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Biomedical subjects

J Warren

Publications and source records attributed to J Warren.

At least 37 records · Page 2Linked to original sources
PubMed2001

An evaluation of the utility of the CEN categorical structure for nursing diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED.

We evaluated the utility of the CEN Categorical Structure for Nursing Diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED. First, we dissected nursing diagnosis term phrases from two source terminologies (North American Nursing Diagnosis Association (NANDA) Taxonomy 1 and Omaha System) into the semantic categories of the CEN categorical structure. Second, we critically analyzed the similarities between the semantic links in the CEN model and the semantic links used to formally define diagnostic concepts in SNOMED RT and SNOMED CT. Our findings demonstrated that focus, bearer, and judgment were present in 100% of the NANDA and Omaha term phrases. The Omaha term phrases contained no additional descriptors beyond those considered mandatory in the CEN model. In contrast, at least 3% of NANDA diagnoses included a term in each semantic category of the categorical structure. The comparison among the semantic links showed that neither SNOMED RT and SNOMED CT currently contain all the semantic links needed to model the two source terminologies for integration. In conclusion, our findings support the potential utility of the CEN categorical structure as a terminology model for dissecting nursing diagnostic concepts for integration into SNOMED RT and SNOMED CT. However, in order to accomplish this task, appropriate semantic links must be added to SNOMED RT and SNOMED CT.

Nursing Diagnosis↗
PubMed2001

The nursing terminology summit: collaboration for progress.

The Nursing Terminology Summit has used collaborative processes to bring about significant changes in the development of terminology standards for nursing. This paper draws on agendas, reports, notes, and other documents from the Summit, in addition to the authors' own experience as Organizer, Steering Committee, and participants, to provide a brief history of the Summit process. The analysis identifies factors that increased the risk of failure as well as factors that fostered success. The paper concludes with lessons learned that can be applied in other arenas to promote change in medical informatics.

Nursing↗
PubMed2001

Data mining for on-line support of general practice.

Statistical relationships among symptoms, diagnoses and treatments can be inferred from large data-bases of health records. We investigate how these "empirical norms" can be utilized to improve the efficiency and quality assurance capability of on-line systems in General Practice medicine. Using a survey-based database of General Practice records, we assess hotlists (case sensitive menus) of diagnoses to speed data entry. We also explore norm violation as an indicator of poor quality in practice or data recording. We find that efficient hotlists of diagnoses can be generated from symptoms. Also, we find that less frequently used hypertension treatments are assessed as of a lower quality than more common ones. The results support the hypothesis that empirical norms have a role to play in improved General Practice systems.

Australia↗
PubMed2001

Toward a model for the evaluation of clinical coding systems.

OBJECTIVE: To demonstrate an empirical method to evaluate the utility of clinical coding systems. To use this method to assess the predictive power of two codes. METHOD: Controlled trial of two coding systems. SETTING: The Read Clinical Codes, version II and the International Classification of Primary Care (ICPC). OUTCOME MEASURES: The association between codes and pharmaceuticals prescribed. RESULTS: The power of both codes to predict pharmaceuticals increased with their precision. ICPC performed better than Read at the same level of precision. CONCLUSION: ICPC may be a more efficient coding system to use than Read. Assessment of the predictive power of a code is central to assessing its utility.

Diagnosis-Related Groups↗
PubMed2001

Breastfeeding rates are increasing in Scotland.

