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At least 19 recordsLinked to original sources
PubMed2006

Complement deficiency and disease: an update.

Complement deficiencies are probably vastly under-diagnosed within clinical medicine. Judging from a Swedish study of C2 deficiency, a deficiency with an estimated prevalence of about 1/20,000 in Western countries, less than 10% of the deficiencies of the classical and alternative pathways and the late complement components are identified in Sweden. C1 inhibitor deficiency and deficiencies of MBL and MASP-2 were not included in the assessment. The introduction of new screening methods should facilitate detection of complement deficiencies in clinical practice. In our study of C2 deficiency (n=40), 57% of the patients had a history of invasive infection with encapsulated bacteria, mainly Streptococcus pneumoniae. This emphasizes the importance of the classical and/or the lectin pathway in defence against severe infection. Rheumatological disease, mainly systemic lupus erythematosus was present in 43% of the patients. In addition, a significant association was found between C2 deficiency and atherosclerosis. Complement-dependent disease mechanisms are discussed together with the potential importance of non-complement genes for disease expression in complement deficiencies. Analysis of larger patient groups is required in order to establish guidelines for investigation and treatment of patients with complement deficiency.

Atherosclerosis↗
PubMedDate not supplied

Complementary medicine. What physicians think of it: a meta-analysis.

BACKGROUND: Complementary (or alternative) medicine has become a prevalent phenomenon in most industrialized countries. At present the evidence from randomized controlled trials investigating its effectiveness is fragmentary and therefore inconclusive. OBJECTIVE: To assess whether physicians perceive complementary medicine as useful and/or effective. METHOD: A literature search was performed to retrieve all relevant articles. Twelve surveys addressing this question were found and analyzed by evaluating perceived usefulness and/or effectiveness. RESULTS: The results show a remarkable variability between surveys. On average physicians perceive complementary medicine as moderately effective--the rating was 46 +/- 18 on a scale of 0 to 100 points. Young physicians seem to judge complementary medicine more optimistically than their more seasoned colleagues. There is no trend to suggest that complementary medicine is increasingly perceived as useful and/or effective. The data do not answer the question whether physicians view complementary medicine as a nonspecific powerful placebo or as specifically effective. CONCLUSION: Complementary medicine may be useful; however, the notion urgently needs to be tested in randomized controlled trials.

Attitude of Health Personnel↗
PubMed1990

Comparing the quality of referrals of general practitioners with high and average referral rates: an independent panel review.

The quality of referrals of four general practitioners, two with high and two with average rates of referral to the department of internal medicine, was judged by an independent expert panel. The panel, consisting of two general practitioners and one specialist, reviewed a set of information about the referrals blindly and in random sequence. The same distribution of quality of referrals was found among the referrals of the two high referring general practitioners (n = 192) as among those of the general practitioners with average rates (n = 88); that is, 57% and 55% respectively, of the cases had clear medical indications for referral, while the data did not permit a conclusion in 15% and 10%, respectively, of the cases. Controlling for sex, age and status of the referral (first or repeat referral) did not alter the results. We conclude that using referral rates to judge referral quality is misleading. However, a blind and randomly performed panel review of referrals is a time consuming but feasible method of quality assessment.

Humans↗
PubMed2006

[Quality improvement of referrals from practising physicians. An example of a practicable strategy].

INTRODUCTION: Referrals from practising physicians to hospital departments are of varying quality. This increases the risk of inappropriate or even incorrect patient treatment courses. We examined the quality of referrals to a large department of nuclear medicine before and after initiatives aimed at improving the information and feedback to the practising physicians. MATERIALS AND METHODS: An evaluation of the quality of referrals (n = 579) from praticising physicians to the Department of Nuclear Medicine, Odense University Hospital, Denmark, recorded during two periods of three months each before and after (1) publication of a referral guideline and (2) a feedback response to those physicians whose referrals were insufficient. A general practitioner (GP) and a specialist in nuclear medicine (NM) judged independently whether the referrals were good, acceptable or unacceptable. RESULTS: During the two periods, 281 and 298 referrals were received, respectively. Of these, 37% and 27%, respectively, were from practising specialists (PSs). After intervention, 23% more referrals were received from GPs, and the share of "good" referrals also increased (before/after: 48%/72% (GP), 61%/84% (NM)). In contrast, there was a 23% decrease in referrals from PSs, whereas the share of "good" referrals remained unchanged or increased (before/after: 64%/66 % (GP), 64%/96% (NM)). In addition, there was a change in the referral pattern from both GPs and PSs. CONCLUSION: Relatively simple and inexpensive intervention caused an increase in the number and quality of referrals from GPs and a fall in referrals from PSs without an obvious improvement in quality.

