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DSM-III and DSM-III-R: what are American psychiatrists using and why?

The purpose of this study was to determine whether American psychiatrists have switched from DSM-III to DSM-III-R as their primary diagnostic reference, and to examine what factors predicted the continued use of DSM-III. In 1989, we conducted a mail survey of practicing psychiatrists (N = 454), residency program directors (N = 128), residents (N = 1,331), and researchers (N = 196) regarding their training in, use of, and opinions about DSM-III and DSM-III-R. Approximately 30% of practitioners continued to use DSM-III as their primary diagnostic reference, although this was less frequently true of researchers and residents. In none of the four groups did a majority believe that DSM-III-R was needed, despite the fact that the majority of each group indicated that it was an improvement over DSM-III. The most commonly perceived reasons for publishing DSM-III-R were that it corrected problems with DSM-III and new research indicated changes were warranted. Compared with DSM-III-R users, DSM-III users more frequently believed that the 7-year interval between the two editions was too short, that DSM-III-R was not needed, and that the revised manual was little better than the original. Thus, 2 years after the publication of DSM-III-R 90% of psychiatrists were using DSM-III-R, at least in part, although a substantial minority continued to use DSM-III as their primary diagnostic manual. Even among DSM-III-R users, many believed that the revised manual was not needed. The perceived need for DSM-III-R was associated with the reasons ascribed to its publication; therefore, acceptance of DSM-IV may be partially a function of how its development is promoted and justified. That nearly one third of a random sample of practicing psychiatrists continued to use DSM-III supports concerns that the publication of DSM manuals every 6 or 7 years will divide the psychiatric community into subgroups using different diagnostic criteria.

Adult↗
PubMed2004

Adoption of innovations by specialised nurses: personal, work and organisational characteristics.

BACKGROUND: To gain insight in the factors that influence the adoption of professional information by specialised nurses, we studied the effects of individual, work and organisational characteristics on the extent to which continence nurses gained knowledge and made use of a book on nursing diagnosis and interventions for patients with urinary incontinence, which they received as a present. METHODS: Subjects were all members of the Dutch Association of Continence Nurses. Data collection took place via a postal questionnaire with closed questions. In total, 109 valid questionnaires (78%) were received back. Stepwise selected ordered logit models were estimated with reading the book and knowledge and use of five selected parts of it as dependent variables and individual, work and organisational characteristics as independent variables. RESULTS: The most important factors found to promote reading of the book and taking knowledge of the parts of it were a personal characteristic of the nurses called "information directedness" (or eagerness to acquire professional information from other sources), the presence of an "innovative atmosphere" at the department, and "relevance" of the information for daily nursing practice. The most important factors found to promote the use of the book are (again) information directedness, working at a (relatively) small department and having experience with nursing diagnosis. CONCLUSIONS: Results suggest that nurses differ in the degree to which they are open to innovations and that information directedness might be a useful indicator of this characteristic. In addition, the degree of innovativeness of the atmosphere at the department and the relevance of the innovation for nursing practice are important factors influencing the success or failure of innovations in nursing practice.

Age Factors↗
PubMed2005

A survey of toxic plants on the market in the district of Bamako, Mali: traditional knowledge compared with a literature search of modern pharmacology and toxicology.

In Mali, the empirical knowledge on plant medicine is held by traditional practioners. Scientific studies have been carried on some plants and they have confirmed their local uses, but few data are available on the toxicity of Malian medicinal plants. In the present work, we record the toxic plants used as medicines in the Bamako district, Mali, with the aim to evaluate the knowledge of traditional healers and herbalists on the toxicity of the plant used. A survey was carried out on the market places in the Bamako district and 106 healers and herbalists were interviewed. A survey of the scientific literature was conducted to verify or sustain the claimed toxicological data. Nineteen plants are arranged according to their frequency of quotation based on the questionnaire. The information includes the botanical name, literature survey on the pharmacology of the plants, the healers' knowledge on plant toxicity and its prevention by some of the healers.

Clinical Competence↗
PubMed2005

Comparison of potentially hepatotoxic drugs among major US drug compendia.

