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PubMed1998

[On the traditional surgery of Choson period (II)].

In this paper, authors discussed the classification of swelling (Chong), swelling-treatment methods (Chi-Chong) in Choson period, traditional notions about the natural history, treatment principles, popular healing methods of swelling, and depicted specially designed acupuncture instruments applied to it. Among the six professional guide books at that time, A Secret Recipe of Swelling Treatment (16th century) introduced the invasive surgical method into the narrow disease category i.e. carbuncle and furuncle, cellulitis, erysipelae, and gravitation abscess. The writer named these diseases as 'fire, stone, water, hemp, silk carbuncle', following each specific characteristics. Another surgical book, Orientation to Swelling Treatment (16th century) extended the surgical method to 'non-external' but 'looks-like swelling' diseases, such as pleurisy, tympanitis, testicular swelling, sequestrum of osteomyelitis. It is natural that some researchers doubted whether the book was used in real practice. However, the content of the book is too detailed to be regarded as an imaginary product. From these books and other materials, we found that the traditional notion of swelling was closely related with the notions of 'knotted' or 'pent in'. So 'pent-up rancor' or grudge was thought to aggravate any kind of swelling, and was tabooed or contraindicated in swelling treatment. 'Knotting in mind' was regarded as one of the principal etiologies of 'swelling and abscess formation in the body'. 'Fire in mind' was also regarded as one of the causes of phlegm aggregation resulting in swelling.

Abscess↗
PubMed1998

Evolution of 20th century attitudes to prophylaxis of pulmonary aspiration during anaesthesia.

PURPOSE: To describe the evolution of aspiration risk identification and prophylactic management during general anaesthesia as presented in the United Kingdom (UK) anaesthesia textbooks published 1900-1998. METHODS: The Cumulated Index Medicus, 1900-1997, was searched under the headings: anaesthesia, aspiration, and pneumonia for relevant articles. A classification of features was created using key words and phrases: fasting guidelines, gastric emptying, intestinal obstruction and peritonitis, gastro-oesophageal function, upper oesophageal sphincter, raised intra abdominal pressure, pregnancy, posture and difficult tracheal intubation. Finally, 46 20th century UK anaesthesia text books were studied for the presence or absence of these features. RESULTS: Throughout the century, intestinal obstruction was a recognized risk factor. Only in the 1940s did some authors mention many of the now known risk factors. Hazards for the pregnant patient were described and in the 1960s the importance of the cricopharyngeus muscle was identified. Prophylactic measures included food and water restriction recommendations, especially in the latter half of the century and gastric lavage and drainage were mentioned throughout the century, as was posture at induction. In the 1950s tracheal intubation began to be routinely recommended. In the 1960s, cricoid pressure appeared and then a burgeoning interest in pharmacological control of gastric content character. Awake tracheal intubation is not always mentioned in 1990-96 textbooks. CONCLUSION: The consensus of information in textbooks since 1970 was lacking in the previous part of the century. Current textbooks are fewer and are published less frequently. Their role in contemporary anaesthesia education and update merits review.

Anesthesia, General↗
PubMed1987

Hot and cold in women's ethnotherapeutics: the American-Mexican West.

The purpose of this paper is to report the current status of hot/cold principles in the ethnotherapeutics of women of southwestern U.S.A., northwestern Mexico. The paper presents a secondary data analysis from three studies, including a data bank of Women's Ethnotherapeutic Agents derived from literature searches, interviews of women in research of Mexican American Grandmothers as Health Care Advisors, and research in the historical roots of the ethnotherapeutic agents used in contemporary domestic medicine. This report presents women's home remedies, what these remedies are believed to do, and the sources of this domestic therapy knowledge. It concentrates on persistence and change in one aspect of the theoretical base of these remedies, their humoral complexional classification. In the analysis of data from these studies, continuation of aspects of the hot/cold theory is demonstrated. It is suggested that the persistence is tacit, with the lack of articulated knowledge of humoral theory today stemming from the content of contemporary remedy books. Instead of arguing either diffusion or independent invention, commonly held ethnophysiological concepts are offered as a possible explanation for the persistence of hot and cold therapy practices.

Cold Temperature↗
PubMed2003

Holding civic medicine accountable: will Morreim's liability scheme work in a disaster?

