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PubMedDate not supplied

An overview of osteopathic medicine.

Despite an initial lack of acceptance by mainstream medicine, and amidst projections of a serious oversupply of physicians, the osteopathic profession continues to grow, successfully competing for shrinking health care resources and attracting the attention of insurers and those in managed care. However, a recent telephone survey of 800 health maintenance organization beneficiaries suggested that the public is not yet familiar with osteopathic medicine. The history, philosophy, and current status of the osteopathic profession are presented, along with theories of the physiologic basis of and supporting evidence for palpatory diagnosis and manipulative therapy.

History, 20th Century↗

PubMed2004

Treating opioid dependence. Growing implications for primary care.

Almost 3 million Americans have abused heroin. The most effective treatment for this concerning epidemic is opioid replacement therapy. Although, from a historical perspective, acceptance of this therapy has been slow, growing evidence supports its efficacy. There are 3 approved medications for opioid maintenance therapy: methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride. Each has unique characteristics that determine its suitability for an individual patient. Cardiac arrhythmias have been reported with methadone and levomethadyl, but not with buprenorphine. Due to concerns about cardiac risk, levomethadyl use has declined and the product may ultimately be discontinued. These recent safety concerns, specifics about opioid detoxification and maintenance, and new federal initiatives were studied. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence. Although only a minority of eligible patients are engaged in treatment, opioid maintenance therapy appears to offer the greatest public health benefits. There is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic illnesses. This model has gained wide acceptance in Europe and is now being implemented in the United States. The recent Drug Addiction Treatment Act enables qualified physicians to treat opioid-dependent patients with buprenorphine in an office-based setting. Mainstreaming opioid addiction treatment has many advantages; its success will depend on resolution of ethical and delivery system issues as well as improved and expanded training of physicians in addiction medicine.

Analgesics, Opioid↗

PubMed2005

Recent trends in use of herbal and other natural products.

BACKGROUND: The benefits of herbal and other natural products (dietary supplements) are increasingly cited in the media. Dramatic increases in use reported during the last decade have led to growing concerns about efficacy and safety. METHODS: To determine which dietary supplements American adults use, whether the prevalence has continued to increase in recent years, and whether popularity of individual supplements has changed, demographic information and details of use of all medicines and dietary supplements in the preceding week were obtained by telephone interview from February 1998 through December 2002 from households in 48 contiguous states and the District of Columbia. Participants included randomly selected residents of households with telephones; compared with 2000 US Census data, participants were representative of the US population. The main outcome measure was the weekly prevalence of dietary supplement use, alone or in a multicomponent product. RESULTS: There were 8470 subjects 18 years or older. The annual prevalence of dietary supplement use increased from 14.2% in 1998-1999 to 18.8% in 2002. Although use did not change among younger subjects, it doubled for men and women 65 years or older. Use of Ginkgo biloba and Panax ginseng declined during the study, while lutein use increased dramatically, because of its addition to multivitamin products. The overall 2002 prevalence excluding lutein use was 13.9%. CONCLUSIONS: The popularity of specific supplements has varied over time and differs according to age and sex. The sharp increase in supplement use in the 1990s appears to have slowed. However, the addition of supplements, such as lutein and lycopene, to mainstream multivitamins has become an important source of exposure.

Adult↗

PubMed1998

The 'first to perish'. Child euthanasia in the Third Reich.

In an attempt to improve racial fitness, racial policy in the Third Reich targeted many groups, including physically and mentally handicapped children. An early program identified disabled children who were systematically selected and then transferred to various hospital centers where they were actively euthanatized. The program, directed by mainstream German physicians, was begun on the eve of war and was a harbinger of the evils to come. This article highlights the "scientific thought" that provided the rationale for this policy together with the details of implementation of the active euthanasia program and profiles one of the major participants, Werner Catel, DrMed, who was a distinguished pediatrician.

Child↗

PubMed1999

The growth of school-based health centers and the role of state policies: results of a national survey.

OBJECTIVES: To document recent growth among school-based health centers across the United States and identify state policies that may be facilitating that growth, using a nationwide survey. This was the fourth in a series of surveys undertaken by the Making the Grade office, Washington, DC. DESIGN: During the period from July to September 1998, a written survey instrument was sent to 50 state governments plus the District of Columbia requesting data on numbers of school-based health centers as well as their basic characteristics and a description of state funding and other policies as they relate to the centers. Follow-up telephone calls and additional mailings secured a 100% completion rate. MAIN OUTCOME MEASURES: The numbers of centers by state and region, basic health center characteristics, levels of state financial support, and numbers of states implementing specific policies to sustain and replicate the centers. RESULTS: School-based health centers increased from 900 during school year 1995-1996 to 1157 in 1997-1998, a 29% gain. Mid-Atlantic and New England states continue to lead the regions with 37% of the total. The fastest growth occurred in the Midwest and the Southwestern/Rocky Mountain states. State grant funding of centers decreased slightly during this period. Other policies, including support from Medicaid and the State Child Health Insurance Program, are increasing third-party revenues. CONCLUSIONS: The spread of school-based health centers into the Southwest and Rocky Mountain states is increasing the importance of the centers to rural communities. Because these areas are generally more conservative than either coast, these developments suggest a continued migration of school-based health centers from the political margins into the mainstream. The growth of the centers during a period of stagnation in state grant funding may also suggest that other sources of support, including third-party payments and support from private institutions, are becoming more significant.

