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PubMed1990

The protean manifestations of hemorrhagic fever with renal syndrome. A retrospective review of 26 cases from Korea.

Twenty-six cases of hemorrhagic fever with renal syndrome from 1981 to 1986 were retrospectively reviewed to determine the scope of clinical presentation and the unique complications of the illness. The diagnosis was confirmed by detection of Hantaan virus antibody in 25 cases and by characteristic autopsy findings in 1 case. The illness could be classified into three distinct clinical subgroups. Fever was universally present. Two patients presented with intractable shock and diffuse hemorrhage and died within 6 days from multi-organ system failure, mimicking the clinical picture of overwhelming sepsis. Eighteen patients presented with acute renal failure with an illness lasting a mean of 21 days (range, 10 to 36 days). Resolution of thrombocytopenia heralded recovery of renal function. At discharge, the serum creatinine level was normal in 13 patients; 5 patients had evidence of minimal renal dysfunction. Acute pulmonary edema requiring hemodialysis and retroperitoneal hemorrhage were the major complications in this subgroup. Six patients had an undifferentiated febrile illness with normal renal function. Fever, thrombocytopenia, abnormal urinalysis, hypertransaminasemia, and a benign clinical course characterized the third clinical pattern. The recent availability of serodiagnostic methods to detect Hantavirus group antibody facilitates the diagnosis of hemorrhagic fever with renal syndrome. Application of this test in the described clinical settings will identify unsuspected cases, broaden the knowledge of the geographic distribution of Hantavirus infection, and increase physician awareness of its protean manifestations.

Acute Kidney Injury↗

PubMed1989

Medicaid program; Medicaid management information system: revised definition of "mechanized claims processing and information retrieval system"--HCFA. Final rule with comment period.

We are making a number of revisions to regulations concerning mechanized claims processing and information retrieval systems ("system" or "systems"). We are revising definitions to show that we will not make available Federal funding at 75 and 90 percent of State Medicaid agency expenditures for eligibility determination systems because they do not meet the definition of a "mechanized claims processing and information retrieval system" or of an enhancement to that system. We are also conforming our regulations to changes made by section 9503(b)(2) and 9518 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99-272), which involve technical changes. One change affects the frequency and scope of our system reviews, and the other involves the date by which States that are not exempt by law must have an operating system.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2000

What is liquid breathing and ventilation?

Liquid ventilation is a rapidly growing ventilation technique. In spite of the large number of scientific and technical papers on the argument, the general concepts, particularly useful for the non-specialist physician, are not easy to acquire. The scope of this simple review is to explain the present general aspects and uses of liquid ventilation, analysing their chronological development.

Fluorocarbons↗

PubMed2002

[Acute myocardial infarction].

Patients with acute myocardial infarction as well as high risk patients for coronary artery disease has been shown to receive benefits from angiotensin-converting enzymes. Since angiotensin receptor blocker(ARB) provides more complete blockade of the RAA system, treatment with ARB may bring more fruitful results. In this article, secondary prevention trials(OPTIMAAL and VALIANT) for patients with acute myocardial infarction and primary prevention trials(LIFE, SCOPE, and VALUE) were reviewed.

Angiotensin Receptor Antagonists↗

PubMed2002

Exploring indicators of experiential place integration in a sample of Queensland rural practitioners: a research note.

INTRODUCTION: Until recently, the focus on the universal problem of insufficient medical practitioners in rural areas had been on training and recruitment. Many of the rural workforce strategies in Australia targeted selection of medical students, medical curricula, postgraduate training and retraining experienced urban graduates. To date, there is little consistent evidence that the rural workforce situation in Australia is improving. The decision to remain in rural practice appears to be a dynamic equilibrium of positive and negative factors, and issues such as overwork and poor adaptation to role changes easily upset this equilibrium. AIM: To perform a scoping exploratory post facto review of interview data with a view to establishing the potential for a dedicated prospective study of rural GP retention. METHODS: Theoretical construct of 'dimensions of integration' was used in a post facto review of in-depth interview transcripts of 17 medical practitioners who had left rural practice. The construct posited integration as an active developmental process based on three 'principles'--security, freedom and identity--which together form the basis of practitioner retention. A series of 'dimensions' (n = 27) exists within each of these principles. RESULTS: Many of the 27 dimensions were found to be absent, particularly for practitioners who left before they originally intended. In some cases, apparently well-established practitioners (in terms of numbers of dimensions present) left because of some external 'pulling factor'. Dimensions related to practitioner security were generally most often missing. CONCLUSION: The potential for a dedicated prospective study was established.

