Biomedical subjects

Thomas White

Publications and source records attributed to Thomas White.

9 recordsLinked to original sources

PubMed2007

Reduction of concurrent antipsychotic prescribing practices through the use of PSYCKES.

The New York State Office of Mental Health has implemented the browser based Psychiatric Clinical Knowledge Enhancement System (PSYCKES) medication application throughout its inpatient system of care. PSYCKES provides detailed current medication regimens and histories, as well as medication best practices reports at the patient, psychiatrist, ward, and facility levels. South Beach Psychiatric Center (SBPC) has made specific use of a best practices report which details proportions of caseloads and number of patients on two or more concurrent antipsychotic medications. Psychiatrists received extensive application and desktop support and individual and group training was conducted. PSYCKES current and historical medication regimens were reviewed for individual cases and best practices reports were used in psychiatry supervision from January 2004 to March 2005. SBPC psychiatrists achieved marked reductions in the proportions of their caseloads on two or more concurrent antipsychotics. Although we cannot impute causality from this pre-post implementation design, the results of this evaluation suggest that the use of PSYCKES was effective in reducing such regimens for inpatients.

Antipsychotic Agents↗

PubMed2006

NAADP as a second messenger: neither CD38 nor base-exchange reaction are necessary for in vivo generation of NAADP in myometrial cells.

Nicotinic acid adenine dinucleotide phosphate (NAADP) has recently been shown to act as a second messenger controlling intracellular Ca(2+) responses in mammalian cells. Many questions remain regarding this signaling pathway, including the role of the ryanodine receptor (RyR) in NAADP-induced Ca(2+) transients. Furthermore, the exact metabolic pathway responsible for the synthesis of NAADP in vivo has not been determined. Here, we demonstrate that the NAADP mediated Ca(2+) release system is present in human myometrial cells. We also demonstrate that human myometrial cells use the NAADP second messenger system to generate intracellular Ca(2+) transients in response to histamine. It has been proposed in the past that the NAADP system in mammalian cells is dependent on the presence of functional RyRs. Here, we observed that the histamine-induced Ca(2+) transients are dependent on both the NAADP and inositol 1,4,5-trisphosphate signaling pathways but are independent of RyRs. The enzyme CD38 has been shown to catalyze the synthesis of NAADP in vitro by the base-exchange reaction. Furthermore, it has been proposed that this enzyme is responsible for the intracellular generation of NAADP in vivo. Using CD38 knockout mice, we observed that both the basal and histamine stimulated levels of NAADP are independent of CD38 and the base-exchange reaction. Our group is the first to demonstrate that NAADP is a second messenger for histamine-elicited Ca(2+) transients in human myometrial cells. Furthermore, the NAADP mediated mechanism in mammalian cells can be independent of RyRs and CD38. Our data provides novel insights into the understanding of the mechanism of action and metabolism of this new second messenger system.

ADP-ribosyl Cyclase↗

PubMed2006

Identification of two gene variants associated with risk of advanced fibrosis in patients with chronic hepatitis C.

BACKGROUND & AIMS: Previously identified clinical risk factors such as sex, alcohol consumption, and age at infection do not accurately predict which patients with chronic hepatitis C (CHC) will develop advanced fibrosis (bridging fibrosis and cirrhosis). The aim of this study was to identify genetic polymorphisms that can predict the risk of advanced fibrosis in patients with CHC. METHODS: A total of 916 subjects with CHC was enrolled from 2 centers. A gene-centric disease association study of 24,832 putative functional, single nucleotide polymorphisms (SNPs) was performed. Of the 1609 SNPs that were significantly associated (P </= .05) with advanced fibrosis in the discovery cohort (University of California San Francisco [UCSF], N = 433), the first batch of 100 SNPs were selected for validation in the replication cohort (Virginia Commonwealth University [VCU], N = 483). RESULTS: A missense SNP in the DEAD box polypeptide 5 (DDX5) gene was significantly associated with an increased risk of advanced fibrosis in both the UCSF and the VCU cohorts (OR, 1.8 and 2.2, respectively). Two diplotype groups, carrying the haplotypes composed of the DDX5 SNP and 2 neighboring POLG2 SNPs were also significantly associated with an increased risk of advanced fibrosis and had comparable or better risk estimates. In addition, a missense SNP in the carnitine palmitoyltransferase 1A (CPT1A) gene was associated with a decreased risk of advanced fibrosis in both the UCSF and the VCU cohorts (OR, 0.3 and 0.6, respectively). CONCLUSIONS: Subjects with CHC carrying DDX5 minor allele or DDX5-POLG2 haplotypes are at an increased risk of developing advanced fibrosis, whereas those carrying the CPT1A minor allele are at a decreased risk.

Adolescent↗

PubMed2006

Current affairs and the public psyche: American anxiety in the post 9/11 world.

BACKGROUND: The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended "natural experiment" allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied. METHODS: Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined. RESULTS: In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher's exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms. CONCLUSIONS: Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods.

Adult↗

PubMed2004

Estrogen receptor genotypes and haplotypes associated with breast cancer risk.

