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Biomedical subjects

J Fowler

Publications and source records attributed to J Fowler.

At least 55 records · Page 3Linked to original sources
PubMed1995

ASOP: a new method and tools for capturing a clinical encounter.

ASOP is a proposed method for future medical record notation. This permutation of the original POMR-SOAP method is necessary to provide the standardized workflow and medical nomenclature which will be essential for automated medical record systems and forms-based encounter recording. The development of an ASOP system is dependent on tools to map assessment to appropriate terminology within a universal medical dictionary and generate intelligent queries across the World-Wide-Web. In this study we intend to demonstrate the need for change in the POMR system and highlight some of the current tools in development to make the ASOP method the medical record notation system of choice.

Computer Communication Networks↗
PubMed1995

Categorization by reference: a novel approach to MeSH term assignment.

Categorization by Reference is a novel text classification technique that examines the existing classifications of the citations found in an as-yet unclassified text to determine what terms should be assigned to that text. The existence of the Medical Subject Headings and MEDLINE make the biomedical domain a prime candidate for application of this technique. We describe our approach and implementation of a prototype, presenting some results of our initial tests. We further discuss refinements that could improve the precision of the technique, and describe its possible use in categorizing portions of the World-Wide Web.

Abstracting and Indexing↗
PubMed1995

Automated MeSH indexing of the World-Wide Web.

To facilitate networked discovery and information retrieval in the biomedical domain, we have designed a system for automatic assignment of Medical Subject Headings to documents retrieved from the World-Wide Web. Our prototype implementations show significant promise. We describe our methods and discuss the further development of a completely automated indexing tool called the "Web-MeSH Medibot."

Abstracting and Indexing↗
PubMed1995

The architecture of a distributed medical dictionary.

Exploiting high-speed computer networks to provide a national medical information infrastructure is a goal for medical informatics. The Distributed Medical Dictionary under development at Baylor College of Medicine is a model for an architecture that supports collaborative development of a distributed online medical terminology knowledge-base. A prototype is described that illustrates the concept. Issues that must be addressed by such a system include high availability, acceptable response time, support for local idiom, and control of vocabulary.

Artificial Intelligence↗
PubMed1995

A server architecture for ambulatory patient record systems.

Baylor College of Medicine is developing the Collaborative Social and Medical Services System (CSMSS) to provide a computerized patient record (CPR) system for the Teen Health Clinics (THC) [1]. The THCs consist of five geographically distributed clinics providing health care and social services to teenagers in the Harris County Hospital District. The CSMSS is the first application built upon the Ambulatory Systems Architecture (ASA) [2]. The ASA is aimed at providing an architecture and application framework for the development and deployment of CPR systems in ambulatory care settings. This paper describes the ASA server architecture.

Ambulatory Care↗
PubMed1995

A proposed architecture for ambulatory systems development.

We have developed an architecture and application framework known as the Ambulatory Services Architecture (ASA) for computerized management of patient records for ambulatory care. Our primary design goals included the development of an architecture that will be readily adaptable to advances in technology needed to enhance computerized patient record systems (e.g., multimedia, human-computer interfaces such as voice-to-text, and a fully distributed objects, etc.) and a data model and database implementation capable of providing the flexibility and extensibility needed to support a broad spectrum of specialty medical practices. This report describes the data model, access control, and the client/server components of the Ambulatory Services Architecture.

Ambulatory Care Information Systems↗
PubMed1995

Collaborative social and medical service application.

Baylor College of Medicine has five Teen Health Clinics (THC) dispersed throughout Harris county. The population served by the clinics includes inner-city adolescent boys and girls 19 years of age and under. Patients receive services such as family planning, sexually transmitted disease screening and treatment, perinatal care, counseling, and support services. Adolescents may receive services at any one of the clinics at no cost to the adolescent or their dependents. Given the geographical distribution of the clinics and the reliance on paper-based records, client services cannot be provided efficiently or expeditiously. According to the statistics developed by Clinic staff, ineffective coordination of service needs and client schedules undermine the follow-up needed for effective care. For example, a counselor will often need to balance a school schedule, clinic visits, well baby follow-up, and the Best Friends Program for a new mother. In addition, the lack of ready access to patient information impairs the ability of clinical and social service staff to provide continuity of care. In fact, some cases of client dropout are attributable to these difficulties. We have developed the Collaborative Social and Medical Service Application (CSMSA) to facilitate the provision of social and medical services to this population. The CSMSA is a domain-specific application based on a robust infrastructure known as the Ambulatory Services Architecture (ASA). This system is designed to support integrated social and ambulatory care. The ASA is a Baylor developed application framework and architecture for the computerization of the patient medical record in the ambulatory care setting. The working environment for the CSMSA user is an integrated desktop which provides an operating environment for both third-party applications and the CSMSA, as well as a fundamental set of services. The integrated desktop services include a mechanism for object organization or grouping, a facility for the management of desktop objects including disposal and storage, and an embedded search utility to assist in the location of desktop objects as well as other application objects. The access control mechanism will provide the security for the desktop environment by requiring the user to log into and out of the environment. This security mechanism will also enable/disable CSMSA tools based on the user's role at the clinic. The CSMSA is designed to provide work process, functionality and data access appropriate to the responsibilities of the user, e.g., a THC clerk may have permission to view a patient's orders but does not have the facility to create an order. Patient context is defined through a patient browser containing the master patient index or a user defined patient list. Patient encounters are managed using forms based on the process for each encounter type (e.g., initial visit). Forms are used for data entry and for queries. Data entry forms are only committed to the patient database (i.e., making the patient data available to other users who have permission to access the data) when the user approves the data. The CSMSA provides a means to suspend an entry into a chart by saving incomplete or non-committed data entry forms as part of the desktop state which is restored when the user logs into the system. CSMSA was designed to provide a robust, expandable application capable of accommodating the changes in health care and social services delivery while encompassing evolving software standards and new technology. This goal was achieved using object-oriented methodologies and technologies, combined with an object-oriented database management system as the foundation of our server to facilitate the evolution of our data model.

