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PubMed2005

Selection of information resources for education in medical pharmacology.

Pharmacology is the foundation science of medical pharmacotherapy. Education in medical pharmacology (EP) requires the use of information resources (IR) to meet the challenge of the continuous introduction of new drugs and new educational, didactic and pedagogical theories to enhance knowledge. Hence criteria for selecting bibliographic material for EP should be clearly outlined and implemented. In this work we present a method to select IR for EP based on systems theory and focusing on the factors determining: (a) the integration of a list of recommended IR for EP; (b) the design of the acquisition list for faculty and students work; (c) the overall organization of the resources available for its optimal use and benefit in the educational process; and (d) a general strategy for assessing the impact of the bibliographic infrastructure. The proposal is based on information from: (i) lists of recommended readings in the academic program of the Pharmacology course given at the School of Medicine of UNAM in the last 30 years; (ii) the extent of discipline development measured by two indexes derived from the contents of Goodman and Gilman's "Pharmacological Basis of Therapeutics" (G & G); (iii) the number of texts currently found in the collection of FM-UNAM which are classified in the section of Pharmacology using the Library of Congress Classification System (LCCS); and (iv) the comparison of academic versus standardized classification of pharmacology topics, such as Medical Subject Heading (MESH) and LCCS The importance of this proposal relates to its usefulness for EP and for other medical disciplines.

Books↗

PubMed2002

[WHO classification of breast tumors and tumors of the female genital organs: pathology and genetics].

Under the supervision of P. Kleihues and L. H. Sobin, the "World Health Organisation Classification of Tumours" with its numerous volumes is currently being re-edited. Following the first three volumes on "Central Nervous System", "Digestive System" and "Haematopoetic System", the volume on "Tumours of the Breast and Female Genital Organs" will be published this autumn. This volume will be edited by F. Tavassoli and P. Devilee. The new WHO books serve a double function of text books and atlases of tumour pathology. The first part of the new volume includes the genetics and pathology of the entire spectrum of malignant tumours and their precursor lesions. The following part is devoted to benign proliferative lesions.

Breast Neoplasms↗

PubMed1986

[Classification of hearing loss in industrial workers for the purpose of expert testimony].

Periodical examinations of 472 industrial workers exposed to noise promoted classification of those workers' hearing into four categories: A. Normal hearing, B. Non-noise-induced impairments, C. Multi-causal impairments, not excluding noise, D. Chronic acoustic trauma. To the particular categories, appropriate qualifying, preventive or therapeutic procedure have been ascribed. Appropriate hearing category (A, B, C or D) entered into the worker's health record book would spare repeating the medical examinations at a new workplace, simplify administrative, certificatory (selection of the workplace, prevention or treatment) and claiming procedures.

Disability Evaluation↗

PubMed2003

Motherhood and schizophrenic illnesses: a review of the literature.

OBJECTIVE: To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder. METHOD: The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books. RESULTS: Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event. CONCLUSIONS: Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.

Depression, Postpartum↗

PubMed1988

TNM classification of genitourinary tumours 1987--position of the EORTC Genitourinary Group.

This report analyses the changes in the classification of the genitourinary tumours introduced by the 1987 edition of the TNM system. Criticism and suggestions for improvement are given. These are based on the extensive experience of the EORTC GU Group with clinical trial work particularly the identification of prognostic factors, on their success in reaching international consensus on tumour classification, and on information from the literature. Many of the changes introduced in the 1987 system are not considered to be strictly necessary. These include the introduction of the new additional descriptors, including "C" and "R", the changes in the T classification of prostatic and renal cancer, and the introduction of uniform N categories for all tumours and other features. We regret the omission of minimal requirements, the omission of the V classification for macroscopic or microscopic vascular invasion, the changes in the T categories of carcinoma of the bladder and the introduction of stage groupings for all urological tumours. Some of these changes are considered unacceptable. The attitude of the EORTC GU Group toward the use of the new TNM classification is indicated in detail.

