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Paulus Aegineta, a seventh century encyclopedist and surgeon: his role in the history of plastic surgery.

Paulus Aegineta (625-690 ad), born on the island of Aegina, practiced medicine at Alexandria. The last of the eclectic Greek compilers in the Byzantine period, he wrote an Epitome of medicine in seven books. The sixth book, which is considered the best section of his work, is devoted mainly to surgery. The first edition, "editio princeps," of his Epitome was published in Greek by the Aldine press in Venice in 1528 and later translated into English for the Sydenham Society by Francis Adams of Banchory (1844-1847). Paulus was not only a compiler but also a competent and skillful surgeon. In addition to his achievements in general surgical progress, Paulus Aegineta, especially in the book on surgery, made valuable contributions in the history of plastic surgery. He may be considered as one of the originators of plastic surgery as it is known today. He described procedures varying from the treatment of nasal and jaw fractures to operations for gynecomastia, ganglion, and hypospadias. This Grecian master influenced not only his own but also the subsequent ages. Rhazes, Haly Abbas, Albucasis, Avicenna, and Fabricius ab Aquapendente were the greatest physicians influenced by Paulus Aegineta. Because the work of Paulus Aegineta was the only source for many of the surgical treatises of Arabian authors, his Epitome bridged Western and Eastern medicine and conveyed surgical experience and knowledge, including several plastic surgery procedures, to the subsequent ages.

Byzantium↗

[French oncology: a spatiotemporal general view from a special observation point, the Year Books of Cancer].

The Year Book(s) of Cancer were analyzed to count selected French articles within the 1965-1982 period. A comparison between two periods: 1966-1976 and 1978-1982 shows an increase in French production from 2.3 per cent to 4.6 per cent. Strong sectors are breast, female genital tract, leukemia and lymphoma, radiotherapy, immunology and immunotherapy. This increase in number of selected papers is mostly due to articles published in biomedical French journals in which French language is prevalent. The place of provincial institutions changed from 1/4 in 1965-1976 to 1/2 in 1978-1982. With the same method of analysis, cancerology seems more developed in France than cardiology or endocrinology. This statistic suggests the necessary endeavours to further regularly improve the situation.

Breast Neoplasms↗

[Roger Frugardi and the tradition of Langobardic surgery].

The surgical manual 'Rogerina' ('cyrurgia') of the Lombardic surgeon Roger Frugardi (before 1140, + about 1195) belongs to the most-read texts in medieval Occident. This book laid the foundation for the species of the occidental surgical manuals and influenced them up to modern times. In addition, Roger's manual shows the literation of an segment of knowledge, that has been transmitted until then orally: Roger has completed the surgical knowledge with Salernitan experiences, he arranged it anatomically and presented it in a pathologic-traumatological systematization. This article describes the history of research of the 'cyrurgia' and analyzes to the last detail the later versions of the surgical manual: The addition of glosses by Roland of Parma, 'Additiones', 'Chirurgia Rolandina', 'First Salernitan Gloss', 'Roger Marginalia of Erfurt', 'Four Masters Gloss', 'Therapeutic Roger Gloss', 'Chirurgia Jamati' and the widely extended Middle High German 'Roger Complex'. The authors demonstrate that Roger Frugardi's manual is in the tradition of the Germanic-Langobardic surgery.

General Surgery↗

Mapping the literature of nursing: 1996-2000.

