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PubMed1990

[Drug information in recent 5 volumes of the Year Book of Dentistry].

The Year Book of Dentistry appears annually, providing a review of dental articles. We surveyed the abstracts of the recent 5 volumes of the Year Book of Dentistry, from 1985 to 1989. Two hundred and eighty articles were abstracted in each volume, divided into about 13 categories. The proportion of abstracts concerned with drugs and drug therapies (here termed drug information) was almost 20% in all volumes. Most of the drug information appeared under the heading "Oral Medicine and Oral Pathology" (63%). The original articles for the abstracts were from many journals, but 70% of the drug information articles were from JADA, Oral Surgery, and 10 other journals. The classification of the drugs in the drug information were: drugs for dental treatment, antibacterials, antiinflammatories, hemostatics, anesthetics, and others. Oral manifestations of systemic diseases or side effects of drugs used for these diseases were also abstracted. There were numerous articles of systemic diseases, due to dental treatments, including infective, hematologic diseases.

Abstracting and Indexing↗

PubMed1996

The history of alcoholism: Brühl-Cramer's concepts and observations.

In 1819 the German-Russian doctor C. von Brühl-Cramer published one of the most important books in the history of alcoholism. He coined the term Trunksucht (which was translated as dipsomania by Hufeland), and he defined it as a physical disease. He discussed aetiology (assuming the consumption of spirits as the main occasional cause and annoyance or depressive feelings as other causes), and pathogenesis (suspecting that repetitive or noxious stimuli provoke a craving for continued intoxication). His recommendations on therapy were influenced by the contemporary ideas on treatment by the laws of chemistry and by concepts of excitability. He offered a classification in terms of continuous, remittent, intermittent, periodic and mixed forms of dipsomania. He described different sequelae, including neuropathy (in which the paresis began at the most distant parts of the limbs), dementia, suppression of the immune system and fetal alcohol syndrome (considering the typical features as proneness to diseases, mental retardation, hyperactivity, facial dysmorphism, incomplete growth). He examined ethnological factors based on his observations in multi-racial Russia. Passages of his work are presented. Relations with works of his contemporaries (especially with Trotter) and influences on later concepts of alcoholism are discussed.

Alcoholism↗

PubMed2007

Hysterical chorea: Report of an outbreak and movie documentation by Arthur Van Gehuchten (1861-1914).

Psychogenic movement disorders remain a frequent and important clinical problem. First described in the Middle Ages, the dancing mania is considered to be one form of mass hysteria characterized by outbreaks of collective movement disorders. Patients may exhibit a wide variety of movement and gait disturbances, including tremulousness, jerks, or convulsions, usually with a sudden onset. Arthur Van Gehuchten (1861-1914), a distinguished Belgian neuroanatomist and neurologist, reported an outbreak of sudden involuntary movements in 13 adolescent girls residing in an orphanage. The description is to be found in his book Les Maladies nerveuses, completed before 1914 and published posthumously in 1920. The chapter is illustrated with sequential photographs of a girl exhibiting a peculiar gait, which is descriptively referred to as "chorée salutatoire" (saluting chorea). The original film with these pictures has been retrieved and is presented here together with a very similar film excerpt also found in Van Gehuchten's film collection. Van Gehuchten's movie documentation of a psychogenic movement disorder--labeled chorea but which should probably be considered as dystonia according to contemporary classification--appears to be unique. This report illustrates the tremendous value of moving pictures in recording and analyzing movement disorders.

Belgium↗

PubMed2005

[Ambulatory geriatric rehabilitation and its legal classification within the statutory health insurance system].

In Germany, the number and proportion of elderly people will continue to increase. Only few hospitals and rehabilitation units are currently providing inpatient geriatric services. Concepts for graded geriatric care see ambulatory geriatric rehabilitation (AGR) as an independent service und as a complement to pre-existing structures in geriatric care. In 2004, the national association of statutory health insurance funds established recommendations for AGR, which include criteria of structural and process quality of ambulant geriatric rehabilitation. This article describes various aspects of these framework recommendations (target groups, rehabilitation indicators, and equipment of services). In addition, the classification of AGR within the legislation of the statutory health insurance system is evaluated. The financing of AGR by the statutory health insurance system and the preconditions for accreditation of AGR-services within this system are discussed. The authors conclude that discrimination between existing partially-inpatient day clinics and AGR services is not appropriate. Furthermore, there is no legal basis for such a discrimination; on the contrary, the terms partially-inpatient and ambulatory rehabilitation services can be seen as a uniform benefit according to book 5 of the German social code, SGB V. Therefore there is no differentiation between AGR and partially-inpatient rehabilitation in the statutory health insurance system.

