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PubMed2004

The historical origins of interstitial cystitis.

PURPOSE: We identify early descriptions of interstitial cystitis and trace its evolution as a clinical entity during the 19th century. MATERIALS AND METHODS: Primary and secondary source documents relating to interstitial cystitis, bladder inflammation and bladder stones were reviewed. RESULTS: What is believed to be the earliest published record of interstitial cystitis appeared in an 1836 textbook by the Philadelphia surgeon Joseph Parrish, who documented a syndrome of chronic frequency, urgency, dysuria and pelvic pain he called "tic doloureux of the bladder." Tic doloureux was a contemporaneous diagnosis used to describe painful, idiopathic disorders of nerves. Parrish attributed this term to his mentor, Dr. Phillip Syng Physick, who applied it to patients with severe lower urinary tract symptoms with no discernible etiology, with the most common etiology during the 19th century being bladder stones. A review of archival material from the Philadelphia College of Physicians indicates that by 1808 Physick had developed a concept of bladder inflammation, a "bladder ulcer," that produced lower urinary tract symptoms in the absence of bladder stone. CONCLUSIONS: By 1808 Philip Syng Physick had described an inflammatory condition of the bladder producing the same lower urinary tract symptoms as a bladder stone. By 1836 he had expanded this concept to include a chronic frequency, urgency and pain syndrome occurring in the absence of demonstrable etiology. We propose that these are the earliest known descriptions of bladder inflammation and interstitial cystitis.

Cystitis, Interstitial↗
PubMedDate not supplied

Primary care physicians' use of office resources in the provision of preventive care.

OBJECTIVES: To assess (1) the extent to which office resources (eg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. DESIGN: Survey. SUBJECTS: Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, III, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. MALE OUTCOME MEASURES: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. RESULTS: Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. CONCLUSIONS: The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics.

Adult↗
PubMed1985

Difference in the location of finger placement on the radial artery for pulse diagnosis in the Orient; and, 15th to 18th century Occidental rare books on pulse diagnosis.

Present day finger placement on the radial artery for pulse diagnosis to determine the relationship between organs and general condition vary according to widely used Chinese or Tibetan method. Variations exist between different historical Chinese periods on finger organ representation points and vary to minimum extent among Tibetan historical and current writers. By photographing lesser known Occidental 15th to 18th century rare books on pulse readings from the New York Academy of Medicine and the Philadelphia College of Physicians and Surgeons, a clearer understanding of Oriental influences to Occidental cardio-vascular understanding is apparent. The Chinese pulse meridian influenced European scales for measurement in pulse speed (or rhythm), vessel size, and organ condition.

Arm↗
PubMed1995

A practice guideline revisited: screening for hypertension.

In 1993, the Clinical Efficacy Assessment Subcommittee began evaluation of new topics and reevaluation of previous guidelines on common screening tests, which were published in Annals of Internal Medicine between 1988 and 1990 and republished as a collection in 1991 (Eddy DM, ed. Common Screening Tests. Philadelphia: American College of Physicians; 1991). Of the 11 guidelines contained in Common Screening Tests, only 3 (for breast, colon, and cholesterol screening) will be published with new data supporting new recommendations. Dr. Littenberg's analysis of the evidence that has appeared since the publication of the original paper on screening for hypertension (Littenberg B, Garber AM, Sox HC. Screening for Hypertension. Ann Intern Med. 1990;112:192-202) presents a new format for updating Clinical Efficacy Assessment Project (CEAP) guidelines that have not been altered by new evidence. This "updated guideline" reports on new published studies and its analysis affirms the approved American College of Physicians recommendations of 1990. The Clinical Efficacy Assessment Subcommittee carried out the Internal and external review procedures that are used for all CEAP guidelines. The plan is to keep all American College of Physicians guidelines updated in this way on a regular basis. Direct any comments or suggestions to Director, Scientific Policy, American College of Physicians, 6th Street at Race, Philadelphia, PA 19106.

Cost-Benefit Analysis↗
PubMed1980

The Founding Fathers and centennial history of the Philadelphia Academy of Surgery.

Samuel D. Gross, the acknowledged "Emperor of American Surgery of the 19th Century," founded the Philadelphia Academy of Surgery, the oldest surgical society in the United States, in 1879. He wrote the constitution and by-laws, became its first president, gave the first Annual Oration, bequeathed his library of 4,000 books, and endowed the "Gross Prize" which has been awarded 17 times between 1895 and 1977. Biographic highlights of Gross and the nine other Founding Fathers are sketched. The College of Physicians of Philadelphia, also the oldest institution of its kind, has been the only home of the Academy in a symbiotic relationship. Honorary Fellowships have been bestowed at various times since 1881 on 73 outstanding surgeons from the U.S. and abroad, the last nine at a gala Centennial Dinner Dance in November, 1979. Memorabilia relating to the Charter Members are housed in the Mutter Museum of The College of Physicians and were put on special exhibit for the Centennial Oration in December, 1979. Many of the pioneer and enduring scientific contributions of the members are recorded in the handwritten minutes of the first 25 years, the 32 volumes of Transactions and Annals of Surgery which has served as its official publication.

Academies and Institutes↗
PubMed1975

Adam Politzer, otology and the Centennial Exhibition of 1876.