Adolescent↗

PubMed1979

Boundary layer separation in models of side-to-end arterial anastomoses.

We performed an investigation of boundary layer separation in models of side-to-end anastomoses, used clinically in axillofemoral and femorofemoral grafting. Boundary layer separation occurs when momentum causes a fluid to flow against a local pressure gradient. Models of side-to-end anastomoses were constructed from Dacron grafting material and from clear plastic blocks and tubing. Fluid energy loss across the anastomosis was small and physiologically insignificant. Local adverse pressure gradients were demonstrated near the anastomosis. Flow visualization studies demonstrated characteristic areas of boundary layer separation in the region of the adverse pressure gradients. The separation region involved both the main limb and the side arm. The separation forms a shell or ring of slow-moving fluid around the mainstream. Preliminary studies with pulsatile flow and with blood demonstrate that boundary layer separation occurs under clinical flow conditions. Boundary layer separation may play a role in the development of anastomotic hyperplasia and atherosclerotic deposits in the vicinity of surgical anastomoses.

Arteriosclerosis↗

PubMed1995

Summary of the 112th Annual Meeting of the German Society of Surgery. Berlin, April 18-22, 1995.

The Annual Meeting of the German Society of Surgery is the main clinical and research forum for the German surgical community. The venue, which was Munich for the past few decades, was changed to Berlin this year in commemoration of the foundation of the society in 1872 in the former and new German capital. Over 3000 surgeons, internists, and basic scientists took part in this year's meeting, which consisted of 1035 presentations. Only single aspects of the meeting can be described: those that are thought either to represent the mainstream of surgical progress in Germany or to depict socioeconomic problems of general interest.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

Health care fraud and abuse.

In recent years, health care fraud and abuse have become major issues, in part because of the rising cost of health care, industry consolidation, the emergence of private "whistle-blowers," and a change in the concept of fraud to include an emerging concern about quality of care. The 3 types of conduct that are generally prohibited by health care fraud laws are false claims, kickbacks, and self-referrals. False claims are subject to several criminal, civil, and administrative prohibitions, notably the federal civil False Claims Act. Kickbacks, or inducements with the intent to influence the purchase or sale of health care-related goods or services, are prohibited under the federal Anti-Kickback statute as well as by state laws. Finally, self-referrals-the referral of patients to an entity with which the referring physician has a financial relationship-are outlawed by the Ethics in Patient Referral Act as well as numerous state statutes. Consequences of violations of these laws can include, in addition to imprisonment and fines, civil monetary penalties, loss of licensure, loss of staff privileges, and exclusion from participation in federal health care programs. Federal criminal and civil statutes are enforced by the US Department of Justice; administrative actions are pursued by the Department of Health and Human Services' Office of Inspector General; and all state actions are pursued by the individual states. In addition, private whistle-blowers may, acting in the name of the United States, file suit against an entity under the False Claims Act. Enforcement of health care fraud and abuse laws has become increasingly commonplace and now affects many mainstream providers. This trend is likely to continue.

Disclosure↗

PubMed2001

Implications of the Human Genome Project for medical science.

The year 2000 marked both the start of the new millennium and the announcement that the vast majority of the human genome had been sequenced. Much work remains to understand how this "instruction book for human biology" carries out its multitudes of functions. But the consequences for the practice of medicine are likely to be profound. Genetic prediction of individual risks of disease and responsiveness to drugs will reach the medical mainstream in the next decade or so. The development of designer drugs, based on a genomic approach to targeting molecular pathways that are disrupted in disease, will follow soon after. Potential misuses of genetic information, such as discrimination in obtaining health insurance and in the workplace, will need to be dealt with swiftly and effectively. Genomic medicine holds the ultimate promise of revolutionizing the diagnosis and treatment of many illnesses.

Human Genome Project↗

PubMed1998

Assessing uncertainty in microsimulation modelling with application to cancer screening interventions.