Aged↗

PubMed1996

The clinical value of computerized information services. A review of 98 randomized clinical trials.

OBJECTIVE: To review all randomized clinical trials addressing the efficacy of clinical information systems and to determine the clinical settings, types of interventions, and effects studied. DATA SOURCES: Extensive and systematic MEDLINE searches were conducted using a combination of medical subject headings (MeSH) and textword terms to collect trial reports. Manual searches of books and monographs as well as informal contacts were also used. STUDY SELECTION: The eligibility criteria were (1) randomized controlled clinical trial, (2) computerized information intervention in the study group, and (3) effect measured on the process or outcome of care. DATA EXTRACTION: Two research assistants independently abstracted from the selected reports the following structured information: trial sites, computerized interventions, effect variables, and outcomes. Three investigators evaluated the combined list of trial features for setting, intervention, and effect. The statistical analysis included an evaluation of agreement in developing classifications and an analysis of the ratio of positive trial outcomes. DATA SYNTHESIS: Most information services were tested in outpatient care (82%), particularly in primary care (66%). The information intervention targeted the provider in 64% of the trials. The effect was primarily measured for the process of care (76%). Provider prompt/reminder, computer-assisted treatment planner, interactive patient education/therapy, and patient prompt/reminder were significantly successful interventions (sign test, P < .05). CONCLUSIONS: Randomized clinical trials confirm that four generic information interventions are active ingredients of computer systems and can make a significant difference in family medicine (physician and patient reminders, treatment planner, and patient education). To manage care and improve quality, primary care computer systems should incorporate these effective information services.

Information Systems↗

PubMed2004

Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column.

OBJECTIVE: The objective of part 1 of this study is to redefine the Letournel anterior column on the basis of developmental and adult pelvic skeletal anatomy. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected patients with acetabular fracture or fracture-dislocations admitted to a level I trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The discrepancy between the Letournel definition of the anterior and posterior columns became readily apparent. Standard text books of anatomy and surgical anatomy were referenced relative to the embryologic and adult components of the acetabulum. RESULTS: The anterior column is redefined with its superior border being the anatomic arcuate and iliopectineal lines, thereby coinciding with the superior border (arcuate line) of the Letournel posterior column. CONCLUSION: Redefinition of the anterior column eliminates diagnostic ambiguity of the Letournel elementary anterior column fracture as well as the Letournel associated anterior column or wall with hemitransverse fracture. The redefined anterior column is integral to the CT-based classification described in part 2 of our study.

Acetabulum↗

PubMed1979

Statistical and other data-analytic techniques for the evaluation researcher: an identification, classification, and description of methods and resources.

The goal of any social/health intervention program is to improve the lot of the people it is designed to serve. Of critical importance is the development and implementation of programs able to achieve such a goal is evaluation research (ER)--a process representing an interface between the generic notion of evaluation and the rigor of social research methodology. The evaluation researcher should be familiar with, and be capable of using, any of a number of (statistical and non-statistical) data-analytic techniques. The objectives of this discussion, therefore, are to (1) identify, categorize, and briefly describe statistical and other data-analytic techniques of potential use to the evaluation researchers; and (2) identify currently available resources, i.e., texts, books of readings, monographs, etc., that offer discussions and analyses of these techniques. It is hoped that such an exposition will lead to a wider understanding, acceptance, and use of these procedures, which can only enhance the quality of subsequent program policy- and decisionmaking.

Analysis of Variance↗

PubMed2003

Sympathectomy for neuropathic pain.

