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Biomedical subjects

R M Gardner

Publications and source records attributed to R M Gardner.

At least 55 records · Page 3Linked to original sources
PubMed1993

Using a hospital information system to assess the effects of adverse drug events.

The most common adverse events experienced by hospitalized patients are drug related. While numerous studies have described the incidence and types of adverse drug events (ADEs), the actual effect of these events on patient outcomes have only been estimated. The studies that have described the effects of ADEs on patient outcomes have not stratified patients by severity of illness and hospital costs were estimated based on a percent of hospital charges. We designed a study to utilize the resources of our hospital information system to assess the attributable effects of ADEs on hospital length of stay and cost of hospitalization. This approach emphasized the difference between study patients and their matched control patients rather than overall differences between patients with and without ADEs. In addition, we used nursing acuity data to help adjust severity of illness within DRG groups and actual hospital costs were used instead of estimated costs. This study found that while the average length of stay for patients with ADEs was 8.19 days compared to 4.36 days for matched control patients, the attributable difference due to the ADEs was 1.94 days. Similar methods found that patients with ADEs had an average cost of hospitalization of $10,584 compared to $5,350 for those without and the attributable difference due to ADEs was $1,939. This indicates that the 569 ADEs at our hospital during 1992 resulted in an additional 1,104 extra patient days at a cost of $1,103,291.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Computerized continuous quality improvement methods used to optimize blood transfusions.

Blood transfusion, although common, is not without risk and expense. Recently there has been a national focus on both overtransfusion and undertransfusion. To provide the best quality of patient care, there must be a balance between both over and undertransfusion. We used a computer system to minimize overtransfusion by prompting physicians when orders that did not meet accepted criteria were made. Continuous quality improvement methods were used to optimize blood transfusions. We also evaluated undertransfusions by assessing patients who did not receive a red cell transfusion when the Hemoglobin or Hematocrit showed it was clearly indicated. Using our computerized alerting system we are able to promptly notify physicians when such conditions exist. Results of the blood ordering show that overtransfusions of red cells have been minimized. Reductions in both mean Hematocrit and the standard deviation have occurred as predicted by continuous quality improvement theory. Assessment of undertransfusions showed that it was a minimal problem, but one that can be easily addressed with our laboratory alerting system.

Blood Transfusion↗
PubMed1993

Decision support for concurrent utilization review using a HELP-embedded expert system.

Utilization Review is the process of evaluating the efficiency of medical care, based on examination of the patient record. At LDS Hospital, the electronic patient record is in an advanced state. This paper describes the development and knowledge base verification of ASSURE (Automated Support System for Utilization Review), an application within the HELP hospital information system. ASSURE applies the Appropriateness Evaluation Protocol (AEP) Day of Care criteria to the electronic patient record, concurrent with the patient's stay. In blinded trials, an experienced Utilization Manager agreed with 92% of ASSURE's decisions on single AEP criteria for 560 acute care patients. Agreement was statistically significant, with kappa = 0.84, P < 0.0001.

Computer Systems↗
PubMed1993

Computers, quality, and the clinical laboratory: a look at critical value reporting.

The reporting of critical values is an important function of the clinical laboratory. The success of critical value reporting depends on laboratory personnel recognizing critical values and effectively communicating them to clinicians, and on clinicians correctly interpreting and using the critical values to provide appropriate patient care. At LDS Hospital, we have conducted a study of the critical value reporting process. Results of the study indicate that few critical values are actually reported by the clinical laboratory (only 28 of 294 critical values during November 24-30, 1992). Data on the quality of critical value documentation showed that 19 of 124 (15%) patient charts audited during January-February, 1993 contained no documentation that clinicians were ever aware of the critical value, or that corrective actions were taken. Other data on the quality of critical value reporting were also collected and analyzed. Study results have been used to design and implement a computerized critical value reporting system to improve the quality of critical value reporting at our hospital.

Clinical Laboratory Information Systems↗
PubMed1993

Computerized detection of arterial oxygen desaturations in an intensive care unit.

Automatic detection of arterial oxygen desaturations was investigated by collecting pulse oximeter saturation data through an MIB. Two algorithms, one based on a threshold principle and the other based on moving median calculations, performed the detection. The median algorithm detected fewer "unimportant" events than did the threshold algorithm, but also did not detect some "important" events that the threshold algorithm detected. Successful detection algorithms will likely need to incorporate into their decision-making other patient information in addition to saturation. A proposed recording algorithm is described.

Algorithms↗
PubMed1993

Fundamentals of physiologic monitoring.

