Biomedical subjects

James Campbell

Publications and source records attributed to James Campbell.

At least 19 recordsLinked to original sources

PubMed2006

Amniotic fluid cytokine profile in association with fetal hyperechogenic bowel.

OBJECTIVES: Fetal hyperechogenic bowel (FEB) is associated with infection, chromosomal abnormalities and poor fetal outcome. FEB may result from an intrauterine fetal bowel cytokine-mediated inflammatory response. Since alterations in the levels of the cytokines interleukin (IL)-6, IL-8, IL-10, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma are associated with pregnancy complications and necrotizing enterocolitis, this study aimed: (i) to determine their involvement in the pathophysiology of FEB and (ii) to identify their role as amniotic fluid markers of this condition. STUDY DESIGN: In this prospective case-control study, amniotic fluid was collected by transabdominal amniocentesis from pregnant women with fetuses presenting (n=10)--or not (n=30)--with FEB during routine 18-20 week ultrasound scans. Cell-free amniotic fluid samples were analysed for cytokine concentrations by fluid-phase multiplex immunoassay. Data were compared by Mann-Whitney U-tests and Pearson correlations. RESULTS: Amniotic fluid IL-8 levels were significantly higher in the FEB group. There was a positive correlation between IL-6 and each of IL-8 and INF-gamma, as well as between IL-8 and IL-10, and TNF-alpha and INF-gamma. CONCLUSIONS: FEB likely ensues from a fetal inflammatory process involving IL-8 and, possibly, IL-6 and IL-10. This indicates the potential of immunomodulatory therapy in the management of FEB.

Adult↗

PubMed2006

Geriatric outcomes are improved by a geriatric trauma consultation service.

BACKGROUND: Traumatic injuries in older patients are complex and have significant impact on the individual, their family, and trauma centers. We hypothesized that greater attention to the timely identification and comprehensive management of comorbid conditions would improve outcomes in the care of the older injured patient. METHODS: This was a prospective, descriptive study of all patients 65 years of age and older admitted to the trauma service. Each elder was seen by a specialist in geriatrics ideally within 24 hours of admission to the trauma service. A standardized consult was developed for the electronic medical record and utilized in every case. Data were obtained from the trauma registry to characterize the nature of injury, injury severity, and outcome. Data from the geriatric consult were compiled to determine the impact of age- associated conditions on the outcome. RESULTS: There were 285 injured patients, aged 65 years and older. Of these, 114 were seen in consultation. Age range was 65 to 96 years, with an average of 77.7 years. Injury Severity Score range was 3 to 75, with an average of 9.3. There were an equal number of male and female patients. Falls and motor vehicle collisions predominated. Geriatricians identified the following: 14% of patients presented with alcohol issues; 36% of patients exhibited signs of delirium; and 46% of patients presented with new medical conditions. Geriatricians assisted with advanced care planning in 15% of cases; disposition decisions to promote function in 49%; made medication changes in 65%; decreased inappropriate medications in 20%; and assisted with pain management in 42%. Trauma surgeons followed one or more recommendations in 91%. CONCLUSION: Outcomes of older patients can be improved through geriatricians' expertise by addressing new and existing medical issues and reducing hospital-acquired complications such as functional decline, falls, delirium, and death.

Aged↗

PubMed2005

A novel strategy using MASCOT Distiller for analysis of cleavable isotope-coded affinity tag data to quantify protein changes in plasma.

A novel strategy consisting of cleavable Isotope-Coded Affinity Tag (cICAT) combined with MASCOT Distiller was evaluated as a tool for the quantification of proteins in "abnormal" patient plasma, prepared by pooling samples from patients with acute stroke. Quantification of all light and heavy cICAT-labelled peptide ion pairs was obtained using MASCOT Distiller combined with a proprietary software. Peptides displaying differences were selected for identification by MS. These preliminary results show the promise of our approach to identify potential biomarkers.

Algorithms↗

PubMed2005

Longitudinal monitoring of two commercial layer flocks and their environments for Salmonella enterica serovar enteritidis and other Salmonellae.