Denmark↗
PubMed1981

[Industrial medical activities of SUVA (Swiss Accident Insurance Agency)].

The group of occupational medicine of the Swiss Accident Insurance Fund (Suva) fulfills functions of standardizing, e.g. setting TLVs, of insurance medicine, i.e. judging cases of occupational disease and, to a great extent, of medical prevention. By means of 100,000 examinations per year and 40 programs, 330,000 employees in 20,000 enterprises are attended. This is not a general provision of public health, but a specific prevention of occupational diseases. The examinations of aptitude at the time of engagement and in periodical controls, help to clarify the fitness for certain dangerous occupations and to detect potential early stages of occupational diseases.

Insurance, Accident↗
PubMed2006

A European's perspective of COX-2 drug safety.

Regulators require less evidence to take action on drug safety concerns than would be required to grant drug efficacy claims. Such an asymmetrical view of risk points to the need for large studies to judge the safety of novel medicines compared with standard therapy as smaller sample sizes might produce unreliable and misleading toxicity signals. Large studies conducted in the classical manner are expensive and difficult to conduct. In addition, tight entry criteria and strictly protocolized care results in such trials having poor external validity. If the safety of medicines is to be judged efficiently, novel, easier to conduct, and less-expensive solutions are required. Such trials could have improved external validity were they incorporated into normal care. This paper discusses the safety of cyclooxygenase-2 inhibitors and describes the sort of studies that could be carried out to gather better safety information on their use versus standard nonsteroidal anti-inflammatory drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Legal issues in the delivery of alternative medicine.

As use of alternative therapies grows, there appears to be heightened concern among health care professionals about the liability implications of delivering these therapies. Little is known about malpractice law in this area. We begin by reviewing the type and frequency of claims brought against alternative medicine practitioners and by analyzing the standard of care to which these practitioners are held when sued. Next we turn to the standard of care question as it relates to physicians (MDs/DOs) who incorporate alternative therapies into their practices. Few cases have addressed this question to date. We argue, however, that when courts decide cases at the intersection between conventional and alternative medicine, they may judge conduct according to standards enunciated by: 1) alternative medicine practitioners who regularly deliver the treatment at issue, 2) physicians who have established similar practices, or 3) conventional practitioners. This latter possibility should be taken seriously; it raises troubling questions for physicians at the outset of the negligence inquiry. Available case law highlights the importance of ensuring that patients are fully informed about any alternative therapies they elect to receive, as well as any conventional treatments they may be foregoing, and that patients expressly consent to treatment in light of this information, preferably in writing.

Complementary Therapies↗
PubMed1987

Untangling causation issues in law and medicine: hazardous substance litigation.

Judges and juries are increasingly being asked to settle questions about disease caused by hazardous products. With the growth of litigation on toxic substances and unsafe products, more and more courts must wrestle with the complicated scientific proof of the relation between exposure and disease or injury. This proof frequently involves the use of probabilistic evidence in the form of statistical tests and epidemiologic studies. Anglo-American law relies on deductive notions of causation and is suspicious of probabilistic evidence of causation. As a result, court decisions of hazardous substance cases are sometimes based on a confused understanding of the critical causal connection. Physicians who testify in such cases, either as the treating doctor or as expert witnesses, must be aware of the court's difficulty with probabilistic evidence. In addition, physicians must state clearly the role of such evidence in the identification of a hazardous substance as the cause of a disease or injury.

Consumer Product Safety↗