is to describe the development and utilization of a unique paperless medical record system in a large multispeciality group practice setting. The Scott and White integrated health care delivery system provides care over a 34-county area in Central Texas. Since 1988, clinicians at Scott and White have developed a text-based, content-searchable electronic medical record system known as EMRx. This system provides a single clinical data repository that allows patient care activities and aggregate data analyses to occur by using the same set of data on a daily basis. Use of this approach has led to the aggregation of over 9.8 million clinical documents since 1994. Over 1,845 health care providers used the system during May 2000 for direct patient care; 866,114 patient records have been accessed since January 1, 1999 to answer questions related to patient care, quality assurance, outcomes research, and accreditation.

Group Practice↗
PubMed2001

Which aspects of ADHD are associated with tobacco use in early adolescence?

Several studies have found a relationship between attention-deficit hyperactivity disorder (ADHD) and substance use, primarily in the context of co-occurring conduct disorder (CD). However, very few have examined the associations between the individual dimensions of ADHD (hyperactivity-impulsivity and inattention) and substance use, even though these dimensions reflect distinct symptom groupings, both by clinical definition (DSM-IV, American Psychiatric Association, 1994) and through empirical demonstration (Lahey et al., 1988: McBurnett et al., 1999). This longitudinal study examines the relationship between dimensions of ADHD (as described by DSM) and substance use, accounting for other psychopathology and factors potentially related to substance use. Participants were 177 clinic-referred boys (initially between ages 7 and 12) followed up over nine annual phases until all participants had reached age 15. Annual assessment included structured clinical interviews with parent and child and self-report questionnaires of substance use, as well as questionnaires related to family factors and parenting behaviors. Seventy-eight per cent of participants reported use of tobacco, alcohol, marijuana, or other illicit drugs during adolescence, with 51% reporting any tobacco use. The inclusion of CD rendered all bivariate relationships with the full diagnosis of ADHD nonsignificant. However, adolescent inattention, considered independently, was associated with a 2.2 times greater risk for concurrent tobacco use, even after controlling for CD. Even when other factors, selected based on their associations with tobacco use in adolescence, were included in a regression model (concurrent adolescent CD odds ratio [OR] = 6.08), duration of tobacco use by age 12 (OR = 5.11), poor parental communication in childhood (OR = 2.9), African-American ethnicity (inversely predictive; OR = 0.15), inattention (OR = 2.3) remained significantly associated with tobacco use in early adolescence. These findings highlight the importance of considering the risks for comorbid substance use separately by individual dimensions of ADHD.

Adolescent↗
PubMed2000

Oppositional defiant and conduct disorder: a review of the past 10 years, part I.

OBJECTIVE: To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD). METHOD: Selected summaries of the literature over the past decade are presented. RESULTS: Evidence supports a distinction between the symptoms of ODD and many symptoms of CD, but there is controversy about whether aggressive symptoms should be considered to be part of ODD or CD. CD is clearly heterogenous, but further research is needed regarding the most useful subtypes. Some progress has been made in documenting sex differences. Symptoms that are more serious, more atypical for the child's sex, or more age-atypical appear to be prognostic of serious dysfunction. Progress has been made in the methods for assessment of ODD and CD, but some critical issues, such as combined information from different informants, remains to be addressed. A proportion of children with ODD later develop CD, and a proportion of those with CD later meet criteria for antisocial personality disorder. ODD and CD frequently co-occur with other psychiatric conditions. CONCLUSIONS: Although major advances in the study of the prevalence and course of ODD and CD have occurred in the past decade, some key issues remain unanswered.

Adolescent↗
PubMed2000

An integrated data warehouse system: development, implementation, and early outcomes.

This paper describes a generic vision of global information flow and the development of an integrated data warehouse system, using clinical data on all patient encounters and administrative data on all operating transactions as part of an integrated health care system. This new integrated data warehouse system has been successfully used for multiple purposes, including patient care, health services research, resource utilization and feasibility studies. During 1999, core analyses included the electronic abstraction, aggregation, and analysis of data on over 400,000 patients. This approach to building a centralized data system comprised of multiple repositories efficiently meets a variety of individual and aggregate information needs, while reducing the need to create duplicate databases.

Database Management Systems↗
PubMed1997

Death with dignity.

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Attitude of Health Personnel↗
PubMed1997

A new standard of care: administration of preoperative antibiotics in the operating room.

