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Cestode systematics: any progress?

In this short review, I summarize the recent advances, the present state and future for research in the field of cestode systematics. First, within an historical context, I briefly outline why our understanding of relationships within the Eucestoda has been problematic and contentious. On this foundation, I then summarize and discuss recent progress at various supraspecific levels, and at the specific level. Of particular interest in this respect is the discrepancy between the methods applied to understand the evolution of a few well-studied taxa, for instance the complex of Echinococcus species, contrasted with our relative ignorance about the systematic status of the vast majority of species. This leads to a review of the diversity of classical and new methodologies currently applied in the field of cestode systematics. Applications of morphoanatomical investigations as well as more recent molecular tools are examined, and some less common approaches are also reviewed. Finally, several practical and theoretical difficulties that are specific to the domain are discussed. These include problems in accessibility of material and adequate consideration of host-specificity. Our current state of knowledge represents an apparent paradox in that significant progress has indeed been achieved during the last 15 years, but appears limited to very specific cases, principally among medically important taxa. Conversely, more general works whose utility has been long recognized have not been addressed despite their conceptual simplicity. Consequently the development of new techniques, especially molecular ones, to allow access to new classes of characters is encouraged. However the need for continuous effort using more traditional approaches, including continued field collection, excellent and detailed descriptions and redescriptions, as well as critical revisions of classical monographs is also emphasized. A synergism linking morphological and molecular characters and phylogenetic approaches to analysis provides a firm foundation for rapid and seminal advances in the elucidation of relationships among the Eucestoda.

Animals↗

Systematic sound preference in phonological disorders: a case study.

Systematic sound preference, where a group of sounds with the same manner of articulation is represented by one or two sounds in the production, is one of the characteristics of children with phonological disorders. This article examines the hypotheses advanced by Weiner (1981) for the phenomenon in the light of the data from a 7-year old Portuguese speaking child. The findings support some of the hypotheses, while providing counter evidence for one of them. They also point to the importance of word position and stress patterns in the systematicity of systematic sound preference.

Articulation Disorders↗

Saccades to remembered target locations: an analysis of systematic and variable errors.

We studied the effects of varying delay interval on the accuracy and velocity of saccades to the remembered locations of visual targets. Remembered saccades were less accurate than control saccades. Both systematic and variable errors contributed to the loss of accuracy. Systematic errors were similar in size for delay intervals ranging from 400 msec to 5.6 sec, but variable errors increased monotonically as delay intervals were lengthened. Compared to control saccades, remembered saccades were slower and the peak velocities were more variable. However, neither peak velocity nor variability in peak velocity was related to the duration of the delay interval. Our findings indicate that a memory-related process is not the major source of the systematic errors observed on memory trials.

Animals↗

Detection of errors in individual patients in radiotherapy by systematic in vivo dosimetry.

We report 5 years of systematic measurements of the dose delivered to each patient undergoing radiotherapy treatment with photon beams in order to detect any systematic error that may have escaped the different checks performed at each step of planning and calculation prior to the first treatment session, or may have arisen during the set-up or the treatment delivery. For each patient the target-absorbed dose is derived from the entrance and exit doses measured by silicon diodes, on the beam axis at the patient's skin. Depending on the discrepancies observed between the measured and expected doses we have set decision levels for the corrective actions to be taken. In addition these measurements allow us to obtain information on the overall accuracy or on the quality of a specific treatment. During 5 years, 7519 patients have been measured and 79 errors were detected. Half could have induced a variation of over 10% in the dose delivered. Seventy-eight out of 79 errors were of human origin. As part of an overall quality assurance programme, it is of the utmost importance to check the dose delivered for each patient undergoing radiotherapy treatment in order to avoid systematic underdosing or overdosing.

Absorption↗

Traditional or systematic nursing? An evaluation of the written curricula of registered and enrolled nurses in Finland.

In order to develop the professional identity of registered nurses (RNs) and enrolled nurses (ENs), it is essential that the core of the written curricula be based on nursing science. In this study, content analysis was used to examine how theoretically-developed elements of nursing education were taken into consideration in the curricula (one local and one nationwide curriculum were analysed). The research questions were: 1. to what extent do the characteristics of either traditional or of systematic nursing appear in the educational objectives of nursing education? 2. to what extent do the characteristics of systematic nursing appear in the curricula, and as distinct elements in the objectives of nursing education? The written nursing curricula which were analysed seem to be characterised by traditional nursing, while features of systematic nursing appear as minor elements only.

Curriculum↗

Systematic analysis of errors in target localization and treatment delivery in stereotactic radiosurgery (SRS).

