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At least 235 records · Page 13Linked to original sources
PubMed1991

Tricyclic antidepressant poisoning.

OBJECTIVE: To review poisoning with tricyclic antidepressants. DATA SOURCE: English language literature search using Australian Medlars Service (1977-1989), manual search of journals and review of bibliographies in identified articles. STUDY SELECTION: Approximately 250 articles, abstracts and book chapters were selected for analysis. DATA EXTRACTION: The literature was reviewed and 93 articles were selected as representative of important advances. DATA SYNTHESIS: The major features of overdose are neurological, cardiac, respiratory and anticholinergic. Life-threatening complications develop within six hours of overdose or not at all. All patients seen within six hours of overdose should have their stomachs emptied. All patients should receive activated charcoal. Coma, convulsions, respiratory depression and hypotension are treated with standard resuscitation techniques and drugs. Treat patients with significant cardiotoxicity or cardiac arrest with alkalinisation by sodium bicarbonate or hyperventilation, aiming for an arterial pH of 7.45-7.55. Lignocaine is used for ventricular arrhythmias. Other antiarrhythmic drugs are contraindicated (Class 1A, Class 1C), potentially lethal (Class II), of no benefit (phenytoin) or of unproven efficacy (Class III and Class IV). Physostigmine has no role at all. Haemodialysis and haemoperfusion are of no benefit. CONCLUSION: The death rate of those who reach hospital is 2%-3%. Most of these deaths are cardiac in origin, and are caused by direct depression of myocardial function rather than cardiac arrhythmias.

Antidepressive Agents, Tricyclic↗
PubMed1992

Drug overdose--reducing the load.

OBJECTIVE: To review available information about various methods for reducing gastrointestinal absorption of a poison or drug. DATA SOURCES: Articles on overdose and accidental poisoning generated by the Australian Medlars Service and concentrating on the period between 1985 and 1990 were surveyed. Earlier studies were included if relevant. STUDY SELECTION AND DATA EXTRACTION: English language articles with an emphasis on studies using objective methods to measure individual and comparative efficacy of gastrointestinal decontamination techniques were selected. A total of 65 articles were reviewed. DATA SYNTHESIS: Gastric emptying procedures (gastric lavage or emesis caused by syrup of ipecac) are only effective if performed within one hour of drug ingestion. Gastric lavage is superior to syrup of ipecac. Oral administration of activated charcoal is more effective than either gastric emptying procedure, and is recommended for most cases of poisoning. Cathartics (sorbitol) can be used with activated charcoal. Whole bowel lavage with polyethylene glycol is indicated in selected cases of potentially lethal overdose where the toxic substance cannot be absorbed by charcoal and has passed the pylorus. CONCLUSIONS: Children--syrup of ipecac can be given at home to children older than 12 months. Most children who reach hospital can be treated by charcoal alone. ADULTS--Most patients are managed with supportive care and, in the absence of contraindications, a single dose of activated charcoal if seen within four hours of ingestion of the poison or drug. Gastric lavage is used if the patient presents within one hour of ingestion and has clinical features of toxicity.

Adult↗
PubMed1990

Screening for hypertension.

PURPOSE: To review the evidence on four questions about screening asymptomatic adults for arterial hypertension: Is hypertension a significant health problem? Is it detectable at an early, presymptomatic stage? Is treatment available and effective? Do the benefits of screening outweigh the costs and risks? DATA IDENTIFICATION AND SELECTION: We did a computerized search of the MEDLARS data base to identify community-based trials of drug therapy for mild hypertension; other relevant citations are included when appropriate. DATA SYNTHESIS: We approached the preliminary questions in our analysis by narrative review and argument. The estimates of therapeutic efficacy are based on previously published meta-analyses. The cost-effectiveness of screening was addressed by formal mathematical modeling of the effect of screening on various U.S. populations. RESULTS OF ANALYSIS: Hypertension is clearly a significant health problem. It can be detected early, and effective treatment is available. Screening asymptomatic adults for hypertension has benefits that compare favorably to the risks and costs involved. According to our estimates, screening is most cost-effective for older adults compared with younger adults and for men compared with women and is highly sensitive to the cost of therapy for mild hypertension. CONCLUSIONS: We recommend hypertension screening for all adults. We also discuss the frequency and setting of screening activities. When a low-cost therapy is used, the cost-effectiveness of screening for hypertension compares favorably with other cardiovascular interventions.