In Holding Health Care Accountable, E. Haavi Morreim differentiates between duties of expertise and resource duties, arguing for tort liability respecting the former and contract liability respecting the latter. Though Morreim's book addresses ordinary clinical medicine, her liability scheme may also be relevant elsewhere. Focusing on disaster medicine, and especially the medical management of violent mass disasters (e.g., where terrorists have deployed weapons of mass destruction), I argue in this essay that Morreim's classification of duties still fits, but that it is difficult to hold government powers accountable for their many resource and expertise duties. This difficulty is compounded by political arrangements that foist under-funded mandates for disaster services on healthcare providers. As a result of such arrangements, hospitals and clinicians are prone to liability for expenditures and clinical interventions that are beyond their scope. This problem can be mitigated, I argue, by examining and clarifying the apparent social compact between society and healthcare.

Bioterrorism↗
PubMed2004

Different patterns of duplicate publication: an analysis of articles used in systematic reviews.

CONTEXT: Duplicate publication is publication of an article that overlaps substantially with an article published elsewhere. Patterns of duplication are not well understood. OBJECTIVE: To investigate duplication patterns and propose a decision tree for classification. DATA SOURCES: We searched a comprehensive list of systematic reviews (1989 through August 15, 2002) in anesthesia and analgesia that is accessible on the Internet. We selected published full articles of duplicates that had been identified in these systematic reviews. Abstracts, letters, or book chapters were excluded. STUDY SELECTION AND DATA EXTRACTION: Authors of 56 (40%) of 141 systematic reviews acknowledged identification of duplicates. Duplication patterns were identified independently by all investigators comparing samples and outcomes of pairs of duplicates and main articles. Information on cross-reference, sponsorship, authorship, and publication characteristics was extracted from the articles. DATA SYNTHESIS: The 56 systematic reviews included 1131 main articles (129 337 subjects) and excluded 103 duplicates (12 589 subjects) that originated from 78 main articles. Sixty articles were published twice, 13 three times, 3 four times, and 2 five times. We identified 6 duplication patterns: (1A) identical samples and identical outcomes (21 pairs); (1B) same as 1A but several duplicates assembled (n = 16); (2) identical samples and different outcomes (n = 24); (3A) increasing sample and identical outcomes (n = 11); (3B) decreasing sample and identical outcomes (n = 11); (4) different samples and different outcomes (n = 20). The prevalence of covert duplicate articles (without a cross-reference to the main article) was 5.3% (65/1234). Of the duplicates, 34 (33%) were sponsored by the pharmaceutical industry, and 66 (64%) had authorship that differed partly or completely from the main article. The median journal impact factor was 1.8 (range, 0.1-29.5) for duplicates and 2.0 (range, 0.4-29.5) for main articles (P =.13). The median annual citation rate was 1.7 (range, 0-27) for duplicates and 2.1 (range, 0-31) for main articles (P =.45). The median number of authors was 4 (range, 1-14) for duplicates and 4 (range, 1-15) for corresponding main articles (P =.02). The median delay in publication between main articles and duplicates was 1 year (range, 0-7 years). CONCLUSIONS: Duplication goes beyond simple copying. Six distinct duplication patterns were identified after comparing study samples and outcomes of duplicates and corresponding main articles. Authorship was an unreliable criterion. Duplicates were published in journals with similar impact factors and were cited as frequently as main articles.

Analgesia↗
PubMed2002

Incidence of four syndromes of pregnancy-related pelvic joint pain.

STUDY DESIGN: A prospective epidemiologic cohort study. OBJECTIVE: To determine the incidence of clearly defined pelvic joint pain in pregnancy based on both history and objective confirmation and to classify pelvic joint pain into four groups and determine their incidence. SUMMARY AND BACKGROUND DATA: Pelvic and low back pain in pregnancy is a substantial problem, and the correct treatment is hampered by several factors, such as the lack of clearly defined clinical conditions, variety of nomenclature, and great variance in reported incidence (range 4-76.4%). This variation in incidence is a problem that calls for a clearly defined criteria and a study design aimed at resolving such varying incidence rates. METHODS: All pregnant women booked for delivery at two Danish hospitals over a 1-year period were offered to participate in the study in week 33 of gestation. Women who reported daily pain from pelvic joints, which could be objectively confirmed, were divided, according to symptoms, into five subgroups: four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome, and double-sided sacroiliac syndrome) and one miscellaneous. A total of 1460 women formed the incidence cohort based on geographic criteria. RESULTS: A total of 293 women (20.1%) were found to have pelvic joint pain divided in one of the four classification groups: pelvic girdle syndrome 6.0%, symphysiolysis 2.3%, one-sided sacroiliac syndrome 5.5%, and double-sided sacroiliac syndrome 6.3%. CONCLUSION: This study proposes new, more precise procedures for the identification and classification of pregnancy-related pelvic joint pain based on both reports from the women and a physical examination. Presumably, the 20.1% incidence rate, identified in the present study, represents the most precise and reliable information available hitherto, regarding the incidence of pregnancy-related pelvic joint pain.