Female↗

PubMed2001

[Research into communication and health. A Spanish and international perspective through bibliometric analysis].

OBJECTIVES: 1. To find the scientific output on communication and health both in Spain and internationally. 2. To compare the two outputs according to the type of articles published and the design of the research. DESIGN: Descriptive and bibliometric study. MATERIAL: The data bases MEDLINE (1995-2000) and IME (1990-2000) and the books summarising papers from semFYC Congresses (1995-2000) were used. MEASUREMENTS: The number of articles on MEDLINE published and indexed with the description < >, plus a series of subject describers that could be included under the heading < >, were counted. On the IME and in the semFYC congress summaries the describers < > were used. The articles indexed on MEDLINE-IME were compared for their classification as original articles, clinical practice guidelines, review, editorial or letter to the editor. Original articles were classified in randomised and non-randomised trials, meta-analysis and observation studies. MAIN RESULTS: 6766 articles were found on MEDLINE, 42 on the IME (0.046% of the total indexed) and 34 summaries from semFYC congresses (1.47% of the total). Among the most commonly studied questions were found patients' information and education, professional stress and psychological interviews; among the least studied were difficult and aggressive patients, negotiation and people accompanying patients. The original articles on MEDLINE and IME were 70% and 37%; and review articles, 11% and 44%. 1.4% of MEDLINE articles were randomised trials; and 0.08%, meta-analysis. CONCLUSIONS: Communication and health research is a young field that still requires descriptive studies. There is little scientific output in this area in Spain, with few original papers and too many reviews.

Bibliometrics↗

PubMed2002

Real-time PCR for detection and differentiation of gram-positive and gram-negative bacteria.

We developed a consensus real-time PCR protocol that enables us to detect spiked bacterial 16S DNA from specimens such as water, urine, plasma, and sputum. The technique allows an exact Gram stain classification of 17 intensive care unit-relevant bacteria by means of fluorescence hybridization probes. All tested bacteria were identified correctly, and none gave a false-positive signal with the opposite Gram probe.

Bacterial Infections↗

PubMed2005

Colored illustrations of pediatric otorhinolaryngologic surgical techniques of a Turkish surgeon, Serefeddin Sabuncuoglu, in the 15th century.

OBJECTIVES: Serefeddin Sabuncuoglu is known to be the author of the first illustrated surgery book, Cerrahiyyetu'l Haniyye (Imperial Surgery), which was written in Turkish in 1465 a.d. at the age of 80. The purpose of this paper is to describe his contributions to pediatric otorhinolaryngology. RESULTS: Cerrahiyyetu'l Haniyye consists of three chapters totaling 412 pages, in which there are 191 sections dealing with a wide range of surgical specialties, including pediatric otorhinolaryngologic surgery. Sabuncuoglu explains some of child diseases and their treatment in a whole section, and gives information on the same subject in relevant part of sections. The illustrations he provides are not at a state of the art level with those of his contemporaries, but they bear a great importance considering the attitudes of Islam to the art of painting. For each section, a single, poetic sentence describes in detail the diagnosis, classification and surgical technique. Some authors have claimed that he only translated Ebu Kasim-al Zahravi (Albucasis)'s Al-Tasrif (Textbook of Surgery) and added the illustrations of the surgical techniques. Even if this is accepted, the illustrations are enough to entitle this work as a milestone. Serefeddin Sabuncuoglu describes medical and surgical management pediatric otorhinolaryngologic diseases such as harelip, hypertrophy of adenoids, atresia of external auditory canal, a foreign body in external auditory canal, short frenulum, abscess of head, mass and abscess of neck in children and unpleasant odor in nose in his textbook. CONCLUSIONS: Although not recognized and rewarded in his time, Serefeddin Sabuncuoglu was a great surgeon in Turkish medical history. The sections on children in his book are of great importance in pediatric otorhinolaryngology which became a different speciality in the last century. Writing his book at his 80's, he deserves to be considered as a distinguished scientist, medical doctor and illustrator of his era, considering the insulting and discriminating ideas toward women and children, especially girls, at that period.

