PubMed Health⌕ Search

Biomedical subjects

J P Fox

Publications and source records attributed to J P Fox.

At least 19 recordsLinked to original sources
PubMed2001

Publets: clinical judgement on the web.

The Internet is now a major channel for publishing medical research data and documents, including clinical practice guidelines. It is now possible to capture guidelines in a computer interpretable form opening up the capability of using the internet (and intra/extranets etc.) to deliver patient-specific advice and other services. A development lifecycle and technology for publishing and delivering services at the point of care ("publets") are described. As with all new technologies, however, these new methods entail risks as well as opportunities. The paper closes with a discussion of quality requirements and an argument that publets should include a safety case as an integral part of their content.

Internet↗
PubMed1999

A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer.

BACKGROUND: Patients scheduled to receive chemotherapy frequently undergo pretherapy dental treatment to eliminate potential sources of odontogenic infection. A prospective study was conducted to assess a new protocol emphasizing minimal pretherapy dental treatment. METHODS: Forty-eight consecutive patients diagnosed with solid or hematologic neoplasms underwent dental examination prior to intensive chemotherapy. All chronic dental pathology was scored as either mild-to-moderate or severe based on the likelihood of conversion to an acute state during chemotherapy. No pretherapy dental treatment was given to patients with chronic dental disease. Intertherapy dental complications and the overall impact on chemotherapy outcomes were assessed. RESULTS: Thirty-eight patients (79%) were diagnosed with pretherapy chronic dental pathology. Twenty-one of these patients (44% of the total population) were identified as having severe pathology and considered at risk for acute intertherapy dental complications. Two patients (4%) experienced acute intertherapy episodes, each presenting as oral abscesses. In both cases, resolution was achieved with antibiotics without interruption of chemotherapy. Oncologic treatment outcomes for all patients were judged to be unaffected by either the presence of chronic pretherapy dental disease or acute intertherapy exacerbations of these disease states. CONCLUSIONS: These results demonstrate that patients with chronic dental pathology can safely proceed with chemotherapy without dental intervention, as conversion of chronic dental disease to an acute state during chemotherapy occurs infrequently. If intertherapy dental infections do arise, they can be managed effectively without interrupting therapy or adversely affecting oncologic treatment outcomes.

Adolescent↗
PubMed1994

Artificial intelligence in molecular biology: a review and assessment.

Over the past ten years, molecular biologists and computer scientists have experimented with various computational methods developed in artificial intelligence (AI). AI research has yielded a number of novel technologies, which are typified by an emphasis on symbolic (non-numerical) programming methods aimed at problems which are not amenable to classical algorithmic solutions. Prominent examples include knowledge-based and expert systems, qualitative simulation and artificial neural networks and other automated learning techniques. These methods have been applied to problems in data analysis, construction of advanced databases and modelling of biological systems. Practical results are now being obtained, notably in the recognition of active genes in genomic sequences, the assembly of physical and genetic maps and protein structure prediction. This paper outlines the principal methods, surveys the findings to date, and identifies the promising trends and current limitations.

Algorithms↗
PubMed1992

Serum cortisol levels predict infarct size and patient mortality.

We have investigated prospectively the serum cortisol response to acute myocardial infarction in 70 consecutive patients admitted to a coronary care unit and we have shown that the levels are significantly raised early in the course of the illness and prior to elevation of the cardiac specific enzyme fraction, creatine kinase MB. The magnitude of the cortisol response is related to the size of the ensuing infarction (rs = 0.54) as calculated from the total creatine kinase MB release (P < 0.001) and very high levels (> 2000 mumol/l) are predictive of mortality (P < 0.05). Serum cortisol levels may have a role in the early identification of myocardial infarction and in predicting those patients with a poor prognosis.

Anistreplase↗
PubMed1991

Microalbuminuria is an early response following acute myocardial infarction.

Ninety-six patients admitted to two coronary care units with suspected acute myocardial infarction were studied. The diagnosis was confirmed in 44, the remaining 52 were used as a control group. The first urine passed after admission, together with early morning urines on the following 3 days, were saved in all patients. Urinary albumin and IgG were measured by automated immunoturbidimetry and expressed as the protein creatinine ratio in mg.mmol-1. The log mean (SD) albumin creatinine ratios for the first urine passed in the myocardial infarction and non-myocardial infarction patient groups were 6.2(4.2) and 1.3(3.4) respectively. The difference in log mean albumin creatinine ratio was 4.9 mg.mmol-1, 95% CI 3.4 to 6.2 mg.mmol-1; t = 6.127 df = 94, P less than 0.0001. The median IgG creatinine ratio for the first urine passed after admission in myocardial infarction patients was 1.0 mg.mmol-1 (95% CI 0.5 to 1.2) and for non-myocardial infarction patients 0.3 (95% CI 0.2 to 0.4). Increased urinary protein excretion appears to be an early and proportional response to acute myocardial infarction.

Adult↗
PubMed1990

Non Q wave infarction: exercise test characteristics, coronary anatomy, and prognosis.