Cohort Studies↗
PubMed1998

Agent Orange in war medicine: an aftermath myth.

Since the late 1970s several epidemiological studies have appeared linking exposure to phenoxy herbicides or chlorophenols to some malignant tumors. Most of these compounds are contaminated with dioxins and dibenzofurans; for example, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a contaminant of 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), a component of Agent Orange which was sprayed in Vietnam during the war. The results of some of the epidemiological studies on cancer risks associated with exposure to these compounds have been manipulated and misinterpreted, particularly by the Australian Royal Commission on the Use and Effects of Chemical Agents on Australian Personnel in Vietnam. Furthermore, a book on Australian war history entitled Medicine at War, commissioned by the Federal Government, reiterates several of these misinterpretations, despite available contrary evaluations from Australian and U.S. authorities. These remarkable and confusing circumstances in the scientific process are considered also in the light of the recent classification of TCDD as carcinogenic to humans, Group 1, by a Working Group at the International Agency for Research on Cancer in Lyon, France.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1993

Graphical knowledge acquisition for medical diagnostic expert systems.

Like many textbook authors use text systems for writing their books, expert system authors should have easy to use knowledge acquisition systems for entering and testing their knowledge bases by themselves without much help from 'knowledge engineers'. In this paper, we report on a graphical knowledge acquisition tool (CLASSIKA) based on an expert system shell for heuristic classification (MED2) and designed for direct use by domain experts. We demonstrate how the system has been used for building a rather large expert system for diagnosing rheumatology diseases which is now being tested in clinical use.

Artificial Intelligence↗
PubMed1993

False statements and the differential diagnosis of abuse allegations.

OBJECTIVE: Because child psychiatrists do not have a consistent way to classify the untruthful child and because there are no generally accepted definitions of the many ways in which false statements occur in allegations of abuse, the objective of this paper is to classify and define the various ways in which false statements occur in allegations of abuse. METHOD: The author reviewed 40 articles, chapters, and books that contained examples of false statements made by children or caregivers in the context of an abuse allegation. RESULTS: This paper clarifies the concepts of indoctrination, suggestion, fantasy, delusion, misinterpretation, miscommunication, innocent lying, deliberate lying, confabulation, pseudologia phantastica, overstimulation, group contagion, and perpetrator substitution. CONCLUSION: The correct classification of abuse allegations is important in both clinical and forensic child psychiatry. The definitions in this paper, which are based on clinical experience, should be studied through systematic research.

Child↗
PubMed1994

The long-term therapeutic management of epilepsy.

OBJECTIVE: To provide a rational strategy for the evaluation and long-term management of epilepsy. DATA SOURCES: Articles written between 1964 and 1993, obtained from a MEDLINE search on epilepsy-related topics as well as from the author's personal files, major reference books on antiepileptic drugs, and references identified from these books. STUDY SELECTION: Articles were selected if they contained well-documented information comparing anti-epileptic drugs, represented controlled clinical trials, or were considered "key" articles of clinical relevance. DATA SYNTHESIS: Epilepsy is a chronic condition requiring careful long-term management. The treatment is complex, involving classification and diagnosis, selection and monitoring of the appropriate antiepileptic agent, and evaluation of the chosen drug's side effects and drug interactions. Because these side effects increase when drugs are combined, monotherapy is recommended. Long-term management issues and optimal drug selection differ from patient to patient. If seizures are not controlled by medication, the patient may have been misdiagnosed or misclassified. Noncompliance, a major cause of apparent unresponsiveness to treatment, should also be ruled out. Recognizing that current therapy is not ideal for many patients, new pharmacologic and surgical therapies are briefly discussed. CONCLUSIONS: Physicians can pursue a rational strategy for the management of epilepsy if they understand the risks and benefits of various pharmacologic and therapeutic options and if they maintain open lines of communication with the patient.

Anticonvulsants↗
PubMed2006

Rome III: the new criteria.

The new Rome III criteria reflects upon a more than 15 year process to legitimize, classify and bring scientific credibility to the functional GI disorders. This has occurred through a series of activities and documents including the recently published Rome III book and a journal issue in Gastroenterology published in April, 2006. The work involved has involved committees of 87 international investigators from 17 countries, 2 of whom are from China. This article will review the Rome committee process that led to the production of these documents, the Rome III classification system, a description of the changes from Rome II (published in 2000) to Rome III and information on the future of Rome Foundation activities.