BACKGROUND: Neuropathic pain is defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. Some examples of this condition are phantom limb pain, post-stroke pain and complex regional pain syndrome type I (reflex sympathetic dystrophy) and type II (causalgia). Treatment options include drugs, physical treatments, surgery and psychological interventions. The concept that many neuropathic pain syndromes, particularly RSD and causalgia are "sympathetically maintained pains" has historically led to attempts to temporarily or permanently interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy the sympathetic chain, but this effect is temporary until regeneration of the sympathetic chain occurs. Surgical ablation can be performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using stereotactic thermal or laser interruption. OBJECTIVES: The review aimed to assess the effects of both chemical and surgical sympathectomy for neuropathic pain. Secondary objectives were to compare the effects of sympathectomy with no treatment, placebo or conventional treatment, and to evaluate whether the technique of sympathectomy influences the outcomes of the procedure. SEARCH STRATEGY: We searched MEDLINE and EMBASE up to February 2003 and the latest issue of the Cochrane Library (Issue 1, 2003). We screened references in the retrieved articles, literature reviews and book chapters. We also contacted experts in the field of neuropathic pain. SELECTION CRITERIA: Clinical trials and observational studies assessing the effects of sympathectomy (surgical or chemical) for neuropathic pain of both central or peripheral origin were included. DATA COLLECTION AND ANALYSIS: Two reviewers applied the selection criteria to titles and abstracts. Full articles of potentially eligible trials were obtained and the same reviewers applied the inclusion criteria to the studies. The methodological quality of the studies was evaluated. The studies were also evaluated for clinical relevance according to a classification developed by our group. Statistical pooling was not possible due to heterogeneity of data; instead a narrative description of each included study was performed. MAIN RESULTS: We included four studies. One randomized trial comparing radiofrequency sympatholysis with phenol sympathectomy was rated as low methodological quality and it showed that radiofrequency sympatholysis does not offer advantage over phenol techniques. However, a modified technique produced sympatholysis comparable to that produced by 6% phenol, with less incidence of post-sympathectomy neuralgia. REVIEWER'S CONCLUSIONS: The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience. Furthermore, complications of the procedure may be significant, in terms of both worsening the pain or producing a new pain syndrome; and abnormal forms of sweating (compensatory hyperhidrosis and pathological gustatory sweating). Therefore, more clinical trials of sympathectomy are required to establish the overall effectiveness and potential risks of this procedure.

Humans↗

PubMed1990

Classifications in the field of mental health.

For the first time in the Ninth Revision of the International Classification of Diseases (ICD-9) the chapter on mental disorders contained short glossary definitions for each category. A number of changes in attitudes and policies at the international and national levels, particularly the reorientation of mental health programmes to include behavioural and psychosocial problems, came at an opportune time and had a positive influence on the development of proposals for the chapter on mental and behavioural disorders in the Tenth Revision (ICD-10). This in turn enabled WHO to undertaken an intensive and extensive assessment of international needs in the classification of mental disorders and, where the situation was not unequivocal, to organize field trials to provide the empirical data necessary for problem solution. The result is a series of compatible classifications of mental and behavioural disorders based on ICD-10. The first, produced mainly as a reference tool for statistical purposes, will be included in ICD-10 with short glossary definitions as was the case for ICD-9. Other versions will be published for practising clinicians (with enhanced glossary definitions followed by diagnostic guidelines) for research (with full definitions, diagnostic guidelines and diagnostic criteria); for use in the provision of services to the mentally ill; and for use in general health (primary) care. There will also be a multiaxial classification of mental disorders in children to identify the clinical syndrome, resulting disability and environmental factors. It is hoped that these versions tailored to the needs of different groups working in the field of mental health will result in further improvements in communications between those responsible for the provision of services and care.

Disease↗

PubMedDate not supplied

One year audit of perinatal mortality at Kathmandu Medical College Hospital.

INTRODUCTION: Perinatal mortality is a sensitive indicator of the quality of service provided to pregnant women and their new borns. Regular audit of perinatal mortality will help in finding out preventive factors and thus helps in reducing perinatal mortality rate in an institution. OBJECTIVE: This study was carried out to determine perinatal mortality rate (PMR) and the factors associated with it at KMCTH in the one year period (Bhadra 2059-Shrawan 2060) MATERIALS AND METHODS: This is a retrospective study of entire still births and early neonatal deaths that occurred at KMCTH during the one year period (Bhadra 2059-Shrawan 2060). The study was done by collecting the data of all stillbirths and early neonatal deaths from record books of the Special Care Baby Unit, Labour Room and operation theatre. RESULTS: Out of 563 total births in the one year study period, 17 were still births (SB) and 10 were early neonatal death (ENND). Out of 17 SB, 7 were of < 1 kg and out of 10 ENND, 3 were of < 1 kg. Thus, perinatal mortality rate during the study period was 30.7 and extended perinatal mortality rate was 47.9 per 1000 births. Perinatal deaths were mostly due to extreme prematurity, birth asphyxia, septicemia and congenital anomalies. According to Wiggleworths classification, 18.5% of perinatal deaths were in Group I, 14.8% in Group II, 22.3% in Group III, 40.7% in Group IV and 3.7% in Group V. Intrapartum asphyxia was the commonest cause of perinatal deaths, but majority of these babies were of low birth weight. Prevention of preterm births, better care during intrapartum period, more intensive care of very low birth weight and preterm babies would help in reducing the present high perinatal mortality.

Cause of Death↗

PubMed2001

Origin and development of concepts of bipolar mixed states.

