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Biomedical subjects

R Morrell

Publications and source records attributed to R Morrell.

15 recordsLinked to original sources
PubMed1994

Expert systems.

The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.

Drug Interactions↗
PubMed1994

Inhibitory effect of the Isolator blood culture system on growth of Mycobacterium avium-M. intracellulare in BACTEC 12B bottles.

The examination of 6,938 clinical specimens collected during the period January 1991 through December 1992 suggested that the Isolator blood culture system (Wampole) inhibited growth of Mycobacterium avium-M. intracellulare complex (MAC) in BACTEC 12B medium. Of 162 MAC blood culture isolates, 94% were recovered from Lowenstein-Jensen (LJ) medium, while only 50% were recovered from 12B medium. The time to detection with LJ medium was 18 days, while that with 12B medium was 24 days. In contrast, 62% of the 305 MAC nonblood culture isolates were recovered from the LJ medium, while 87% were found in the 12B medium. The time to detection for these cultures was also reversed, i.e., 28 days for LJ medium versus 15 days for 12B medium. Dilution studies using the lysis-anticoagulant reagent from Isolator tubes demonstrated inhibition of both clinical and American Type Culture Collection strains of MAC, even at low concentrations of lysis-anticoagulant reagent. Washing the Isolator blood sediment prior to inoculating the 12B bottles eliminated any growth inhibition. Clinical and experimental data suggest that the use of the Isolator blood culture tube with the BACTEC 12B medium is contraindicated for mycobacterial blood cultures.

Bacteremia↗
PubMed1993

Personal computer-based expert system for quality assurance of antimicrobial therapy.

A personal computer (PC)-based expert system developed to monitor the appropriateness of antimicrobial therapy is described. Susceptibility test data and antimicrobial therapy data are downloaded daily from the microbiology department and pharmacy department computer systems. Relational database software allows for the indexing, sorting, and manipulation necessary for analysis. The expert system accomplishes its analyses using (1) databases of organisms, antimicrobial drugs, and susceptibility cutoff values, (2) programs for evaluating pathogenicity and therapy, and (3) algorithms that determine the timing and sequence of the analysis. System output consists of discrepant therapy reports that indicate that no therapy is being given despite the presence of pathogens, that the pathogens isolated are resistant to the therapy being given, that the therapy cannot be matched with susceptibility data on the isolates, or that the therapy was discontinued too quickly. The expert system has been in continuous operation at an 800-bed referral hospital since July 1991. During an 11-month period, the system generated 1538 discrepant therapy reports. The percentage of isolates resulting in reports varied substantially with the source of the isolate. Therapy was more likely to be improved when the physician was contacted about the potential problem indicated by the report than when the physician was not contacted. A PC-based expert system using data from unlinked pharmacy and microbiology computer systems automatically evaluated the appropriateness of antimicrobial drug therapy in light of susceptibility test data.

Anti-Bacterial Agents↗
PubMed1988

Forgetting of pictures over a long retention interval in young and older adults.

Young and older adults were presented with pictures for study. Their recognition of the information was tested at five retention intervals: immediately, and 48 hr, 1 week, 2 weeks, and 4 weeks later. The main finding of interest was that picture recognition did not show an age-related decline until the 1-week retention interval.

Adult↗
PubMed1975

Effect of antithymocyte globulin and other immune reactants on human platelets.

Human platelets suspended in autologous plasma do not respond to nonspecific immune complexes as do platelet suspensions from rabbits and dogs. However, platelets of all three species do undergo aggregation and the release reaction when exposed to antibodies directed against platelets. Antithymocyte globulin (ATG) contains such antibodies, apparently because of antigens common to both thymocytes and platelets. ATG-induced platelet aggregation and release is thus a specific reaction which may be responsible for the thrombocytopenia and thrombotic complications occasionally seen following the administration of ATG. However, if ATG is given properly, its effect on platelets should not constitute a contraindication to the use of this immunosuppressive drug. Since nonspecific immune complexes do not affect human platelets in the presence of plasma, it would appear that platelet aggregates seen in hyperacute and acute rejection result from endothelial damage rather than an effect of immune complexes on platelets.

Animals↗
PubMed1975

Toxic-therapeutic ratio of sodium cyanate.

Six patients with sickle cell anemia were treated with sodium cyanate (30 mg/kg/day). In four, treatment was stopped because of definite or suspected toxicity, and no improvement was seen in the other two. Most alarming was the sudden development of peripheral motor neuropathy in a patient whose red blood cells contained less than 0.6 mols NCO-/mol of hemoglobin: six months after treatment was stopped, function had not completely returned in this patient. Safe oral dosage regimens may not be effective, but extra-corporeal treatment of sickle cells with cyanate, or other compounds, might circumvent that problem.

Adult↗