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Biomedical subjects

Jim Warren

Publications and source records attributed to Jim Warren.

14 recordsLinked to original sources
PubMed2006

Issues in data generation using email group conversations for nursing research.

AIM: The purpose of this paper is to provide an overview of the issues we have confronted when generating and analysing dialogue data by using electronic mail. BACKGROUND: The decision to use email for our research arose from our developing understanding of some of the consequences of illness that people living with chronic illness confront in their lives. As researchers, we recognized the potential of the Internet for computer-mediated communication using email for communication between researchers and research participants. DISCUSSION: We consider the functional aspects of generating data by email, such as the software needed, and then explore the issues encountered during the research process including ethical considerations, fluctuating participation, participants' familiarity with using email, facilitating lurkers towards participation, establishing group norms, and the role of the facilitator. CONCLUSION: As a collaborative inquiry, email conversation allowed us to spend time with participants over 2 years to explore chronic illness experience. However the scope and viability of computer-mediated communication as a qualitative method of research remains relatively unexplored, hence this paper.

Attitude to Computers↗
PubMed2006

Can homeopathic treatment slow prostate cancer growth?

BACKGROUND: Homeopathy is a complementary medicine widely used around the world. Despite extensive use of homeopathy for cancer and other serious conditions with reported success, clinical and laboratory research has been equivocal, and no rigorous research has been done on cancer. In 1999, the US National Cancer Institute evaluated the effects of homeopathic treatment of cancer from a clinic in India and has released a request for protocols to conduct further research into this treatment. Therefore, the authors conducted a series of carefully controlled laboratory studies evaluating the effects of commonly used homeopathic remedies in cell and animal models of prostate cancer. STUDY DESIGN: One hundred male Copenhagen rats were randomly assigned to either treatment or control groups after inoculation with prostate tumor cells. METHODS: Prostate tumor cells DU-145, LNCaP, and MAT-LyLu were exposed to 5 homeopathic remedies. Male Copenhagen rats were injected with MAT-LyLu cells and exposed to the same homeopathic remedies for 5 weeks. In vitro outcomes included tumor cell viability and apoptosis gene expression. In vivo outcomes included tumor incidence, volume, weight, total mortality, proliferating cell nuclear antigen (PCNA) expression, apoptotic cell death (terminal deoxynucleotidyl transferase mediated d-uridine triphosphate nick end labeling), and gene expression (rAPO-multiprobe). RESULTS: There were no effects on cell viability or gene expression in 3 prostate cell lines with any remedies at any exposure time. There was a 23% reduction in tumor incidence (P < .0001), and for animals with tumors, there was a 38% reduction in tumor volume in homeopathy-treated animals versus controls (P < .02). At time of killing, experimental animals with tumors had a 13% lower average tumor weight (P < .05). Tumors in these treated animals showed a 19% increase in apoptotic cell death (P < .05) and reduced PCNA-positive cells. CONCLUSIONS: The findings indicate that selected homeopathic remedies for the present study have no direct cellular anticancer effects but appear to significantly slow the progression of cancer and reduce cancer incidence and mortality in Copenhagen rats injected with MAT-LyLu prostate cancer cells.

Animals↗
PubMed2006

Effect of homeopathic treatment on gene expression in Copenhagen rat tumor tissues.

BACKGROUND: Increasing evidence suggests that the inability to undergo apoptosis is an important factor in the development and progression of prostate cancer. Agents that induce apoptosis may inhibit tumor growth and provide therapeutic benefit. In a recent study, the authors found that certain homeopathic treatments produced anticancer effects in an animal model. In this study, the authors examined the immunomodulating and apoptotic effects of these remedies. MATERIALS AND METHODS: The authors investigated the effect of a homeopathic treatment regimen containing Conium maculatum, Sabal serrulata, Thuja occidentalis, and a MAT-LyLu Carcinosin nosode on the expression of cytokines and genes that regulate apoptosis. This was assessed in prostate cancer tissues, extracted from animals responsive to these drugs, using ribonuclease protection assay or reverse transcription polymerase chain reaction. RESULTS: There were no significant changes in mRNA levels of the apoptotic genes bax, bcl-2, bcl-x, caspase-1, caspase-2, caspase-3, Fas, FasL, or the cytokines interleukin (IL)-1alpha, IL-1beta, tumor necrosis factor (TNF)-beta, IL-3, IL-4, IL-5, IL-6, IL-10, TNF-alpha, IL-2, and interferon-gamma in prostate tumor and lung metastasis after treatment with homeopathic medicines. CONCLUSIONS: This study indicates that treatment with the highly diluted homeopathic remedies does not alter the gene expression in primary prostate tumors or in lung metastasis. The therapeutic effect of homeopathic treatments observed in the in vivo experiments cannot be explained by mechanisms based on distinct alterations in gene expression related to apoptosis or cytokines. Future research should explore subtle modulations in the expression of multiple genes in different biological pathways.

Animals↗
PubMed2005

Empowering patients with essential information and communication support in the context of diabetes.

OBJECTIVES: Patients with diabetes need to be aware of essential information to be involved in decision-making, manage diabetes properly, and communicate with doctors and other healthcare providers effectively. We have developed Violet Technology (VT) to provide features beyond previous health information tailoring systems by dynamically prioritizing diabetes learning topics and providing integrated direct support for patient-provider communication through formulation of individualized agendas to take to healthcare encounters. METHODS: A particular feature of the VT approach is a Diabetes Information Profile (DIP) that models psychosocial and educational exposure features, as well as clinical characteristics, and considers expressed patient information preferences and recent information browsing history. The agenda facility recommends questions that the patients may have based on their profile, as well as helping to initialize a patient empowerment protocol. The technology uses a modular and extensible approach for key components, including consumer health information, prioritization rules, and methods of instantiating the DIP. VT has been implemented into a web portal for patient use. Two phases of evaluation studies have been conducted to collect patient and healthcare provider feedback. RESULTS AND CONCLUSIONS: Results indicate that VT prioritizes relevant and important information for individual patients. Moreover, both patients and providers indicate that formulating an agenda of questions is important for patients. More extensive system use is needed to establish if the technology can deliver an improved patient-provider partnership and, ultimately, improved health outcomes.

