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Biomedical subjects

J Westbrook

Publications and source records attributed to J Westbrook.

At least 19 recordsLinked to original sources
PubMed2006

The safety and quality of decision support systems.

OBJECTIVES: The use of clinical decision support systems (CDSS) can improve the overall safety and quality of health care delivery, but may also introduce machine-related errors. Recent concerns about the potential for CDSS to harm patients have generated much debate, but there is little research available to identify the nature of such errors, or quantify their frequency or clinical impact. METHODS: A review of recent literature into electronic prescribing systems, as well as related literature in decision support. RESULTS: There seems to be some evidence for variation in the outcomes of using CDSS, most likely reflecting variations in clinical setting, culture, training and organizational process, independent of technical variables. There is also preliminary evidence that poorly implemented CDSS can lead to increased mortality in some settings. Studies in the US, UK and Australia have found commercial prescribing systems often fail to uniformly detect significant drug interactions, probably because of errors in their knowledge base. Electronic medication management systems may generate new types of error because of user-interface design, but also because of events in the workplace such as distraction affecting the actions of system users. Another potential source of CDSS influenced errors are automation biases, including errors of omission where individuals miss important data because the system does not prompt them to notice them, and errors of commission where individuals do what the decision aid tells to do, even when this contradicts their training and other available data. Errors of dismissal occur when relevant alerts are ignored. On-line decision support systems may also result in errors where clinicians come to an incorrect assessment of the evidence, possibly shaped in part by cognitive decision biases. CONCLUSIONS: The effectiveness of decision support systems, like all other health IT, cannot be assessed purely by evaluating the usability and performance of the software, but is the outcome of a complex set of cognitive and socio-technical interactions. A deeper understanding of these issues can result in the design of systems which are not just intrinsically 'safe' but which also result in safe outcomes in the hands of busy or poorly resourced clinicians.

Decision Support Systems, Clinical↗
PubMed2004

The status of structural genomics defined through the analysis of current targets and structures.

Structural genomics--large-scale macromolecular 3-dimenional structure determination--is unique in that major participants report scientific progress on a weekly basis. The target database (TargetDB) maintained by the Protein Data Bank (http://targetdb.pdb.org) reports this progress through the status of each protein sequence (target) under consideration by the major structural genomics centers worldwide. Hence, TargetDB provides a unique opportunity to analyze the potential impact that this major initiative provides to scientists interested in the sequence-structure-function-disease paradigm. Here we report such an analysis with a focus on: (i) temporal characteristics--how is the project doing and what can we expect in the future? (ii) target characteristics--what are the predicted functions of the proteins targeted by structural genomics and how biased is the target set when compared to the PDB and to predictions across complete genomes? (iii) structures solved--what are the characteristics of structures solved thus far and what do they contribute? The analysis required a more extensive database of structure predictions using different methods integrated with data from other sources. This database, associated tools and related data sources are available from http://spam.sdsc.edu.

Computational Biology↗
PubMed2001

Miniature radio-frequency mobility analyzer as a gas chromatographic detector for oxygen-containing volatile organic compounds, pheromones and other insect attractants.

A high electric field, radio-frequency ion mobility spectrometry (RF-IMS) analyzer was used as a small detector in gas chromatographic separations of mixtures of volatile organic compounds including alcohols, aldehydes, esters, ethers, pheromones, and other chemical attractants for insects. The detector was equipped with a 2 mCi 63Ni ion source and the drift region for ion characterization was 5 mm wide, 15 mm long and 0.5 mm high. The rate of scanning for the compensation voltages was 60 V s(-1) and permitted four to six scans to be obtained across a capillary chromatographic elution profile for each component. The RF-IMS scans were characteristic of a compound and provided a second dimension of chemical identity to chromatographic retention adding specificity in instances of co-elution. Limits of detection were 1.6-55 x 10(-11) g with an average detection limit for all chemicals of 9.4 x 10(-11) g. Response to mass was linear from 2-50 x 10(-10) g with an average sensitivity of 4 pA ng(-1). Separations of pheromones and chemical attractants for insects illustrated the distinct patterns obtained from gas chromatography with RF-IMS scans in real time and suggest an analytical utility of the RF-IMS as a small, advanced detector for on-site gas chromatographs.

Chromatography, Gas↗
PubMed2001

The PDB data uniformity project.

The Protein Data Bank (PDB; http://www.rcsb.org/pdb/) is the single worldwide archive of structural data of biological macromolecules. This paper describes the data uniformity project that is underway to address the inconsistency in PDB data.

