PubMed Health⌕ Search

Biomedical subjects

John Brehm

Publications and source records attributed to John Brehm.

4 recordsLinked to original sources

Development of a multi-pathogen oligonucleotide microarray for detection of Bacillus anthracis.

An oligonucleotide microarray system has been specifically designed to detect and differentiate Bacillus anthracis from other bacterial species present in clinical samples. The pilot-scale microarray initially incorporated probes to detect six common species of bacteria, which were fully evaluated. The microarray comprised long oligonucleotides (50--70-mer) designed to hybridise with the variable regions of the 16S rRNA genes. Probes which hybridised to virulence genes were also incorporated; for B. anthracis, these initially included the pag, lef, cap and vrrA (for partial genotyping) genes. Hybridisation conditions were initially optimised to be run using 5 x SSC, 0.1% SDS, 50 degrees C for 16 h. The detection limits of the microarray were determined under these conditions by titration of chromosomal DNA and unlabelled amplicons followed by hybridisation to determine the levels of sensitivity that could be obtained with the microarray. Two different amplification methodologies were also compared-specific-primer based PCR and random PCR (with the labelling stage incorporated). Higher sensitivity was obtained using specific PCR primers, however, since one of the desired outcomes of a microarray-based detection system was the high discrimination that it offered, random amplification and labelling was used as the amplification method of choice. The length of hybridisation was investigated using a time-course, and 1--2h was found to give optimal and higher signals than 16 h incubation. These results indicate that microarray technology can be employed in a diagnostic environment and moreover, results may be obtained in a similar time-scale to a standard PCR reaction, but with the advantage that no a priori knowledge of the infectious agent is required for detection.

Bacillus anthracis↗

Improving self-reporting of adverse drug events in a West Virginia hospital.

Adverse drug events significantly increase length of stay and costs of hospitalization but are underreported in health care institutions. We hypothesized that hospitals could improve the accuracy of adverse drug event self-reporting by comparing adverse drug events recorded in an occurrence reporting tool with those detected by surveillance of "rescue" drugs administered to treat adverse drug events. We conducted a prospective cohort study of all adult inpatient discharges from a 200-bed rural acute care hospital in West Virginia during a 6-month period. We performed 3572 chart audits, of which 1011 included rescue drug administration. Our outcome measure was the proportion of adverse drug events in the rescue drug surveillance that were found in the occurrence reporting tool. We found that less than 4% of all adverse drug events involving use of rescue drugs were reported. We concluded that underreporting of preventable adverse drug events in this hospital is comparable to published rates and that surveillance of adverse drug events to detect underreporting is feasible.

Adverse Drug Reaction Reporting Systems↗

Physician supply in key medical specialties in West Virginia hospitals, 2001-2004.

This article describes the development, implementation and analysis of an ongoing prospective physician supply survey of the largest acute care hospitals in West Virginia. This survey was designed to assess changes in availability of physicians in key specialties from 2001-2004, a period of years that included a "malpractice insurance crisis." The malpractice crisis in this article describes the period of time in 2001-2002 when medical malpractice insurance rates increased abruptly in West Virginia and a number of physicians publicized their departure from practice in the state. We calculated the absolute and relative percentage change in the median number of physicians in each specialty between 2001-2004, calculated percentage change for each specialty by year, and performed univariate analysis on the percentage changes among all hospitals. We also calculated univariate analysis on the percentage changes among all hospitals. The median number of staff physicians in these hospitals declined steadily from 2001-2004. Declines in the number of specialists (some statistically significant) occurred, especially early in the three-year period, notably among surgical specialties. The availability of nephrologists increased significantly from 2003-2004. Decreases in staff physician numbers may have leveled off, but there is no evidence of sustained growth.

Health Workforce↗