BACKGROUND: Although a large number of drugs include warnings or listed adverse reactions that describe reports of associated hepatotoxicity, the hepatotoxic risk is documented with different definitions in major drug compendia. OBJECTIVES: The purposes of this study were to compare inclusion of potentially hepatotoxic drugs, and analyze the ratings of hepatotoxic risk among major drug compendia. METHODS: To assess the risk of drug-associated hepatotoxicity, we used current literature of epidemiological studies and developed a 4-level rating scale of hepatotoxic drugs: 3, clear literature evidence of life-threatening hepatotoxicity; 2, multiple case reports or significant liver injuries; 1, no significant liver damage has been reported; and 0, no information. All drugs were evaluated using the 5 major US drug compendia: American Hospital Formulary Service (AHFS), United States Pharmacopeia Drug Information (USPDI), Facts and Comparisons (F&C), Physicians' Desk Reference (PDR), and Clinical Pharmacology (CP). Average rating scores were calculated as the sum of each drug rating score divided by the total number of drugs. One-way analysis of variance and independent t tests were conducted to compare the difference among the rating scores. RESULTS: In total, 175 different drugs and 3 therapeutic classes with hepatotoxic effects were identified in the compendia, including 59 antineoplastics, 28 anti-infectives, 17 nonsteroidal anti-inflammatory drugs, 17 antipsychotics or phenothiazine derivatives, 9 angiotensin-converting enzyme inhibitors, 6 anticonvulsants, 4 histamine-2 receptor antagonists, and other drugs. Average rating scores were 1.65 for AHFS, 1.10 for USPDI, 1.27 for F&C, 1.34 for PDR, and 1.61 for CP (F=7.93, P<.0001). The risk categories were significantly different among compendia in 4 therapeutic classes of antipsychotics and/or phenothiazines (F=3.471, P=.011), nonsteroidal anti-inflammatory drugs (F=7.866, P<.0001), antineoplastics (F=2.476, P=.044), anti-infectives (F=2.003, P=.098), and angiotensin-converting enzyme inhibitors (F=38.125, P<.0001). CONCLUSIONS: Rating scores of hepatotoxicity were significantly different among drug compendia. The different compendium put different emphasis on hepatotoxicity severity. Comprehensive evaluations of hepatotoxic-related drugs provide critical information for health practitioners.

Chemical and Drug Induced Liver Injury↗
PubMed2001

A review of the genotoxicity of marketed pharmaceuticals.

Information in the 1999 Physician's Desk Reference as well as from the peer-reviewed published literature was used to evaluate the genotoxicity of marketed pharmaceuticals. This survey is a compendium of genotoxicity information and a means to gain perspective on the inherent genotoxicity of structurally diverse pharmaceuticals. Data from 467 marketed drugs were collected. Excluded from analysis were anti-cancer drugs and nucleosides, which are expected to be genotoxic, steroids, biologicals and peptide-based drugs. Of the 467 drugs, 115 had no published gene-tox data. This group was comprised largely of acutely administered drugs such as antibiotics, antifungals, antihistamines decongestants and anesthetics. The remaining 352 had at least one standard gene-tox assay result. Of these, 101 compounds (28.7%) had at least one positive assay result in the pre-ICH/OECD standard four-test battery (bacterial mutagenesis, in vitro cytogenetics, mouse lymphoma assay (MLA), in vivo cytogenetics). Per assay type, the percentage of positive compounds was: bacterial mutagenesis test, 27/323 (8.3%); in vitro cytogenetics 55/222 (24.8%); MLA 24/96 (25%); in vivo cytogenetics 29/252 (11.5%). Of the supplemental genetic toxicology test findings reported, the sister chromatid exchange (SCE) assay had the largest percentage of positives 17/39 (43.5%) and mammalian mutagenesis assays (excluding MLA) had the lowest percentage of positives 2/91 (2.2%). The predictive value of genetic toxicology findings for 2-year bioassay outcomes is difficult to assess since carcinogenicity can occur via non-genotoxic mechanisms. Nevertheless, the following survey findings were made: 201 drugs had both gene-tox data and rodent carcinogenicity data. Of these, 124 were negative and 77 were equivocal or positive for carcinogenicity in at least 1 gender/1 species. Of the 124 non-carcinogens, 100 had no positive gene-tox findings. Of the remaining 24, 19 were positive in in vitro cytogenetics assays. Among the 77 compounds that exhibited equivocal or positive effects in carcinogenesis studies, 26 were positive in gene-tox assays and 51 were negative. Of the 51 negatives, 47 had multiple negative gene-tox assay results suggesting that these are probably non-genotoxic carcinogens. Statistical analyses suggested that no combination of gene-tox assays provided a higher predictivity of rodent carcinogenesis than the bacterial mutagenicity test itself.

Animals↗
PubMed2001

Elizabeth Blackwell--the forgotten herbalist?

This article looks at the work of Elizabeth Blackwell (1707-1758), by all accounts the first British female herbalist. To raise funds to free her husband from debtors prison, she produced her hand drawn, engraved and coloured 'Curious Herbal' in 1735. Using the copies of the herbal in the British Library, the article will look at the circumstances surrounding production of the herbal, her influences and sources used, including the people who recommended production of the book to the Society of Apothecaries and some of the current projects to put her name back on the map.

Herbal Medicine↗