Surgical site infections increase total hospital expenses and extend the length of hospital stay. Properly administered antibiotics are successful in minimizing postoperative subcutaneous wound infection secondary to perioperative bacterial contamination at the surgical site and are effective in most clean-contaminated surgical procedures. It is imperative that therapeutic levels of antibiotics be present during the time when the wound is open to maximize their effect to prevent the development of surgical wound infections. Only 32 per cent of 97 patients sampled from 1992 to 1994 at the Louisville Veterans Affairs Medical Center were administered preoperative antibiotics within 1 hour prior to surgical incision. Changing the responsibility for preoperative antibiotic administration from ward or holding room nurses to the anesthesiologist in the operating room rendered such antibiotics delivered closer to the induction of anesthesia and subsequent incision. Eighty-eight per cent of 220 patients sampled in 1995 had antibiotics administered within 1 hour of incision. This change in institutional policy of antibiotic administration maximizes the likelihood of appropriate antibiotic tissue levels and thereby their potential efficacy. Routine prophylaxis should be administered as close to the time of induction of anesthesia as possible to provide the best chance for appropriate tissue levels above the minimum inhibitory concentration for potential bacterial contamination.

Antibiotic Prophylaxis↗
PubMed1996

Schizosaccharomyces pombe skp1+ encodes a protein kinase related to mammalian glycogen synthase kinase 3 and complements a cdc14 cytokinesis mutant.

We report the cloning of the skp1+ gene, a Schizosaccharomyces pombe homolog of the glycogen synthase kinase 3 (GSK-3) family whose members in higher eukaryotes are involved in cell fate determination, nuclear signalling, and hormonal regulation. skp1 is 67% identical to mammalian GSK-3 beta and displays similar biochemical properties in vitro. Like GSK-3 beta, skp1 is phosphorylated on a conserved tyrosine residue, and this phosphorylation is required for efficient activity. skp1 is also phosphorylated at a serine which has been identified as S-335. Phosphorylation at this site is likely to inhibit its function. Unlike the mammalian enzyme, skp1 both tyrosine autophosphorylates in yeast cells and can phosphorylate other proteins on tyrosine in bacteria. The skp1+ gene is not essential. However, cells with deletions in skp1+ are sensitive to heat shock and exhibit defects in sporulation. Overexpression of wild-type skp1+ specifically complements cdc14-118, one of several mutations causing a defect in cytokinesis. In addition, certain phosphorylation site mutants induce a delay or block in cytokinesis when overexpressed. Together, these data identify novel interactions of a fission yeast GSK-3 homolog with elements of the cytokinesis machinery.

Amino Acid Sequence↗
PubMed1996

Problem gambling hits home.

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Disruptive, Impulse Control, and Conduct Disorders↗
PubMed1995

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Adult↗
PubMed1995

Medical services use by patients before and after detoxification from benzodiazepine dependence.

OBJECTIVE: The authors examined use of medical and mental health services before and after detoxification among a group of patients detoxified from benzodiazepines to see if the data suggested a reduction in service use and costs after detoxification, the so-called offset effect observed for treatment of alcohol and mental disorders. METHODS: Through a medical record review, information was collected about medical service use for patients aged 40 and older who were detoxified from benzodiazepines at Scott and White Clinic and Hospital between 1987 and 1991. RESULTS: Among the 76 patients, medical and mental health outpatient visits fell from an average rate of 25.4 visits per year before detoxification to 4.4 per year after detoxification. For the 44 patients with at least one inpatient stay besides the admission for detoxification, the mean number of inpatient days remained constant at three days per year before and after detoxification. CONCLUSIONS: Although a retrospective record review suffers from a range of limitations, the findings suggest that detoxification from benzodiazepines may be effective in reducing use of outpatient medical and mental health services and presumably in reducing costs of care.

Adult↗
PubMed1994

The Schizosaccharomyces pombe cdc5+ gene encodes an essential protein with homology to c-Myb.

The Schizosaccharomyces pombe cdc5+ gene was identified in the first screen for cell division cycle mutants in this yeast. The cdc5+ gene was reported to be required for nuclear division but because of its modest elongation and leaky nature at the non-permissive temperature, it was not investigated further. Here, we report the characterization of the single allele of this gene, cdc5-120, in more detail. The mutant arrests with a 2N DNA content and a single interphase nucleus. Further genetic analyses suggest that cdc5+ gene function is essential in the G2 phase of the cell cycle. We have cloned and sequenced the cdc5+ gene. The deduced protein sequence predicts that Cdc5 is an 87 kDa protein and contains a region sharing significant homology with the DNA binding domain of the Myb family of transcription factors. Deletion mapping of the cdc5+ gene has shown that the N-terminal 232 amino acids of the protein, which contain the Myb-related region, are sufficient to complement the cdc5ts strain. A cdc5 null mutant was generated by homologous recombination. Haploid cells lacking cdc5+ are inviable, indicating that cdc5+ is an essential gene. A fusion protein consisting of bacterial glutathione S-transferase joined in-frame to the N-terminal 127 amino acids of the Cdc5 protein is able to bind to DNA cellulose at low salt concentrations. This evidence suggests that cdc5+ might encode a transcription factor whose activity is required for cell cycle progression and growth during G2.