Journal Article↗

PubMed2005

Scope for improvement in the quality of reporting of systematic reviews. From the Cochrane Musculoskeletal Group.

OBJECTIVE: To assess the quality of reporting in Cochrane musculoskeletal systematic reviews (excluding back and injury reviews). METHODS: This study assessed all the Cochrane Musculoskeletal Group's systematic reviews from Issue 4, 2002, of the Cochrane Library Database of Systematic Reviews. Two reviewers independently extracted data and assessed quality. Two assessment tools were used, including an 18 item checklist and flow chart developed by the Quality of Reporting of Meta-analysis (QUOROM) consensus group, and a 10 item scale, the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ). One question on the latter scale (item 10) scores overall quality on a 7 point scale, with high scores indicating superior quality. Data were analyzed using univariate approaches. RESULTS: The 57 systematic reviews assessed were found to have good overall quality, with scores on individual items revealing only minor flaws. Documenting the flow of included and excluded studies and summarizing the results are 2 areas needing improvement in reporting. According to the Oxman-Guyatt scale the overall scientific quality of the Cochrane musculoskeletal reviews was good [mean 5.02 (95% CI 3.71-6.32)]. CONCLUSION: Our study found that the reporting quality of Cochrane musculoskeletal systematic reviews was generally good, although there was room for improvement. For example, it might be feasible to develop specific guidelines for reporting protocols. Certainly more work is needed in reporting search results, documentation of the flow of studies, identification of the type of studies, and summarization of the key findings.

Evidence-Based Medicine↗

PubMedDate not supplied

Nano- or submicron-sized liposomes as carriers for drug delivery.

Liposomes are tiny spheres ranging in diameters from 50 nm to several microns. The scope of this mini review is to introduce the concept of liposomes and to describe some aspects and mechanisms of stimulating topical and injectable products with liposomes. Two examples discussed in this article are topical delivery across skin and injectable formulations for anticancer drugs. Classic liposomes are of little value as carriers for drug delivery via the skin because they do not penetrate it deeply. Only specially designed liposomes have been shown to be capable of achieving enhanced delivery. The incorporation of additives, such as anionic surfactants and ethanol, can fluidize the phospholipid bilayers, thus increasing the depths to which liposomes can penetrate the intercellular pathways of the skin. Also, liposomes that have been conjugated with PEG or antibodies can increase the residence time of anticancer drugs in the circulation and enhance drug accumulation in tumors.

Administration, Topical↗

PubMed1989

[Introduction to the problem of compliance].

The following article attempts to elucidate the basic knowledge and essential statement of the problem of compliance research--based on an exemplary literature review. Characteristics of the scope of dental care are introduced into the discussion. The following is being pointed out: 1. Non-Compliance constitutes one of the major practical problems in medicine; 2. Compliance resp. Non-Compliance can only be understood appropriately from the wider structure of the doctor-patient-relationship; 3. Non-Compliance often occurs even in the case of serious diseases; and 4. Several concrete measures can be formulated which comprise an improvement of Compliance.

Dental Care↗

PubMed1983

[Environmental and occupational factors in the development of congenital malformations].

Teratology has grown from a little known discipline to a discipline embracing a vast accumulation of literature on experimental studies in many animal forms. Emphasis has shifted from preoccupation with descriptions of anatomical defects to concern about subtle and interacting causative factors. The aim of this work is to assemble a source of facts, concepts, methods and references within the broad scope of teratology. Our review summarizes reports of teratogenic effects in mammals. The major intent of this work, however, has been to introduce into a field of teratology. Special attention has been paid to the relation of animal studies to the problem in man and to the interactions between teratogens and environmental variables. We present a number of illustrative examples of various kinds of interactions that may occur and their possible significance. Striking degrees of potentiative interactions have been demonstrated in laboratory animals when two or more compounds were used simultaneously at doses at or below the threshold level for teratogenicity of the same compound when applied singly. We propose the name coteratogenesis for the agents which are not teratogenic but which aggravate teratogenicity of the other factors known as teratogens.

Abnormalities, Drug-Induced↗

PubMed1994

Reducing violent injuries: priorities for pediatrician advocacy.

A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria. Developing strategies for educating the public and for approaching legislative/regulatory bodies. Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change. To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas. Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence. Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors. Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.

Adolescent↗

PubMed1988

Genetic polymorphisms of animal complement components.