The exercise test characteristics, coronary anatomy, and prognosis of patients discharged after non Q wave myocardial infarction were compared with those in whom Q wave infarction occurred. Of the 339 patients studied, all of whom were less than or equal to 70 years, 87 (26%) had had a non Q wave infarction. There were no significant differences in the exercise test characteristics between the two groups, and in those 149 patients in whom angiography was performed triple vessel disease was present in 36/114 (32%) of the Q wave group and 9/35 (26%) of the non Q wave group. The infarct related artery was more often patent in the non Q wave group (27/35 (77%] than in the Q wave group (53/114 (46%]. The one year mortality and the reinfarction and angina rates were similar in the two groups and the exercise test remained a good discriminator for predicting patients at risk of future cardiac events in both groups. In view of the similar outcome and severity of coronary disease in those aged less than or equal to 70 with non Q wave infarcts, the distinction between Q and non Q wave infarction need not influence management decisions in patients after myocardial infarction.

Adult↗
PubMed1988

Persistent enteral infections with adenovirus types 1 and 2 in infants: no evidence of reinfection.

Isolates of adenovirus types 1 and 2, obtained from 11 infants with prolonged faecal excretion (up to 515 days), were compared by DNA restriction analysis with seven standard endonucleases which recognize hexanucleotides and two additional endonucleases which recognize tetranucleotides. In all instances identical genome types were identified in isolates obtained early and late after infection. Our interpretation of these data is that a chronic persistent infection occurred in these children, and not a reinfection with the same serotype.

Adenoviridae Infections↗
PubMed1988

Silent ischaemia following myocardial infarction: frequency, characteristics and prognosis.

Pre-discharge exercise tests were performed in 359 survivors of an acute myocardial infarction to determine the frequency, characteristics and prognostic implications of silent ischaemia. Tests were negative in 152 patients (42%), silent ischaemia was observed in 103 (29%) and painful ischaemia in 82 (23%). Heart rates at the development of ischaemia and the final double products were similar in both ischaemic groups but patients with silent ischaemia were able to exercise for longer (13.1 +/- 0.5 min) than those with painful ischaemia (9.3 +/- 0.5 min; P less than 0.0001). The 12 month mortality rose from 2% in patients with a negative test, to 4% in those with silent ischaemia and to 8% in those with painful ischaemia. Re-infarction rates increased similarly across the groups (3%, 8% and 18% respectively). Patients with silent ischaemia subsequently developed angina more frequently (47%) than those with negative tests (16%; P less than 0.001). These results suggest that exercise-induced silent ischaemia following myocardial infarction was common, occurring in 29% of patients. Although the final myocardial oxygen consumption was similar in both ischaemic groups those with silent ischaemia were able to exercise for longer. Finally silent ischaemia conferred an intermediate risk of death or re-infarction and was a strong predictor of subsequent angina pectoris.

Cohort Studies↗
PubMed1986

Rises in titers of antibody to human coronaviruses OC43 and 229E in Seattle families during 1975-1979.

Sequential serum specimens were obtained every four months during 1975-1979 from 44 children and adults of 10 Seattle families. The 419 specimens were tested for antibody to human coronaviruses OC43 and 229E by enzyme-linked immunosorbent assay (ELISA). Antibody titers were found to increase with age, and titers as well as frequency of rises were greater for OC43 than for 229E virus in all age groups. Significant antibody rises were most frequent in specimens bracketing the winter interval, but some also occurred in the spring-summer and summer-fall intervals. Concurrent significant antibody rises to OC43 virus in different members of the same family were observed in 15 instances, to 229E virus in seven instances, and to OC43 virus in some members and 229E virus in others in eight instances. Significant antibody rises to OC43 or 229E virus indicating reinfections were frequently observed throughout the three-year period but were always separated by at least two four-month intervals. Concurrent significant antibody rises to both 229E and OC43 viruses were seen only in three persons. Finally, the frequency of significant antibody rises in children, about one per person-year, was almost three times higher than in adults.

Adolescent↗
PubMed1985

Rhinoviruses in Seattle families, 1975-1979.