The Centennial Exhibition of 1876 was held in Philadelphia. Among the exhibits was a collection of temporal bone dissections produced by Adam Politzer of Vienna. This exhibit included both normal and pathological temporal bones, and emphasized the relationship of the tympanic membrane to the middle ear, external canal and bony labyrinth. At the close of the Centennial Exhibition the collection was purchased by the College of Physicians of Philadelphia. This collection and the congress associated with the Centennial had a tangible effect on the otology in this country.

Ear Canal↗
PubMed1982

Jacob Mendez DaCosta: medical teacher, clinician, and clinical investigator.

J. M. DaCosta, a scholarly, well-trained and observant clinician, was recognized during his lifetime as a well-known authority on physical diagnosis and had an unexcelled reputation as a clinical teacher. Chairman of Medicine at the Jefferson Medical College for 19 years, president of the College of Physicians of Philadelphia in 1884 and again in 1895, he was one of the original members of the Association of American Physicians and its president in 1897. Earlier in his career, his extensive Civil War study of "a form of cardiac malady common among soldiers . . . the study of which is equally interesting to the civil practitioner" was described in his 1871 paper "On Irritable Heart; A Clinical Study of a Form of Functional Cardiac Disorder and Its Consequences." Soon labeled DaCosta's syndrome, the irritable heart lineage can be traced through the soldier's heart, the effort syndrome, and neurocirculatory asthenia in World War I, anxiety neurosis in World War II, and the mitral valve prolapse syndrome in the second half of the 20th century.

Cardiology↗
PubMed2001

How to develop cost-conscious guidelines.

BACKGROUND: Clinical guidelines, defined as 'systematically developed statements to assist both practitioner and patient decisions in specific circumstances', have become an increasingly familiar part of clinical care. Guidelines are viewed as useful tools for making care more consistent and efficient and for closing the gap between what clinicians do and what scientific evidence supports. Interest in clinical guidelines is international and has its origin in issues faced by most healthcare systems: rising healthcare costs; variations in service delivery with the presumption that at least some of this variation stems from inappropriate care; the intrinsic desire of healthcare professionals to offer, and patients to receive, the best care possible. Within the UK, there is ongoing interest in the development of guidelines and a fast-developing clinical-effectiveness agenda within which guidelines figure prominently. Over the last decade, the methods of developing guidelines have steadily improved, moving from solely consensus methods to methods that take explicit account of relevant evidence. However, UK guidelines have tended to focus on issues of effectiveness and have not explicitly considered broader issues, particularly cost. This report describes the methods developed to handle benefit, harm and cost concepts in clinical guidelines. It reports a series of case studies, each describing the development of a clinical guideline; each case study illustrates different issues in incorporating these different types of evidence. HEALTH ECONOMICS AND CLINICAL GUIDELINES: There has been no widely accepted successful way of incorporating economic considerations into guidelines. Unlike other areas of guideline development, there is little practical or theoretical experience to direct the incorporation of cost issues within clinical guidelines. However, the reasons for considering costs are clearly stated: "health interventions are not free, people are not infinitely rich, and the budgets of [health care] programmes are limited. For every dollar's worth of health care that is consumed, a dollar will be paid. While these payments can be laundered, disguised or hidden, they will not go away" (Eddy DM. A manual for assessing health practices and designing practice policies: the explicit approach. Philadelphia: American College of Physicians; 1992). Such opportunity costs are a universal phenomenon. In the USA it has been recommended that every set of clinical guidelines should include information on the cost implications of the alternative preventive, diagnostic, and management strategies for each clinical situation. The stated rationale was that this information would help potential users to evaluate better the potential consequences of different practices. However, it was acknowledged that "the reality is that this recommendation poses major methodological and practical challenges" (Institute of Medicine. Guidelines for clinical practice: from development to use. Washington: National Academy Press; 1992). METHODS OF DEVELOPING CLINICAL GUIDELINES: A guideline development process summarises the technical information about the value of treatments in a manner that makes them accessible and ready for use in clinical practice, alongside information on contextual issues. The requirement is that the presentation of costs and benefits of treatments is methodologically sound, robust and accessible. This report includes a summary of the current best practice in evidence-based guideline development, including recent methodological advances. The manner in which cost and cost-effectiveness concepts have been successfully incorporated into the guideline process is introduced. GUIDELINE DEVELOPMENT CASE STUDIES: The 'cost-effectiveness' sections of 11 guidelines are reported to illustrate both the range of methods used and the nature of the recommendations reached by the guideline development groups when considering the profile of consequences of treatments including costs. These guidelines are broadly grouped as: (1) those using qualitative evidence summary methods; (2) those using quantitative evidence summary methods and addressing relatively narrow clinical questions; (3) those using quantitative evidence summary methods and addressing a broad clinical area; (4) a guideline based upon a decision analysis model. CONCLUSIONS: The focus of this project was to explore the methods of incorporating cost issues within clinical guidelines. However, the process of reviewing evidence in guideline development groups is becoming increasingly sophisticated, not only in considerations of cost but also in review techniques and group process. At the outset of the project it was unclear how narrowly or broadly the concept of 'cost' could be considered. (ABSTRACT TRUNCATED)

Arthritis↗