Electronic journals.
Explore the source record for details and available documents.
Computer Communication Networks↗
Biomedical subjects
S Kay
Publications and source records attributed to S Kay.
Medical records and other stories: a narratological framework.
A new model of the medical record is introduced which can incorporate context, structure, process and use of the medical record within a single narratological framework. It is claimed that the analysis of narrative and, in particular, the study of the story metaphor can provide a theoretical model which provides coherence within the broad discipline of Medical Informatics. It is argued that this framework maintains different levels of abstraction, is useful for teaching and clinical practice, and that its concepts can be readily understood by those in both lay and technical healthcare professions.
Communication↗
Obituaries. Should be witty and interesting.
Explore the source record for details and available documents.
Biographies as Topic↗
Colon cancer: personality factors predictive of onset and stage of presentation.
This study examined premorbid personality correlates of colon cancer and stage of presentation of colon cancer to health care providers. Sixty-one male veterans who completed the MMPI between 1947 and 1975 and were then diagnosed with colon cancer between 1977 and 1988 were matched with control patients. A 21-factor solution of the MMPI [1] was used to seek potential personality differences between colon cancer cases and their controls in terms of presence of colon cancer and stage of presentation for this disease. A stepwise conditional regression analysis found significant differences between the colon cancer and control groups on the Aggressive Hostility variable (p < 0.018). A multivariate analysis of variance conducted across the stages of colon cancer presentation found that patients who presented later on for colon cancer had higher Phobia scores (p < 0.05). Religious Fundamentalism was also related to presentation (p < 0.05), but in a nonlinear manner. Discussion is related to previous findings regarding the relationship between personality and development of cancer, as well as to implications for patient screening.
Colon↗
Condyloma and cervical intraepithelial neoplasia of the endometrium.
Many studies have shown the presence of squamous metaplasia, dysplasia, carcinoma in situ and squamous cell carcinoma of the endometrium, whether they arose de novo or from direct extension from the cervix. Condyloma associated with squamous metaplasia or dysplasia of the endometrium is rare. We report a case of cervical intraepithelial neoplasia (CIN I) and condyloma of the endometrium. A 58-year-old woman presented with high-grade dysplasia on two successive pap smears. A total vaginal hysterectomy showed extensive CIN I and condyloma involving the entire endometrium. DNA in situ hybridization and polymerase chain reaction documented the presence of condyloma.
Base Sequence↗
Pathologic quiz case 2. Odontogenic fibromyxoma.
Explore the source record for details and available documents.
Biopsy↗
The role of microsurgery and free tissue transfer in the reconstruction of the paediatric upper extremity.
A review of the role of microvascular autotransplantation in reconstructive surgery of the paediatric upper limb is presented. Such techniques bring versatility to reconstruction of the upper limb that has previously not been available. In particular they offer the opportunity for transplantation of skin flaps in one stage, and the transplantation of vascularised joints and growth centres. Most importantly however, they offer the opportunity to reconstruct digits by transplantation of homologues from the foot. The surgical techniques are complex but reliable, and we place emphasis upon the value of the specialised care team and the counselling of families and patients. This also has the benefit of minimising the morbidity of these procedures to a level that is equal to or better than their conventional alternatives.
Amputation, Traumatic↗
The SAPPHIRE toolkit: an interactive system for the evaluation of primary healthcare computing.
Since April 1992, the SAPPHIRE Project (Systems Accreditation Project in Primary Healthcare Informatics Requirements and Evaluations) has been funded by the Department of Health in the United Kingdom with the goal of providing a framework for the fair and objective evaluation of General Medical Practice (GMP) computer systems [1]. SAPPHIRE is comprised of three 'facets': A comprehensive specification list for GMP information systems. An Assessment methodology to apply the SAPPHIRE specifications. The Integrated Toolkit. The SAPPHIRE Integrated Toolkit has been developed as an interactive computer-based guide for use in the processes of GMP system procurement and education. By integrating the two other 'facets' of SAPPHIRE, it provides a means of matching a set of user-defined specifications against the systems under consideration. This is achieved by enabling the Toolkit user to interactively weight the presented SAPPHIRE specifications to their individual requirements and then match this weighted specification against a database of benchtest results for available systems. The output from this matching process then gives the range of systems which most clearly meet that particular user's needs as well as highlighting the areas where systems fail to meet their defined requirements. Since the SAPPHIRE specification list is a lengthy document comprised of technical language, the Toolkit uses a range of browsing models to display the specifications in accessible ways to the end-user. These browsing models present the specifications in contexts that are familiar to the everyday experience of healthcare employees and hence are easy to access and understand. In addition, the Toolkit offers a 'Quick Route Questionnaire' which accesses a shortcut to the matching process described above. his presentation will demonstrate the main functions of the Toolkit and outline specific scenarios of use. Another area of discussion will be the approach of the SAPPHIRE Project to the problems and issues of computer system evaluation, with reference to the Toolkit in a communications context, assisting in the transfer of understanding between the technical language of system designers and suppliers and the healthcare professional, who may lack computer expertise [2]. The SAPPHIRE Toolkit has a wide range of applications for facilitating the procurement of, and the education processes entailed in, primary healthcare computing. We view the Toolkit as a potential benefit to many aspects of the healthcare profession, including General Practice, Surgery, Healthcare IT Administration, and Information System Supply and Management.