Adult↗
PubMed1990

Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment.

PURPOSE: To evaluate evidence that concurrent infection with human immunodeficiency virus (HIV) alters both the natural history of syphilis (by increasing the frequency of early neurosyphilis) and the response to penicillin. DATA IDENTIFICATION: Review of major works on syphilis in the English language and files maintained since 1971, supplemented by a systematic search using Index Medicus and MEDLARS. DATA EXTRACTION: The works mentioned above were critically reviewed for information on early neurosyphilis and, where relevant, HIV infection. RESULTS OF DATA ANALYSIS: The central nervous system is regularly involved in early syphilis. Standard recommended doses of benzathine penicillin provide cerebrospinal fluid levels that are probably at the borderline of efficacy, and cure relies on treatment and an adequate host immune response. Early neurosyphilis, appearing within 2 years of onset of infection with Treponema pallidum, was uncommon in the prepenicillin era and usually occurred after inadequate therapy. This complication was exceedingly rare in the first three decades of penicillin use. In contrast, in the past decade, 40 patients with HIV infection have been reported to have asymptomatic neurosyphilis, or syphilitic meningitis, cranial nerve abnormalities (predominantly in cranial nerves II and VIII), or cerebrovascular accidents, singly or together. In 40% of cases, HIV infection was first diagnosed when neurologic symptoms appeared. Of the 38 patients for whom information was available, 18 had the acquired immunodeficiency syndrome (AIDS), 7 had AIDS-related complex, and 13 had antibody to HIV. Sixteen had previously been treated for syphilis, of whom 5 (31%) had received benzathine penicillin within the previous 6 months. Preliminary data also suggest that skin lesions and VDRL (Venereal Disease Research Laboratory) antibody in HIV-infected patients with secondary syphilis respond more slowly to conventional penicillin therapy. CONCLUSION: Intensive therapy and follow-up observation is indicated for early syphilis in HIV-infected subjects. Novel approaches to treatment deserve systematic evaluation.

HIV Infections↗
PubMed1990

Effect of intravenous streptokinase on early mortality in patients with suspected acute myocardial infarction. A meta-analysis by anatomic location of infarction .

PURPOSE: To determine the effect of intravenous streptokinase on early mortality in patients with suspected acute anterior and acute inferior myocardial infarctions. DATA IDENTIFICATION: A literature search of English-language studies on the use of intravenous streptokinase in the treatment of suspected acute myocardial infarction for the period 1966 to 1989 using Medlars II and the bibliographies of relevant articles. In a number of instances, additional details on early mortality by location of myocardial infarction were provided by the authors. STUDY SELECTION: Of 140 originally identified articles, 6 that specifically met our inclusion criteria were selected: randomized trials that used intravenous streptokinase in a dose of 1.5 million units, with or without additional agents, compared with a group that differed only by the absence of streptokinase. Trials were selected by review of the methods section without regard for the results. DATA EXTRACTION: Data were extracted independently by two observers using specific methodologic criteria for infarct location and early mortality. After they conferred, the observers agreed completely on the data. RESULTS OF DATA SYNTHESIS: Among the 9155 patients with suspected acute anterior myocardial infarction, the mortality rate in the control group was 17.4%. In contrast, patients treated with streptokinase had a 12.5% mortality. The mean risk difference was -4.8% (95% CI, -7.5% to -2.1%) and the summary risk ratio was 0.72 (CI, 0.65 to 0.79). A total of 9650 patients with suspected inferior infarction had a mortality rate in the control group of 7.6% [corrected]. The mortality for streptokinase-treated patients was 6.6%. The mean risk difference was -0.8% (CI, -1.8% to 0.2%) and the summary risk ratio was 0.87 (CI, 0.76 to 1.01). CONCLUSIONS: Intravenous streptokinase clearly confers a protective effect against early mortality in patients with suspected acute anterior myocardial infarction. The magnitude of this effect is on the order of a 5% absolute reduction in risk of death by 21 to 35 days. For these patients, 21 need to be treated to save 1 additional life. For patients with suspected acute inferior infarction, the benefit of treatment on reducing early mortality is of smaller magnitude and less certain. These patients have an estimated absolute reduction of early mortality of approximately 1%, which would require treating 125 patients to save 1 additional life.