PURPOSE: To systematically analyze the spatial uncertainties associated with each step of the stereotactic radiosurgery (SRS) procedure and the overall spatial accuracy in the treatment delivery. METHODS AND MATERIALS: A special test device has been designed and fabricated to permit accurate simulation, localization and treatment portal verification of a SRS target. This device with simulated targets dispersed in 3-D space can be rigidly attached to the BRW CT or angio frame for localization, to the BRW phantom base for target coordinate determination, and to the floor stand for portal verification. The setup allows evaluation of the accuracy of each procedure separately as well as the overall accuracy in the delivery of SRS treatment. RESULTS: Biplanar film localizations reveal a systematic error in the phantom base pointer of the order of 0.1 mm that is applied as a correction to the measured target coordinates. Targets localized by planar film angiography had a mean positional error of 0.38 +/- 0.1 mm compared to 1.0 +/- 0.7 mm for digital angiographic localization. The positional accuracy associated with CT localization was superior when a 2 mm vs. 4 mm slice thickness was used (0.9 +/- 0.3 mm vs. 1.6 +/- 0.5 mm error). Cumulative mean errors, including inaccuracies associated with treatment setup, were 1.0 +/- 0.4 mm for radiographic localization, 1.2 +/- 0.5 mm for CT with a 512 x 512 matrix and 2 mm slice thickness, and 2.0 +/- 0.6 mm for CT at a 4 mm slice thickness (256 x 256 matrix). Larger errors would be expected in the clinical setting. CONCLUSION: Spatial errors in stereotactic radiosurgery are best estimated using a systematic approach to isolate independent contributing factors. The accuracy in target localization determines the overall accuracy of SRS procedure, provided the mechanical accuracy of the treatment apparatus is assured. Biplanar treatment portal verification with a fiducial localization frame is an accurate method of verifying the target coordinates before delivering treatment.

Humans↗

Systematic and medicinal reasoning in Mitla folk botany.

This paper reviews cognitive, symbolic, systematic botanical, and biochemical bases of plant classification, and analyzes their interrelationships in the medicinal folk botany of Mitla, Oaxaca, Mexico. It evaluates the "pharmacological wisdom" of the local population, along with their symbolic use of the environment, to show how they construct medicinal plant classifications which follow a folk logic, but often conform as well to modern botanical classifications based on the principles of systematic botany or chemistry. Working from both the chemical data and the folk categories, the analysis suggests the local Zapotec population systematically selected plants which foam for symbolic reasons to treat illnesses of the "soul" and identifies their underlying chemical constituents and medicinal qualities. Other correspondences between chemical, medicinal and reputed folk qualities are also suggested.

Animals↗

Application of radioreceptor assays for systematic toxicological analysis--2. Theoretical considerations and evaluation.

In this paper the applicability of radioreceptor assays for systematic toxicological analysis will be evaluated on a theoretical basis as well as on the basis of the outcomes of the analysis of a large number of urine samples collected after administration of a selected number of drugs to healthy volunteers and patients. Many drugs and other substances of toxicological relevance exert their action through an interaction with one or more receptor (sub)types. Whether the number of persons are using particular drugs intentionally or unintentionally, radioreceptor assays can be a useful tool for systematic toxicological analysis in that they can be applied to the identification of entire pharmacological classes of substances as well as pharmacologically active metabolites. In part 1 of this paper detailed procedures for radioreceptor assays for benzodiazepines, anticholinergics and antihistaminics have been described in detail in order to illustrate not only the potentials but also the limitations of assay conditions. Fifteen drugs were administered to patients and volunteers and urine samples were collected and determined with the three radioreceptor assays. The results of this study underline the theoretical applicability of receptor assays in systematic toxicological analysis though sample pretreatment procedures may contribute to an improvement in sensitivity and applicability to other biofluids.

Benzodiazepines↗

[Is systematic radiography needed before spinal manipulation? Recommendations of the SOFMMOO].

OBJECTIVES: The French National Health Authority recommends systematic radiography before lumbar manipulation. However, current research shows radiography to have more disadvantages than advantages. For the cervical spine, in cases of complication following cervical manipulation, the lack of prior radiography is a fault, even if such x-ray results would have advised manipulation. To establish clear recommendations on this topic, we searched in the literature for complications of spinal manipulations that could have been prevented had preliminary radiography been performed to determine whether these complications were anticipated or not by the international guidelines. MATERIAL AND METHODS: Literature search. RESULTS: For the lumbar and thoracic spine, the international guidelines are sufficient, except in cases of aneurysmal bone cyst, which can appear until the age of 25 years. For the cervical spine, despite a lack of data in the literature, prudence and medicolegal issues justify the performance of systematic radiography. CONCLUSION: The SOFMMOO recommends systematic radiography prior to cervical manipulation and in case of back or neck pain in patients of less than 25 years of age. In all other cases, the international guidelines provide sufficient recommendations.

Adolescent↗

[Should double J catheter be systematically considered in renal transplantation?].