Ambulatory Care Information Systems↗
p53 tumor suppressor oncogene expression in squamous cell carcinoma of the hypopharynx.
BACKGROUND: Although abnormalities of the p53 tumor suppressor oncogene system are being detected in many human cancers, the frequency and prognostic significance of such events in squamous cell cancer of the head and neck remain unknown. METHODS: Immunohistochemical studies were performed on archival tumor tissue taken from 43 patients with squamous cell carcinoma of the hypopharynx. Statistical analyses examining potential associations between p53 oncoprotein accumulation and various clinicopathologic parameters (including survival) were conducted. RESULTS: Sixteen (37%) tumors demonstrated strong specific staining for p53. Patients whose tumors stained strongly for p53 were significantly younger, presented at a more advanced clinical disease stage, and tended to have increased expression of epidermal growth factor receptor (P = 0.056). There was no correlation between p53 expression and the incidence of multiple primary cancers, tumor grade, DNA ploidy, or percent of S-phase. Median survival times were 11.6 months and 18.0 months for the p53-positive and p53-negative groups (NS). A Cox regression analysis confirmed the lack of significance of p53 in overall survival. CONCLUSIONS: These data suggest that although abnormalities of the p53 oncoprotein are common in this cancer, this finding is of little clinical significance.
Age Factors↗
SAPPHIRE: scenarios, architecture, and process.
General Medical Practice (GMP) information systems within the UK are becoming more sophisticated and more complex and are widely available from numerous suppliers. Although such systems are viewed as being important, they are problematic in terms of interpreting and assessing their usefulness, and their impact upon work and the organisation (G. Walsham, Interpreting Information Systems in Organizations (Wiley, Chichester, 1993)). In particular, it is difficult for any who have an interest in these systems to apply existing technical specifications to a specific situation, and to match individual requirements with the supplier's products. The research project SAPPHIRE seeks to inform the decision making of stakeholders, e.g. GPs, facilitators and suppliers, with respect to procurement, update, design and supply of GMP systems by developing the means of evaluating such systems, and by facilitating an accreditation process through that evaluation. This extended paper introduces the multi-faceted approach, scenarios, architecture and process of SAPPHIRE.
Accreditation↗
Abductor digiti minimi transfer for the restoration of opposition in children.
Abductor digiti minimi transfer was used to restore opposition in 20 patients, the majority suffering from congenital anomalies of the hand. The transfer was shown to be effective in restoring abduction, but less effective in restoring the rotational component of opposition in these cases. The donor site was critically reviewed and found to be acceptable. The surgical techniques and benefits of this transfer are reviewed.
Adolescent↗
Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub.
This study examined the effects of a 10-minute nursing back rub on salivary secretory immunoglobulin A (s-IgA) and state anxiety in well older adult subjects. A control group (n = 14) received no intervention, and an experimental group (n = 18) received a slow stroke effleurage back rub. All subjects initially completed the state portion of the Spielberger State/Trait Anxiety Inventory (STAI) and provided a timed, nonstimulated saliva sample. Control subjects lay positioned in bed for 10 minutes, and experimental subjects received the back rub. Both groups then provided a second saliva sample and completed the STAI again. Anxiety scores decreased for both groups, but not significantly, and s-IgA concentration increased in the experimental group. This study provides rationale for further research into the holistic benefits of the nursing back rub and should encourage nurses to continue to provide caring touch interventions to patients.
Adult↗
Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx.
