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Biomedical subjects

Mary Brown

Publications and source records attributed to Mary Brown.

13 recordsLinked to original sources
PubMed2006

Brief report: development of a prescription medication information webliography for consumers.

BACKGROUND: Websites offering drug information vary in coverage and quality, and most health care consumers are poorly equipped to assess the quality of internet medication information. OBJECTIVE: To establish a webliography of recommended prescription medication information websites for health care consumers and providers. DESIGN AND METHODS: Drug information websites were systematically identified based on recommendations from health professionals and text-word searches of MEDLINE and Google. The resulting sample of websites was evaluated in a 2-step process. Candidate websites were first screened using inclusion/exclusion criteria representing minimum information requirements. Websites that passed the inclusion/exclusion criteria were then rated on 16 quality criteria using a 5-point scale by 3 trained judges. Website ratings were averaged, then multiplied by the corresponding importance weight of each criterion and summed to generate a total score. Websites with the highest total scores were included in the webliography. RESULTS: Ten websites were selected for inclusion in the webliography. The 3 highest-scoring websites were Anthem Blue Cross and Blue Shield (http://home.anthemhealth.com/topic/drugcenter), U.S. National Library of Medicine (https://www.nlm.nih.gov/medlineplus/druginformation.html), and Healthvision (http://www.yourhealthinformation.com/library/healthguide/en-us/drugguide/default.htm). CONCLUSION: Medication information websites vary widely in quality and content. The online webliography is a valuable and easily accessed tool that can be recommended by health care professionals to patients who request referral to reliable websites.

Blue Cross Blue Shield Insurance Plans↗
PubMed2006

Diagramming patients' views of root causes of adverse drug events in ambulatory care: an online tool for planning education and research.

OBJECTIVE: Diagram patients' views of the causes of adverse drug events (ADEs) in ambulatory care, examine characteristics of causes reported by patients, and identify those that have been studied in the medical and social science literatures. METHODS: Twenty-two primary care patients were interviewed using a root cause analysis approach. Diagrams derived from interviews were consolidated and displayed online as a composite interactive causal diagram. Patient-reported causes were compared to evidence in the social science and medical literatures. RESULTS: Patients ascribed 164 causes to ADEs occurring through eight major pathways, including medication nonadherence, prescriber-patient miscommunication, patient medication error, failure to read medication label/insert, polypharmacy, patient characteristics, pharmacist-patient miscommunication, and self medication. Most frequently reported causes were intrapsychic and interpersonal in nature. Most patient-reported causes have been studied, however, several practical and motivational antecedents lack research. CONCLUSION: Conducting root cause analysis with patients reveals multiple logically linked aspects of medication safety in community settings that merit further research and consideration in patient and prescriber education. PRACTICE IMPLICATIONS: This causal diagram provides a broadly accessible planning tool for reducing ambulatory ADEs by showing a comprehensive picture of potential causes, identifying causal factors supported by evidence, and disclosing likely consequences of change efforts. Also, patient-centered medication safety strategies should address psychological and practical barriers patients face in their everyday lives.

Adolescent↗
PubMed2006

Patients consulting outside of funded practices within primary health organisations: implications for utilisation reporting.

AIM: To consider two definitions for utilisation reporting in primary care in New Zealand and to assess the affect of two reporting methods on volumes of utilisation in four primary health organisations (PHOs). METHODS: Utilisation data was analysed for a 6-month period from 60 practices across four PHOs. Analysis was based on comparing the expected volumes from two alternative collection and reporting methods, named "matched" and "unmatched" reporting. The "unmatched" method is potentially sensitive to patients consulting outside of the practice in which they are funded. Volumes were grouped into categories based on those used for reporting. RESULTS: There was up to 25% difference in volumes in some reporting groups depending on the matching method used. Several of these were for high deprivation, New Zealand Maori, Pacific Islanders, and Community Service Card (CSC) holders--all potentially target populations within PHOs. Two PHOs were more affected having a total of 7.6% and 6.4% fewer reported encounters using the "unmatched" method. Data implies that some groups of patients may not be receiving continuity of care. CONCLUSIONS: There were differences in reporting volumes between the two methods. The Ministry of Health (MOH), district health boards (DHBs), and PHOs should be aware of how these results may potentially apply to them, especially where they have after-hours services or target groups as minorities.