Amino Acid Sequence↗
PubMed1994

Molecular cloning and characterization of the Schizosaccharomyces pombe his3 gene for use as a selectable marker.

A DNA fragment which carries the his3 gene of Schizosaccharomyces pombe has been isolated and characterized for use as a selectable marker in transformations. The his3 gene encodes the imidazole acetol phosphate transaminase enzyme (E.C.2.6.1.9), which is responsible for converting imidazole acetol-P to histidinol-P in step 8 of histidine biosynthesis. The nucleotide sequences of a 2196 bp gene fragment and a corresponding cDNA clone were determined. Three intron sequences punctuate the 1451 bp coding region which generates a predicted polypeptide of 384 amino acids with a molecular mass of 42736 daltons. Northern analysis of his3 mRNAs indicates that the transcript is approximately 1.6 kb in size. Steady-state levels are down-regulated by nitrogen limitation but are unaffected by histidine starvation. The deduced amino acid sequence was compared to the Saccharomyces cerevisiae HIS5, Escherichia coli HisC, and Salmonella typhimurium HisC proteins, all of which are imidazole acetol phosphate transaminases. The S. pombe his3 protein was 49.5% identical to the S. cerevisiae HIS5 protein and 21.5% identity was found when all four proteins were compared. The shuttle vector pBG1 was constructed by subcloning the smallest functional region of his3 and the S. pombe ars1 sequence into pUC18 for use in transformation of His3--S. pombe strains. New S. pombe strains in which the his3 gene was deleted have also been constructed.

Amino Acid Sequence↗
PubMed1994

The Schizosaccharomyces pombe cdc3+ gene encodes a profilin essential for cytokinesis.

The fission yeast Schizosaccharomyces pombe divides by medial fission and, like many higher eukaryotic cells, requires the function of an F-actin contractile ring for cytokinesis. In S. pombe, a class of cdc- mutants defective for cytokinesis, but not for DNA replication, mitosis, or septum synthesis, have been identified. In this paper, we present the characterization of one of these mutants, cdc3-124. Temperature shift experiments reveal that mutants in cdc3 are incapable of forming an F-actin contractile ring. We have molecularly cloned cdc3 and used the cdc3+ genomic DNA to create a strain carrying a cdc3 null mutation by homologous recombination in vivo. Cells bearing a cdc3-null allele are inviable. They arrest the cell cycle at cytokinesis without forming a contractile ring. DNA sequence analysis of the cdc3+ gene reveals that it encodes profilin, an actin-monomer-binding protein. In light of recent studies with profilins, we propose that Cdc3-profilin plays an essential role in cytokinesis by catalyzing the formation of the F-actin contractile ring. Consistent with this proposal are our observations that Cdc3-profilin localizes to the medial region of the cell where the F-actin contractile ring forms, and that it is essential for F-actin ring formation. Cells overproducing Cdc3-profilin become elongated, dumbbell shaped, and arrest at cytokinesis without any detectable F-actin staining. This effect of Cdc3-profilin overproduction is relieved by introduction of a multicopy plasmid carrying the actin encoding gene, act1+. We attribute these effects to potential sequestration of actin monomers by profilin, when present in excess.

Actins↗
PubMed1994

Increased rates of drug abuse and dependence after onset of mood or anxiety disorders in adolescence.

OBJECTIVE: The aim of the study was to examine the relationship of prevalence and age at onset of drug abuse and dependence to mood and anxiety disorders, using epidemiologic data. METHODS: Life-table analyses using data collected on 20,745 respondents in the National Institute of Mental Health's Epidemiologic Catchment Area surveys were used to calculate the hazard rate for developing drug disorders subsequent to adolescent-onset or adult-onset mood and anxiety disorders. RESULTS: For respondents with onset of a mood disorder during adolescence, the peak age for developing drug abuse and dependence occurs between 15 and 19 years; when the mood disorder begins in adulthood, the peak onset for drug disorders is delayed to between 25 and 29 years of age. Similar but less striking results are found for onset of drug abuse and dependence following either panic or obsessive-compulsive disorder. CONCLUSIONS: These findings highlight the need for future prospective studies of children and adolescents to date the onset of mental disorders and substance use disorders. If prospective studies can confirm the apparent pattern of substance use disorders occurring subsequent to mental disorders, prevention and treatment strategies for youth at risk should be developed.

Adolescent↗