BACKGROUND: Postoperative radiation is considered to be "standard of care" therapy for advanced, resectable squamous cell carcinoma of the head and neck. This approach has been supported by retrospective data but has not been validated in randomized clinical trials. PATIENTS AND METHODS: The present analysis examined the clinical course of 110 patients with squamous cell cancer of the hypopharynx treated with surgery alone (n = 65) and postoperative radiotherapy alone (n = 45) between 1966 and 1990. Staging of patients was performed using the 1988 American Joint Committee on Cancer criteria. Cox regression analyses identified clinical and pathologic factors that were significant for disease-free and overall survival. Crude and adjusted cancer-specific survival rates were calculated. RESULTS: The postoperative radiotherapy group presented with more advanced disease than the surgery alone group (stage III and IV combined, 96% versus 77%, P = 0.015). Crude 5-year cancer-specific survival probabilities were 43% for the postoperative therapy group and 27% for the surgery alone group (P = NS). Adjusted 5-year survival rates, correcting for differences in significant prognostic variables between groups, were 18% and 48%, respectively, for the surgery and postoperative radiotherapy groups (P = 0.029). CONCLUSIONS: The addition of postoperative radiotherapy was associated with improved disease-free and adjusted overall cancer-specific survival in patients with advanced hypopharyngeal squamous cancer. The potential survival benefit of postoperative radiotherapy should be addressed in a randomized clinical trial.
Carcinoma, Squamous Cell↗
Primary carcinoid tumor of the bladder arising beneath an inverted papilloma.
We describe a 54-year-old woman with a primary carcinoid tumor of the bladder arising beneath an inverted papilloma diagnosed by light microscopy and immunohistochemical studies. After the patient complained of hematuria and voiding difficulties, a polypoid mass was detected during cystoscopy and removed for examination. The distinctive histologic features of an inverted papilloma were readily identified. The characteristic pattern of a carcinoid tumor was confirmed with immunohistochemical studies.
Carcinoid Tumor↗
Epidermal growth factor receptor expression in squamous cell carcinoma of the hypopharynx.
Expression of the epidermal growth factor receptor (EGFR) has been demonstrated in normal and malignant squamous epithelia. Its presence has been suggested to be important in the pathophysiology and prognosis of epithelial cancers. Archival tumour specimens from 57 patients with squamous cell carcinoma of the hypopharynx were studied using OM-11-951, a new murine anti-EGFR monoclonal antibody which recognizes the receptor on deparaffinized tissue. By visual inspection, 28 (49%) tumours were EGFR negative; 29 (51%) tumours were EGFR positive. While patients whose tumours were EGFR positive were younger, there was no significant correlation with other clinical or pathological variables (including grade and stage). Patients whose tumours were EGFR negative had a median survival of 21 (95% CI 4.3-37.7) months compared with a median survival of 17 (95% CI 11.4-22) months for patients whose tumours were EGFR positive. The difference was not statistically significant. A multiple regression analysis did not demonstrate EGFR status to be important in predicting survival. These data cast doubt on the prognostic significance of EGFR expression in this neoplasm.
Antibodies, Monoclonal↗
Sequence of a tobacco (Nicotiana tabacum) gene coding for type A phytochrome.
Explore the source record for details and available documents.
Amino Acid Sequence↗
A framework for modelling the electronic medical record.
This paper presents a model for an electronic medical record which satisfies the requirements for a faithful and structured record of patient care set out in a previous paper in this series. The model underlies the PEN & PAD clinical workstation, and it provides for a permanent, completely attributable record of patient care and the process of medical decision making. The model separates the record into two levels: direct observations of the patient and meta-statements about the use of observations in decision making and the clinical dialogue. The model is presented in terms of "descriptions" formulated in the Structured Meta Knowledge (SMK) formalism, but many of its features are more general than the specific implementation. The use of electronic medical records based on the model for decision support and the analysis of aggregated data are discussed along with potential use of the model in distributed information systems.
Computer Simulation↗
Serine-to-alanine substitutions at the amino-terminal region of phytochrome A result in an increase in biological activity.
We have used a tobacco transgenic plant system to assay the structure/function relationship of phytochrome A (phyA), a plant photoreceptor. The amino terminus of phyA from different plant species is very rich in serine residues. To investigate whether these serine residues are required for phytochrome function, the first 10 serine codons encoding amino acid residues 2-4, 10-14, 19, and 20 in the amino-terminal domain of the rice phyA gene (phyA) were changed to alanine codons. The mutant (S/A phyA), as well as the wild-type phyA cDNA, was placed under the control of the 35S promoter, and the chimeric genes were transferred into the tobacco genome by Agrobacterium-mediated transformation. Transgenic tobacco plants expressing either wild-type or S/A phyA showed similar phenotypic alterations, including dwarfism and dark-green leaves. However, hypocotyl elongation experiments revealed that transgenic seedlings expressing S/A phyA showed a higher amplitude of the red light response with respect to the inhibition of hypocotyl elongation. The observed difference is not correlated with expression levels of the transgene. The chromophore is attached to the mutant phyA apoprotein (PHY A), and the mutant photoreceptor is photoreversible, giving a difference spectrum indistinguishable from that of the rice phyA. Our results indicate that the S/A mutant has a higher biological activity as compared with the wild-type rice phyA.
Alanine↗