Biomedical subjects

Paul Dexter

Publications and source records attributed to Paul Dexter.

6 recordsLinked to original sources

PubMed2005

A pilot study of usefulness of clinician-patient videoconferencing for making routine medical decisions in the nursing home.

OBJECTIVES: To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs). DESIGN: Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair. SETTING: A 240-bed, county-managed, urban nursing home. PARTICIPANTS: NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003. MEASUREMENTS: Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument. RESULTS: For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment. CONCLUSION: FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.

Adult↗

PubMed2005

Computerized reminders to improve isolation rates of patients with drug-resistant infections: design and preliminary results.

Infections with multi-drug resistant organisms (MDROs) are a steadily increasing threat to inpatients as they move through the hospital. We constructed a computerized reminder system, integrated with existing data sources maintained by the infection control service. We tested the hypothesis that computerized reminders from a centralized infection control expert system can improve rates of barrier isolation in patients with MDROs. Immediately after institution of this reminder system, isolation of eligible ward patients increased from a baseline rate of 33% to 95% (p<0.0001). The median time to isolation decreased from 16.6 hours to 0 hours, indicating that the majority of patients post-intervention had isolation orders written prior to arrival on the ward. We conclude that a computerized reminder system can dramatically increase the clinical impact of data sources maintained by hospital Infection Control services.

Drug Resistance, Multiple↗

PubMed2005

SPIN query tools for de-identified research on a humongous database.

The Shared Pathology Informatics Network (SPIN), a research initiative of the National Cancer Institute, will allow for the retrieval of more than 4 million pathology reports and specimens. In this paper, we describe the special query tool as developed for the Indianapolis/Regenstrief SPIN node, integrated into the ever-expanding Indiana Network for Patient care (INPC). This query tool allows for the retrieval of de-identified data sets using complex logic, auto-coded final diagnoses, and intrinsically supports multiple types of statistical analyses. The new SPIN/INPC database represents a new generation of the Regenstrief Medical Record system - a centralized, but federated system of repositories.

Confidentiality↗

PubMed2003

Open Source software in medical informatics--why, how and what.

'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Database Management Systems↗

PubMed2003

Computerized reminders for syphilis screening in an urban emergency department.

Point of care reminders have been shown to be effective in changing ordering behavior in primary care settings, but electronic reminders in the emergency department have not been studied. We retrospectively evaluated a computerized system designed to prompt syphilis testing in an emergency department during an outbreak. Most individual reminders were not followed by a test. However, there was a marked general increase in syphilis testing.

Adult↗

PubMed2002

Escherichia coli DegP protease cleaves between paired hydrophobic residues in a natural substrate: the PapA pilin.

The DegP protein, a multifunctional chaperone and protease, is essential for clearance of denatured or aggregated proteins from the inner-membrane and periplasmic space in Escherichia coli. To date, four natural targets for DegP have been described: colicin A lysis protein, pilin subunits and MalS from E. coli, and high-molecular-weight adherence proteins from Haemophilus influenzae. In vitro, DegP has shown weak protease activity with casein and several other nonnative substrates. We report here the identification of the major pilin subunit of the Pap pilus, PapA, as a natural DegP substrate and demonstrate binding and proteolysis of this substrate in vitro. Using overlapping peptide arrays, we identified three regions in PapA that are preferentially cleaved by DegP. A 7-mer peptide was found to be a suitable substrate for cleavage by DegP in vitro. In vitro proteolysis of model peptide substrates revealed that cleavage is dependent upon the presence of paired hydrophobic amino acids; moreover, cleavage was found to occur between the hydrophobic residues. Finally, we demonstrate that the conserved carboxyl-terminal sequence in pilin subunits, although not a cleavage substrate for DegP, activates the protease and we propose that the activating peptide is recognized by DegP's PDZ domains.

Amino Acid Sequence↗