Rhinovirus infections in Seattle families with schoolchildren (1975-1979) and in selected outpatients were revealed by virus shedding or antibody rise. These observations extend those in the Seattle Virus Watch (1965-1969). Analysis of rhinovirus serotype prevalence again revealed certain "common" persisting serotypes but provided no further evidence that new serotypes are continuing to emerge. Two seasonal peaks, spring higher than fall, were again evident. Infection rates, again inversely related to age, were lower overall than in the Virus Watch (0.42 vs. 0.64 per person-year), probably because there were fewer young children. Frequencies of antibody response by virus shedders again varied widely by serotype but differed greatly from those in the Virus Watch in rank order of response rate, suggesting that immunogenicity is not a stable serotype characteristic. The frequency and magnitude of antibody response of virus shedders increased with age. Antibody-related protection against infection was evident only in persons age greater than or equal to 10 years. Observations in 7 families during successive homotypic infection episodes indicate that postinfection immunity to natural challenge requires persistence of antibody. Of all reported respiratory illness, 11.9% (0.31 per person-year) were due to rhinoviruses and 6.9% to influenza viruses. Of viruses recovered from family members, rhinoviruses, herpes simplex, and influenza comprised 56%, 12.6%, and 12.4%, respectively. Although households often experienced greater than or equal to 2 concurrent or closely consecutive episodes of infection with different viruses, only 29 individuals were shown to shed 2 viruses at the same time. Most of the second viruses, include 3 rhinoviruses and 18 other nonhemadsorbing viruses, appeared when 582 rhinovirus-positive specimens were retested after treatment with homotypic antibody. These results suggest that rhinoviruses interfere with nonhemadsorbing viruses in cell culture but mostly with other rhinoviruses in humans.

Adolescent↗
PubMed1983

Influenza surveillance in the Pacific Northwest 1976-1980.

Between June 1976 and June 1980 active year-round surveillance for influenza was carried out in Seattle in order to establish an early warning system. This report compares yield by different community groups and age. Waves of influenza virus infection appearing in three successive springs were followed in each instance by epidemics with the same subtype virus(es) in the following winter. These included two co-circulating A/H3N2 variants (A/Victoria/75 and A/Texas/77) in spring 1977 and winter 1977-1978, A/H1N1 (A/USSR) in spring 1978 and H1N1 (A/Brazil) winter 1978-1979, and type B influenza in spring 1979 and winter 1979-1980. Despite intensive surveillance through the summer and fall, the first isolate was not obtained until early December each year. Young adults (18-30) were as good sources for influenza viruses as children (less than 18).

Adolescent↗
PubMed1982

Estimating household and community transmission parameters for influenza.

A maximum likelihood procedure is given for estimating household and community transmission parameters from observed influenza infection data. The estimator for the household transmission probability is an improvement over the classical secondary attack rate calculations because it factors out community-acquired infections from true secondary infections. The mathematical model used does not require the specification of infection onset times and, therefore, can be used with serologic data which detect asymptomatic infections. Infection data were derived by serology and virus isolation from the Tecumseh Respiratory Illness Study and the Seattle Flu Study for the years 1975-1979. Included were seasons of influenza B and influenza A subtypes H1N1 and H3N2. The transmission characteristics of influenza B and influenza A(H3N2) and A(H1N1) outbreaks during this period are compared. Influenza A(H1N1), A(H3N2) and influenza B are found to be in descending order both in terms of ease of spread in the household and intensity of the epidemic in the community. Children are found to be the main introducers of influenza into households. the degree of estimation error from the misclassification of infected and susceptible individuals is illustrated with a stochastic simulation model. This model simulates the expected number of detected infections at different levels of sensitivity and specificity for the serologic tests used. Other sources of estimation error, such as deviation from the model assumption of uniform community exposure and the possible presence of superspreaders, are also discussed.

Epidemiologic Methods↗
PubMed1982

Influenzavirus infections in Seattle families, 1975-1979. I. Study design, methods and the occurrence of infections by time and age.

Intensive surveillance of Seattle, Washington, families with school-age children for influenzavirus infections during 1975-1979 encompassed 639 family- and 2732 person-seasons of observation, covering four influenzavirus epidemic seasons: type B (1975-1979), type A/H3N2 (1975-1976 and 1977-1978) and type A/H1N1 (1978-1979). Late spring "herald" waves of infection occurred in 1977 (A/H3N2), 1978 (A/H1N1) and 1979 (type B), the latter presaging an epidemic in 1979-1980. Out-of-season infections, recognized by serology only, included type B and A/H3N2 viruses in each summer and A/H1N1 virus in 1978. In epidemic seasons, infection rates were highest in children aged 5-9 years (A/H3N2) or in teenagers (A/H1N1 and type B). A/H1N1 virus caused the sharpest epidemic, with 31% of the population (but only 2% of adults) infected and 72% of households invaded in 1978-1979. These compare with infection rates of 17-24% overall and 6-13% of adults and the invasion of 38-53% of households observed in the type B and two A/H3N2 epidemics. Extended observation (largely serologic) of a cohort of 1965-1969 Virus Watch families for up to 14 years (including one three-year gap) indicated overall infection rates of 13.7 and 16.4 per 100 person-years with types B and A/H3N2 viruses, respectively, and rates of first and second reinfections of about 3 and 1 per 100 person-years, respectively, with each virus. Close surveillance in 1975-1979 revealed second family episodes of infection with each prevalent virus, 37 with A/H3N2, 15 with type B and 13 with A/H1N1 virus. Risk of infection in these episodes was related more to current hemagglutination-inhibiting titers than to experience (infected or not) in the initial episodes, with 67-100% reinfection when titers were low. Among younger (less than 20 years old) members, related illness was as frequent with reinfection as with initial infection.

Adolescent↗