China↗
PubMed1997

Adolescent pregnancy: a high risk group.

In a retrospective study the obstetric behaviour and outcome in 80 teenage pregnancies (< or = 19 years of age) were compared to a control group (n = 80) of women (20-30 years) of same parity. There were 32 booked cases (40%) in study group and 45 (56.2%) in control group (p < 0.05). The overall teenage pregnancy was 3.2%. Majority of patients were 18 years (27.5%) and 19 years (65.0%) in study group and most of them (87.5%) were primiparas. Of all cases 27.5% were grouped under Kuppuswamy classification III in assessing socio-economic status. Anaemia (27.5%), intra-uterine growth retardation (27.5%) and hypertension (15%) were mostly found as complications in study group as compared to controls (11.2%, 8.7% and 8.7% respectively). The incidence of forceps delivery was higher (17.4%) in the study group as compared to controls (6.2%). Stillbirth rate was 1.25% and there was no maternal mortality.

Adolescent↗
PubMedDate not supplied

[Sanitary classification of publishing products].

The natural asthenopic pattern of the process of reading shows it necessary to set sanitary standards of publishing production, namely, printing type styling and the printing quality of publications. The necessity of sanitary classification of publishing production stems from the specificity of reading the publications of different functional uses and from the physiological features of vision in different age group readers. The developed sanitary classification of printing production is based on the researches into the actual visual load while reading the publications of different types by readers of different ages.

Adolescent↗
PubMed2006

Flow cytometric analysis of lymphomas: current status and usefulness.

CONTEXT: Immunophenotyping has become a routine practice in the diagnosis and classification of most cases of non-Hodgkin lymphoma, and flow cytometry is often the method of choice in many laboratories. The role that flow cytometry plays, however, extends beyond just diagnosis and classification. OBJECTIVE: To review and evaluate the current roles of flow cytometry in non-Hodgkin lymphoma, to compare it with immunohistochemistry, and to discuss its potential future applications in the molecular diagnostic era. DATA SOURCES: The information contained herein is derived from peer-reviewed articles on the subject published in the English-language medical literature during the years 1980 to 2005 that were identified using PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi, 1980-2005) search, various books and other sources on flow cytometry, and the author's personal experience of more than 10 years with flow cytometric analysis of lymphomas and leukemia using Becton-Dickinson (San Jose, Calif) and Beckman-Coulter (Miami, Fla) flow cytometers. STUDY SELECTION: Studies were selected based on adequate material and methods, statistically significant results, and adequate clinical follow-up. DATA EXTRACTION: The data from various sources were compared when the methods used were the same or similar and appropriate controls were included. Most of the studies employed 2-color, 3-color, or 4-color flow cytometers with antibodies from Becton-Dickinson, Beckman-Coulter, or DakoCytomation (Carpinteria, Calif). Results were evaluated from studies utilizing the same or similar techniques and flow cytometers. Only objective data analyses from relevant and useful publications were included for reporting and discussion. DATA SYNTHESIS: Flow cytometry serves a variety of roles in the field of lymphoma/leukemia including rapid diagnosis, proper classification, staging, minimal residual disease detection, central nervous system lymphoma detection, evaluation of prognostic markers, detection of target molecules for therapies, ploidy analysis of lymphoma cell DNA, and evaluation of multidrug-resistance markers. It offers many advantages in comparison to immunohistochemistry for the same roles and provides uses that are either not possible or not preferable by immunohistochemistry such as multiparameter evaluation of single cells and detection of clonality in T cells. CONCLUSIONS: By virtue of its ability to evaluate not only surface but also cytoplasmic and nuclear antigens, flow cytometry continues to enjoy widespread use in various capacities in lymphoma evaluation and treatment. Additional roles for flow cytometry are likely to be invented in the future and should provide distinctive uses in the molecular era.

Clone Cells↗
PubMed1998

Neural network classifications and correlation analysis of EEG and MEG activity accompanying spontaneous reversals of the Necker cube.