Nearly one in eight US women will develop breast cancer in their lifetime. Most breast cancer is not associated with a hereditary syndrome, occurs in postmenopausal women, and is estrogen and progesterone receptor-positive. Estrogen exposure is an epidemiologic risk factor for breast cancer and estrogen is a potent mammary mitogen. We studied single nucleotide polymorphisms (SNPs) in estrogen receptors in 615 healthy subjects and 1011 individuals with histologically confirmed breast cancer, all from New York City. We analyzed 13 SNPs in the progesterone receptor gene (PGR), 17 SNPs in estrogen receptor 1 gene (ESR1), and 8 SNPs in the estrogen receptor 2 gene (ESR2). We observed three common haplotypes in ESR1 that were associated with a decreased risk for breast cancer [odds ratio (OR), approximately O.4; 95% confidence interval (CI), 0.2-0.8; P < 0.01]. Another haplotype was associated with an increased risk of breast cancer (OR, 2.1; 95% CI, 1.2-3.8; P < 0.05). A unique risk haplotype was present in approximately 7% of older Ashkenazi Jewish study subjects (OR, 1.7; 95% CI, 1.2-2.4; P < 0.003). We narrowed the ESR1 risk haplotypes to the promoter region and first exon. We define several other haplotypes in Ashkenazi Jews in both ESR1 and ESR2 that may elevate susceptibility to breast cancer. In contrast, we found no association between any PGR variant or haplotype and breast cancer. Genetic epidemiology study replication and functional assays of the haplotypes should permit a better understanding of the role of steroid receptor genetic variants and breast cancer risk.

Base Sequence↗

PubMed2004

Cognitive evaluation of an innovative psychiatric clinical knowledge enhancement system.

Psychiatric Clinical Knowledge Enhancement System (PSYCKES) is an innovative information system that presents patient medication history in tabular and graphical form. The system is designed to support therapeutic decision making. In this paper, we present a multifaceted cognitive evaluation of this system. The evaluation includes a cognitive walkthrough which is a task-analytic method for usability evaluation. We also conducted cognitive studies of two trainee and two attending psychiatrists using the system. One of the attending subjects is presented as a case study. An objective of this research is to characterize the way PSYCKES mediates reasoning. The study found that clinicians were able to use the system effectively to extract and coordinate information and draw appropriate inferences. The expert clinicians were better able to construct a coherent patient representation. The study also documented a few usability problems pertaining to the temporal integration of patient data. PSYCKES is a multifaceted tool that can significantly enhance therapeutic decision making.

Cognitive Science↗

PubMed2003

Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results.

OBJECTIVE: (1) To evaluate preliminary effects of a computerized support system on congruence between patients' reported symptoms and preferences and those addressed in the patient consultation and (2) to investigate the system's ease of use, time requirements, and patient satisfaction. DESIGN: Fifty-two patients were randomly assigned to intervention or control conditions. MEASUREMENTS: Cancer patients scheduled for an outpatient visit used the system on a tablet computer to report their symptoms and preferences prior to their consultation. This information was processed, printed, and provided to the patient and clinician in the subsequent consultation in the experimental group but not in the control group. RESULTS: While patients in both groups were equivalent at baseline in symptom characteristics, there was significantly greater congruence between patients' reported symptoms and those addressed by their clinicians in the experimental group. The system scored high on ease of use. There were no significant group differences in patient satisfaction. CONCLUSION: This study provided beginning evidence that eliciting patients' symptoms and preferences and providing clinicians with this information prior to consultation can be an effective and feasible strategy to improve patient-centered care.

Attitude to Computers↗

PubMed2003

Depression, homicide and diminished responsibility: new Scottish directions.

In a recent Scottish Appeal Court opinion (Kim Louise Scarsbrook or Galbraith v. Her Majesty's Advocate, 2001) it was successfully argued by the appellant that her conviction of murder was unsound inter-alia on the basis of overly restrictive pre-existing definitions of diminished responsibility in Scottish law resulting in unduly narrow directions being given by the trial judge to the jury in her case. We felt it timely to present a revised overview of the defence of diminished responsibility in Scotland and to consider the issues surrounding its applicability in cases of clinical depression. The psychiatric literature regarding depression and homicide is reviewed.

Depressive Disorder↗

PubMed2003

Piloting web-based NAMCS data collection for nurse-managed centers.

Research consistently has shown that Nurse Practitioners (NPs) provide health care equivalent to that of physicians, and especially excel in patient education and case management, essential interventions to promote self-care in chronically ill ambulatory patients. Yet large-scale national studies have not been done. Nurse-managed centers are not included in the sampling frame of the National Ambulatory Medical Care Survey (NAMCS) and only 2.1% of the 2000 sample was from patient encounters with NPs.1 The aims of this pilot study were to create a web-based format for the NAMCS; to expand it by adding selected nursing diagnoses, interventions, and outcomes; and to pilot-test it with 300 patient encounters in 5 nurse-managed centers.

Ambulatory Care Facilities↗