For centuries, medical practitioners had no electronic medical instruments and had to rely on their senses of sight, hearing, smell, taste, and touch to obtain physiologic measurements. Although it is possible to estimate blood pressure by palpating the pulse at the radial or brachial artery, such estimates are not accurate. Determining arterial oxygen saturation of hemoglobin is more complex: how "blue" a patient appears depends on skin coloration, lighting, and the examiner's sense of color. Finally, using radiographic images to validate pulmonary edema when clinicians suspect that there is an elevated left atrial or pulmonary artery wedge pressure also challenges human senses. However, today's medical instruments use transducers and signal processors to convert patient information into a form that clinicians can easily perceive and understand. This article defines terms used with biomedical instrumentation and discusses the components of ideal physiologic patient monitoring systems.

Blood Pressure Monitors↗
PubMed1992

Familiarity and anticipation of negative life events as moderator variables in predicting illness.

A 10-month longitudinal study with 79 university students examined the role of positive and negative life experiences on the subsequent development of health problems. The Life Experiences Survey (LES; Sarason, Johnson & Siegel, 1978) was modified to measure the potential role of five moderating variables on illness. Students gave monthly reports of life events experienced, as well as health status, on the Seriousness of Illness Rating Scale (Wyler, Masuda & Holmes, 1968). Results indicated that both positive and negative life events were predictors of subsequent health problems. Negative life events that were familiar to the students and were unanticipated proved to be significant moderator variables; both factors were significant predictors of the number of health problems subsequently experienced.

Adaptation, Psychological↗
PubMed1992

Computerized identification of patients at high risk for hospital-acquired infection.

Surveillance for hospital-acquired infections is required in U.S. hospitals, and statistical methods have been used to predict the risk of infection. We used the HELP (Health Evaluation through Logical Processing) Hospital Information System at LDS Hospital to develop computerized methods to identify and verify hospital-acquired infections. The criteria for hospital-acquired infection are standardized and based on the guidelines of the Study of the Efficacy of Nosocomial Infection Control and the Centers for Disease Control. The computer algorithms are automatically activated when key items of information, such as microbiology results, are reported. Computer surveillance identified more hospital-acquired infections than did traditional methods and has replaced manual surveillance in our 520-bed hospital. Data on verified hospital-acquired infections are electronically transferred to a microcomputer to facilitate outbreak investigation and the generation of reports on infection rates. Recently, we used the HELP system to employ statistical methods to automatically identify high-risk patients. Patient data from more than 6000 patients were used to develop a high-risk equation. Stepwise logistic regression identified 10 risk factors for nosocomial infection. The HELP system now uses this logistic-regression equation to monitor and determine the risk status for all hospitalized patients each day. The computer notifies infection control practitioners each morning of patients who are newly classified as being at high risk. Of 605 hospital-acquired infections during a 6-month period, 472 (78%) occurred in high-risk patients, and 380 (63%) were predicted before the onset of infection. Computerized regression equations to identify patients at risk of having hospital-acquired infections can help focus prevention efforts.

Cross Infection↗
PubMed1992

Effect of estriol on the structure and organization of collagen in the lamina propria of the immature rat uterus.

Estradiol produces both hypertrophic and hyperplastic changes in the uterus, and these changes are associated with alterations in the structure of collagen in the lamina propria. Estriol induces only hypertrophic responses in the immature rat uterus; its effects on collagen structure were characterized in this study. Light micrographs of Masson's trichrome-stained sections revealed that the intensity of the collagen stain in the lamina propria of the rat uterus was profoundly reduced, relative to that in controls, 4 h after estriol (40 micrograms/kg) administration. These changes were not evident 24 h after estriol administration. In control uteri, transmission electron micrographs revealed that the collagen fibers surrounding stromal cells formed dense collections of bundles that were seen throughout the extracellular matrix, whereas in tissues exposed to estriol 4 h earlier, large regions of the extracellular spaces were devoid of collagen bundles. The 4-h changes in collagen were eliminated when animals were pretreated with actinomycin D (8 mg/kg) or cycloheximide (4 mg/kg). Dense collections of collagen bundles were present in tissues 24 h after estriol treatment, and their appearance was not altered by actinomycin D or cycloheximide treatment. Alterations in collagen 4 h after hormone administration appeared to be estrogen-specific since dexamethasone (600 micrograms/kg) and dihydrotestosterone (400 micrograms/kg) had no effect. These data provide evidence that the changes in collagen structure in the uterus are associated with events that function during the hypertrophic growth responses induced by estrogens.

Animals↗
PubMed1992

The fast flush test measures the dynamic response of the entire blood pressure monitoring system.