Between August 20, 2001, and September 17, 2002, 1429 samples including drag swabs, egg belt or egg rollout swabs, fan-blade swabs, rodent organ and intestinal pools, beetle (Alphitobius diaperinus) pools, housefly (Musca domestica) pools, chicken organ and intestinal pools, and egg pools were obtained for Salmonella culture from two flocks from two different commercial layer ranches. The two ranches were purposefully selected for the study based on their previous status of Salmonella Enteritidis isolation using environmental drag swabs in cooperation with practicing veterinarians. Salmonella sp. was isolated from 337 out of 979 (34.42%) non-egg samples. No Salmonella was isolated from 450 egg pools collected from either ranch. S. enteritidis was isolated from samples obtained from ranch 1 from manure drag swabs, 4/284 (1.4%); rodent organs, 1/24 (4.2%); and housefly pool cultures 1/21 (4.8%). Salmonella Enteritidis was isolated from ranch 2 from mouse organ and intestinal pool samples, 1/24 (4.2%). Salmonella group B was isolated from all sample types except the insects. There was a statistically significant difference in isolation rates among seven serogroups of Salmonella: groups B, C1, C2, D, E, K, and untypeable (Pearson chi-square 18.96, P = 0.002). Overall, statistically significant differences were observed with respect to Salmonella isolation among the types of samples taken (Pearson chi-square 118.54, P < 0.0001). Intensive monitoring for Salmonella Enteritidis can be used to optimize a Salmonella reduction program for an individual poultry biosecurity unit.

Animals↗

PubMed2004

Effects of social work intervention on nonemergent pediatric emergency department utilization.

The purpose of this study was to determine whether social work intervention would reduce nonemergent visits to the emergency department and increase scheduled pediatric visits. A high-risk repeater group of 104 pediatric patients with three or more emergency department visits was randomly selected to receive social work intervention. Control and intervention groups were compared for inappropriate emergency department utilization and scheduled primary care visits. Pre- and postintervention emergency department visits were significantly reduced in the intervention group compared with the group that received no intervention and with prior utilization. Scheduled visits declined in the control group but increased by 26 percent in the intervention group.

Adolescent↗

PubMed2004

Predictors of HIV/AIDS among individuals with tuberculosis: health and policy implications.

The purpose of this report was retrospectively to assess the application of clinical predictors (i.e. signs and symptoms) for the diagnosis of the human immunodeficiency virus (HIV) infections, including the acquired immunodeficiency syndrome (AIDS), among tuberculosis (TB)-positive subjects enrolled within an urban heterosexual sero-discordant couple (one partner HIV-positive and the other HIV-negative) cohort study at an HIV prevention and research centre in Lusaka, Zambia. Available medical, clinical and laboratory records from 1994 to mid-1998 were reviewed, with follow-up visits to the local chest clinics and sputum analyses laboratories instituted as additional quality assurance measures. A nested case-control study was employed. The World Health Organization clinical case definition for HIV/AIDS (WHOCCDA) was observed to be significantly more likely to predict HIV/AIDS among TB-positive HIV-positive subjects than TB-positive HIV-negative subjects. Therefore, this report documents the relative effectiveness of the WHOCCDA in predicting HIV/AIDS cases and discusses the health and policy implications, especially for the developing world which accounts for a significant proportion and impact of HIV/AIDS. Further research studies based on prospective randomized controlled trails or other rigorous evaluation strategies are warranted to substantiate these findings.

Adolescent↗

PubMed2004

Opportunistic infections in hospitalized HIV-infected adults in Ho Chi Minh City, Vietnam: a cross-sectional study.

The HIV epidemic is emerging rapidly in Vietnam. We studied the prevalence of opportunistic infections by performing clinical and microbiological investigations in 100 hospitalized HIV-infected adults in Ho Cho Minh City, Vietnam. The median CD4 count was 20 cells/mm(3) and in-hospital mortality was 28%. The most frequent diagnoses were oral candidiasis (54), tuberculosis (37), wasting syndrome (34), lower respiratory tract infection (13), cryptococcosis (9), and penicilliosis (7). Bacterial (other than tuberculosis) and parasitic infections were uncommon. Regional differences should be considered when deciding which diagnostic procedures and prophylactic measures to implement. In Vietnam, routine mycobacterial blood cultures do not provide greater yield than chest radiography and sputum and lymph node aspirate smears. Prophylactic trimethoprim/sulphamethoxazole against Pneumocystis jiroveci pneumonia may confer little benefit, and high rates of isoniazid resistance may affect the efficacy and feasibility of tuberculosis chemoprophylaxis. However, the usefulness of itraconazole prophylaxis for cryptococcosis and penicilliosis merits further consideration.

AIDS-Related Opportunistic Infections↗

PubMed2004

Modeling guidelines for integration into clinical workflow.

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunization guideline in a real clinical information system and by reconstructing the workflow context of a deployed decision-support system for guideline-based care. We discuss the implication of deployment-driven guideline encoding for sharability of executable guidelines.

Decision Making, Computer-Assisted↗

PubMed2004

The SAGE guideline modeling: motivation and methodology.