Protection of urinary anastomoses using a ureteral catheter is a frequent option in urology but such use in a systematic manner remains debated in renal transplantation. Some consider that systematic insertion of a double J sound decreases the incidence of ureteral complications (fistula and stenosis). Others who prefer a selective use in some situations with a related risk consider that the implementation of a double J catheter cannot compensate a technical defect. It is even responsible for specific complications (infections, incrustation, haemorrhages); it increases implantation costs and is useless in more than 90% of the cases. This article analyses the risks related to systematic implementation of a double J catheter in Lich-Gregoir ureterovesical anastomoses for renal transplantation, together with the related costs and the infectious risk. The benefits in terms of prevention of ureteral complications are evaluated.

Catheterization↗

Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propranolol in long term prophylaxis of migraine.

OBJECTIVES: To evaluate utility of biofeedback assisted diaphragmatic breathing and systematic relaxation in migraine and to compare their efficacy with propranolol in long term prophylaxis of migraine. METHODS: 192 migraine patients were randomly distributed into two groups. Propranolol group received propranolol 80 mg/day while biofeedback group received electromyogram (EMG) and temperature biofeedback assisted diaphragmatic breathing and systematic relaxation training accompanied by home practice for 6 months. RESULTS: Significant clinical response was seen with biofeedback in 66.66% and with propranolol in 64.58% of patients. Frequency, severity, duration of attacks and number of vomiting episodes were significantly reduced in both the groups at 6 months but inter-group differences were statistically insignificant. During 1 year post-treatment period, significantly lesser resurgence of migraine was seen in biofeedback group as whole (9.37%) and in biofeedback responders in biofeedback group (9.37%) in comparison to resurgence of migraine in propranolol group as whole (38.54%) and in propranolol responders in propranolol group (53.22%) respectively. CONCLUSIONS: Biofeedback assisted diaphragmatic breathing and systematic relaxation were very useful in migraine and had significantly better long-term prophylactic effect than propranolol in migraine.

Adolescent↗

The effect of an endorectal balloon and off-line correction on the interfraction systematic and random prostate position variations: a comparative study.

PURPOSE: To investigate the effect of an endorectal balloon (ERB) and an off-line correction protocol on the day-to-day, interfraction prostate gland motion, in patients receiving external beam radiotherapy for prostate cancer. METHODS AND MATERIALS: In 22 patients, irradiated with an ERB in situ (ERB group) and in 30 patients without an ERB (No-ERB group), prostate displacements were measured daily in three orthogonal directions with portal images. Implanted gold markers and an off-line electronic portal imaging correction protocol were used for prostate position verification and correction. Movie loops were analyzed to evaluate prostate motion and rectal filling variations. RESULTS: The off-line correction protocol reduced the systematic prostate displacements, equally for the ERB and No-ERB group, to 1.3-1.8 mm (1 SD). The mean 3D displacement was reduced to 2.8 mm and 2.4 mm for the ERB and No-ERB group, respectively. The random interfraction displacements, relative to the treatment isocenter, were not reduced by the ERB and remained nearly unchanged in all three directions: 3.1 mm (1 SD) left-right, 2.6 mm (1 SD) superior-inferior, and 4.7 mm (1 SD) for the anterior-posterior direction. These day-to-day prostate position variations can be explained by the presence of gas and stool beside the ERB. CONCLUSIONS: The off-line corrections on the fiducial markers are effective in reducing the systematic prostate displacements. The investigated ERB does not reduce the interfraction prostate motion. Although the overall mean displacement is low, the day-to-day interfraction motion, especially in anterior-posterior direction, remains high compared with the systematic displacements.

Catheters, Indwelling↗

Identifying studies for systematic reviews of diagnostic tests was difficult due to the poor sensitivity and precision of methodologic filters and the lack of information in the abstract.

BACKGROUND AND OBJECTIVES: Methods to identify studies for systematic reviews of diagnostic accuracy are less well developed than for reviews of intervention studies. This study assessed (1) the sensitivity and precision of five published search strategies and (2) the reliability and accuracy of reviewers screening the results of the search strategy. METHODS: We compared the results of the search filters with the studies included in two systematic reviews, and assessed the interobserver reliability of two reviewers screening the list of articles generated by a search strategy. RESULTS: In the first review, the search strategy published by van der Weijden had the greatest sensitivity, and in the second, four search strategies had 100% sensitivity. There was "substantial" agreement between two reviewers, but in the first review each reviewer working on their own would have missed one paper eligible for inclusion in the review. Ascertainment intersection techniques indicate that it is unlikely that further papers have been missed in the screening process. CONCLUSION: Published search strategies may miss papers for reviews of diagnostic test accuracy. Papers are not easily identified as studies of diagnostic test accuracy, and the lack of information in the abstract makes it difficult to assess the eligibility for inclusion in a systematic review.