Humans↗
PubMed1992

Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I).

PURPOSE: To review the clinical, epidemiologic, immunologic, and virologic aspects of the chronic myelopathy associated with human T-cell leukemia/lymphoma virus type I (HTLV-I), currently called tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). DATA IDENTIFICATION: Studies done after 1985, when TSP/HAM was first recognized, were identified by a computer search using MEDLARS II and CANCERLIT. Additional information was acquired from personal files and bibliographies of existing literature. STUDY SELECTION: A total of 400 articles, 90 book chapters, and 150 abstracts from meetings covering all aspects of HTLV-I and neurologic diseases were critically analyzed, and information from 250 publications was included. RESULTS OF DATA ANALYSIS: TSP/HAM is present in most HTLV-I endemic areas, with a prevalence ranging from 5.1 to 128 per 100,000 inhabitants. Up to 20% of patients develop TSP/HAM after transfusion of HTLV-I contaminated blood. Pathologic characteristics indicate a chronic meningomyelitis. The clinical features consist of a chronic progressive spastic paraparesis or paraplegia, sphincter disturbances, and minimal sensory loss. Supraspinal and peripheral nerve involvement is sometimes observed. High titers of HTLV-I-specific antibodies are present in the serum and cerebrospinal fluid. The high level of humoral and cellular immunologic response and the association of TSP/HAM with other immunologic diseases suggest an immune-mediated process. Corticosteroids and immunosuppressor treatment usually result in only short-term improvement. CONCLUSION: TSP/HAM is a common neurologic disease in many parts of the world. All patients with chronic progressive myelopathies should be tested for serum and cerebrospinal fluid HTLV-I-specific antibodies. Systematic screening of blood donors for HTLV-I is necessary to help prevent the dissemination of the virus and the occurrence of post-transfusional cases.

Adolescent↗
PubMed1993

T-cell subsets in health, infectious disease, and idiopathic CD4+ T lymphocytopenia.

PURPOSE: To update our knowledge about normal absolute values for CD4+ and CD8+ peripheral T-lymphocyte subsets and to show how these values are influenced by infectious disease. These data are discussed in the context of a newly identified syndrome, idiopathic CD4+ T lymphocytopenia and severe unexplained human immunodeficiency virus (HIV)-negative immune suppression (ICL/SUHIS). DATA IDENTIFICATION: Studies done after 1978, when T-lymphocyte subset analysis using monoclonal antibodies was introduced, identified from a MEDLARS computer search and from personal files. STUDY SELECTION: All English-language articles that included the number of patients studied; the criteria for patient selection; and the means, ranges, and standard deviations for absolute counts of peripheral T-cell subsets. RESULTS OF DATA ANALYSIS: The effects of certain bacterial, viral, parasitic, and fungal infections; analytic variance; and biologic factors on T-lymphocyte subsets must be considered in assessing such values in health and disease. Quantitative T-cell abnormalities secondary to advanced HIV infection may be dissociated from physiologic changes, congenital disorders, and most other conditions by documentation of absolute CD4 counts of less than 400/mm3, a progressive depletion of CD4 cells, and a CD4:CD8 ratio of less than 1.0. Designation of ICL/SUHIS as a new syndrome, dependent solely on CD4 cell count, raises the possibility that persons with an extraordinary diversity of conditions, including those with stable, "physiologic" CD4 lymphopenia, will be given the diagnosis. CONCLUSIONS: Persons with a CD4 count of less than 300 to 400/mm3, a progressive decline in absolute CD4 count, and a CD4:CD8 ratio of less than 1.0 should be aggressively investigated for HIV infection as well as for other causes of immune deficiency, regardless of intercurrent infections. The search for potential novel infectious causes in syndromes such as ICL/SUHIS may be most productive among such a subset of all persons with CD4 counts less than normal levels.