Adolescent↗
PubMed2006

Assessing the relationship between preterm delivery and various microorganisms recovered from the lower genital tract.

OBJECTIVE: To determine if the likelihood of preterm delivery is more dependent on the specific organisms present in the vagina than on the presence of bacterial vaginosis. METHODS: We evaluated the vaginal fluid of a prospective cohort of women at 23-32 weeks of gestation with signs and symptoms of preterm labor and intact membranes. Forward stepwise logistic regression models were used to evaluate the relationship between preterm delivery and the presence of anaerobic bacteria, Gardnerella, ureaplasmas and mycoplasmas, and sialidase. RESULTS: The cohort included 137 women, and complete delivery information was available for 134 of them. The rate of preterm delivery was 28% (37 of 134). Mycoplasma genitalium independently was associated with spontaneous preterm delivery (OR 3.48; 95% CI 1.41, 8.57). After controlling for this factor, none of the other variables were significantly prognostic for spontaneous preterm delivery (residual overall p = 0.19). CONCLUSION: The presence of Mycoplasma genitalium in the vagina of pregnant women is an independent risk factor for spontaneous preterm delivery.

Adult↗
PubMed2005

Application of targeted radiotherapy/gene therapy to bladder cancer cell lines.

OBJECTIVES: A targeted radiotherapy/gene therapy strategy for transitional cell carcinoma of bladder is described, using [131I]meta-iodobenzylguanidine ([131I]MIBG), a radionuclide combined with a tumour-seeking drug. The aim is to decrease side effects from radiation toxicity, while increasing radiation dose to tumour. This tumour cell kill approach is augmented by radiological bystander effects. METHODS: The bladder cancer cell line EJ138 was transfected with a gene encoding the noradrenaline transporter (NAT) under the control of tumour-specific telomerase promoters. Resulting uptake of [131I]MIBG was assessed by gamma-counting of cell lysates, and NAT transgene expression by real-time RT-PCR. Cell kill of monolayers and disaggregated spheroids, dosed with [131I]MIBG, was assessed by clonogenic assay. RESULTS: NAT gene transfected cells exhibited a significantly increased active uptake of [131I]MIBG, leading to dose-dependent cell kill. Clonogenic assay of disaggregated spheroids, a three-dimensional model, suggested cell kill via bystander effects. CONCLUSIONS: Expression of a functional NAT after in vitro transfection of bladder cancer cells with the NAT gene under the control of telomerase promoters leads to active uptake of [131I]MIBG and dose-dependent cell kill. This strategy could produce a promising new treatment option for bladder cancer.

3-Iodobenzylguanidine↗
PubMed2005

The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II.

INTRODUCTION: This study was designed to assess whether right ventricular pacing in the implantable cardioverter defibrillator (ICD) arm of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II was associated with an unfavorable outcome. METHODS AND RESULTS: Data on the number of ventricular paced beats were available in 567 (76%) of 742 MADIT II patients with ICDs. The number of ventricular paced beats over the total number of beats showed a bimodal distribution with patients being predominantly paced or nonpaced. Therefore, patients were dichotomized at 0-50% and 51-100% of cumulative pacing with median pacing rate 0.2% and 95.6%, respectively. Endpoints included new or worsening heart failure, appropriate ICD therapy for VT/VF, and the combined endpoint of heart failure or death. Clinical features associated with frequent ventricular pacing included age >or=65 years, advanced NYHA heart failure class, LVEF < 0.25, first degree AV and bundle branch block, and amiodarone use. During follow-up, 119 patients (21%) had new or worsened heart failure, 130 (23%) had new or worsened heart failure or death, and 142 (25%) had appropriate therapy for VT/VF. In comparison to patients with infrequent pacing, those with frequent pacing had significantly higher risk of new or worsened heart failure (hazard ratio = 1.93; P = 0.002) and VT/VF requiring ICD therapy (HR = 1.50; P = 0.02). CONCLUSIONS: Patients in MADIT II who were predominantly paced had a higher rate of new or worsened heart failure and were more likely to receive therapy for VT/VF. These results suggest the deleterious consequences of RV pacing, particularly in the setting of severe LV dysfunction.

Aged↗
PubMed2005

Clinical course and implantable cardioverter defibrillator therapy in postinfarction women with severe left ventricular dysfunction.

