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PubMed2001

An inventory of Canadian anesthesiology. Human research from 1995 through 1999.

PURPOSE: The year 2000 provides a symbolic opportunity to assess the past initiatives in anesthesia research. As in many other fields, medical research has benefited from utilizing computerized data bases to facilitate enumerating areas of interest. We have created a baseline survey of past research in the fields of anesthesia, anesthetics, analgesia, and analgesics to highlight Canadian studies. METHODS: The survey was undertaken using the Medical Literature Analysis and Retrieval System (MEDLARS) medical literature archive for the years 1995 through 1999. The principal categories and sub-categories of MEDLARS' anesthesia classifications were counted for 70 countries contributing to the archive. RESULTS: Canadian contributions ranged from 141 (1992) to 185 (1999) and represented annually 3% of the world total in the anesthesia categories. The greatest number of studies (30-38%) were about adults aged 19 to 44 yr, and there were between 4% and 14% more studies of females than males. "Pharmacology" and "therapeutic use" were the most frequent topics, lidocaine, fentanyl, and propofol were the most studied anesthetics, and non-steroidal anti-inflammatories, opium, morphine, and fentanyl were the most studied analgesics. Among the types of studies, those classified as "quality of health care" occurred most frequently (16%). Canadian trends closely follow world trends. CONCLUSION: The collected counts provide a comprehensive overview of research trends for the past five years.

Adult↗
PubMed1987

Experience with the use of generalized data base management systems in cooperative group clinical trials (a project of the Gynecologic Oncology Group).

Roswell Park Management Information System (RPMIS) is a formatted video-based system of programs for file creation, data entry, editing, updating, retrieval, and report generation. It has been utilized in more than 800 intrainstitutional research studies at Roswell Park. The Gynecologic Oncology Group (GOG) is a multiinstitutional, multidisciplinary cooperative group. Its clinical trials encompass the planning, initiation, execution, analysis, and presentation of results of management and treatment of patients with gynecologic cancer. The GOG Statistical Office, located at Roswell Park Memorial Institute, is responsible for data management and analysis of all patients entered into GOG protocols. Present annual accrual is approximately 2000 patients per year; 38 protocols are actively accruing patients while follow-up continues on 14 studies that are closed to patient entry. A previous paper (J Med Syst 7:235-242, 1983) described a time study comparing use of RPMIS and a paper batch processing system in GOG data management. The time study results and potential advantages of RPMIS warranted a gradual total conversion to this system. Presently GOG maintains 43 separate, self-contained applications of RPMIS and routinely develops a new system in conjunction with each new study initiated. This paper documents GOG experience with RPMIS during the past 4 years.

Clinical Trials as Topic↗
PubMed1992

Practice and communications systems: a word processor based communications system.

The majority of computerized systems currently available for the orthodontic office have been designed for and aimed at those offices that have a volume practice and frequently have multiple practitioners. The stand-alone practitioner and the small office have been grossly ignored. Systems designed for large practices are frequently too complex, too involved in business administration, and too costly for the small office to use effectively. This article describes how an office communications system can be assembled by using commercially available programs. For background information and definition of terms used in this article, I suggest referring to "An Introduction to the Computerization of the Orthodontic Practice," in the Oct. issue of this Journal.

Communication↗
PubMed1993

Epidemiologic methods in mastitis treatment and control.

Methods and concepts of epidemiology offer means whereby udder health can be monitored and evaluated. Prerequisite to a sound epidemiologic approach is development of measures of mastitis that minimize biases and that account for sensitivity and specificity of diagnostic tests. Mastitis surveillance offers an ongoing and passive system for evaluation of udder health, whereas clinical and observational trials offer a more proactive and developmental approach to improving udder health.

Animals↗
PubMed2002

Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation.

In the century and a quarter since William Osler delivered his framed lectures on endocarditis substantial advancements have occurred in the understanding and treatment of this disease. This article summarizes current understanding of endocarditis in the areas of population epidemiology, host factors, microorganisms, diagnosis, and therapy. In addition, the authors discuss possible directions for investigation in the future, including a new multinational consortium, the International Collaboration on Endocarditis (ICE). This collaboration aims to provide a mechanism to advance the understanding of endocarditis in areas difficult to study without an established network. The multinational nature of the collaboration may also permit a more global view of IE and provide opportunities for studies such as randomized trials of therapeutic treatment strategies.

Bacteria↗
PubMed2001

Adolescent HMO enrollees' utilization of out-of-plan services.

PURPOSE: To examine use of reproductive health services, correlates of out-of-plan care, and reasons for seeking out-of-plan care among adolescent health maintenance organization (HMO) enrollees. METHODS: We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget Sound (GHC) who had been enrolled for at least 12 months. The sample was selected from GHC's computerized enrollment database. Questionnaire topics included reproductive history, sexual behavior, and use of health services. Analysis included Chi-square tests to examine differences by gender and out-of-plan status and multivariate analysis using logistic regression. RESULTS: About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1.84; 95% confidence interval (CI) = 1.35-2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI = 1.29-2.48), living with parents (OR = 0.65; 95% CI =.46-.92), and being female (OR = 1.60; 95% CI = 1.21-2.11). During the prior year, over 80% of sexually active respondents had obtained contraceptives out-of-plan and 45% of those tested for sexually transmitted diseases (STDs) reported out-of-plan testing. The primary reasons reported for using any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active respondents). CONCLUSIONS: A substantial proportion of GHC-enrolled adolescents used out-of-plan care. Those who did were more likely to have had STDs and other health problems than those who used only in-plan services. Without continuity of care, these at-risk adolescents may not be receiving optimal services.

Adolescent↗
PubMed2002

Status and potential of gene therapy in clinical medicine. Assessment of an emerging health technology through systematic survey of clinical gene therapy protocols and published results.

OBJECTIVE: Somatic gene therapy is a new method in the rapidly expanding field of molecular medicine. Due to recent encouraging results and the promising prospect for some disease groups, Norwegian health authorities wanted to assess somatic therapy with evidence-based standards for strategic use. This article presents the results of this assessment, discussed in the context of the policy-making process in Norway, including ethical and legislational considerations. METHODS: Clinical gene therapy protocols, ongoing or completed with published results, where available, were identified through a systematic survey of descriptive protocols and publications. Preclinical literature was also reviewed. RESULTS: Gene therapy is dominated by preclinical and clinical research. Most of the gene therapy protocols identified are in early phases (phases I and II) with only a few patients in each study. Of the protocols included in the assessment, only three phase III studies are represented. Except for the use of soluble antisense oligonucleotides against cytomegalovirus eye infection, gene therapy is presently not an established treatment modality. Promising results have been observed in treatment of cancer and cardiovascular diseases and, most recently, in inherited severe combined immunodeficiency and hemophilia. Several interesting principles addressing a large panel of conditions are currently being developed and tested. CONCLUSIONS: Gene therapy is developing into an important medical concept that needs to be included within the Norwegian healthcare system. It is recommended that the Norwegian Ministry of Health and Social Affairs fund a national program to boost infrastructure in selected scientific groups both in preclinical and clinical research. The national procedures regulating approval of gene therapy trials should be made more efficient while at the same time allowing for proper control and ethical considerations. It is emphasized that gene therapy trials should be carefully monitored for side effects.

Clinical Protocols↗