CD4-Positive T-Lymphocytes↗
PubMed1994

Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research.

OBJECTIVE: To review the evidence from controlled trials of the effects of computer-based clinical decision support systems (CDSSs) on clinician performance and patient outcomes. DATA SOURCES: The literature in the MEDLARS, EMBASE, SCISEARCH, and INSPEC databases was searched from 1974 to the present. Conference proceedings and reference lists of relevant articles were reviewed. Evaluators of CDSSs were asked to identify additional studies. STUDY SELECTION: 793 citations were examined, and 28 controlled trials that met predefined criteria were reviewed in detail. DATA EXTRACTION: Study quality was assessed, and data on setting, clinicians and patients, method of allocation, computer system, and outcomes were abstracted and verified using a structured form. Separate summaries were prepared for physician and patient outcomes. Within each of these categories, studies were classified further according to the primary purpose of the CDSS: drug dose determination, diagnosis, or quality assurance. RESULTS: Three of 4 studies of computer-assisted dosing, 1 of 5 studies of computer-aided diagnosis, 4 of 6 studies of preventive care reminder systems, and 7 of 9 studies of computer-aided quality assurance for active medical care that assessed clinician performance showed improvements in clinician performance using a CDSS. Three of 10 studies that assessed patient outcomes reported significant improvements. CONCLUSIONS: Strong evidence suggests that some CDSSs can improve physician performance. Additional well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient outcomes.

Clinical Competence↗
PubMedDate not supplied

Is pan masala-containing tobacco carcinogenic?

BACKGROUND: Pan masala-containing tobacco (PM-T) was introduced in the Indian market during the 1970s. It is a mixture of areca nut, tobacco, lime, catechu and spices. Despite mounting evidence of health hazards of tobacco, tobacco manufacturers as well as policy-makers often seek evidence regarding the carcinogenicity of newer tobacco mixtures such as PM-T. METHODS: All the studies on pan masala (with or without tobacco) listed on MEDLARS, and the studies known to the expert committee on the subject constituted by the Directorate General of Health Services, were reviewed. The studies on individual components and PM-T like substances were also reviewed. The interpretation of carcinogenicity of PM-T has been made, based on studies on (i) PM-T; (ii) PM-T like mixtures; and (iii) the effect of individual ingredients of PM-T and the likely effect of their combination. RESULTS: Studies on Chinese hamster ovary cells and Ames test indicate that PM-T is mutagenic. There is limited evidence that it may be carcinogenic to animals. The proportion of areca nut and tobacco in PM-T is in between the proportion of these substances in two known tobacco-areca nut mixtures of India (Mainpuri tobacco and mawa). Studies on Mainpuri tobacco indicate that it is carcinogenic, while literature suggests an association between mawa use and oral submucous fibrosis. CONCLUSION: Human studies on PM-T like mixtures and the limited studies on PM-T suggest that PM-T is likely to be carcinogenic.

Animals↗
PubMed1975

National Library of Medicine: international cooperation for biomedical communications.

The international programs of the National Library of Medicine may vary in mechanism, but all share the common objective of improved medical research, education, and practice. They are a natural extension of domestic responsibilities and represent a sharing of time, talent, and resources. The programs may be service-oriented, cooperative efforts based on the computerized information storage and retrieval system (MEDLARS), or establishment of regional medical library programs. Policy and operational aspects are presented.