BACKGROUND: There are limited data regarding implantable cardioverter defibrillator (ICD) therapy in postinfarction women with severe left ventricular dysfunction. The aim of this study was to evaluate the risk of cardiac events and effects of ICD therapy in women as compared to men enrolled in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). METHODS AND RESULTS: Among 1,232 patients enrolled in MADIT II, there were 192 (16%) women and 1,040 (84%) men. When compared to men, women had an increased frequency of NYHA class > or =II (70 vs 63%; P = 0.067), hypertension (60% vs 52%; P = 0.047), diabetes (42% vs 34%; P = 0.027), and LBBB (25% vs 17%; P = 0.011), and less frequent CABG surgery (42% vs 60%; P < 0.001). The 2-year cumulative mortality in patients randomized to conventional therapy was not significantly different in women and men (30% and 20%, respectively; P = 0.19). Adjusting for relevant clinical covariates, the hazard ratios for ICD effectiveness were similar in women (0.57; 95% CI = 0.28-1.18; P = 0.132) and men (0.66; 95% CI = 0.48-0.91; P = 0.011). The risk of appropriate ICD therapy for VT/VF was lower in women than in men (hazard ratio = 0.60 for female vs male gender; 95% CI = 0.37-0.98; P = 0.039). CONCLUSIONS: MADIT II women had similar mortality and similar ICD effectiveness when compared to men. MADIT II women with ICDs had a lower risk of arrhythmic events with fewer episodes of ventricular tachycardia than men.

Aged↗
PubMed2004

Diagnostic accuracy of Fischer Senoscan Digital Mammography versus screen-film mammography in a diagnostic mammography population.

RATIONALE AND OBJECTIVES: To compare the diagnostic accuracy of the Fischer Senoscan Digital Mammography System with that of standard screen-film mammography in a population of women presenting for screening or diagnostic mammography. MATERIALS AND METHODS: Enrollment of patients took place at six different breast-imaging centers between 1997 and 1999. A total of 247 cases were selected for inclusion in the final reader study. All known cancer cases were included (111) from all six participating sites representing 45% of the total cases. The remaining 136 cases (55%) were randomly selected from all available benign or negative cases from three of the six sites. A complete case consisted of both a (unilateral or bilateral) digital and screen-film mammogram of the same patient. Eight radiologists interpreted the cases in laser-printed digital and screen-film hardcopy formats. The study was designed to detect differences of 0.05 in the ROC area under the curve (AUC) between digital and screen-film radiologist interpretation performance. RESULTS: The average AUC for the Senoscan digital was 0.715 for the 8 readers. The average AUC for screen-film was 0.765. The difference AUC of -0.05 falls within the 95% confidence interval (-0.101, 0.002). The average sensitivity was 66% and specificity 67% for SenoScan full-field digital mammography. The average screen-film mammography sensitivity and specificity were 74% and 60%, respectively. CONCLUSION: No statistically significant difference in diagnostic accuracy between the Fischer Senoscan and screen-film mammography was detected in this study.

Adult↗
PubMed2002

Establishing a collaborative relationship with a college of nursing.

Perioperative nursing typically is a small part of nursing school curricula, which makes it difficult to recruit new graduates into the perioperative field. St Luke's Episcopal Hospital, Houston, has taken a unique approach to addressing this problem by establishing a collaborative relationship with Prairie View A&M University, Houston. This collaborative relationship introduces perioperative nursing to nursing students who may never have considered the OR as an area of practice. In addition, it provides an opportunity for students to network with perioperative nurses, and it serves as a method for recruiting new graduates to St Luke's Episcopal Hospital.

Curriculum↗
PubMed2002

Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Developing effective policy for environmental health issues requires integrating large collections of information that are diverse, highly variable, and uncertain. Despite these uncertainties in the science, decisions must be made. These decisions often have been based on risk assessment. We argue that two important features of risk assessment are to identify research needs and to provide information for decision making. One type of information that a model can provide is the sensitivity of making one decision over another on factors that drive public health risk. To achieve this goal, a risk assessment framework must be based on a description of the exposure and disease processes. Regarding exposure to waterborne pathogens, the appropriate framework is one that explicitly models the disease transmission pathways of pathogens. This approach provides a crucial link between science and policy. Two studies--a Giardia risk assessment case study and an analysis of the 1993 Milwaukee, Wisconsin, Cryptosporidium outbreak--illustrate the role that models can play in policy making.

Animals↗