It has recently been suggested that reentrant connections are essential in systems that process complex information [A. Damasio, H. Damasio, Cortical systems for the retrieval of concrete knowledge: the convergence zone framework, in: C. Koch, J.L. Davis (Eds.), Large Scale Neuronal Theories of the Brain, The MIT Press, Cambridge, 1995, pp. 61-74; G. Edelman, The Remembered Present, Basic Books, New York, 1989; M.I. Posner, M. Rothbart, Constructing neuronal theories of mind, in: C. Koch, J.L. Davis (Eds.), Large Scale Neuronal Theories of the Brain, The MIT Press, Cambridge, 1995, pp. 183-199; C. von der Malsburg, W. Schneider, A neuronal cocktail party processor, Biol. Cybem., 54 (1986) 29-40]. Reentry is not feedback, but parallel signalling in the time domain between spatially distributed maps, similar to a process of correlation between distributed systems. Accordingly, it was expected that during spontaneous reversals of the Necker cube, complex patterns of correlations between distributed systems would be present in the cortex. The present study included EEG (n=4) and MEG recordings (n=5). Two experimental questions were posed: (1) Can distributed cortical patterns present during perceptual reversals be classified differently using a generalised regression neural network (GRNN) compared to processing of a two-dimensional figure? (2) Does correlated cortical activity increase significantly during perception of a Necker cube reversal? One-second duration single trials of EEG and MEG data were analysed using the GRNN. Electrode/sensor pairings based on cortico-cortical connections were selected to assess correlated activity in each condition. The GRNN significantly classified single trials recorded during Necker cube reversals as different from single trials recorded during perception of a two-dimensional figure for both EEG and MEG. In addition, correlated cortical activity increased significantly in the Necker cube reversal condition for EEG and MEG compared to the perception of a non-reversing stimulus. Coherent MEG activity observed over occipital, parietal and temporal regions is believed to represent neural systems related to the perception of Necker cube reversals.

Adolescent↗
PubMed1995

The ICD family of classifications.

The history from the Sixth to the Ninth Revisions of the ICD is described. The 10th revision is presented as the 21st Century classification. The preparation of the ICD-10 included a long process with two expert committee meetings. A classification of diseases can be defined as a system of categories to which morbid entities are assigned according to established criteria. The purpose of the ICD is to permit the systematic analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. In practice, the ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. It was felt that the main ICD (the three- and four-character classification), covered by three volumes of ICD-10, could not incorporate all this additional information and remain accessible, and relevant to its traditional users, so the idea arose of a "family" of disease and health-related classifications, including volumes published separately form the main ICD, to be used as required. A statistical classification of diseases must be confined to a limited number of mutually exclusive categories, able to encompass the whole range of morbid condition, and must have well defined place in the list of categories. Consequently, throughout the classification, there will be residual categories for other and miscellaneous conditions that cannot be allocated to the more specific categories. As few conditions as possible should be classified to residual categories. Consequently, throughout the classification, there will be residual categories for other and miscellaneous conditions that cannot be allocated to the more specific categories.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease↗
PubMed2002

Risk management strategies in the Physicians' Desk Reference product labels for pregnancy category X drugs.

BACKGROUND: Drugs that carry a concern for teratogenicity are often classified as pregnancy category X in the drug label and contraindicated for use during pregnancy. Many drug labels can be found in the Physicians' Desk Reference (PDR), a widely used source of drug information by American clinicians and patients. OBJECTIVE: To review product labelling in the electronic PDR for the pregnancy category X products for pregnancy prevention risk management components in labelling. METHODS: The electronic version of the 2001 and 2002 PDR was searched for 'pregnancy category X' products using the full text search feature. All product labels identified were retrieved and reviewed for trade name, generic name, manufacturer and indication. Product labels were manually searched for any pregnancy prevention risk management strategies included in labelling. Those labels that had specific pregnancy prevention risk management strategies were further evaluated. RESULTS: One hundred and seventeen pregnancy category X products were obtained from 2249 products searched in the 2001 PDR database and 124 pregnancy category X products were obtained from the 2150 products in the 2002 PDR database. All pregnancy category X products identified were drug products. The label/package insert for each drug was reviewed to identify risk management strategies for pregnancy prevention. The majority of the labels include as the sole risk management strategy either a black box warning and/or a contraindication for use in women who are or may become pregnant. Only 13 drugs contained specific pregnancy prevention risk management strategies in the label directing the clinician and/or patient, e.g. frequency of pregnancy testing, number and type of contraception methods. Two drugs, bexarotene capsules and gel, were only included in the 2001 PDR. Three drugs, isotretinoin, acitretin, and thalidomide, have formal pregnancy prevention risk management programmes. CONCLUSION: This study demonstrates the varied risk management approaches in labelling for pregnancy prevention for pregnancy category X drugs. There is a need for consistency in the classification of pregnancy category X products and the pregnancy prevention risk management strategies utilised in the labelling for them.

Contraindications↗