The fast flush test (FT) is the only test that allows clinicians to determine in vivo the natural frequency (fn) and damping coefficient (zeta) of an invasive blood pressure monitoring system. The underlying assumption to the validity of the FT is that it activates the whole system including the distal catheter. We devised an in vitro model of a typical invasive blood pressure monitoring system to determine whether this assumption was true. The model consisted of a conventional transducer with a flush device attached to various lengths of connecting tubing (91.4, 182.9, and 274.3 cm) terminated by four different diameter catheters (5.1 cm 14 G, 16 G, 18 G, and 20 G). A microtipped transducer catheter was inserted into the distal catheter tubing system. A FT was performed and the fn and zeta were recorded from the conventional transducer and simultaneously from the microtipped transducer catheter. Similar studies were conducted using the ROSE damping device as well as with systems including 0.1 ml of air near the conventional transducer. These studies utilized 18- and 20-G catheters with each of the three lengths of connecting tubing. All measurements of fn and zeta at the proximal conventional transducer were identical to those measurements as recorded by the distal microtipped transducer catheter. We conclude that the FT activates the whole monitoring system and that fn and zeta are the same throughout the system including the distal catheter.

Blood Pressure Monitors↗
PubMed1992

Evaluation of accuracy and reproducibility of peak flowmeters at 1,400 m.

Peak flow meters provide physicians and patients with objective measures about changes in pulmonary obstruction. We evaluated eight models of peak flowmeters and measured their accuracy and reproducibility with methods recently recommended by the National Asthma Education Program (NAEP). Waveforms from the American Thoracic Society's spirometer testing set were used to drive a computer-controlled syringe. Testing was done at Salt Lake City at an altitude 1,400 m. It appears that the original Wright peak flowmeter has been used as the "de facto" standard. We found that the original Wright peak flowmeter overestimated flows in its midrange; and, as a consequence, most of the other peak flowmeters also overestimated peak flows. The overestimation of peak flows may have been understated because of the 1,400-m altitude testing site. To the credit of the instrument manufacturers, we were pleasantly surprised with the quality, accuracy, and reproducibility of presently available peak flowmeters; however, as a result of our testing, we suspect that with little effort, manufacturers of peak flowmeters could improve the accuracy of their devices. Standardized testing methods and equipment should make the task of peak flowmeter design, manufacture, and testing even easier. We trust that manufacturers of peak flowmeters will respond appropriately and improve their instruments.

Adult↗
PubMed1992

Digital electronic communication between ICU ventilators and computers and printers.

UNLABELLED: Although many modern ICU ventilators offer the option of electronic communication, most of these systems are not used because there is a huge communication gap between the ventilator and the computer it might be connected to. When such systems are now used, a large part of what is communicated is artifactual and misleading. We need to overcome both legal and knowledge barriers in the effort to provide seamless communication between ventilators and computers. With regard to the specific issues raised in this paper, here are our answers. Issue #1: Is it essential to have a digital electronic communication port on an ICU ventilator? ANSWER: No, it is not essential. The purpose of the mechanical ventilator is to support pulmonary ventilation by supplying gas and pressure. There is no vital role for digital communication in the gas-delivery function of the ventilator; however, in the future it will be essential to have effective electronic communication in order to guarantee accurate and timely charting. Issue #2: What impact does electronic communication between a ventilator and a computer have on patient outcome? ANSWER: Our preliminary data show that electronic communication can reduce the number of charting errors and can improve the timeliness of data entry. However, there is little evidence, other than anecdotal, that this has any impact on patient outcome. Automated charting has been shown to reduce the time spent on charting. This time-savings could be used to increase time spent in direct patient care, but there is no conclusive evidence that this occurs. In fact, one report on computerized charting systems indicates that the result is less time spent in direct patient care. Issue #3: If electronic communication is to be effective in the future, how should these interfaces be configured for mechanical ventilation? ANSWER: We recommend an optimal algorithm for automated respiratory care charting that has been suggested. Sampling frequency: Sample data from the ventilator every 10 seconds. Ventilator-setting changes: Report every new setting if change lasts more than 3 minutes. Measured respiratory care data: Filter raw MIB-collected data with a 3-minute moving-median filter. Report one filtered value every hour for each variable. In addition, use a threshold table (Table 3) to define significant events. Report changes that remain above threshold more than 3 minutes. Report all measured respiratory-care data 1 minute following any ventilator-mode changes.

Computer Communication Networks↗
PubMed1992

Integration of a stand-alone expert system with a hospital information system.