OBJECTIVE: To measure the change in prevalence of breastfeeding between 1990/1991 and 1997/1998 in Scotland, using information collected on Guthrie cards when newborn infants are about seven days old. DESIGN: Analysis, by geographic postcode area, health board and maternity unit, for babies born in 1990/1991 and 1997/1998. For 1997, maternity unit and health board breastfeeding rates were also compared after standardisation for maternal age, deprivation and age of infant. SETTING: Scotland. SUBJECTS: 131,759 babies born in 1990/1991 and 118,055 in 1997/1998. RESULTS: In 1990/1991, 46,949 (35.6%) were breastfed as were 49,615 (42.0%) in 1997/1998, an increase of 6.4% (95% CI 6.0, 6.8) over eight years. A 3.8% increase remained after adjustment for change in maternal age. Maternity units with the Baby Friendly award improved 8.1% (95% CI 7.0, 9.2) compared with those with a certificate of commitment 6.1% (95% CI 5.2, 7.0). Other units improved 2.2% (95% C1 1.6, 2.8) no more than estimates due to increase in maternal age. Standardised rates were higher on the East Coast of Scotland 111 (109, 112) than the West or Central Regions 97 (96, 99). CONCLUSION: Breastfeeding has increased over eight years in Scotland. Less than half can be explained by demographic change in maternal age. However present breastfeeding targets are unlikely to be met. Maternity units should be urged to participate fully in the UNICEF U.K. Baby Friendly Initiative. Effective interventions prior to pregnancy are required so that more young men and women want their babies to be breastfed.

Breast Feeding↗
PubMed2000

Past and future technologic developments for rhythm and conduction disturbances.

Since the first cardiac pacemaker was implanted in 1958, continuing technologic innovations have steadily improved the therapeutic power of implantable cardiac device therapy. This evolution has benefited both patients and their physicians, expanding the conditions manageable through pacing and implantable defibrillation while streamlining implant and follow-up procedures. This progress is likely to continue unabated because (1) devices will continue to grow smaller; (2) more advanced features will be introduced, with an increased level of automaticity; and (3) the quality and quantity of telemetered diagnostic information about both patient and device will continue to expand, and device sophistication will soon reach the point at which prediction and prevention of specific events will be a reality. This article reviews historical developments and presents concepts that are guiding future technologic innovations.

Arrhythmias, Cardiac↗
PubMed2000

Child hunger in Canada: results of the 1994 National Longitudinal Survey of Children and Youth.

BACKGROUND: In Canada, hunger is believed to be rare. This study examined the prevalence of hunger among Canadian children and the characteristics of, and coping strategies used by, families with children experiencing hunger. METHODS: The data originated from the first wave of data collection for the National Longitudinal Survey of Children and Youth, conducted in 1994, which included 13,439 randomly selected Canadian families with children aged 11 years or less. The respondents were asked about the child's experience of hunger and consequent use of coping strategies. Sociodemographic and other risk factors for families experiencing hunger, use of food assistance programs and other coping strategies were analyzed by means of multiple logistic regression analysis. RESULTS: Hunger was experienced by 1.2% (206) of the families in the survey, representing 57,000 Canadian families. Single-parent families, families relying on social assistance and off-reserve Aboriginal families were overrepresented among those experiencing hunger. Hunger coexisted with the mother's poor health and activity limitation and poor child health. Parents offset the needs of their children by depriving themselves of food. INTERPRETATION: Physicians may wish to use these demographic characteristics to identify and assist families with children potentially at risk for hunger.

Activities of Daily Living↗
PubMed2000

Phenylethylthiazolylthiourea (PETT) non-nucleoside inhibitors of HIV-1 and HIV-2 reverse transcriptases. Structural and biochemical analyses.

Most non-nucleoside reverse transcriptase (RT) inhibitors are specific for HIV-1 RT and demonstrate minimal inhibition of HIV-2 RT. However, we report that members of the phenylethylthiazolylthiourea (PETT) series of non-nucleoside reverse transcriptase inhibitors showing high potency against HIV-1 RT have varying abilities to inhibit HIV-2 RT. Thus, PETT-1 inhibits HIV-1 RT with an IC(50) of 6 nM but shows only weak inhibition of HIV-2 RT, whereas PETT-2 retains similar potency against HIV-1 RT (IC(50) of 5 nM) and also inhibits HIV-2 RT (IC(50) of 2.2 microM). X-ray crystallographic structure determinations of PETT-1 and PETT-2 in complexes with HIV-1 RT reveal the compounds bind in an overall similar conformation albeit with some differences in their interactions with the protein. To investigate whether PETT-2 could be acting at a different site on HIV-2 RT (e.g. the dNTP or template primer binding site), we compared modes of inhibition for PETT-2 against HIV-1 and HIV-2 RT. PETT-2 was a noncompetitive inhibitor with respect to the dGTP substrate for both HIV-1 and HIV-2 RTs. PETT-2 was also a noncompetitive inhibitor with respect to a poly(rC).(dG) template primer for HIV-2 RT. These results are consistent with PETT-2 binding in corresponding pockets in both HIV-1 and HIV-2 RT with amino acid sequence differences in HIV-2 RT affecting the binding of PETT-2 compared with PETT-1.