Adolescent↗
PubMed1994

Sculpting with people--an educational experience.

This paper explores the technique known as 'sculpting' and examines its application to the education of nurses. It identifies the therapeutic origins of sculpting, the processes and techniques involved and other requirements necessary for its application to nurse education. The experiences of both facilitator and participant are also described. It is argued that experiential learning methods in many cases continue to be met with anxiety and distrust often being carried out by facilitators who lack the skill and expertise to provide for the psychological safety of participants. The neglect or improper use of experiential learning methods denies students a valuable 'educational experience'.

Education, Nursing↗
PubMed1994

A study of chromium induced allergic contact dermatitis with 54 volunteers: implications for environmental risk assessment.

Over the past 60 years, dose-response patch test studies by various methods have been conducted in an attempt to identify the minimum elicitation threshold (MET) concentration of hexavalent chromium (Cr(VI)) that produces an allergic response in Cr(VI) sensitive subjects. These data are not adequate, however, to provide an accurate estimate of the MET because of the variability in the patch testing techniques and the variability in diagnostic criteria used. Furthermore, the data were not reported in terms of mass of allergen per surface area of skin (mg Cr/cm2-skin), which is necessary for conducting occupational or environmental health risk assessments. Thus the purpose of this study was to determine the MET (mg allergen/cm2) for Cr(VI) and trivalent chromium (Cr(III)) by patch testing techniques. A patch test method that delivers a controlled amount of allergen per surface area of skin was used. A group of 54 Cr(VI) sensitised volunteers were patch tested with serial dilutions of Cr(VI) and Cr(III) to determine the cumulative response rate at several concentrations. The results indicate that the 10% MET for Cr(VI) based on the cumulative response was 0.089 micrograms Cr(VI)/cm2-skin. Only one of the 54 volunteers may have responded to 33 micrograms Cr(III)/cm2-skin, otherwise Cr(III) was unable to produce allergic contact dermatitis in these highly sensitive volunteers. Two supplemental studies were also conducted to assess whether the surface area of the patch and the concentration of Cr(VI) in the patch (related to patch thickness) were likely to influence the results. The data from these studies were used to assess the risk of developing allergic contact dermatitis due to contact with Cr(VI) and Cr(III) in soil. The findings indicated that soil concentrations at least as high as 450 ppm Cr(VI) and 165,000 ppm Cr(III) should not pose an allergic contact dermatitis hazard for at least 99.99% of the people in the community who might be exposed.

Adult↗
PubMed1994

In vitro adsorption of dichlorvos and parathion by activated charcoal.

Accidental and suicidal ingestions of organophosphate compounds continue to be a common occurrence in Turkey. Activated charcoal administration without gastric emptying has been advocated as primary therapy in most acute poisoning cases, although some references do not recommend activated charcoal use in organophosphate poisoning. This study was performed to determine the in vitro adsorption of dimethyl dichlorovinyl phosphate (dichlorvos) and parathion by activated charcoal over a wide range of charcoal:organophosphate ratios (1:1, 2.5:1, 5:1, 10:1 and 20:1, g:g). The charcoal binding ability of dichlorvos and parathion were studied in both pH 1.2 and pH 7 environments. The supernatant was extracted with n-hexane and then analyzed by gas chromatography. Each incremental increase in charcoal dose increased the percent adsorption of dichlorvos and parathion. At the 20:1 ratio, 82.8 +/- 2.0/87.3 +/- 2.9% (pH 1.2/7.0) of dichlorvos and 59.3 +/- 4.5/64.5 +/- 6.1% (pH 1.2/7.0) of parathion were bound by activated charcoal. There were no significant differences in amounts of compound bound in the acid and neutral solutions. Large doses of activated charcoal effectively bind dichlorvos and parathion in vitro. In vivo research should be performed to determine activated charcoal's role in organophosphate poisoning cases.