This review summarizes current knowledge of complement polymorphisms in non-human vertebrate species. The information presented is intended to be representative of animal complement genetics in general; it is not therefore exhaustively detailed about any one specialized area. Although the majority of the genes for the human complement components have been cloned, most of the genetic data on animal complement component variation have been produced by protein studies, consequently the emphasis on the protein rather than DNA is reflected in the present discussion. The objectives of undertaking comparative genetic studies of complement are divided into two broad areas. The first concerns the evolution, the structure and regulation of the genes and gene clusters together with data relevant to their chromosomal organization in different species. The second goal is the practical one; since many complement components are highly polymorphic they have considerable intrinsic value as genetic markers. In addition, there are biomedical and veterinary aspects to be considered which draw on the knowledge of the structural and functional properties of the components in relation to physiological considerations. This review discusses the practical approaches employed in the study of animal complement variation. The data on animal complement component polymorphisms are summarized in tabular form and some of the evolutionary implications of these data are discussed. The review concludes by examining the scope for future comparative studies.

Animals↗

PubMed2006

Water decontamination of chemical skin/eye splashes: a critical review.

Skin/eye chemical splashes are a significant workplace problem. Initial water decontamination is usually recommended, but there are few well-conducted experimental animal and human studies of efficacy. An extensive review of the literature and other available information sources was performed to define the scope of the problem and critically review the evidence for water decontamination efficacy. Although water decontamination can decrease the severity of chemical skin/eye burns, it cannot completely prevent them. An ideal replacement decontamination solution would be sterile, nontoxic, chelating, polyvalent, amphoteric, and slightly hypertonic to retard skin or corneal penetration of the chemical.

Animals↗

PubMed2004

Do interventions to increase income improve the health of the poor in developed economies and are such policies cost effective?

Health policy has shifted towards placing a greater emphasis on the role of lifestyle and life circumstances in improving health. The factors that are associated with poor health status are known, but the comparative effectiveness of specific policy interventions in improving health and reducing inequalities in health is unclear. For example, there is little evidence that specific policies aimed at providing income support or poverty eradication have any measurable impact on health. Two previous reviews have addressed the evidence in this area but in a fairly restrictive way. One considered only randomised trials and the other excluded non-cash benefits. This article builds on the previous reviews in three ways: a broader scope of study designs and types of intervention is considered; more recent literature is reviewed; and it considers the extent to which an economic evaluation framework has been applied. A systematic search of electronic databases was carried out for literature published since 1980 and in the English language. Each study was appraised in terms of its relevance to the question of interest, and the quality of the study design was appraised in terms of its capacity to provide robust answers. Few studies were found with health outcomes as their main focus. Most of the studies that used secondary data sources or survey data were of poor quality. Where economic evaluations were reported, these tended to be restricted to financial assessments. Different types of interventions were evaluated. In studies of cash benefits, there was limited evidence that they had a positive effect on some health domains, mainly psychosocial. Studies in welfare-to-work interventions produced mixed results in terms of impact on either income or health; there was no consistent relationship between income gains and health improvements. Five welfare-to-work studies included 'benefit-cost analysis', but these were essentially financial assessments. Studies of benefits in kind did not meet the quality criteria for inclusion in this article. Overall, we found no evidence of the potential cost effectiveness of income support or anti-poverty initiatives in improving health, nor is there a strong effectiveness literature on which to build such analysis. However, the hypothesis that increased income may improve health cannot be said to have been properly tested. Studies generally analyse the incremental effect of changes to the welfare system and do not estimate the health effects of current provisions. The production function for good health is complex. Increasing income may be a necessary, but not a sufficient, condition for the creation of better health in those with low incomes.

Cost-Benefit Analysis↗

PubMed2004

Bring me home: renal dialysis in the Kimberley.

The incidence of end-stage renal failure (ESRF) in the Kimberley region at the top end of Western Australia far exceeds known national rates and trend analysis demonstrates a close parallel to what is occurring in the Northern Territory. Dialysis prevalence in the Kimberley has nearly tripled in the last decade and has increased at a much faster rate than the rest of Western Australia. Almost all of these people with ESRF are Aboriginal Australians living in remote communities. In January 2004, the Western Australia Country Health Service and Kimberley Aboriginal Medical Services' Council, under the auspices of the Kimberley Aboriginal Health Planning Forum, embarked upon a review of renal disease in the Kimberley funded by the Western Australia Department of Health. The main purpose of the review was to identify the scope of the problem and make projections upon which to base programme and service development over the next 10 years. This paper outlines the findings of the Review of Renal Disease in the Kimberley and presents, for the first time, regional data analysis and comparisons. In addition, future projections on the impact of ESRF and recommendations for improving current service delivery are discussed. Given the challenges of remoteness and individuals' desire to return home, this review recommends development of locally-based expertise capable of providing training and support to patients and their families, reinvigoration of community-based dialysis modalities, and the initiation of planning for a second satellite service in the Kimberley.

