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PubMed2006

[Definition and validation of quality indicators of prescription in primary care].

OBJECTIVE: To define and validate a battery of prescription indicators on the use of anti-hypertensives, lipid-lowerers, diabetes drugs, and insulin, as measurements of family doctors' quality of prescription in primary health care. DESIGN: Transversal, descriptive study. SETTING: Two primary care health districts, Camas and Sierra Norte, Spain. PARTICIPANTS: Eighty three family doctors, 94.32% of the doctors in the study area. DEFINITION AND VALIDATION OF INDICATORS: To construct the prescription indicators, we used evidence found in the scientific bibliography available. To validate it, we analysed its statistical relationship with a series of selected clinical tests, collected from the clinical records. RESULTS: For each doctor, there was a statistically significant relationship between the index of quality of prescription and the clinical quality seen in the records (P=.004). The variables of age, sex, and training fine-tuned the model. CONCLUSIONS: There is a statistically significant relationship between a good prescription indicator and proper control of intermediate health variables.

Adult↗

PubMed1992

Thrombolytic therapy for the treatment of acute pulmonary embolism.

OBJECTIVES: To determine whether thrombolytic therapy reduces the rate of death or complications in patients with acute pulmonary embolism and whether a particular thrombolytic regimen is more effective than others. DATA SOURCES: The key words "fibrinolytic agents," "plasminogen activators," "streptokinase," "urokinase" and "pulmonary embolism" were used to search MEDLINE for relevant articles in English; the bibliographies of these articles were reviewed for additional publications. STUDY SELECTION: Articles were included if they were of a randomized controlled design; 10 such articles were found. DATA EXTRACTION: Ten trials were appraised with the use of the following methodologic criteria: a clear description of the study population; use of objective criteria to diagnose pulmonary embolism and to assess outcomes; use of clinically relevant outcomes; and blinded outcome assessments. RESULTS: In the nine trials that met the methodologic criteria thrombolytic therapy led to a more rapid resolution of the radiographic and hemodynamic abnormalities associated with acute pulmonary embolism than did anticoagulant therapy alone, although these benefits were short-lived. No difference was detected in the death rate or the resolution of symptoms between patients receiving thrombolytic therapy and those receiving anticoagulant therapy alone. In addition, bleeding complications were more frequent and serious in patients who received lytic therapy, although these events were related to the use of invasive procedures. CONCLUSION: There is a lack of evidence that thrombolytic therapy improves clinically relevant outcomes of patients with acute pulmonary embolism. This may be a reflection of the small sample size of the clinical trials. Further research is required to define the role of thrombolytic therapy in the management of patients with acute pulmonary embolism.

Evaluation Studies as Topic↗

PubMed1999

A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease.

BACKGROUND: The aim of this study was to critically review the literature regarding interventions to improve cardiovascular patients' compliance with medication-taking, obtaining medication refills, or appointment keeping. METHODS: The search for relevant randomized trials involved searching the Medline, Healthplan, and Psychlit databases from 1985 to 1996; searching the bibliographies of located studies; contacting Australian government departments, non-government organizations, and pharmaceutical companies; and ultimate review of the resulting list by two field experts. The 33 located trials were critically appraised and classified as being of good, fair, or poor methodological quality. Descriptive and effectiveness data were then extracted from the 20 good and fair quality trials. Interrater reliability was high on the 20% of references double-coded. RESULTS: The 20 studies reviewed evaluated the effectiveness of 18 intervention strategies. Tentative recommendations were made for many patient-focused and structural strategies across all three target behaviors. Physician-focused strategies, tested only for appointment keeping, were all tentatively recommended against. CONCLUSIONS: The methodological quality of many of the located trials was less than optimal, prohibiting strong recommendations. Therefore, further good-quality, randomized trials are necessary in order to clarify the effectiveness of those strategies identified as potentially useful in this review.

Adult↗

PubMedDate not supplied

[Design and analysis of a prognosis study in urological clinical research].

Prognosis is a description of the course of a disease from the beginning. In comparison to risk factors, prognostic factors are relatively frequent and may often be estimated by our personal clinical experience. Nevertheless, the cases of diseases usually cared for at hospitals and described in the medical bibliography are often biased samples and have the tendency to overestimate severity. Cohort studies imply follow-up of the groups of individuals over time. They are the observational studies with the highest acceptance within the scientific community, because they include the target population in the study. If we look for providing solid information, the observation of the members of a cohort, independently of what they have in common, should comply with two criteria: 1. Cohorts should be observed for a significant period of time of the natural history of the event studied. 2. All members in a cohort should be observed for the full follow-up period. As in any cohorts observation, studies comparing prognosis among various groups of patients may be blased if differences appear due to cohort recruitment methods, patients shifting from their initial groups, and unequal results evaluation.