Adsorption↗
PubMed1994

A welcome focus on a key relationship. Using Peplau's model in palliative care.

1. Nurses involved in an area of nursing where the nurse-patient relationship is significant would be well advised to review Peplau's work. 2. Peplau sees this relationship as a dynamic one and identifies four phases which interlock and overlap. 3. A significant similarity between the writings of Peplau, Murray Parks and Kubler Ross is the acceptance that the patient/relatives go through a process which has recognisable parts and that nurses can have a significant influence on whether it is a positive or negative experience.

Humans↗
PubMed1994

Modeling past, current, and future time in medical databases.

Recent research has focused on increasing the power of medical information systems by incorporating time into the database system. A problem with much of this research is that it fails to differentiate between historical time and future time. The concept of bitemporal lifespan presented in this paper overcomes this deficiency. Bitemporal lifespan supports the concepts of valid time and transaction time and allows the integration of past, current, and future information in a unified model. The concept of bitemporal lifespan is presented within the framework of the Extended Entity-Relationship model. This model permits the characterization of temporal properties of entities, relationships, and attributes. Bitemporal constraints are defined that must hold between entities forming "isa" hierarchies and between entities and relationships. Finally, bitemporal extensions are presented for database query languages in order to provide natural high-level operators for bitemporal query expressions.

Information Systems↗
PubMed1994

Collaborative Social and Medical Service System.

This paper describes the Collaborative Social and Medical Services System, a robust information infrastructure for integrated social and medical care. The Collaborative Social and Medical Services System design and architecture address the primary goals of creating a readily extensible social and ambulatory care system. Our initial step toward reaching this goal is the delivery of an application supporting the operations of the Baylor Teen Health Clinics. This paper discusses our prototype experiences, system architecture, components, and the standards we are addressing.

Adolescent↗
PubMed1994

How accurate is the pelvic examination as compared to transvaginal sonography? A prospective, comparative study.

Findings at pelvic examination in 120 patients were compared to those obtained by transvaginal sonography (TVS). Overall, 102 of 472 (22%) pelvic examination assessments did not agree with the TVS findings. Twenty-nine (36%) uterine assessments differed, while 46 (32%) ovarian assessments differed. Among 37 pelvic masses assessed in 20 cases (54%) the pelvic examination differed from the findings obtained by TVS. Only 4 (29%) cases assessed by pelvic examination were in agreement with the laparotomy findings as compared with 10 (71%) cases assessed by TVS.

Adolescent↗
PubMed1994

Flow characteristics in benign and malignant gynecologic tumors using transvaginal color flow Doppler.

OBJECTIVE: To assess flow characteristics of benign and malignant gynecologic tumors by transvaginal color flow Doppler. METHODS: Records of the Ultrasound Laboratory, Women's Cancer Center, University of Minnesota were analyzed retrospectively. Gray scale findings were recorded as either "diagnostic" or "nondiagnostic." Color flow assessment was performed on intratumor vessels or ovarian and/or uterine arteries. Flow was recorded as either "absent" or "present." Spectral analysis allowed determination of the systolic, diastolic, and mean velocities and calculation of the pulsatility and resistance indices. Malignancy was then predicted based upon color flow findings alone, with malignant tumors demonstrating increased color flow and a pulsatility index of at most 1.0 or a resistance index of at most 0.4. Color flow Doppler findings were then recorded as "giving additional useful information" that either confirmed questionable gray scale findings or changed the gray scale sonographic diagnosis, or as "not giving additional information" over the gray scale diagnosis. RESULTS: Two hundred thirty-one patients had gray scale sonography, and 167 also had color flow Doppler performed. Gray scale sonographic findings were sufficient to make a diagnosis in 156 (93%) of the scans. Color flow Doppler findings added useful information in 49 scans (30%). Increased color flow was highly significant (P < .0001), as was the calculated pulsatility index (P < .02) and resistance index (P < .008), in distinguishing benign from malignant tumors. Ovarian and uterine artery and intratumor assessments of the systolic, diastolic, and mean velocities were not significantly different between the benign and malignant tumors. Regression analysis confirmed the presence or absence of color flow as an independent predictor of malignancy or benignity (P < .0001). CONCLUSIONS: Our large study confirms the overall accuracy of gray scale scanning. When used alone, color flow Doppler--although specific--lacks sensitivity and predictive value as an independent predictor of malignancy. When findings were combined with those obtained from gray scale scanning, sensitivity, specificity, and predictive value were improved to acceptable levels. Significant differences existed between benign and malignant tumors for calculated pulsatility index and resistance index, but neither was sufficiently sensitive, specific, or predictive to be used alone as sole criteria of malignancy prediction. Other flow indices studied (systolic, diastolic, and mean velocities) in general did not differ significantly between groups. Physicians should be cautioned against using color flow findings alone for clinical decision making. We recommend a multi-institutional study to investigate the multiple vascular assessments to determine the role of color flow Doppler in the preoperative prediction of pelvic tumors and in screening for gynecologic abnormality.

Adult↗