Ambulatory Care Facilities↗

PubMed1992

Review article: non-steroidal, anti-inflammatory drugs--the extending scope of gastrointestinal side effects.

The gastrointestinal side effects of non-steroidal, anti-inflammatory drugs extend beyond the duodenal bulb, and comprise a variety of lesions in all parts of the gut. Gastroduodenal ulceration is quantitatively dominant, although a major part of these lesions probably go unnoticed and heal spontaneously. Adaptation has been demonstrated for acetylsalicylic acid, and may be of importance for other substances as well. Non-steroidal anti-inflammatory drugs (NSAIDs) may induce relapse of inflammatory bowel disease. Permeability changes and mucosal inflammation are found in the small and large bowel in the majority of subjects taking NSAIDs, although the clinical significance is still not clear. Ulceration and perforation do, however, occur in this part of the gut as well. Treatment of NSAID-associated ulceration is similar to traditional ulcer treatment, possibly with extended treatment duration if the NSAID is continued. Prophylaxis is of some value, but is not required for every patient receiving an NSAID.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1991

Uniform clinical data set begins new scope.

The uniform clinical data set (UCDS) will be introduced into the PRO review process as PROs enter the next contract cycle and begin to operate under the Fourth Scope of Work. As reported in the July issue, the Keystone Peer Review Organization (KePRO) will come under the Fourth Scope on December 1, 1991.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2003

Effectively displaying broad scope sub-licensee radioactive material inventory allocations and possession quantities.

As part of its annual broad scope license radiation protection program review, the University of Texas Health Science Center at Houston radiation safety program discovered that although inventory control and monitoring mechanisms were being effectively implemented at the sublicensee level, a method did not exist to demonstrate compliance with collective broad scope license possession limits at the institutional level. To address this shortcoming, the radiation safety program data warehouse system was modified, and an automatic summary report showing collective sub-licensee maximum possession authorizations was created. But this report did not effectively present the summary information in a manner that key stakeholders could readily comprehend, as the data was not referenced to collective institutional possession limits. So a graphic version of the summary report was created wherein, for each isotope possessed, the collective institutional limit was displayed, along with the totals of all the individual sub-licensee maximum possession limits and current amounts on hand. This simple graphic served to effectively communicate the current status of the institution's radiation source inventory to the radiation safety committee, executive management, and state regulatory officials. The effort has served to simplify the sometimes-complicated source inventory control process and has facilitated subsequent program reviews. In the future, the method is expected to assist the radiation protection program in anticipating when broad license amendments may be needed to accommodate operational changes.

Licensure↗

PubMed2002

Home treatment for mental health problems: a systematic review.

BACKGROUND: Concerns have been raised about the scope and generalizability of much community mental health research. In particular, both experimental and control services are poorly characterized. METHODS: To review the effectiveness of 'home treatment' for mental health problems in terms of hospitalization, we conducted a systematic review, using Cochrane methodology but with a wider remit. Non-randomized studies were included in response to concerns about RCTs' generalizability. All authors were followed up for data on service components. 'Home treatment' was defined broadly for the purposes of the literature search, but included studies were then assessed against service components specifically focused on delivering treatment at home. The study tested components and other features for associations with days in hospital, as well as conducting a conventional meta-analysis of data on days in hospital. RESULTS: We found 91 studies, 18 comparing home to in-patient treatment. Sixty per cent of authors responded to follow-up. The vast majority of the services studied had a 'home treatment function' and regularly visited patients at home. The heterogeneity of control services made meta-analysis problematical as did the limited availability of data. There was some evidence that 'regular' home visiting and combined responsibility for health and social care were associated with reduced hospitalization. The inclusion of non-randomized studies rarely affected the findings. CONCLUSIONS: Evidence concerning the effectiveness of home treatment remains inconclusive. A centrally coordinated research strategy is recommended, with attention to study design. Experimental and control service components should be prospectively recorded and reported to enable meaningful analysis.

Community Mental Health Services↗