Binding, Competitive↗
PubMed2000

Fitting in: maintaining a sense of self during hospitalisation.

In this study the patients' perspective of 'fitting in' was gained through participant observation and interviews. Eleven patients' stories confirmed that while hospitalisation can alleviate the suffering caused by illness, it may cause distress. In order to minimise this threat to self patients adjust to hospital life. They are supported by family, friends and health professionals in interpreting the social rules of the ward by conforming to, circumventing and challenging them.

Adaptation, Psychological↗
PubMed2000

Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women.

OBJECTIVES: There is a paucity of long term studies on exercise training in elderly women. The purpose of this study was to investigate the effects of one year of progressive resistance exercise (PRE) on dynamic muscular strength and the relations to bone mineral density (BMD) in elderly women. METHODS: Forty four healthy sedentary women (mean age 68.8 years) volunteered for this study and were randomly assigned to either an exercise group or a control group. The exercise group were involved in three one hour sessions a week for 52 weeks of supervised PRE to strengthen the large muscle groups of the body, while the control group were instructed to continue their normal lifestyle. The exercise circuit included three sets of eight repetitions at 75% of one repetition maximum focused on the large muscle groups. BMD was measured by dual energy x ray absoptiometry (Lunar DPX) at the lumbar spine and at three sites in the proximal femur. Other selected parameters of physical fitness were also measured. RESULTS: Statistical analyses (analysis of covariance) showed significant strength gains (p < 0.01) in bilateral bench press (> 29%), bilateral leg press (> 19%), and unilateral biceps curl (> 20%). No significant difference between groups was evident in body weight, grip strength, flexibility, waist to hip ratio, or the sum of eight skinfolds. Significant relations (p < 0.05) were recorded between dynamic leg strength and the BMD of the femoral neck, Ward's triangle, and the lumbar spine. CONCLUSIONS: Significant strength changes, after one year of PRE, were evident in elderly women, and the muscle increases may parallel changes in BMD; however, correlation coefficients were moderate.

Aged↗
PubMed1999

Imaging of asteroid 433 eros during NEAR's flyby reconnaissance

During the 23 December 1998 flyby of asteroid 433 Eros, the Near-Earth Asteroid Rendezvous (NEAR) spacecraft obtained 222 images of Eros, as well as supporting spectral observations. The images cover slightly more than two-thirds of Eros (best resolution is approximately 400 meters per pixel) and reveal an elongated, cratered body with a linear feature extending for at least 20 kilometers. Our observations show that Eros has dimensions of 33 x 13 x 13 kilometers. The volume, combined with the mass determined by the NEAR radio science experiment, leads to a density of 2.5 +/- 0.8 grams per cubic centimeter. This relatively high density, and the presence of an extensive linear feature, suggest that Eros may be a structurally coherent body.

Journal Article↗
PubMed1999

Crime scene analysis and the escalation of violence in serial rape.

The current study examines the crime scene behavior manifest by 108 serial rapists responsible for the perpetration of 565 rapes across various cities within the US. The goal of the current study is to identify which aspects of crime scene behavior reported to law enforcement by the victim are most useful in predicting, early in a series of offenses, which rapists are most likely to escalate into higher and, at times, life threatening levels of violence. Using 58 scales that quantify the verbal, physical, and sexual behavior manifest by a rapist in his interaction with his victim during his first reported rape and 36 modal variables that summarized approach, timing, demographics, and weapon usage across the series of rapes, the study attempts to differentiate between those rapists who escalate in their use of blunt force (Increasers) from those who do not (Non-Increasers). A logistic regression indicates that rapists who are white rather than of minority status and who, at the time of their first reported rape, rape their victims for longer periods of time and use more profanity are more likely to escalate in their level of blunt force than those rapists who do not exhibit these behaviors. The relevance of this type of predictive framework for law enforcement in its attempts to prioritize particular investigations is discussed.