The SAGE (Standards-Based Sharable Active Guideline Environment) project is a collaboration among research groups at six institutions in the US. The ultimate goal of the project is to create an infrastructure that will allow execution of standards-based clinical practice guidelines across heterogeneous clinical information systems. This paper describes the design goals of the SAGE guideline model in the context of the technological infrastructure and guideline modeling methodology that the project is developing.

Decision Support Systems, Clinical↗

PubMed2003

Effects of prenatal cocaine exposure and maternal separation on heart rate, orienting response habituation, and retention.

Effects of the presence or absence of the dam during testing and the retention interval on pretone heart rate (HR) and habituation and retention of an HR orienting response to tone were examined in prenatally cocaine-exposed and nontreated Sprague Dawley rat pups in two experiments. On postnatal day 16, each pup received two test sessions, separated by a 4-hr retention interval during which pups were either isolated or placed with their dam and siblings. For testing, each pup was placed in the test apparatus in the presence or absence of an anesthetized dam where, after a 15-min adaptation period, 10 tone presentations were given, each separated by a 65-s intertrial interval, with HR measured during a 5-s pretone period and throughout the 10-s tone for each trial. Experiment 1 used offspring from the regular breeding colony and observed the typical HR lowering effect of maternal presence during testing, an effect that was surprisingly potentiated, however, following the retention interval in animals that were isolated during this interval. This apparent potentiation by prior isolation of the HR lowering effect of the dam was confirmed in Experiment 2 in nontreated offspring, but did not emerge convincingly in offspring of either dams subcutaneously injected with 40 mg/kg of cocaine HCl daily from gestational days 8 to 20 (C40) or dams injected with saline and pair-fed 4 days (PF4) to mimic the acute anorexic effects of cocaine administration. Consistent with prior work, C40 offspring also were found to exhibit better retention of the habituated orienting response than offspring of NT dams and to some extent PF4 dams as well, a retention effect that was not significantly influenced, however, by social context during the retention interval.

Acoustic Stimulation↗

PubMed2003

Pediatric pneumonia.

Respiratory disease is common in pediatrics and diagnosing pneumonia may be clinically challenging. Changes in pneumococcal resistance and immunization practices continue to change the incidence and etiologies of pneumonia. Careful attention to epidemiologic, seasonal, and specific pediatric clinical factors and using adjunct radiographs and laboratory tests should guide the emergency physician in his or her management strategy, including selection of antibiotics and inpatient or outpatient disposition.

Adolescent↗

PubMed2003

The structure of guideline recommendations: a synthesis.

We propose that recommendations in a clinical guideline can be structured either as collections of decisions that are to be applied in specific situations or as processes that specify activities that take place over time. We formalize them as "recommendation sets" consisting of either Activity Graphs that represent guideline-directed processes or Decision Maps that represent atemporal recommendations or recommendations involving decisions made at one time point. We model guideline processes as specializations of workflow processes and provide possible computational models for decision maps. We evaluate the proposed formalism by showing how various guideline-modeling methodologies, including GLIF, EON, PRODIGY3, and Medical Logic Modules can be mapped into the proposed structures. The generality of the formalism makes it a candidate for standardizing the structure of recommendations for computer-interpretable guidelines.

Decision Making, Computer-Assisted↗

PubMed2003

Web-based physician order entry: an open source solution with broad physician involvement.

Computerized physician order entry (CPOE) is a disruptive technology but holds great promise for reducing medical errors, improving workflow and in the long run, producing cost-savings. However, many studies have reported significant physician resistance to implementing CPOE. In this manuscript we present a two-prong strategy for quick implementation of CPOE: 1) a web-based deployment tool using an open source, secure environment that allows rapid development and deployment of content, and 2) the development of a large set of disease specific order sets and knowledge bases based on established vocabulary standards such as LOINC and SNOMED CT by teams of multidisciplinary content experts at the departmental level. The order sets can be viewed, edited and signed through a standard browser interface. This paper presents the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗

PubMed2003

Rapid deployment of physician order entry using web-based, disease-specific order sets.

Computerized physician order entry (POE) is a disruptive technology that holds great promise to reduce medical errors and improve workflow. However, Studies have reported significant physician resistance. This presentation will describe a two-pronged strategy to build broad support for POE: To build a secure, open source, browser-based platform to support POE and create a large number of disease-specific order-sets for immediate use. This presentation will demonstrate the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗

PubMed2002

Resource use data by patient report or hospital records: do they agree?