Microsimulation is fast becoming the approach of choice for modelling and analysing complex processes in the absence of mathematical tractability. While this approach has been developed and promoted in engineering contexts for some time, it has more recently found a place in the mainstream of the study of chronic disease interventions such as cancer screening. The construction of a simulation model requires the specification of a model structure and sets of parameter values, both of which may have a considerable amount of uncertainty associated with them. This uncertainty is rarely quantified when reporting micro-simulation results. We suggest a Bayesian approach and assume a parametric probability distribution to mathematically express the uncertainty related to model parameters. First, we design a simulation experiment to achieve good coverage of the parameter space. Second, we model a response surface for the outcome of interest as a function of the model parameters using the simulation results. Third, we summarize the variability in the outcome of interest, including variation due to parameter uncertainty, using the response surface in combination with parameter probability distributions. We illustrate the proposed method with an application of a microsimulator designed to investigate the effect of prostate specific antigen (PSA) screening on prostate cancer mortality rates.

Adult↗

PubMed1999

Multiple-case depth research: bringing experience-near closer.

The term "experience-near" has become associated with a variety of alternatives to mainstream clinical research. These alternatives converge on one basic methodological goal-faithfulness to clinical phenomena as lived. This article presents one approach to lived clinical phenomena that I term multiple-case depth research or MCDR. MCDR is a novel and highly sensitive methodology that combines both in-depth case investigation with experiential therapeutic principles. To illustrate the power of MCDR, I present a hypothetical process and outcome study involving three client cohorts (those who undergo respectively cognitive-behavioral therapy, intersubjective psychoanalytic therapy, and existential-humanistic therapy). I detail the structure of this hypothetical study, the steps by which it proceeds, and the yield that it portends. I conclude that, if conducted properly, MCDR can provide rich, valid, and unprecedented insight into effective psychotherapy.

Cognitive Behavioral Therapy↗

PubMed2000

Blood-letting in anorexia nervosa: a case study.

BACKGROUND: Deliberate blood-letting has been characterized as an alternative to purging behavior in bulimia. METHOD: We describe a female healthcare worker with an 8-year history of restrictive anorexia nervosa, who initially presented with anemia, using blood-letting, cold baths, and starvation to control her mental state. RESULTS: In contrast with the previous cases of bulimia, the aim of blood-letting in this case of anorexia nervosa was to achieve anemia. She compared the psychic correlates of anemia to emaciation, rather than to deliberate self-harm or purging. DISCUSSION: We note that mainstream 19th century psychiatry prescribed "baths, blood-letting and diet" as a treatment of "madness."

Anemia↗

PubMedDate not supplied

Mass spectrometry in the search for uremic toxins.

This article reviews the literature on the mass spectrometry (MS) that has been used in the research of uremic toxins. Gas chromatography/mass spectrometry (GC/MS) has been most often used for the analysis of low-molecular-weight compounds in uremic blood such as organic acids, phenols, and polyols. However, it cannot be used for the analysis of middle- to high-molecular-weight substances or for involatile compounds. The development of fast atom bombardment (FAB) and liquid secondary ion mass spectrometry (LSIMS) has made possible the analysis of middle-molecules and involatile low-molecular-weight substances such as peptides and nucleosides. The development of atmospheric pressure chemical ionization (APCI) has also lead to the analysis of involatile low-molecular-weight substances. The recent advances in ionization methods, such as electrospray ionization (ESI) and matrix-assisted laser desorption ionization (MALDI), have permitted the MS analysis of high-molecular-weight substances such as beta 2-microglobulin, a major component of dialysis amyloid. Liquid chromatography/mass spectrometry (LC/MS), using ESI, APCI, or FAB as an ionization method, is currently the preferred method for the analysis of low- to high-molecular-weight substances in uremic blood. ESI-LC/MS and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOFMS) are useful for elucidating the structure of post-translationally modified proteins obtained from the blood and tissues of uremic patients. Post-translational modification such as the formation of advanced glycation end-products and carbamoylation is enhanced in uremic patients, and is considered to be responsible for some uremic symptoms. Laser microprobe MS is unique in its capability for the two-dimensional detection of atoms such as aluminum in a tissue section obtained from uremic patients. This review focuses on the mainstream research for discovering uremic toxins, specific uremic toxins identified or quantified using MS, and the MS analysis of post-translationally modified proteins in uremia. These studies have provided ample evidence that MS has played an important role in the search for uremic toxins.

Gas Chromatography-Mass Spectrometry↗

PubMed1997

Mutations affecting eye morphology in the developing zebrafish (Danio rerio).