This paper reviews the historical origins of the contemporaneous resurgence of interest in mixed states. This is a classical concept whose origins can be traced back to ancient times. In more modern times, already in the pre-Kraepelinian era we can find descriptions and classifications of "mixed states". For example, in his classification of mental disorders described "mixtures of exaltations and depression", and he distinguished among "mixed mood disorders", "mixed mental disorders", and "mixed volition disorders". Subsequently, (the father of empirical and biological psychiatric research in Germany) described the "mid-forms". Half a century later we encounter the crucial role of Emil Kraepelin and the development and systemization of his views between 1899 and 1913--leading to the characterization of such conditions as "depressive-anxious mania", "excited depression", and "stuporous mania". The remainder of this article focuses on the essential points of the first book on mixed states in the psychiatric literature: On The Mixed States of Manic-Depressive Insanity by. For much of the present 20th century nothing new emerges, followed by a contemporary renaissance of mixed states, particularly in the United States. The paper concludes with proposal of mixed states as temperament intruding into an episode of opposite polarity.

Affect↗

PubMed1986

Paediatric urology 1000 years ago.

In this paper we present a commentary on four books from the paediatric urology point of view; al-Hawi (Continens), R. fi Siyasat as-Sibyan wa tadbirihim, at-Tasrif and al-Qanun by the Moslem scholars ar-Razi, Ibn al-Jazzar, al Zahrawi and Ibn Sina who lived within the period of the ninth to the eleventh centuries. In these books the supreme abilities of the authors as clinicians and their role in the creation of clinical medicine are shown by: The presentation of the various pathological conditions usually starting with the complaint then describing the origin of the disease and enumerating the accurate signs necessary for diagnosis. Differential diagnosis between various conditions which produce similar complaints is precisely described. For example, retention of urine and different types of anuria, types of renal haematuria, dormant and moving renal stones and their precise localisation, renal or vesical pain and pain due to colitis. Finally, the methodical classification of the diseases according to the organs affected is discussed. The description of the pathology and the knowledge of new diseases was an important advance made by these scholars. From the urological point of view, spina bifida and its relation to incontinence was first described by ar-Razi and most of the diseases of the kidney and bladder can be recognized in the systemic classification of the diseases of these organs given by Ibn Sina who pointed out the psychological role in some cases of nocturnal enuresis.(ABSTRACT TRUNCATED AT 250 WORDS)

General Surgery↗

PubMed2002

Development of a preference-weighted health status classification system in France: the Health Utilities Index 3.

The Health Utilities Index is a generic multiattribute preference-based system for assessing health-related quality of life, devised by Torrance et al. It is being used in cost-effectiveness evaluations in North America and in international multicentre studies but was not available in France. Following adaptation of the HUI3 classification in France, the purpose of the reported investigation was to derive French preference weights. This article provides a reminder of the theoretical foundations used to model the multiattribute utility function. Within this framework, a multiattribute multiplicative aggregate utility function was constructed in accordance with the explicitly decomposed approach. The study took place in June 1999 over a sample of 365 persons from the French general population, aged between 20 and 65, and not suffering from any chronic or incapacitating illness. The recruitment procedure was based upon a random selection of individuals, using the phone book. Interviews took place in the homes of the interviewees. The methods of revelation (VAS and SG) were applied by setting the value of the best possible state of the HUI3 a priori at 1, and leaving a choice between two states (worst possible state, death) for 0. The aggregated individuals (person-mean and median) were calculated and the multiplicative utility functions constructed. A comparison of the calculated utilities with the observed ones provides a primary indicator of the validity of the person-mean or median functions constructed. The slight absolute differences obtained between observed and calculated utilities and the low RMSE scores lead us towards a favourable conclusion.

Adult↗

PubMed2006

Review of the toxicity of chemical mixtures: Theory, policy, and regulatory practice.

An analysis of current mixture theory, policy, and practice was conducted by examining standard reference texts, regulatory guidance documents, and journal articles. Although this literature contains useful theoretical concepts, clear definitions of most terminology, and well developed protocols for study design and statistical analysis, no general theoretical basis for the mechanisms and interactions of mixture toxicity could be discerned. There is also a poor understanding of the relationship between exposure-based and internal received dose metrics. This confounds data interpretation and limits reliable determinations of the nature and extent of additivity. The absence of any generally accepted classification scheme for either modes/mechanisms of toxic action or of mechanisms of toxicity interactions is problematic as it produces a cycle in which research and policy are interdependent and mutually limiting. Current regulatory guidance depends heavily on determination of toxicological similarity concluded from the presence of a few prominent constituents, assumed from a common toxicological effect, or presumed from an alleged similar toxic mode/mechanism. Additivity, or the lack of it, is largely based on extrapolation of existing knowledge for single chemicals in this context. Thus, regulatory risk assessment protocols lack authoritative theoretical underpinnings, creating substantial uncertainty. Development of comprehensive classification schemes for modes/mechanisms of toxic action and mechanisms of interaction is needed to ensure a sound theoretical foundation for mixture-related regulatory activity and provide a firm basis for iterative hypothesis development and experimental testing.