Databases, Factual↗
PubMed2001

Effects of Buddleja globosa leaf and its constituents relevant to wound healing.

An aqueous extract of Buddleja globosa leaves, used traditionally in Chile for wound healing, was tested for the ability to stimulate growth of fibroblasts in vitro and for antioxidant activity in the same fibroblast cell system challenged with hydrogen peroxide. Low concentrations of the extract gave an increase in fibroblast growth which was not statistically significant but cytotoxicity was observed at concentrations greater than 50 microg/ml. The extract showed strong antioxidant effect and fractionation led to the isolation of three flavonoids and two caffeic acid derivatives, each of which was shown to contribute to the antioxidant effect at concentrations below 10 microg/ml. These activities would accelerate the healing of wounds.

Antioxidants↗
PubMed2000

The Protein Data Bank.

The Protein Data Bank (PDB; http://www.rcsb.org/pdb/ ) is the single worldwide archive of structural data of biological macromolecules. This paper describes the goals of the PDB, the systems in place for data deposition and access, how to obtain further information, and near-term plans for the future development of the resource.

Databases, Factual↗
PubMed2000

Upregulation of the Bcl-2 family of proteins in end stage heart failure.

OBJECTIVES: To elucidate the pattern of expression of four members of the Bcl-2 family of proteins and to correlate this with terminal deoxynucleotidyl transferase [TdT]-mediated dUTP nick end labelling (TUNEL) and DNA fragmentation. BACKGROUND: Apoptosis has been implicated as a possible mechanism in the development of heart failure. However, the mechanisms involved remain unclear. METHODS: We have studied the expression of four members of the Bcl-2 family that are involved in the regulation of apoptosis and analyzed DNA fragmentation as a marker of apoptosis and as a biochemical criterion to distinguish between apoptosis and necrosis in dilated cardiomyopathy (DCM), ischemic heart disease (IHD) and normal donors. RESULTS: Western blot analysis and immunocytochemistry of the proapoptotic and antiapoptotic Bcl-2 proteins demonstrated significantly higher levels of all these proteins in the diseased groups compared with normal donors. Additionally, Bax was significantly higher in the IHD group compared with DCM. Terminal deoxynucleotidyl transferase [TdT]-mediated dUTP nick end labelling analysis demonstrated a significantly higher percentage of TUNEL-positive cells in the diseased groups compared with the control. Genomic DNA extraction of ventricular myocardial tissue showed no demonstrable DNA laddering for any of the groups. CONCLUSIONS: The significant increases in the levels of the proapoptotic proteins Bak and Bax and the higher percentage of TUNEL-positive cells in both diseased groups suggests the presence of ongoing apoptosis. However, increases in the antiapoptotic proteins, Bcl-2 and Bcl-xL, suggest a possible concomitant, compensatory antiapoptotic mechanism in patients with heart failure.

Adult↗
PubMed2000

A national comparison of health information management students' career expectations and anticipated involvement in professional activities.

The aim of this paper is to present the results of a survey of Australian health information management students relating to their career aspirations and expectations and anticipated involvement in professional activities following graduation. To explain reasons for the differences in results between states and student years, interviews were conducted with academic staff and other health information management educators. Three hundred and sixty three students completed the questionnaire in 1996, which represented a response rate of 86%. It was found that the majority of students thought they had made the correct career choice and were confident they would find full-time employment within six months of graduation. A high percentage of students also indicated that they would undertake continuing education after graduation. There was less support for involvement in the activities of their professional association, particularly at a national level. Students in New South Wales and Queensland indicated that they would be significantly less likely to work in the field of health information management for the rest of their careers. They also reported they would be significantly less likely to conduct research in an area related to health information management. Victorian students were significantly more likely to present a paper at a conference than students from Queensland, New South Wales or Western Australia. Western Australian students were significantly more likely to report that they would undertake postgraduate studies compared to students from the other three states.

Australia↗
PubMed1998

The Nucleic Acid Database: A resource for nucleic acid science.

The Nucleic Acid Database (NDB) distributes information about nucleic acid-containing structures. Here the information content of the database as well as the query capabilities are described. A summary of how the technology developed by this project has been used to develop other macromolecular databases is given.

Database Management Systems↗
PubMed1996

Nucleic acid crystallography: a view from the nucleic acid database.