Abstracting and Indexing↗

EMBASE search strategies achieved high sensitivity and specificity for retrieving methodologically sound systematic reviews.

OBJECTIVES: Systematic reviews of the literature are instrumental for bridging research to health care practice and are widely available through databases such as MEDLINE and EMBASE. Search strategies have been developed to aid users in MEDLINE, but no empirical work has been done for EMBASE. The objective of this study was to develop search strategies that optimize the retrieval of methodologically sound systematic reviews from EMBASE. STUDY DESIGN AND SETTING: An analytic survey was conducted, comparing hand searches of 55 journals with retrievals from EMBASE for 4,843 candidate search terms and 17,004 combinations. Candidate search strategies were run in EMBASE, the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. RESULTS: Two hundred twenty (16.2%) of the 1,354 articles classified as a review met basic criteria for scientific merit. Combinations of search terms reached peak sensitivities of 94.6% with specificity at 63.7%, whereas combinations of search terms to optimize specificity reached peak specificities of 99.3% with sensitivity at 61.4%. CONCLUSION: Empirically derived search strategies can achieve high sensitivity and specificity for retrieving methodologically sound systematic reviews from EMBASE.

Databases, Bibliographic↗

Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.

OBJECTIVES: The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. METHODS: We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process. RESULTS: Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made. CONCLUSION: Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures. PRACTICE IMPLICATIONS: Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.

Adolescent↗

[Interest of performing systematically the protein profile in an internal medicine department. National survey and prospective study on 229 admissions].

INTRODUCTION: Despite a wide national use, the usefulness of the protein profile has only been evaluated in a small number of studies, essentially in patients with unknown diagnoses. METHODS: We conducted a survey on 339 french internal medicine departments to evaluate how the protein profile was used in these services. Concomitantly we achieved a prospective study on 229 patients in our department, with a mean follow up of 9 months, to evaluate how did the protein profile influence the diagnosis process. RESULTS: We received 183 responses to our national survey: the protein profile was available in 110/183 (60%) departments with 94/110 (85%) using it during hospitalisation and 20/94 (21.3%) using it systematically. Among the 229 protein profile analysed in our department, 44 (19.2%) were considered useful with 20 (8.7%) of them allowing the diagnosis of a new pathology. If the profile had not been done systematically, the physicians of our department would have performed the profile in 102/229 (44.5%) cases, whereas seven (3%) useful profiles would not have been done. CONCLUSION: We think that the profile has a consistent interest in hospitalized patients with a known or unknown pathology but performing systematically such a test appears to be of limited benefit.

Blood Proteins↗

Treatment of venous thromboembolism with low-molecular-weight heparin: a synthesis of the evidence published in systematic literature reviews.

OBJECTIVE: To evaluate the methodology and cumulative evidence presented in systematic reviews of clinical trials comparing low-molecular-weight heparin (LMWH) with unfractionated heparin (UFH) for the treatment of venous thromboembolism. METHODS: We reviewed all systematic reviews of clinical trials published until March 2002. Fourteen systematic literature reviews were published between 1994 and 2000. Deficiencies in methodological quality were common, particularly in the description of search strategies, assessment of clinical trial quality, and methods used to combine results. RESULTS: Results of reviews indicate that LMWH is superior to UFH for the treatment of venous thromboembolism, particularly in reducing mortality. Patients with isolated deep venous thrombosis or deep venous thrombosis with concomitant pulmonary embolism seemed to have similar benefit. However, the benefits of LMWH over UFH were smaller in magnitude in reviews that included more recent clinical trials.

Anticoagulants↗

Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: an overview of five Cochrane systematic reviews.

BACKGROUND: A range of physical therapies (including airway clearance and physical training) are used in cystic fibrosis (CF). The aim of this paper is to summarise the main findings from Cochrane systematic reviews that have considered the evidence for physical therapies in CF. METHODS: All outcomes reported in relevant Cochrane systematic reviews are summarised. RESULTS: Review 1 provides some evidence from short-term trials of the benefit of airway clearance over no airway clearance in improved mucus transport but no definitive evidence from long-term trials to support the efficacy of airway clearance over no airway clearance; review 2 provides some evidence that conventional chest physiotherapy (CCPT) is at least as effective as other forms of airway clearance, but that patients may have a preference for self-administered treatments over CCPT; review 3 provides some evidence that positive expiratory pressure (PEP) is at least as effective as other forms of airway clearance; review 4 provides some evidence to support the use of non-invasive ventilation during airway clearance in patients with moderate to severe disease who have difficulty clearing sputum; review 5 provides some evidence of the benefits of different types of physical training. CONCLUSION: The Cochrane systematic reviews summarised in this paper provide some evidence to support the inclusion of physical therapies in the care-management plan of CF. They also provide information to steer the direction and focus of future research in this area.

Body Weight↗