INTRODUCTION: This project is a collaborative effort of the Task Force on Mapping the Nursing Literature of the Nursing and Allied Health Resources Section of the Medical Library Association. This overview summarizes eighteen studies covering general nursing and sixteen specialties. METHOD: Following a common protocol, citations from source journals were analyzed for a three-year period within the years 1996 to 2000. Analysis included cited formats, age, and ranking of the frequency of cited journal titles. Highly cited journals were analyzed for coverage in twelve health sciences and academic databases. RESULTS: Journals were the most frequently cited format, followed by books. More than 60% of the cited resources were published in the previous seven years. Bradford's law was validated, with a small core of cited journals accounting for a third of the citations. Medical and science databases provided the most comprehensive access for biomedical titles, while CINAHL and PubMed provided the best access for nursing journals. DISCUSSION: Beyond a heavily cited core, nursing journal citations are widely dispersed among a variety of sources and disciplines, with corresponding access via a variety of bibliographic tools. Results underscore the interdisciplinary nature of the nursing profession. CONCLUSION: For comprehensive searches, nurses need to search multiple databases. Libraries need to provide access to databases beyond PubMed, including CINAHL and academic databases. Database vendors should improve their coverage of nursing, biomedical, and psychosocial titles identified in these studies. Additional research is needed to update these studies and analyze nursing specialties not covered.

Abstracting and Indexing↗

Harrison's.

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Adaptation, Psychological↗

Cohen vs. PDR.

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Antihypertensive Agents↗

Adverse drug effects, compliance, and initial doses of antihypertensive drugs recommended by the Joint National Committee vs the Physicians' Desk Reference.

BACKGROUND: Compliance problems are common causes of the inadequate treatment of hypertension, with 16% to 50% of patients quitting treatment within 1 year. Dose-related adverse drug events (ADEs) frequently cause compliance problems, and many ADEs occur with the initial doses of antihypertensive drugs. Thus, it is an established tenet to initiate antihypertensive therapy at low doses to avoid ADEs that diminish patients' quality of life and reduce compliance. However, what are the lowest effective doses of antihypertensive drugs? OBJECTIVE: To compare the initial doses recommended in the Physicians' Desk Reference (PDR) with those recommended by the Sixth Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). METHODS: Review of the latest JNC VI report (1997) and the 1999 and 2000 editions of the PDR and the medical literature. RESULTS: The JNC VI recommends substantially lower initial doses for 23 (58%) of 40 drugs, compared with the PDR. In addition, for 37 (82%) of 45 drugs, PDR guidelines do not suggest lower initial doses for old or frail patients than for younger adults. CONCLUSIONS: Although the PDR is the drug reference most used by physicians, it does not reflect the lowest initial doses that are recommended by the JNC VI for many of the most prescribed antihypertensive drugs. Because avoidance of ADEs is essential to maintaining compliance with antihypertensive therapy, and because many antihypertensive ADEs are dose related, physicians must know the very lowest, effective, least ADE-prone doses. Patients and physicians would benefit by establishing mechanisms to make this information readily available to all practicing physicians.

Adult↗

Finding and applying evidence during clinical rounds: the "evidence cart".

CONTEXT: Physicians need easy access to evidence for clinical decisions while they care for patients but, to our knowledge, no investigators have assessed use of evidence during rounds with house staff. OBJECTIVE: To determine if it was feasible to find and apply evidence during clinical rounds, using an "evidence cart" that contains multiple sources of evidence and the means for projecting and printing them. DESIGN: Descriptive feasibility study of use of evidence during 1 month (April 1997) and anonymous questionnaire (May 1997). SETTING: General medicine inpatient service. PATIENTS: Medical students, house staff, fellows, and attending consultant. INTERVENTION: Evidence cart that included 2 secondary sources developed by the department (critically appraised topics [CATs] and Redbook), Best Evidence, JAMA Rational Clinical Examination series, the Cochrane Library, MEDLINE, a physical examination textbook, a radiology anatomy textbook, and a Simulscope, which allows several people to listen simultaneously to the same signs on physical examination. MAIN OUTCOME MEASURES: Number of times sources were used, type of sources searched and success of searches, time needed to search, and whether the search affected patient care. RESULTS: The evidence cart was used 98 times, but could not be taken on bedside rounds because of its bulk; hard copies of several sources were taken instead. When the evidence cart was used during team rounds and student rounds, some sources could be accessed quickly enough (10.2-25.4 seconds) to be practical on our service. Of 98 searches, 79 (81%) sought evidence that could affect diagnostic and/or treatment decisions. Seventy-one (90%) of 79 searches regarding patient management were successful, and when assessed from the perspective of the most junior team members responsible for each patient's evaluation and management, 37 (52%) of the 71 successful searches confirmed their current or tentative diagnostic or treatment plans, 18 (25%) led to a new diagnostic skill, an additional test, or a new management decision, and 16 (23%) corrected a previous clinical skill, diagnostic test, or treatment. When the cart was removed, the perceived need for evidence rose sharply, but a search for it was carried out only 12% of the time (5 searches performed out of the 41 times evidence was needed). CONCLUSIONS: Making evidence quickly available to clinicians on a busy medical inpatient service using an evidence cart increased the extent to which evidence was sought and incorporated into patient care decisions.