Computers↗
PubMed1975

The SUNY biomedical communication network: six years of progress in on-line bibiographic retrieval.

The SUNY Biomedical Communication Network became operational in 1968 as the first on-line bibliograhpic retrieval service for biomedical literature. Since 1968, the SUNY/BCN has grown in size from nine to thirty-two medical and university libraries and has expanded its data base coverage to include the ERIC and Psychological Abstracts data bases in addition to the full ten-year retrospective MEDLARS data base. Aside from the continuous provision of an on-line searching system, the SUNY experience over the last six years has yielded valuable information in the following areas of: (1) monograph indexing and retrieval, (2) shared cataloging, (3) user interaction and education in on-line systems, and (4) member participation in Network policy-making processes. The continued success of the SUNY/BCN is evidence that it is possible to provide a high quality on-line bibliographic retrieval system at cost to academic institutions. SUNY's success in this effort is the result of centralized resource sharing and effective regional networking, combined with thoughtful planning by user advisory committees.

Cataloging↗
PubMed1975

Automatic and manual indexing performance in a small file of medical literature.

A test of the performance of an automatic indexing procedure based on the processing of the full text of medical journal articles shows results comparable to those achieved using Excerpta Medica and MEDLARS manual indexing. A file of nineteen documents was partitioned by sixteen questions, for each of which two search strategies in each indexing language were formulated. The results were compared to ideal answers chosen by a fourth-year medical student who read the entire file and posed the questions.

Abstracting and Indexing↗
PubMedDate not supplied

Non-asbestos related diffuse malignant mesothelioma.

AIMS: The association between asbestos exposure and the development of malignant mesothelioma is well known. Nonetheless, a proportion of patients suffering from this disease do not appear to have documented exposure to asbestos fibers from any known source. Available information suggests that a true "background" incidence of this disease exits raising the possibility that other factors contribute to its etiology. This paper will review existing data related to non-asbestos related mesothelioma and suggest avenues for further research. METHODS AND STUDY DESIGN: A comprehensive electronic MEDLARS search of the literature pertinent to non-asbestos related malignant mesothelioma was performed including the years 1996-2001. Hand searches were also carried out to supplement electronically derived information and literature pre-dating 1996. The resulting references were stratified into the following categories and reviewed; (1) radiation associated mesothelioma, (2) familial mesothelioma, (3) dietary factors, (4) childhood mesothelioma and (5) the role or SV40. RESULT: Available information suggests that genetic factors may play a larger role in the etiology of this disease than currently appreciated. The interplay of genes and environment require further elucidation in the pathogenesis of mesothelioma. The role of diet is poorly understood with few studies directly addressing this issue. Whether other environmental or infectious agents are involved in mesothelioma development remains speculative. CONCLUSION: The biology of mesothelioma is an enigma. Although this disease appears to occur in the absence of asbestos exposure, the genetic and biological differences between asbestos related and non-asbestos related tumors is unclear. Additional epidemiological and laboratory studies are needed to provide a better understanding of the relationship between environmental and non-environmental causes of mesothelioma.

Adolescent↗
PubMed2003

[Observation on efficacy of CT positioning scalp circum-needling combined with Chinese herbal medicine in treating poly-infarctional vascular dementia].

OBJECTIVE: To observe the short-term effect of patients with poly-infarctional vascular dementia (PIVD) treated by CT positioning scalp circum-needling (SCN) combined with Chinese herbal medicine. METHODS: Eighty-nine patients of PIVD were enrolled and divided into the treated group (n = 57) and the control group (n = 32). They were all treated with oral taking of Fuyuan mixture (FYM, consisted of ginseng, medlar, salvia, bitter cardamon, etc). To the treated group, SCN was applied additionally with the unilateral area around the reflecting region (localized by CT) in scalp as main needling points and Ganshu, Shenshu, Zusanli, Hegu as supplementary points. Two courses of SCN were performed. The changes of clinical symptoms, intelligence and hemorrheological characteristics in patients were analysed. RESULTS: After two courses of treatment, the total effective rate in the treated group was 96.5%, which was better than that in the control group (75.0%), with significant difference (u = 2.423, P < 0.01); HDS scores increased in both groups after treatment, showing significant difference as compared with that before treatment (P < 0.01), hemorrheologic parameters were also apparently improved. CONCLUSION: CT positioning SCN combined Chinese herbal medicine treatment has definite therapeutic effect in treating PIVD.