Biomedical Research↗

PubMed1989

Pulmonary edema associated with tocolytic therapy.

PURPOSE: To familiarize the general internist with the unique features of pulmonary edema occurring in association with tocolytic therapy (drugs used to inhibit uterine contractions). DATA IDENTIFICATION: The literature in English was searched using MEDLINE (1.966 to 1988), and bibliographies of pertinent articles and texts were reviewed. STUDY SELECTION: Fifty-eight case reports were examined by both authors and served as the database. DATA EXTRACTION: Several clinical variables, when available, were extracted from each case reported. Each variable was analyzed to provide an accurate composite description of pulmonary edema resulting from tocolytic therapy. RESULTS OF DATA SYNTHESIS: Patients with this syndrome present with dyspnea and may or may not have chest pain. Women at risk are receiving or have recently received sympathomimetic agents to arrest uterine contractions, with or without steroids. The incidence of the syndrome is higher in women with twin gestations. In postpartum cases, the syndrome usually occurs within 12 hours of delivery. Most women have intact membranes at presentation. Patients rarely have hypotension but usually have tachycardia and tachypnea. Chest roentgenograms usually show bilateral alveolar infiltrates and a normal-sized heart. Arterial blood gas values reveal an increased alveolar-arterial oxygen gradient. Hemodilution may cause a decrease in potassium values and the hematocrit. Patients respond rapidly to treatment with diuresis and oxygen administration and show clinical improvement usually within 24 hours. The underlying mechanism appears to be related to increased hydrostatic pressure and not to increased permeability or a direct toxic effect of tocolytic agents. CONCLUSIONS: Familiarity with the clinical features outlined above should increase the internist's ability to manage this problem without further invasive or noninvasive testing that might otherwise be used in evaluating dyspnea in pregnancy.

Adolescent↗

PubMed2001

[Adult celiac disease: study of 21 cases and review of the bibliography].

Celiac sprue is a chronic disease characterized by a typical lesion in the small intestine and nutrient malabsorption that improves on withdrawal of dietary gluten. Adult celiac disease (or gluten enteropathy) is a common and under-diagnosed disease since presentation varies among a) symptomatic or clinically active forms (including mono- or oligosymptomatic forms), b) asymptomatic, subclinical or silent forms, and c) latent forms. We present a descriptive study of a retrospective series of patients diagnosed with symptomatic or clinically active adult celiac disease who required hospitalization between January 1993 and June 2000. The form of symptomatic expression, biological alterations, investigations that confirm the diagnosis, associated diseases, complications and response to treatment are described.

Adolescent↗

PubMed2006

Two-photon fluorescence excitation and related techniques in biological microscopy.

This review is concerned with two-photon excited fluorescence microscopy (2PE) and related techniques, which are probably the most important advance in optical microscopy of biological specimens since the introduction of confocal imaging. The advent of 2PE on the scene allowed the design and performance of many unimaginable biological studies from the single cell to the tissue level, and even to whole animals, at a resolution ranging from the classical hundreds of nanometres to the single molecule size. Moreover, 2PE enabled long-term imaging of in vivo biological specimens, image generation from deeper tissue depth, and higher signal-to-noise images compared to wide-field and confocal schemes. However, due to the fact that up to this time 2PE can only be considered to be in its infancy, the advantages over other techniques are still being evaluated. Here, after a brief historical introduction, we focus on the basic principles of 2PE including fluorescence correlation spectroscopy. The major advantages and drawbacks of 2PE-based experimental approaches are discussed and compared to the conventional single-photon excitation cases. In particular we deal with the fluorescence brightness of most used dyes and proteins under 2PE conditions, on the optical consequences of 2PE, and the saturation effects in 2PE that mostly limit the fluorescence output. A complete section is devoted to the discussion of 2PE of fluorescent probes. We then offer a description of the central experimental issues, namely: choice of microscope objectives, two-photon excitable dyes and fluorescent proteins, choice of laser sources, and effect of the optics on 2PE sensitivity. An inevitably partial, but vast, overview of the applications and a large and up-to-date bibliography terminate the review. As a conclusive comment, we believe that 2PE and related techniques can be considered as a mainstay of the modern biophysical research milieu and a bright perspective in optical microscopy.