What are the future directions of the field of nucleic acid crystallography? Although there have been many duplex structures determined, the sample is still relatively small. This is especially true if one wants to derive enough information about the relationships between sequence and structure. Indeed, there are data for all the possible 10 dimer steps, but for some steps it is very limited. If the structural code resides in trimers or tetrad steps then there is simply not enough data to do meaningful statistical analyses. So the first direction that needs to be explored is the determination of more structures with more varied sequences. The other noticeable thing about the data is the shortness of the strands. While it is probably true that attempts to crystallize very long sequences will not meet with success, the idea of crystallizing sequences engineered to fit together via sticky ends such as has been done for the CAP-DNA complex (Schultz et al., 1990) should give data about the behavior of much longer stretches of DNA. The question of the effects of environment on the structure of DNA continues to be a very important one to address since DNA is rarely alone. The preliminary data we have analysed from the current sample shows that the conformation of some steps are very sensitive to packing type. Numerous studies of the hydration around DNA shows that there is a real synergy between the hydration structure and the base conformation. More data will allow further quantitation of these observations. RNA structure is the next very exciting frontier. The emerging structures of duplexes with internal loops, the two hammerhead ribozyme structures and the group I intron ribozyme have given us a glimpse of the complexity and elegance of this class of molecules. With the technology now in place to allow the determination of the structures of these molecules, the expectation is that now we will see a large increase in the number of these structures in the NDB.

Base Sequence↗
PubMed1996

Why is it difficult for staff to discuss advance directives with chronic dialysis patients?

General experience and reported data show that a substantial number of patients, at least 10% in many surveys, eventually choose to withdraw from chronic dialysis. There are additional studies suggesting that discussing and completing advance directives (AD) can promote more acceptance and less acrimony for patients, families, and staff when patients die. Even so, surprisingly few AD are completed, and dialysis staff often shun discussion of AD with patients. Thus, in this study, a survey of approximately 400 dialysis staff from 12 representative Michigan dialysis facilities was undertaken both to determine the beliefs, attitudes, and life experiences that might influence such discussions, as well as to guide future strategies aimed at encouraging the discussion and meaningful execution of AD. More than 50% (210) of the distributed questionnaires were completed. Overall results show that respondents report having discussed AD with only 30% of patients on average and that as many as 40% of respondents report never having done so. Among the professional disciplines responding to this survey, social workers report the largest percentage of patients with whom they discussed AD (60%), physicians a smaller percentage (38%), licensed practical (30%) and registered (25%) nurses even fewer patients, and dialysis technicians (20%) and dietitians (4%) the least. Across all disciplines, staff reported discussing AD with a larger percentage of patients when staff had experienced significant losses within their own personal lives, discussed such issues with friends or family, or had prepared their own AD. In rating specific barriers that correlated strongly with reported discussion of AD, each professional discipline had characteristic responses reflecting the approach of the discipline to addressing AD. The survey results suggest that the interdisciplinary variations observed are attributable to: (1) important differences not only in training, but also in the customary roles taken by each discipline; (2) inherent cultural differences, suggested by the findings among nonwhite staff of a lower reported frequency of having discussed AD with patients and of more concern over the barriers to doing so; and (3) a lack of support from supervisory and physician staff within the dialysis team. In conclusion, this survey shows, not surprisingly, that personal experiences and intrinsic cultural differences influence the attitudes of dialysis staff toward discussing AD with patients. The results of this survey underscore important differences between individual professional disciplines that affect both the perceived barriers to, as well as the likelihood of, discussing AD with patients. It seems that emotional issues such as death and dying stress interdisciplinary team interaction and amplify discomfort. However, it may be possible to increase the level of comfort in talking to patients about AD for each professional discipline by addressing the findings from this study (role differences and barriers) through focused interventions and by facilitating mutual support among the distinct members of the dialysis staff.

Adult↗
PubMed1994

America's health care reforms.

President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding.

Australia↗
PubMed1993

Gastric carcinoma in children.

Primary gastric carcinoma accounts for only 0.05% of pediatric gastrointestinal malignancies. The pattern, presentation, and location of childhood gastric carcinoma are similar to those of adult gastric carcinoma. Diagnosis is based on a high index of suspicion in children who present with symptoms mimicking acid peptic disease. Delay in diagnosis is common and avoided by early upper gastrointestinal radiography and endoscopy with biopsy. Surgical therapy alone may prolong survival but thus far it has proven only palliative. The role of chemotherapy and radiation in gastric carcinoma is still not well defined, although some new studies in adults may support the use of etoposide, doxorubicin, and cisplatin as primary therapy or combined with surgery and radiation. Long-term survival in children is rare. We present the case of a 3-year survivor, free of disease, treated with resection and chemotherapy.

Adenocarcinoma↗