Animals↗

PubMedDate not supplied

Perinatal mortality in Ludhiana, Punjab--a seven year hospital study.

Perinatal deaths occurring over a seven year period were studied in a teaching hospital in Punjab. Causes of death were analysed as per Wigglesworth's classification. We have further modified this by correlating different gestations and weight groups with causes of death. The perinatal mortality rate (PNMR) in the present study was 74/1000 and showed a downward trend secondary to a statistically significant fall of early neonatal mortality. There was a decline in PNMR among babies of 1500-2000 g. birth weight and 33-36 weeks gestation. Asphyxia and macerated still births were found to be the two main causes of death. Macerated still births were seen more commonly among babies of lower weight at all gestations. The PNMR of babies born to booked mothers was 22/1000 as compared to 152/1000 among unbooked mothers. It was concluded that to bring down the PNMR, economic development alone is not enough. Provision of adequate antenatal care to all mothers, health education and timely referral of high risk mothers is very essential.

Asphyxia Neonatorum↗

PubMed2005

International Committee on Taxonomy of Viruses and the 3,142 unassigned species.

In 2005, ICTV (International Committee on Taxonomy of Viruses), the official body of the Virology Division of the International Union of Microbiological Societies responsible for naming and classifying viruses, will publish its latest report, the state of the art in virus nomenclature and taxonomy. The book lists more than 6,000 viruses classified in 1,950 species and in more than 391 different higher taxa. However, GenBank contains a staggering additional 3,142 "species" unaccounted for by the ICTV report. This paper reviews the reasons for such a situation and suggests what might be done in the near future to remedy this problem, particularly in light of the potential for a ten-fold increase in virus sequencing in the coming years that would generate many unclassified viruses. A number of changes could be made both at ICTV and GenBank to better handle virus taxonomy and classification in the future.

Advisory Committees↗

PubMed2004

Initial experience with bosentan therapy in patients with the Eisenmenger syndrome.

Bosentan, an endothelin-1 antagonist that can be administered orally, has been shown to be effective in the treatment of idiopathic pulmonary arterial hypertension and may be of benefit to patients with the Eisenmenger syndrome. Nine patients with Eisenmenger's syndrome were treated with bosentan at a dose of 125 mg twice a day. After treatment with bosentan, 6 of 9 patients (67%) had an improvement in New York Heart Assocation classification of >/=1 grades (p = 0.03). Oxygen saturation levels increased from 79 +/- 5% to 88 +/- 6%, (p = 0.03). The side effects of bosentan therapy were minor; no significant changes in liver function tests were noted. These preliminary data suggest that oral administration of bosentan therapy for Eisenmenger's syndrome results in improved oxygenation and functional status with minimal side effects.

Adult↗

PubMed2000

The epilepsy tutorial.

Within the European Neurological Network (ENN) project an interactive multimedia tutorial covering the medical field of epilepsy has been created. The first priorities of that project to educate health care professionals, e.g. General Practitioners (GP), throughout the European community as how to best diagnose and treat patients (e.g. reduction of frequent consultations, avoiding of excessive and unnecessary medication and useless laboratory tests) and to inform patients and carers are reached by producing a distributable CD-ROM. Later frequent updates of the content of the installed tutorial will take place by a telematic network contacting the multimedia database of the ENN-project. Using the toolbook author-system with integrated sound, images, animation and videos the data collected from about 10 experts are arranged as an electronic book, with multiple-linked pages and an object oriented program design, based for instance on customisable navigation buttons, special text arrangement, graphics, and staging areas for content and interaction display. The multimedia tutorial about epilepsy contains case reports, specific multiple choice questions with scoring, video clips etc. and several possibilities for access such as help-pages available all times, index, search machine for phrases, bookmark settings and roadmaps for graphical orientation. Detailed text is prepared including physiology and pathophysiology, differential diagnosis, investigations, therapeutics, epilepsy in children, advice for patients and carers, and is supported by a glossary, special definitions and proposals for classification of the different kinds of epilepsy. The tutorial runs with Windows 3.1, 95 and NT and contains 1300 pages text with 382 Fig.s, 14 videos, 70 sound files, 196 definitions and 8 roadmaps. The epilepsy tutorial has been distributed in March/May 1998 to more than 100 general physicians in Germany, Portugal and France.

Adolescent↗