Biology↗

PubMed2006

Meningococcal meningitis prevention programs for college students: a review of the literature.

BACKGROUND AND PURPOSE: The incidence of meningococcal meningitis in college students is higher than in other populations. College students, especially 1st-year students living in dormitories or residence halls, are among those at highest risk of developing the disease. It is estimated that immunization can prevent up to 83% of cases among adolescents and college students. A review of the literature was undertaken to identify and critique the research-based prevention programs that are focused on college students. METHOD: An extensive search of the Cochrane Database of systematic reviews, Medline, PubMed, and CINAHL was undertaken. The Journal of American College Health was hand searched, and bibliographies were reviewed for studies not otherwise identified. Four publications met the search criteria. These studies were reviewed and graded for level of evidence. FINDINGS: One study could not be compared with the other three because of its lack of detail. Of the other three studies, two were descriptive and factors were identified that related to vaccination and nonvaccination in the college student population (both Evidence Grade C). Only one study was described that included an educational intervention, which resulted in increased vaccination rates in a college student population (Evidence Grade B). CONCLUSIONS AND IMPLICATIONS: The published literature is severely limited in the area of meningococcal meningitis prevention programs in the at-risk college student population. A critical need exists for controlled studies to test the interventions that are most effective in this population as well as broader-based studies to further identify those students at increased risk for the disease as well as for nonvaccination.

Adolescent↗

PubMed1977

[Bronchial spasm and bronchial motoricity].

The author recalls the phenomena which control bronchomotility, without a personal study but based on recent bibliography. After recalling the bronchial nerve supply, the chemical intermediates, the various responses of the bronchial tree to autacoids, the author recalls the association of anesthesia and bronchospasm. Although the bronchial reactions of histaminic origin are the most frequent, mechanical or chemical irritation is recalled with an elementary description of "irritant receptors" and stretch receptors. Finally, the other causes of bronchial narrowing are considered: vago-sympathetic imbalance, atopic background, influence of the anesthetic on vagal tone or on adrenal medullary secretion.

Anesthesia, General↗

PubMed1994

A meta-analysis of methods to prevent venous thromboembolism following total hip replacement.

OBJECTIVE: While several methods of prophylaxis have been shown to reduce the risk of venous thromboembolism following total hip replacement, the safest and most effective agent is unclear. To clarify this issue, we performed a meta-analysis of the randomized trials of methods used to prevent venous thromboembolism following total hip replacement. DATA SOURCE: English-language human studies articles from 1966 through 1993 were obtained from a MEDLINE database search with indexing terms including thromboembolism, hip replacement or hip prosthesis, and randomized controlled trials. Additional references were obtained from study bibliographies. STUDY SELECTION: The following criteria were used to select studies for inclusion: study design--randomized clinical trial; study population--patients undergoing elective total hip replacement; interventions--aspirin, warfarin, dextran, heparin, low-molecular-weight heparin, compression stockings; and outcomes--venous thromboembolism, major hemorrhage. DATA EXTRACTION: Methodological and descriptive data from each study were abstracted by one author who was blinded to quantitative outcomes data. DATA SYNTHESIS: Ninety-one treatment groups and 25 control groups were identified from 56 trials. Four treatment groups were excluded because of rarely used combinations. Trial populations were clinically homogeneous. When compared with the control arm, all treatments except aspirin reduced the risk of all deep venous thromboses (risk differences range, 0.18 to 0.31; all P values < .05). All treatments except aspirin reduced the risk of proximal venous thrombosis (risk differences range, 0.09 to 0.18; all P values < .05). Only low-molecular-weight heparin and stockings reduced the risk of pulmonary embolism, both with risk differences equal to 0.02. The crude risks of clinically important bleeding as defined by the individual trials were 0% for stockings, 0.3% for controls, and 1.8% for low-molecular-weight heparin. CONCLUSIONS: The results suggest that low-molecular-weight heparin and compression stockings have the greatest relative efficacy in preventing venous thromboembolism following total hip replacement. Low-molecular-weight heparin may be more effective, though at a small risk of clinically important bleeding.

Aspirin↗

PubMed2001

A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97.