BACKGROUND: Economic evaluations alongside clinical trials are becoming increasingly common. Cost data are often collected through the use of postal questionnaires; however, the accuracy of this method is uncertain. We compared postal questionnaires with hospital records for collecting data on physiotherapy service use. METHODS: As part of a randomised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal questionnaires and from hospital records. RESULTS: 315 patients were referred for physiotherapy. Hospital data on attendances was available for 30% (n = 96), compared with 48% (n = 150) of patients completing questionnaire data (95% Cl for difference = 10% to 24%); 19% (n = 59) had data available from both sources. The two methods produced an intraclass correlation coefficient of 0.54 (95% Cl 0.31 to 0.70). However, the two methods produced significantly different estimates of resource use with patient self report recalling a mean of 1.3 extra visits (95% Cl 0.4 to 2.2) compared with hospital records. CONCLUSIONS: Using questionnaires in this study produced data on a greater number of patients compared with examination of hospital records. However, the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysis.

Adult↗

PubMed2002

Evaluation of a single dose of half strength inactivated influenza vaccine in healthy adults.

Because of delays in the manufacturing of the 2000-2001, trivalent inactivated influenza vaccine in the US, there were concerns that there might be shortages of vaccine supply in the US. Therefore, we conducted a prospective, randomized, open-label, multicenter trial at six academic medical centers in the US, to evaluate the immunogenicity of a half dose of inactivated vaccine in healthy adults. Healthy adults between the ages of 18 and 49 were randomized to receive either a full 0.5ml (15.5 microg of each HA antigen) dose or a 0.25ml (7.75 microg of each HA antigen) dose of the 2000-2001 trivalent inactivated influenza vaccine by intramuscular injection. Sera were obtained for assessment of hemagglutination-inhibiting antibody to each of the three strains contained in the vaccine before and 21 days after vaccination. The proportions of individuals achieving a post-vaccination titer of > or =1:40, the geometric mean titers (GMTs) of post-vaccination antibody, and the proportions of individuals with a four-fold or greater increase in antibody were lower for all three strains in those receiving 0.25ml of vaccine compared to those receiving 0.5ml. However, the differences were small for all three antigens. The upper 95% confidence limits for differences between 0.25 and 0.5ml doses were less than 20% for rates of achieving a titer of > or =1:40 and four-fold response, and less than 1.5 for the ratios of GMTs between dose groups, for all three vaccine antigens. These results suggest that when vaccine is in short supply, a strategy using a half dose in healthy adults could increase the number of people vaccinated with relatively little adverse impact on vaccine immunogenicity.

Adolescent↗

PubMed2002

Economic analyses of respiratory syncytial virus immunoprophylaxis in high-risk infants: a systematic review.

OBJECTIVE: To systematically review all published economic analyses of the only 2 available agents for respiratory syncytial virus immunoprophylaxis in high-risk infants: respiratory syncytial virus immunoglobulin intravenous and palivizumab. DATA SOURCES: Economic evaluations of respiratory syncytial virus immunoprophylactic agents were identified from the MEDLINE and HealthSTAR databases using various combinations of the following search terms: respiratory syncytial virus immunoglobulin intravenous, palivizumab, cost, and cost-effectiveness. The search was limited to articles published in English between January 1, 1990, and August 31, 2001. Additional studies were obtained by searching bibliographies of all relevant identified articles. STUDY SELECTION: Only studies that performed an economic analysis of either or both of these agents in an infant population were included. Letters to the editor and commentaries that included informal economic analyses were excluded. Twelve of the 21 identified studies met the selection criteria. DATA EXTRACTION: Two of us (S.K.-B. and J.D.) independently reviewed the articles and extracted summary information using a standardized abstraction form, with differences resolved by consensus. DATA SYNTHESIS: Estimates ranging from cost savings to considerable incremental costs per hospitalization avoided with use of either agent were observed across studies. Studies comparing the 2 agents reported mixed results about their relative cost-effectiveness in different infant subgroups. The divergent results may be explained by differences in the study methods and assumptions, but they also reflect the poor quality of some of the economic analyses. CONCLUSION: In light of the issues identified in this review, providers, payers, and health policymakers need to critically appraise and judiciously interpret cost-effectiveness research on these agents.

Antibodies, Monoclonal↗

PubMed2002

Gynecology: select topics.

Menopause, premenstrual syndrome, dysmenorrhea, female fertility, and mastalgia are common problems not easily treated by conventional medicine. Women often seek alternative therapies to help address these conditions. Some evidence points to the efficacy of black cohosh, exercise, and possibly Kava and St. John's wort, in the treatment of menopausal symptoms. Clinical trials indicate that symptoms of premenstrual syndrome may be alleviated with calcium, magnesium, vitamin E. Thiamine, omega-3 fatty acids, the Japanese herbal concoction, TSS, and calcium have proved useful in treating women with dysmenorrhea. Symptoms of mastalgia may be attenuated by evening primrose oil, chaste tree and flaxseed oil may be helpful.

Attitude to Health↗