Adult↗
PubMed2005

The ethics of research using electronic mail discussion groups.

AIM: The aim of this paper is to identify and discuss the ethical considerations that have confronted and challenged the research team when researchers facilitate conversations using private electronic mail discussion lists. BACKGROUND: The use of electronic mail group conversations, as a collaborative data generation method, remains underdeveloped in nursing. Ethical challenges associated with this approach to data generation have only begun to be considered. As receipt of ethics approval for a study titled; 'Describing transition with people who live with chronic illness' we have been challenged by many ethical dilemmas, hence we believe it is timely to share the issues that have confronted the research team. These discussions are essential so we can understand the possibilities for research interaction, communication, and collaboration made possible by advanced information technologies. DISCUSSION: Our experiences in this study have increased our awareness for ongoing ethical discussions about privacy, confidentiality, consent, accountability and openness underpinning research with human participants when generating data using an electronic mail discussion group. We describe how we work at upholding these ethical principles focusing on informed consent, participant confidentiality and privacy, the participants as threats to themselves and one another, public-private confusion, employees with access, hackers and threats from the researchers. CONCLUSION: A variety of complex issues arise during cyberspace research that can make the application of traditional ethical standards troublesome. Communication in cyberspace alters the temporal, spatial and sensory components of human interaction, thereby challenging traditional ethical definitions and calling to question some basic assumptions about identity and ones right to keep aspects of it confidential. Nurse researchers are bound by human research ethics protocols; however, the nature of research by electronic mail generates moral issues as well as ethical concerns. Vigilance by researchers is required to ensure that data are viewed within the scope of the enabling ethics approval.

Confidentiality↗
PubMed2005

Introduction of electronic prescribing in an aged care facility.

Residents of aged care facilities are at high risk of adverse drug events. Electronic prescribing may reduce some of these risks. This article reports on the introduction of electronic prescribing software to a residential aged care facility with the aim of improved medication safety.

Aged↗
PubMed2005

Understanding caseload and practice through analysis of therapeutic state transitions.

Increasing uptake of electronic medical records (EMRs) offers opportunities for analysis and quality assurance of clinical practice; but making appropriate inferences about chronic disease management is non-trivial. We propose a state-transition model for analysis of chronic disease therapy by community practices based on clinical practice guidelines. We abstract guideline recommendations to key therapeutic states, and map electronic prescribing data into a series of states and transitions, which can then be interpreted with respect to the recommendations of the guideline. By applying our approach to a patient cohort diagnosed with both hypertension and diabetes mellitus, we demonstrate that the method identifies cases at risk of suboptimal care, deserving further review by General Practitioners (GPs).

Australia↗
PubMed2005

XForms and XML events to support decisions about medication management.

Representation and presentation of information in healthcare is problematic, including issues related to common formats and accessibility. XML technology infrastructure (particularly XForms and XML events) appears promising in addressing some of these issues. These technologies were investigated in the context of decision support for medication management. XForms allows rapid prototyping of information models and interfaces. XML events are useful to model simple alerts although currently limited by some components, such as date functionality.

Decision Support Techniques↗
PubMed2003

Internet-based intervention to promote organ donor registry participation and family notification.

BACKGROUND: Little is known regarding the potential of Internet-based educational interventions to increase organ donor registry participation and family notification of donation wishes. We studied the effects of an Internet-based multimedia intervention (www.journey.transweb.org) on donor registry participation and family notification. METHODS: Visitors to a specially designed web site were studied between December 14, 2000, and March 31, 2002. Demographic characteristics were requested, and a pretest was administered to one half of the participants (selected randomly) before web site content exposure. All visitors were offered a posttest. Eight knowledge questions (true/false), three attitude questions (7-point scale), and three behaviors (yes/no) were assessed. RESULTS: A total of 10,884 visitors provided demographic data. Correct answers to knowledge questions increased from 85.1% to 87.0% overall (pretest vs. posttest; P<0.001) and from 80.6% to 82.0% for teenagers (P<0.001). Willingness to donate increased (scores of 6.34 vs. 6.39; P<0.001), as did willingness to join a donor registry (scores of 5.53 vs. 5.67; P<0.001). Willingness measures were less positive among teenagers but increased significantly after exposure to the intervention. Almost 10% of visitors directly linked to an online registry and 2,489 (23%) used the web site facilities to communicate donation wishes. Increases in knowledge were not associated with changes in attitudes, but an increase in pro-donation attitude was a significant predictor of donor registry participation (P<0.001). CONCLUSIONS: Increases in donation attitudes among visitors to an organ donation web site resulted in positive behaviors, such as enrollment in a donor registry and family notification. Future efforts should focus on using Internet-based interventions to improve attitudes toward donation and to facilitate pro-donation behaviors.

Adolescent↗
PubMed2003

Linking guidelines to Electronic Health Record design for improved chronic disease management.

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Chronic Disease↗
PubMed2003

Adaptive filtering and prioritizing of diabetes consumer information for promoting consumer-provider partnership and communication.

To engender patient partnership in care we have designed an algorithm to filter and prioritize diabetes consumer information. This enables customized adaptive presentation for patients to highlight the most relevant issues. The profile for adaptation considers significant data (clinical and nonclinical), patient knowledge level and interests. An XML based implementation is the subject of ongoing experimental assessment.

Communication↗