OBJECTIVES: To appraise findings from studies examining the impact of computers on primary care consultations. DESIGN: Systematic review of world literature from 1980 to 1997. DATA SOURCES: 5475 references were identified from electronic databases (Medline, Science Citation Index, Social Sciences Citation Index, Index of Scientific and Technical Proceedings, Embase, OCLC FirstSearch Proceedings), bibliographies, books, identified articles, and by authors active in the field. 1892 eligible abstracts were independently rated, and 89 studies met the inclusion criteria. MAIN OUTCOME MEASURES: Effect on doctors' performance and patient outcomes; attitudes towards computerisation. RESULTS: 61 studies examined effects of computers on practitioners' performance, 17 evaluated their impact on patient outcome, and 20 studied practitioners' or patients' attitudes. Computer use during consultations lengthened the consultation. Reminder systems for preventive tasks and disease management improved process rates, although some returned to pre-intervention levels when reminders were stopped. Use of computers for issuing prescriptions increased prescribing of generic drugs, and use of computers for test ordering led to cost savings and fewer unnecessary tests. There were no negative effects on those patient outcomes evaluated. Doctors and patients were generally positive about use of computers, but issues of concern included their impact on privacy, the doctor-patient relationship, cost, time, and training needs. CONCLUSIONS: Primary care computing systems can improve practitioner performance, particularly for health promotion interventions. This may be at the expense of patient initiated activities, making many practitioners suspicious of the negative impact on relationships with patients. There remains a dearth of evidence evaluating effects on patient outcomes.

Bibliometrics↗

PubMed2006

Current status of cetuximab for the treatment of patients with solid tumors.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical evidence, and safety, as well as the potential directions for use, of the epidermal growth factor receptor (EGFR) monoclonal antibody cetuximab. DATA SOURCES: A MEDLINE search (1966-December 2005) was conducted using the following terms: cetuximab, Erbitux, C225, epidermal growth factor receptor, and EGFR. Additional information was obtained via meeting abstracts, bibliographies from relevant articles, national guidelines, and the manufacturer. STUDY SELECTION AND DATA EXTRACTION: Preclinical and clinical trials utilizing cetuximab in the treatment of solid tumors were selected from the data sources. All published, randomized clinical trials involving cetuximab in treatment of metastatic colorectal cancer and studies providing a description of the pharmacology, pharmacokinetics, safety, or efficacy were included in this review. DATA SYNTHESIS: Many solid tumors overexpress EGFR, making it an ideal target for anticancer agents. Cetuximab is the only EGFR monoclonal antibody commercially available and is approved for the treatment of EGFR-expressing, metastatic colorectal cancer in patients refractory or intolerant to irinotecan. Data on patients with other solid tumors are encouraging with cetuximab used as monotherapy or in combination with chemotherapy, radiation, or other targeted agents. Common adverse effects include dermatologic and hypersensitivity reactions. CONCLUSIONS: Further clinical data are necessary to clearly define the role of cetuximab in the treatment of patients with solid malignancies, with emphasis on survival and quality-of-life benefits relative to its cost.

Animals↗

PubMed1990

The prognosis of depression in the elderly.

Controversy prompted a systematic and critical review of original research articles to determine the prognosis of depression in the elderly. A search of three computer databases for articles published from January 1980 to May 1989 and of the bibliographies of articles located revealed 10 reports, involving 990 subjects, that met the following inclusion criteria: original research, published in English or French since 1950, sample of at least 25 patients, inclusion of only patients over 60 years, mean follow-up period of 1 year or more and description of the patients' mental state during follow-up. The methods and study designs were then assessed with the use of the criteria for prognostic studies established by McMaster University Health Sciences Centre, Hamilton, Ont. All of the studies had serious, multiple flaws. Nevertheless, when the results were combined it appeared that at least 60% of the patients remained well or had relapses with recovery (mean follow-up 31.9 months); up to 25% remained continuously ill. Physical illness, cognitive impairment and severe depressive symptoms were frequently related to poor prognosis; most of the social factors studied were not related to prognosis. Future studies must pay attention to methods and design, particularly the composition of study populations, the assessment of outcomes and the control of extraneous prognostic factors.

Aged↗

PubMed1988

The California Child Health and Development Studies of the School of Public Health, University of California at Berkeley.