Acupuncture Therapy↗
PubMed1992

[Esophageal achalasia: cardiomyotomy or pneumatic dilatation?].

Sixty-four patients with achalasia of the esophagus were surgically treated during the period 1973-1990. They were analyzed a late follow-up (mean = 78 months) by means of subjective and objective parameters. The Authors emphasize the efficiency of the diagnostic approach so that surgical treatment offers better results. The surgical technique of choice consists of an anterior esophagomyotomy (extending from 6 cm above the esophagogastric junction down to 1-2 cm below it) with the addition of an anterior Dor antireflux procedure through a laparotomy. The other therapeutic approach to achalasia is pneumatic dilatation of lower esophageal sphincter. A retrospective comparison of two different treatments is made through the analysis of the literature (medlars 1986-1990). Relief of dysphagia is reported in 92.78% of patients treated by myotomy and in 78.71% of those treated by forceful dilatation. The morbidity rate is greater after pneumatic dilatation (6% vs 5%) and the mortality rate is 1.1% after myotomy and 0.2% after dilatation. There are not rigorous criteria of choice between the two treatment methods but the Authors indicate that Heller's myotomy with an antireflux procedure achieve better and lasting results.

Adolescent↗
PubMed2003

What is the prevalence of health-related searches on the World Wide Web? Qualitative and quantitative analysis of search engine queries on the internet.

While health information is often said to be the most sought after information on the web, empirical data on the actual frequency of health-related searches on the web are missing. In the present study we aimed to determine the prevalence of health-related searches on the web by analyzing search terms entered by people into popular search engines. We also made some preliminary attempts in qualitatively describing and classifying these searches. Occasional difficulties in determining what constitutes a "health-related" search led us to propose and validate a simple method to automatically classify a search string as "health-related". This method is based on determining the proportion of pages on the web containing the search string and the word "health", as a proportion of the total number of pages with the search string alone. Using human codings as gold standard we plotted a ROC curve and determined empirically that if this "co-occurance rate" is larger than 35%, the search string can be said to be health-related (sensitivity: 85.2%, specificity 80.4%). The results of our "human" codings of search queries determined that about 4.5% of all searches are "health-related". We estimate that globally a minimum of 6.75 Million health-related searches are being conducted on the web every day, which is roughly the same number of searches that have been conducted on the NLM Medlars system in 1996 in a full year.

Bibliometrics↗
PubMed1992

A critical appraisal of the literature on the effects of computer-based clinical decision support systems on clinician performance and patient outcomes.

OBJECTIVE: To review the evaluations of computer-based clinical decision support systems (CDSS's). DATA SOURCES: The literature collected in the MEDLARS, EMBASE, SCISEARCH and INSPEC databases was searched from 1974 to the present. The reference lists of relevant articles were reviewed as were conference proceedings. STUDY SELECTION: Prospective, controlled studies were included. Studies were rated for methodological quality. DATA EXTRACTION: Study quality was assessed and data on study setting, subjects, method of allocation, and computer system were collected and verified using a structured form. CONCLUSIONS: There is considerable heterogeneity in both systems evaluated and design features of those systems. Future evaluations of CDSS's should focus on methodological issues in order to enhance overall quality of evaluations.

Clinical Medicine↗
PubMed2003

True aneurysm of popliteal artery due to trauma: a case report.

Incidence of true aneurysm of popliteal artery due to trauma is extremely rare and not yet known. Medlar search failed to reveal any report. This case is presented due to its rarity and atypical clinical manifestations. An awareness of this can help in preventing unnecessary amputations.

Aneurysm↗