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Biomedical subjects

K Levy

Publications and source records attributed to K Levy.

14 recordsLinked to original sources
PubMed2005

Improving end of life care: an information systems approach to reducing medical errors.

Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best-known precedent cases. The prototype uses the opensource CASPIAN shell developed by the University of Aberystwyth, Wales and is available by anonymous FTP. We will discuss and analyze the preliminary results we have obtained using this CBR tool. Our research suggests that automated information systems can be used to improve the quality of care at the end of life and disseminate expert level 'know how' to palliative care clinicians. We will present how our CBR prototype can be successfully deployed, capable of securely transferring information using a Secure File Transfer Protocol (SFTP) and using a JAVA CBR engine.

Artificial Intelligence↗
PubMed2005

Development of an expert system for classification of medical errors.

The 1999 report published by the Institute of Medicine (IOM) indicated that between 44,000 and 98,000 unnecessary deaths per year occurred in hospitals alone, as a result of errors committed by medical professionals in the United States. There has been considerable speculation that these figures are either overestimated or underestimated. For example, the possibility that they focus on isolated injuries rather than error, or the majority of surveyed respondents did not know what constitutes a (medical) error. These disagreements have led experts to challenge the estimates of patient harm attributable to error, as well as the methodologies used to enumerate them. Of particular concern is the process used in the identification, classification and prevention of medical errors. There have been numerous attempts to develop classifications of medical errors, and currently an abundance of taxonomies exist to describe their mechanism.In previous research, (Kopec, Kabir, Reinharth, Rothschild & Castiglione, 2003) a new taxonomy of Medical Errors was designed by expanding the IOM classification. This model and its extension can be used as a blueprint for future design, development and implementation of an expert system for classification of medical errors. Effective classification can facilitate pattern recognition, and pattern recognition will help in understanding the nature, background and abatement of medical errors. Such a system's goal will be to perform convincingly as an advisory consultant, exhibiting expertise on a par with and beyond human experts in specified domains. Despite substantial disagreement on the validity of the published figures for fatalities in hospitals in the IOM report, what is of importance is that the number of deaths caused by such errors is nonetheless alarming. The identification and classification of errors in medical care delivery is a very complex process, and this process can be facilitated and simplified by the implementation of an effective classification system.

Delivery of Health Care↗
PubMed2002

Sleep deprivation does not affect seizure frequency during inpatient video-EEG monitoring.

OBJECTIVE: To determine whether acute sleep deprivation facilitates seizures during inpatient monitoring in a controlled protocol. METHODS: Eighty-four patients with medically refractory partial epilepsy undergoing inpatient monitoring were assigned in consecutive blocks to either sleep deprivation every other night or to normal sleep. In both groups, subjects were requested to stay awake during the day, from 6 AM to 10 PM. In the sleep deprivation group, patients also stayed awake between 10 PM and 6 AM every other night beginning with Day 2. Patients were removed from sleep deprivation if they had two or more secondarily generalized seizures within 24 hours. Patients were removed from the normal sleep group and were sleep deprived if they did not have a complex partial or secondarily generalized seizure by Day 6 of monitoring. In these patients removed from sleep deprivation or from normal sleep, data were analyzed up to and including the day of removal from the protocol. RESULTS: The sleep deprivation and normal sleep subjects did not differ in age, sex, seizure localization, or percent dosage reduction in antiepileptic drugs from baseline at days 1 to 3 of monitoring. Protocol duration was 6.5 +/- 2.4 days (mean +/- SD) for the sleep deprivation group and 5.8 +/- 2.0 days for the normal sleep group. Seizures per day for complex partial, secondarily generalized, and combined complex partial and secondarily generalized, calculated from admission until end of protocol, did not differ significantly between the two groups. CONCLUSION: Acute sleep deprivation did not affect seizure frequency during inpatient monitoring in our patients with intractable complex partial seizures with secondary generalization.

Adult↗
PubMed2000

Obstructive sleep apnea is common in medically refractory epilepsy patients.

BACKGROUND: Previous reports have documented the coexistence of obstructive sleep apnea (OSA) and epilepsy and the therapeutic effects of treatment on seizure frequency and daytime sleepiness. The authors' objective was to determine the prevalence of OSA and its association with survey items in a group of patients with medically refractory epilepsy undergoing polysomnography (PSG). METHODS: Thirty-nine candidates for epilepsy surgery without a history of OSA underwent PSG as part of a research protocol examining the relationship of interictal epileptiform discharges to sleep state. Subjects also completed questionnaires about their sleep, including validated measures of sleep-related breathing disorders (Sleep Apnea Scale of the Sleep Disorders Questionnaire [SA/SDQ]) and subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]). RESULTS: One-third of subjects had OSA, defined by a respiratory disturbance index (RDI) > or = 5. Five subjects (13%) had moderate to severe OSA (RDI > 20). Subjects with OSA were more likely to be older, male, have a higher SA/SDQ score, and more likely to have seizures during sleep than those without OSA (p < 0.05). Seizure frequency per month, the number or type of antiepileptic drugs (AED) prescribed, the localization of seizures (temporal versus extratemporal), and the ESS were not statistically different between the two groups. CONCLUSIONS: In our sample, previously undiagnosed obstructive sleep apnea was common, especially among men, older subjects, and those with seizures during sleep. The impact of treating OSA on seizure frequency and daytime sleepiness in medically refractory epilepsy patients warrants further controlled study.