Evidence-Based Medicine↗

Terminologia anatomica: new terminology for the new anatomist.

Over many years, anatomical terminology has been the subject of much controversy and disagreement. Previously, the International Anatomical Nomenclature Committee has been responsible for the production of six editions of Nomina Anatomica. In 1989 a new committee, the Federative Committee on Anatomical Terminology (FCAT), was created by its parent body, the International Federation of Associations of Anatomists (IFAA). FCAT has worked for 9 years and published Terminologia Anatomica (TA) in 1998. FCAT's aim has been to democratize the terminology and make it the internationally accepted, living language of anatomy. The worldwide adoption of the same terminology would eliminate national differences, which were causing extreme confusion in instances where the same structure was known by several names. The new terminology is thus the result of worldwide consultation and contains Latin and equivalent English terms. It is indexed in Latin and English and contains an index of eponyms in order to find the correct non-eponymous term. The future goal of FCAT is to continue to improve the terminology-new structures are described, different terms come into use, and the terminology needs to be expanded to include terms used by clinicians for structures that currently do not appear in the list. Future versions of the terminology must accommodate the needs of all who use it, both in the clinical and scientific worlds.

Anatomy↗

Terminologia anatomica: considered from the perspective of next-generation knowledge sources.

This report examines the semantic structure of Terminologia Anatomica, taking one page as an example. The focus of analysis is the meaning imparted to an anatomical term by virtue of its location within the structured list. Terminologia's structure, expressed through hierarchies of headings, varied typographical styles, indentations, and an alphanumeric code, implies specific relationships among the terms embedded in the list. Together, terms and relationships can potentially capture essential elements of anatomical knowledge. The analysis focuses on these knowledge elements and evaluates the consistency and logic in their representation. Most critical of these elements are class inclusion and part-whole relationships. Since these are implied, rather than explicitly modeled, by Terminologia, the use of the term list is limited to those who have some knowledge of anatomy; computer programs are excluded from navigating through the terminology. Assuring consistency in the explicit representation of anatomical relationships would facilitate adoption of Terminologia as the anatomical standard by the various controlled medical terminology (CMT) projects. These projects are motivated by the need to computerize the patient record, and their aim is to generate machine-understandable representations of biomedical concepts, including anatomy. Because of the lack of a consistent and explicit representation of anatomy, each of these CMTs has generated its own anatomy model. None of these models is compatible with any other, yet each is consistent with textbook descriptions of anatomy. The analysis of the semantic structure of Terminologia Anatomica leads to some suggestions for enhancing the term list in ways that would facilitate its adoption as the standard for anatomical knowledge representation in biomedical informatics.

Anatomy↗

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children.