The zebrafish (Danio rerio) has received considerable attention as a mainstream model for the molecular and genetic study of vertebrate development. In our laboratory, we have conducted a third-generation screen of chemically mutagenized zebrafish for recessive mutations affecting the visual system. This report describes the visible phenotypes and number of morphological mutants so far observed and presents a more detailed histological analysis of six of these mutations. Through analysis of mutant larvae, it was determined that several of the subtle morphological mutations resulted in degeneration of specific cellular layers of the retina. Other mutations resulted in some degeneration distributed diffusely across the entire retina or concentrated at the retinal margin. A single mutation affecting invagination of the optic cup and lens vesicle formation resulted in a failure to develop an anterior chamber. These results demonstrate the utility of a small-scale, highly focused screen for uncovering novel loci involved in retinal and eye development.

Animals↗

PubMed2000

Radical psychology institutionalized: a history of the Journal Psychologie & Maatschappij [psychology & society].

Starting out as a newsletter for radical psychologists, the Dutch journal Psychologie & Maatschappij (Psychology & Society) moved in the past decade toward the theoretical mainstream within psychology. In this paper, the major changes in the journal are described and analyzed, as well as the features that did not change: an emphasis on theory and history, an interdisciplinary approach, and an emphasis on discussion. The main transformations were from psychology as instrumental toward the goals of the progressive movement in the Netherlands, then to extreme criticism of all scientific and professional psychological activities, and finally to adherence to the most advanced approaches within academic psychology.

Communism↗

PubMed1993

Trends in patterns of treatment of childhood cancer in Los Angeles County.

To assess the proportion of children with cancer who have been managed by mainstream pediatric cancer programs, population-based cancer incidence data for Los Angeles County (LAC) children (under 20 years of age) for the years 1972 through 1987 were linked with patient records of children registered with the two national cooperative pediatric oncology groups, Children's Cancer Study Group and Pediatric Oncology Group. The proportion of children with cancer who were registered by cooperative groups increased markedly over time: 9% of LAC children younger than 15 years of age who were diagnosed with cancer in 1972 were registered with cooperative groups, compared to 52% of those diagnosed in 1980 and 62% of those diagnosed in 1987. Registration rates decreased with increasing age at cancer diagnosis. In the most recent time period, 1984-1987, 66% of LAC children diagnosed with cancer under age 5 years were registered with cooperative groups compared to 62% of those who were 5 to 9 years old and 49% of those who were 10 to 14 years old; although they were frequently diagnosed with tumors considered to be childhood cancers, only 19% of older adolescents (aged 15-19 years) were registered. In LAC, there was no apparent bias in registration rates with regard to gender or racial-ethnic background. Among patients diagnosed in the period 1984-1987, children in the highest of five socioeconomic status categories were underrepresented among registrants. Registration rates were highest (70% or greater) for patients with acute lymphocytic and acute nonlymphocytic leukemia, medulloblastoma, hepatoblastoma, Wilms tumor, and rhabdomyosarcoma. Fewer than 50% of patients with other brain and central nervous system tumors, retinoblastoma, other soft tissue sarcomas, and bone tumors were registered with the cooperative groups.

Adolescent↗

PubMed1993

The impact of clinical trial protocols on patient care systems in a large city hospital. Access for the socially disadvantaged.

Some Americans suffer a higher cancer incidence and mortality than those in mainstream American society, and, in general, do not enjoy the same health status. Black Americans, for example, have higher cancer incidence and lower survival rates than do white Americans. To date, there is no known genetic basis to account for the disparities in cancer incidence and outcome between these races. Controlling for socioeconomic status greatly reduces, and sometimes nearly eliminates, the apparent contrast in cancer mortality and incidence between ethnic groups. Poverty clearly is associated with diminished access to health care, an increased incidence of cancer, and 10-15% lower 5-year survival rates. Diminished access often is manifested by low quality and inadequate continuity of health care, as well as insufficient access to methods of disease detection, diagnosis, treatment, and rehabilitation. Poor people tend to concentrate on day-to-day survival, often feel hopeless and powerless, and may become socially isolated. It is more difficult to conduct cancer treatment trials in a population characterized by such dramatic socioeconomic and cultural differences. Lack of insurance and lack of compliance become trial-limiting issues. This paper examines what must be done to tear down the economic and cultural barriers to prevention, early detection, and treatment of cancer.

Clinical Trials as Topic↗

PubMed2001

A simple method of determining the modulus of orthopedic bone cement.

Accurate determination of the elastic modulus of surgical bone cements is of primary importance, when evaluating the stresses within the cement mantle in Total Joint Arthroplasty. This article presents a new method of determining the modulus of surgical bone cements from the biaxial flexural test. The biaxial flexural test is not currently employed in mainstream orthopedic mechanical testing, which is surprising because most loading in orthopedic applications is biaxial in nature. Nor has this method been utilized for dental materials, even though the biaxial flexure test has been used for many years in this field. It has been demonstrated that the modulus of surgical bone cements can be determined from the biaxial flexural test, and these results are in agreement with results from compressive and bending tests.

Bone Cements↗