Books, Illustrated↗

PubMed2005

Fetomaternal outcome in pregnancy with cardiac disease.

OBJECTIVE: To determine fetal and maternal outcomes in women presenting with heart disease during pregnancy and labor. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Gynae/Obstetrics, MCH, Center, Unit II, PIMS, Islamabad, during a period of 2 years from March 2001 to February 2003. PATIENTS AND METHODS: Forty-two pregnant women with heart disease delivered at MCH Center, Unit II, during the study period were included. Maternal outcome measures included obstetric and medical complications and maternal mortality while fetal outcome measures were prematurity, intrauterine growth restriction and perinatal mortality, intrauterine death and indicated terminations of pregnancy. RESULTS: The mean age was 27.50 -/+ 5.17 years (standard deviation). Of the 42 women, 33 (78.6%) were booked for antenatal care and 9 (21.4%) were non-booked. Congenital heart disease was present in 7 (16.7%) while 28 (65.3%) had rheumatic heart disease and mitral valve disease was the commonest. Among the remaining 7 women with acquired heart disease, 3 (7.1%) women had ischemic heart diseases (IHD), 1 (2.4%) had primary pulmonary hypertension, 2 (4.8%) patients had peripartum cardiomyopathy and 1 (2.4%) had aortic dissection. Based on New York Heart Association Functional classification (NYHA) 16 (38.1%) patients were asymptomatic (class I) and 3 (7.1%) in class IV. Thirty-two (76.2%) achieved spontaneous vertex delivery (SVD), LSCS was performed in 4 (9.5%) women, 2 (4.8%) women had spontaneous expulsions of dead fetus and 2 (4.8%) had suction and curettage for therapeutic termination of pregnancy on medical grounds. Obstetric complications occurred in 17 (40.4%) women, 5 (11.9%) had medical complications and 3 (7.1%) maternal mortalities occurred. Regarding fetal outcome, 6 (14.3%) infants had intrauterine growth restriction (IUGR), 2 (4.8%) perinatal deaths occurred due to prematurity while there was 1 (2.4%) intrauterine death. Indicated terminations of pregnancy were done for 4 gestations (7.1%). Low birth weight was noted in 12 (28.6%) infants. CONCLUSION: Heart disease with pregnancy is a very high risk condition and maternal mortality ratio (MMR) was 7142/100,000 births. The management of these cases should be multidisciplinary to optimize care for these patients and large families be strongly discouraged.

Adult↗

PubMed2004

[Dynamic internal fixation of the periprosthetic femoral fractures after total hip arthroplasty].

Periprosthetic fractures of the femur after total hip arthroplasty are a big orthopaedic problem, particularly in elderly patients and quite a challenge for orthopaedic surgeons. There is no universal method in treating these fractures. Rigid plates fixation can be limited and aggravated especially in the proximal part of the femur where the endoprosthesis stem does not allow for an undisturbed fixation of both femur cortexes by means of screws. Mitkovic's dynamic internal fixator is an original implant allowing for an undisturbed fixation of both femur cortexes regardless of the presence of the endoprosthesis stem. Fixation is made possible by means of movable clamps and a convergent possibility to place screws. A dynamic internal fixator can fix all types of periprosthetic femoral fractures. The paper shows the early experience in fixating periprosthetic femoral fractures after total hip arthroplasty in 14 patients, average age 69.7. According to Vancouver classification, 3 patients had the type A fracture, 9 patients had the type B fracture, and 2 patients had the type C fracture. All fractures were fixed by Mitkovic's dynamic internal fixator. The fracture occurred 2-12 years after primary total hip arthroplasty. The follow-up of the operated patients was 12 months. The method is less invasive than the methods described in books. Mechanical complications are not likely to appear due to the fracture dynamics along the femoral shaft axis, which is made possible by this implant. Our initial experience in femur fracture fixation after hip arthroplasty ahows that it is modern and effective dynamic implant which will contribute significantly to the improving of the treatment of these often very complicated fractures.