A stand-alone PC expert system for evaluating the appropriateness of inpatient admissions has been integrated with an existing hospital information system. The expert system supports preadmission screening for appropriateness of inpatient admissions. The HIS provides extensive clinical data in a coded electronic form, permitting high-level decision support. The integrated system was developed for a 20 week randomized clinical trial to evaluate the effects of preadmission screening on inappropriate inpatient admissions. Three factors of the integration are considered: programmatic integration of the expert system, seamless presentation of mixed platform applications, and integration of coded data from the stand-alone application into the HIS data structure.

Evaluation Studies as Topic↗
PubMed1991

In vivo regulation of parathyroid hormone-related peptide messenger ribonucleic acid in the rat uterus by 17 beta-estradiol.

During pregnancy, elevated levels of PTH-related peptide (PTHrP) persist in the myometrium of the rat uterus. Near term, intrauterine occupancy is correlated with high levels of PTHrP messenger RNA in the gravid horn of the unilaterally pregnant uterus. In nongravid tissue from these same animals the presence of smaller yet significant elevations of PTHrP mRNA suggests that the PTHrP gene also may be regulated by humoral factor(s). To test this hypothesis, we assessed the action of 17 beta-estradiol (E2) on the expression of the PTHrP gene in the uterus of the ovariectomized rat. While low levels of PTHrP mRNA are detected in uteri from ovariectomized rats, a single dose of E2 (4, 40, or 400 micrograms/kg body weight) stimulated a 6- to 8-fold increase in the levels of PTHrP mRNA in the uterus at approximately 2 h after E2 treatment. This increase was transient with levels gradually declining to pretreatment (basal) levels within 24 h. Other steroid hormones tested, including dihydrotestosterone, dexamethasone, and progesterone, failed to stimulate this response. The increase of PTHrP mRNA accumulation required a dose greater than 0.4 micrograms/kg. The magnitude and duration of PTHrP mRNA accumulation were very similar when doses of 40 or 400 micrograms/kg were used. In addition, the stimulation of the PTHrP gene by E2 is neither age dependent nor specific to the rat and is, in part, under transcriptional control. Together, these data indicate that in vivo E2 regulates the levels of PTHrP mRNA in the rat uterus and support a role for E2 in the increased expression of PTHrP mRNA in early gestational tissue, as well as in the nongravid horn of the unilaterally pregnant uterus.

Aging↗
PubMed1991

In vivo regulation of Zif268 messenger RNA expression by 17 beta-estradiol in the rat uterus.

Administration of 17 beta-estradiol (E2) induces a mitogenic response in the rat uterus. Previous studies have shown that this effect involves the transient activation of c-fos and c-myc expression, followed by significant increases in both DNA synthesis and cell proliferation. Zif268 is a zinc finger-containing, DNA-binding transcription factor that has been implicated in the regulation of cell growth and development and has been shown to be coregulated with c-fos in a number of systems. To determine whether Zif268 is also a target for estrogen regulation, we measured the effects of E2 on Zif268 mRNA expression in the uterus of the ovariectomized rat. In this report we demonstrate that although low levels of Zif268 mRNA expression are detectable in the uteri from ovariectomized control rats, treatment with E2 (4, 40, or 400 micrograms/kg BW) induces a rapid and transient 45- to 50-fold increase in the level of Zif268 mRNA 2 h after E2 treatment. The elevated levels of Zif268 mRNA returned to basal 6 h after hormone treatment. Lower doses of E2 (0.004, 0.04, and 0.4 micrograms/kg) had little or no effect on Zif268 mRNA expression, while higher doses of E2 (4-400 micrograms/kg) resulted in maximal increases in Zif268 expression. Dexamethasone, 5 alpha-dihydrotestosterone, and progesterone had no effect on uterine Zif268 mRNA expression, and the induction of Zif268 by E2 was abolished by pretreating the animals with the RNA synthesis inhibitor actinomycin-D. In addition, stimulation of Zif268 mRNA expression was observed with the short-acting estrogen estriol, suggesting that the response may be specific for estrogenic steroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Actins↗
PubMed1991

Body-size judgments and eye movements associated with looking at body regions in obese and normal weight subjects.

Eye movements of 20 male and 20 female obese and nonobese subjects were monitored during two body-size estimation tasks using a computer-based video technology. Analysis indicated no differences in body-size estimation between subjects using the staircase method. All subjects slightly underestimated body size; however, obese subjects were more sensitive than normal-weight subjects in detecting size distortion when a signal-detection task was employed. Eye-movement data indicated subjects looked longest at the chest, followed by waist, head, thighs, and calves/feet, in both the staircase and the signal-detection methods. Women viewed the waist region longer than men. On a signal-detection task subjects were better at detecting body-size distortion when viewing the body from the back than from front or profile.

Adolescent↗