Adult↗
PubMed1996

Optimizing the cell efficacy of synthetic ribozymes. Site selection and chemical modifications of ribozymes targeting the proto-oncogene c-myb.

Expression of the proto-oncogene c-myb is necessary for proliferation of vascular smooth muscle cells. We have developed synthetic hammerhead ribozymes that recognize and cleave c-myb RNA, thereby inhibiting cell proliferation. Herein, we describe a method for the selection of hammerhead ribozyme cleavage sites and optimization of chemical modifications that maximize cell efficacy. In vitro assays were used to determine the relative accessibility of the ribozyme target sites for binding and cleavage. Several ribozymes thus identified showed efficacy in inhibiting smooth muscle cell proliferation relative to catalytically inactive controls. A combination of modifications including several phosphorothioate linkages at the 5'-end of the ribozyme and an extensively modified catalytic core resulted in substantially increased cell efficacy. A variety of different 2'-modifications at positions U4 and U7 that confer nuclease resistance gave comparable levels of cell efficacy. The lengths of the ribozyme binding arms were varied; optimal cell efficacy was observed with relatively short sequences (13-15 total nucleotides). These synthetic ribozymes have potential as therapeutics for hyperproliferative disorders such as restenosis and cancer. The chemical motifs that give optimal ribozyme activity in smooth muscle cell assays may be applicable to other cell types and other molecular targets.

Animals↗
PubMed1996

Medical outreach to Armenia by telemedicine linkage.

Telemedicine, an electronic mode of transmitting medical information interactively between remote sites, was launched as an educational support for a 3-year-old medical partnership between Boston University School of Medicine and Emergency Hospital, of Yerevan, Armenia. Emergency Hospital is the first site in Armenia to have an audiographic teleconference capability linking it to a major medical center. Emergency Hospital and Boston University School of Medicine share the remote connection in order to allow educational conferences, peer consultations, and distance learning to take place, thus enhancing the partnership's aims to improve the emergency and trauma care system of Yerevan. To date, eight teleconferences have been transmitted linking 100 physicians, nurses and hospital administrators. The teleconference program provides, in effect, a formal continuing medical education program for Emergency Hospital. It is a key tool of low-cost technology transfer with the potential of broadening resources over the wide territory of the 15 republics of the former Soviet Union. The telemedicine system is comprised of Optel Communications' Remote Viewing System computer hardware and software plus two dedicated AT&T telephone lines. The system has been in use at Boston University School of Medicine for live voice and still image transmission between international sites since 1987. This level of technology suited environmental conditions in Armenia, marked by frequent power outages and unreliability of local telephone connections. A protocol for presentations was established governing length of time, number of visuals per session, visual format, compatibility with interpretive services, congruence with project mission, and adaptability to local conditions that was shown to provide clear and concise delivery of the information necessary. This paper reports the process of development, installation, and initial use of the technology in one nation of the post-Soviet world.

Armenia↗
PubMed1996

Trauma system development in Armenia.

UNLABELLED: A medical partnership program between Boston University School of Medicine and the the Emergency Hospital, of Yerevan, Armenia, has been developed to improve the care of the injured in that city. The Emergency Hospital, a trauma center, was site-visited by experts from a Level I trauma center who evaluated prehospital and hospital-based emergency and trauma services and made system-wide recommendations. Recognizing local limitations, the hospital was found to have the leadership commitment, staff complement, and basic infrastructure to meet the American College of Surgeons' criteria for Level II trauma centers. The goal of integration of the academic, clinical, and research roles of a medical center consistent with Level I-type trauma centers was formulated. After 36 months, several issues raised in the assessment are being addressed notwithstanding political and economic turbulence. The Emergency Hospital has established an accredited residency program in emergency medicine; implemented programs for postgraduate medical education of its staff; begun to develop medical information systems; expanded the scope of its activities to other institutions; and restructured the emergency admissions area. Management systems remain largely undeveloped as the discipline lacks recognition as an analytic tool for institutional improvement. CONCLUSIONS: The use of existing published resources for assessment and improvement of health services in dissimilar health-care systems has been validated as a systematic approach. For system advances to be well-founded, a combination of education, management, and clinical approaches needs to be addressed. Of these, our experience is that management issues are the most resistant to change.