Adult↗
PubMed1999

Development and evaluation of a microprocessor-based ergonomic dosimeter for evaluating carpentry tasks.

This portable and self-contained lightweight microprocessor based Ergonomic Dosimeter is designed to collect continuously postural angles of the torso and the upper arm in the sagittal plane and the number of kneeling activities. Up to 4 h of task performance data can be stored in a non-volatile memory of the dosimeter, which can then be downloaded to a lap-top computer. The portable dosimeter was tested for test-retest reliability, compared with posture data obtained with a computer-based video analysis system and evaluated at a carpenter's apprentices school and at a construction site. The dosimeter was shown to be suitable for collecting posture and kneeling data for a prolonged period at construction sites.

Anthropometry↗
PubMed1999

Effect of age and surgical approach on complications and short-term mortality after radical prostatectomy--a population-based study.

OBJECTIVES: To use population-based data to accurately delineate the types and incidence of complications, risk of readmission, and influence of age and surgical approach on short-term mortality after radical prostatectomy. METHODS: Medicare claims from 1991 to 1994 were used to identify and quantify the types and risks of complications, rehospitalization within 90 days, and mortality at 30 and 90 days after perineal or retropubic prostatectomy. Logistic regression was used to determine the relationships between age, surgical approach, and short-term outcomes while adjusting for potential confounders. RESULTS: On the basis of data from 101,604 men, complications affected 25.0% to 28.8% of patients treated with the perineal or retropubic approach. The retropubic approach had a higher risk of respiratory complications (relative risk [RR] = 1.53, 95% confidence interval [CI] 1.37 to 1.71) and miscellaneous medical complications (RR = 1.77, 95% CI 1.60 to 1.97) and a lower risk of miscellaneous surgical complications (RR = 0.86, 95% CI 0.78 to 0.94). Differences in medically related gastrointestinal complications partially accounted for the differences in miscellaneous medical complications. Rectal injury with the perineal approach was only approximately 1% to 2%. Readmission within 90 days was necessary for 8.5% to 8.7% of patients who underwent the retropubic or perineal approach. The 30-day mortality was less than 0.5% for men aged 65 to 69; it approached 1% for men aged 75 and older. CONCLUSIONS: Complications and readmission after prostatectomy are substantially more common than previously recognized. Notable differences exist in the incidence of respiratory and nonsurgical gastrointestinal complications, although many short-term outcomes are comparable for the two approaches. Older age is associated with elevated surgical mortality and complications.

Age Factors↗
PubMed1999

The impact of geographic accessibility on the intensity and quality of depression treatment.

OBJECTIVES: For depression, this research measures the impact of travel time on visit frequency and the probability of receiving treatment in concordance with AHCPR guidelines. METHODS: The medical, insurance, and pharmacy records of a community-based sample of 435 subjects with current depression were abstracted to identify those treated for depression, to determine the number of depression visits made over a 6-month period, and to ascertain whether treatment was provided in concordance with AHCPR guidelines. A Geographic Information System was used to calculate the travel time from each patient to their preferred provider. Poisson and logistic regression analyses were used to estimate the impact of travel time on visit frequency and guideline-concordance, controlling for patient casemix. RESULTS: In the community-based sample, 106 subjects were treated for depression by 105 different preferred providers. About one-third (30.7%) were treated by a mental health specialist. One average, patients made 2.8 depression visits over the 6-month period. One-third (28.9%) of the patients received guideline-concordant treatment for depression. The average number of visits for those receiving guideline-concordant care was significantly greater than for those not receiving guideline-concordant care (P < 0.01). Travel time to the preferred provider was significantly associated with making fewer visits (P < 0.0001) and having a lower likelihood of receiving guideline-concordant care (P < 0.05). DISCUSSION: For depression, both pharmacotherapy and psychotherapy treatment regimens require frequent provider contact to be effective. This study suggests that travel barriers may prevent rural patients from making a sufficient number of visits to receive effective guideline-concordant treatment.

Adult↗