Aged↗

PubMed1994

Cytogenetics in acute myeloid leukaemia.

A wealth of literature spanning 20 years describing cytogenetic abnormalities in acute myeloid leukaemia (AML) already exists. It ranges from single case reports of unusual abnormalities to large multicentre studies of hundreds of cases. A landmark publication was the Fourth International Workshop on Chromosomes in Acute Leukaemia which established a base line for diagnosis, prognosis and frequency of chromosome abnormalities in AML. Two large sources of information are a book, 'The Chromosomes in Human Cancer and Leukemia' and a catalogue of chromosome abnormalities, which aims to list all chromosome abnormalities described in the scientific and medical literature from 1973, when the widespread use of banding techniques, enabled the precise definition of the chromosome breakpoints. In this review the common cytogenetic abnormalities seen in AML with reference to associations with the French-American-British (FAB) classification, their possible prognostic significance and their associated molecular biology are summarized.

Acute Disease↗

PubMedDate not supplied

Nursing diagnosis and nursing theory: exploration of factors inhibiting and supporting simultaneous use.

PURPOSE: To explore the values and philosophies of nursing theories that inhibit the simultaneous use of nursing diagnosis and nursing theory. SOURCES: Published articles, books, book chapters. DATA SYNTHESIS: Four factors in the literature and reflected in practice may have had a negative influence on the use of nursing diagnoses: (a) commitment to the uniqueness of each person, (b) an abandonment of the nursing process, (c) a perspective that nursing care is an evolving interaction, and (d) a belief that theory-derived language is more articulate and precise than standard classifications. PRACTICE IMPLICATIONS: Strategies for combining theory and diagnoses include emphasizing the diagnostic terms as professional shorthand and permitting flexibility in modifying diagnoses as needed; widely disseminating the concept that classification can be used effectively with newer iterations of the nursing process reflecting circular, simultaneous, and intuitive processes; developing classification language based on concepts of hypothesis and perception; and including diagnostic categories associated with theoretical perspectives.

Documentation↗

PubMed1997

Craniofacial access to the anterior and middle cranial fossae and skull base.

A profusion of surgical approaches to gain access to the anterior and middle cranial fossa and skull base have been described. An attempt has been made to simplify the position by suggesting a classification of surgical approaches and to describe a standard approach (of at most 4 defined osteotomies, or at least 2) to give a craniofacial approach to the anterior and middle cranial fossae, the infratemporal fossa, the orbit and the superior nasal cavity. The full extent of the osteotomies have been likened to an ancient Corinthian face mask, or to the stylized face-mask worn by the comic book hero, Batman.

Adult↗

PubMed1997

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies.

Cause of Death↗

PubMed1991

George Gaylord Simpson as mentor and apologist for paleoanthropology.

The influence of George Gaylord Simpson (1902-1984) on paleoanthropology provides a well-documented, historical example of how one scientific discipline can impact upon another, bringing the latter quickly "up to speed" without having to retrace ground covered by the former. Paleoanthropologists were bystanders during the formulation of the evolutionary synthesis (1936-1947). After World War II, the younger paleoanthropologists looked to George Gaylord Simpson as one of several mentors regarding the implications of the synthesis for their own discipline. But why Simpson? Having earlier defined the superfamily Hominoidea (1931) as holding the Pongidae and Hominidae and monographed lower primate fossils (e.g., "Studies on the earliest primates," 1940), Simpson's "Principles of classification and a classification of mammals" (1945) further solidified his reputation as a mammalian systematist. Simpson's Meaning of Evolution (1949) was widely read as an introduction to the synthesis, and his Tempo an Mode in Evolution (1944) made accessible the more complex aspects. Consequently, in the 1950s and 1960s paleoanthropologists invited Simpson to participate in their symposia (e.g., "Some principles of historical biology bearing on human origins," 1951; "The meaning of taxonomic statements," 1964), used his books as classroom texts, and cited his publications to support claims for their own work. Later in the 1960s, Simpson moved from mentor to apologist, as the paleoanthropologists were by then familiar with the synthesis and incorporated its theoretical concepts in their interpretations of the many newly discovered hominoid fossils. Simpson now took special care to celebrate these results in his more general, less technical writings, acting as a forceful apologist for the materialistic view of human origins (e.g., "The biological nature of man," 1966; "The evolutionary concept of man," 1972). During the 1970s, Simpson's influence waned, and he became just another practitioner at the margin of the discipline. However, anthropologists acknowledged Simpson's earlier impact, for example, when he was invited, yet again, to address them at the 50th anniversary celebration of the American Association of Physical Anthropologists in 1981.