Armenia↗
PubMed1995

Integration of United States emergency medicine concepts into emergency services in the New Independent States.

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system. A curriculum (text and slides) has been developed and translated into Armenian and Russian. To date, the Armenian EMSI has trained nearly 300 emergency medical personnel: physicians, nurses, drivers, and first responders. The Armenian EMSI faculty have received training in directing instruction of emergency care providers. Plans are in place to begin training in Armenian cities outside of Yerevan and in neighboring republics. An emergency medicine residency program received ministry approval and was begun with six resident physicians in January 1995. To date, 45 nurses have graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health care system. Officials of the partner hospital requested assistance in upgrading the skills of its abundant emergency care workforce, citing cardiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Armenia↗
PubMed1993

Logistic regression of inhalation toxicities of perchloroethylene--application in noncancer risk assessment.

Unlike the impressive advancement of cancer risk assessment, the "cutoff approach" based on hazard quotient in noncancer risk assessments recommended by the EPA has crucial deficiencies. Several alternative approaches have been suggested in the literature to modify the noncancer risk characterization based on reference doses. Recent studies have indicated that the effects of perchloroethylene (PERC) on the central nervous system (CNS) is a much more sensitive noncancer endpoint than cancer which is currently the basis for deriving its public health criteria and standards. Studies indicate that 20 ppm of inhaled PERC concentration elicited adverse effects on the CNS in experimental animals and humans. However, the existing EPA oral reference dose (RfD), a noncancer toxicity parameter for PERC (0.01 mg/kg/day), is based on the induction of hepatotoxicity and increased body weight gain induced by PERC in rats. An attempt was made in this paper to examine whether logistic regression of dose-response data could be applied to assess the noncancer risks. In order to perform logistic regression the inhalation toxicity data of PERC were classified according to the severity of toxicity paradigm used in toxicity analysis. Based on the sensitive noncancer endpoints identified from severity classification, a logistic regression analysis of the data was performed and its potential applicability in noncancer risk characterization was described for workers exposure to PERC in dry-cleaning operations.

Administration, Inhalation↗
PubMedDate not supplied

An Internet-based exercise as a component of an overall training program addressing medical aspects of radiation emergency management.

The use of ionizing radiation and radioactive materials continues to increase worldwide in industry, medicine, agriculture, research, electrical power generation, and nuclear weaponry. The risk of terrorism using weapons of mass destruction or simple radiological devices also has increased, leading to heightened concerns. Radiation accidents occur as a consequence of errors in transportation of radionuclides, use of radiation in medical diagnosis and therapy, industrial monitoring and sterilization procedures, and rarely, nuclear power generation. Compared to other industries, a small number of serious radiation accidents have occurred over the last six decades with recent cases in the Republic of Georgia, Peru, Japan, and Thailand. The medical, psychological, and political consequences of such accidents can be considerable. A number of programs designed to train medical responders in the techniques of radiation accident management have been developed and delivered in many countries. The low frequency of serious radiation accidents requires constant re-training, as skills are lost and medical staff turnover occurs. Not all of the training involves drills or exercises in which responders demonstrate learning or communication over the broad spectrum of medical response capabilities. Medical preparedness within the context of a total emergency response program is lacking in many parts of the world, particularly in Central and Eastern Europe and the Newly Independent States. This paper describes an effort to enhance medical preparedness in the context of a total program of international cooperation and conventions facilitated by the International Atomic Energy Agency. The paper concludes that novel application of telecommunications technology as part of a training activity in radiation accident preparedness can help address gaps in training in this field in which preparedness is essential but experience and practical field exercises are lacking.

Attitude of Health Personnel↗
PubMedDate not supplied

Expanding the role of nurses in Armenia.

The dissolution of the Soviet Union and the declaration of Independence by the Republic of Armenia created the need for significant changes in the healthcare delivery system in Armenia. The desire to raise the level of health care presented challenges and opportunities for nurses within the Republic. Members of the departments of nursing at Boston City Hospital/Boston Medical Center in Boston, Massachusetts, University of Massachusetts Medical Center, Worcester, Massachusetts, and the Emergency Scientific Medical Center of Yerevan, Armenia, joined forces through a grant written by Boston University School of Medicine and sponsored by the American International Health Alliance under a cooperative agreement with the United States Agency for International Development to expand the role of nursing. This article describes the assessment, planning, implementation, and evaluation of changes to the role of nursing and the development of new roles for nurses within a hospital in the capital city of Yerevan.

Armenia↗