The Child Health and Development Studies are prospective longitudinal studies on medical and social aspects of pregnancies and on the health and development of children. Data have been assembled on about 20,000 pregnancies occurring in one hospital between 1959 and 1967, and on follow-up of the children through adolescence. A currently ongoing project updates certain vital statistics of the entire study population. The data assembled in this longitudinal study supported a wide range of research projects, several of which proved to be important for the health of mothers and children. Notwithstanding, subsets of the assembled data, with potential value for public health, have not yet been explored. The data archive has been made accessible to the research community at large so that other significant research topics can be investigated. In the following article, brief descriptions are given of the history and design of the Child Health and Development Studies, of the contents of the data archive, and of the major areas of research that have been explored. Procedures to obtain access to the data and to the user's manual are explained, and a bibliography is included.

Adolescent↗

PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: From a total of 48 potentially relevant reviews preselected in a screening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. CONCLUSIONS: A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials.

Acupuncture↗

PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with homeopathy. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of homeopathy; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: Eighteen out of 22 potentially relevant reviews preselected in the screening process met the inclusion criteria. Six reviews addressed the question whether homeopathy is effective across conditions and interventions. The majority of available trials seem to report positive results but the evidence is not convincing. For isopathic nosodes for allergic conditions, oscillococcinum for influenza-like syndromes and galphimia for pollinosis the evidence is promising while in other areas reviewed the results are equivocal. INTERPRETATION: Reviews on homeopathy often address general questions. While the evidence is promising for some topics the findings of the available reviews are unlikely to end the controversy on this therapy.

Asthma↗

PubMed2003

[Henry IV de Castilla( 1454-1474). An exceptional urologic patient. Morphological and personality portrait of Henry IV " The impotent" in contemporary chronicles and manuscripts (I)].

OBJECTIVES: To make an update on Gregorio Marañon's work "Biological essay about Henry IV and his time" (Madrid 1930), reviewing the clinical diagnosis made by the famous spanish doctor-historian more than 70 years ago on the last Monarch of the Castilian Trastamara, because we consider that diseases suffered by Henry IV were urologic mainly. METHODS: We reviewed 10 chronicles, 5 contemporary manuscripts, and 25 works about the figure of Henry IV published up to year 2000. For comparisons between works we evaluated not only the chronicles and works used by Marañon, but also the more recent ones of medical character, which have resulted in a significant increase in the amount of data about the figure of the Monarch. Additionally, following our current knowledge we tried to adapt the clinical diagnosis from Marañon--eunucoid dysplasia with acromegalic reaction--to current nomenclature in order to define the kind of endocrinopathy the Monarch suffered. RESULTS: Following a review of contemporary chronicles and recent bibliography about Henry IV, the Monarch was a singular urologic patient. He suffered chronic renal lithiasis, impotence, a presumptive penile anomaly, and almost surely infertility, although all his uro-andrological diseases were part of the endocrinopathy the Monarch suffered, probably a hypophyseal tumor. Included in the work there are descriptions of his physiognomy and psychopathological characters of his personality from the chronicles, commenting on all clinical symptoms the Monarch suffered according to his biographers and present day doctors and historians.

Famous Persons↗

PubMed2003

Epidural steroids in the management of chronic spinal pain and radiculopathy.

Epidural injections with or without steroids are used extensively in the management of chronic spinal pain. However, evidence is contradictory with continuing debate about the value of epidural steroid injections in chronic spinal syndromes. The objective of this systematic review is to determine the effectiveness of epidural injections in the treatment of chronic spinal pain. Data sources include relevant literature identified through searches of MEDLINE, EMBASE (Jan 1966- Mar 2003), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings. Both randomized and non-randomized studies were included in the review based on the criteria established by the Agency for Healthcare Research and Quality (AHRQ). Studies were excluded from the analysis if they were simply review or descriptive and failed to meet minimum criteria. The results showed that there was strong evidence to indicate effectiveness of transforaminal epidural injections in managing lumbar nerve root pain. Further, evidence was moderate for caudal epidural injections in managing lumbar radicular pain. The evidence in management of chronic neck pain, chronic low back pain, cervical radiculopathy, spinal stenosis, and post laminectomy syndrome was limited or inconclusive. In conclusion, the evidence of effectiveness of transforaminal epidural injections in managing lumbar nerve root pain was strong, whereas, effectiveness of caudal epidural injections in managing lumbar radiculopathy was moderate, while there was limited or inconclusive evidence of effectiveness of epidural injections in managing chronic spinal pain without radiculopathy, spinal stenosis, post lumbar laminectomy syndrome, and cervical radiculopathy.

Journal Article↗