Anthropology↗

PubMed1978

[Open disponibility before self - on Medard Boss' Basis of Medicine and Psychology].

In this book, written in collaboration with Heidegger, Medard Boss endeavours for the first time to use Heidegger's late philosophical oeuvre as a basis for medicine and psychology. Boss attempts to uncover behind the understanding of man as existence, which prevail in "Sein und Zeit" and which has been so influential for Binswanger's existential analysis, a more original understanding of man as eksistence, as "open disponibility" (Offenständigkeit). The interest of this view resides in the resulting general principle of classification and interpretation of all forms of disease, giving rise to an "existenialistic pathology". The problematic aspect consists in the failure to integrate the "being-onself" in the understanding of human existence as open disponibility, which leads to a one-sided interpretation of disease processes.

Ego↗

PubMed2005

Madness explained: why we must reject the Kraepelinian paradigm and replace it with a 'complaint-orientated' approach to understanding mental illness.

This article is a synopsis of the argument outlined in my book Madness explained: Psychosis and human nature, in which I describe a new paradigm (which might be called a 'complaint-orientated' approach) for understanding the psychotic disorders, the most disabling forms of psychiatric illness. Despite extensive efforts to study the genetics, pathophysiology and neuropsychology of the psychoses, replicable findings have been rare. I argue that this is because the phenomena concerned have been poorly defined. Since the end of the 19th century, research into the psychoses has been dominated by the system of classification first proposed by the German psychiatrist Emil Kraepelin, which assumes that the severe mental illnesses fall into discrete types such as 'schizophrenia' and 'manic depression', and that there is a clear dividing line between madness and normal functioning. However, Kraepelinian diagnoses fail all empirical tests of their validity. For example, they do not identify patients with common symptoms, with common aetiologies, who respond to specific treatments. I suggest that we therefore need to abandon psychiatric diagnoses altogether and must instead attempt to explain the specific complaints ('symptoms') that patients bring to our attention. These include hallucinations, delusional beliefs, thought and communication disorders, which are much more widely experienced than was previously thought (for example, about 10% of the population have experienced hallucinations). I show that recent psychological research has revealed much about the mechanisms underlying each of these complaints. For example, auditory hallucinations occur when the individual mistakes inner speech for an external stimulus, and delusions appear to be the product of abnormal inferential processes. The new approach has implications for aetiology. For example, researchers working within the Kraepelinian paradigm have often assumed that the psychoses are endogenous. However, there is compelling evidence that the risk of experiencing psychotic complaints is influenced by adverse environmental factors such as insecure attachment relations and exposure to sexual and other kinds of trauma. These associations are relatively easy to understand once the psychological mechanisms leading to specific complaints are known. When all of the psychotic complaints have been explained, there will be no 'schizophrenia' or 'manic depression' left behind awaiting explanation. The approach that I advocate is not only more scientific than the Kraepelinian approach, but also more humane. In contrast to the Kraepelinian approach, which has encouraged disrespect for patients' experiences, it encourages us to treat patients as rational agents and to take what they say seriously.

Cognition↗

PubMed1998

Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates.

OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the fetal biophysical profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last fetal biophysical profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, -coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial fetal biophysical profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded biophysical profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the fetal biophysical profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test fetal biophysical profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by fetal biophysical profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy.

Birth Weight↗