BACKGROUND: Anti-leukotrienes agents are currently being studied as alternative first line agents to inhaled corticosteroids in mild to moderate chronic asthma. OBJECTIVES: To compare the safety and efficacy of anti-leukotriene agents with inhaled glucocorticoids (ICS) and to determine the dose-equivalence of anti-leukotrienes to daily dose of ICS. SEARCH STRATEGY: We searched MEDLINE (1966 to Aug 2003), EMBASE (1980 to Aug 2003), CINAHL (1982 to Aug 2003), the Cochrane Airways Group trials register, and the Cochrane Central Register of Controlled Trials (August 2003), abstract books, and reference lists of review articles and trials. We contacted colleagues and international headquarters of anti-leukotrienes producers. SELECTION CRITERIA: Randomised controlled trials that compared anti-leukotrienes with inhaled corticosteroids during a minimal 30-day intervention period in asthmatic patients aged 2 years and older. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality or trials and extracted trial data. The primary outcome was the rate of exacerbations requiring systemic corticosteroids. Secondary outcomes included lung function, indices of chronic asthma control, adverse effects and withdrawal rates. MAIN RESULTS: 27 trials (including 1 trial testing two protocols) met the inclusion criteria; 13 were of high methodological quality; 20 are published in full-text. All trials pertained to patients with mild to moderate persistent asthma. Only 3 trials focused on children and adolescents. Trial duration varied from 4 to 37 weeks. In most trials, daily dose of ICS was 400 mcg of beclomethasone or equivalent. Patients treated with anti-leukotrienes were 65% more likely to suffer an exacerbation requiring systemic steroids [Relative Risk 1.65; 95% Confidence Interval (CI) 1.36 to 2.00]. Twenty six (95% CI: 17 to 47) patients must be treated with anti-leukotrienes instead of inhaled corticosteroids to cause one extra exacerbation. Significant differences favouring ICS were noted in secondary outcomes where()the improvement in FEV(1) reached 130 mL [13 trials; 95% CI: 50, 140 mL ]. Other significant benefits of ICS were seen for symptoms, nocturnal awakenings, rescue medication use, symptom-free days, and quality of life. Anti-leukotriene therapy was associated with 160% increased risk of withdrawals due to poor asthma control. Twenty nine (95% CI 20 to 48) patients must be treated with anti-leukotrienes instead of inhaled corticosteroids to cause one extra withdrawal due to poor control. Risk of side effects was not different between groups. REVIEWERS' CONCLUSIONS: Inhaled steroids at a dose of 400 mcg/day of beclomethasone or equivalent are more effective than anti-leukotriene agents given in the usual licensed doses. The exact dose-equivalence of anti-leukotriene agents in mcg of ICS remains to be determined. Inhaled glucocorticoids should remain the first line monotherapy for persistent asthma.

Administration, Inhalation↗

Understanding and using the history of social psychology.

Authors in this collection offer both critique and contextualist counterpoint to the standard, "official" histories of the field-successive editions of the Handbook of Social Psychology in 1954, 1968, 1985, and 1998. Unlike mainstream histories, the collected studies do not together constitute a seamless chronicle of continual progress for practitioners in a research area seeking social science status, viability, and legitimacy. Rather the authors focus on choice points, crises, and debates (some still ongoing), pay special heed to non-mainstream branches and voices, question numerous assumptions concerning the interrelationships among social psychological methodology, ontology (Danziger; MacMartin & Winston; Stam, Radtke, & Lubek), boundaries (Good), and individualisms (moral, political, and/or methodological). The specific contributions of Floyd and Gordon Allport are discussed from several perspectives as they helped define and shape and write the history of the field (Lubek & Apfelbaum; Parkovnick; Greenwood; Chung), and bridge it to neighboring areas (personality) and disciplines (psychology and sociology) (Nicholson; Barenbaum; Cherry). The constraints, origin myths, insensitivities, and omissions of standard histories are pointed out (Samelson), some partial correctives are advanced, and a more generative role for future historical studies is suggested.

Historiography↗

Strains in experimental social psychology: a textual anaylsis of the development of experimentation in social psychology.

A textual analysis of post-World War II social psychology methodology manuals and handbook chapters on "methods" indicates that the introduction of the experimental method was enforced and gradually strengthened through the use of scientific rhetoric and the minimization of alternative research strategies. As a consequence, by the 1960s experimentation had become such an established identifying feature of psychological social psychology that the acceptability of ideas in the field came to depend largely on the ability of authors to couch them in the language of the experiment. Text writers continually shored up the defenses of scientific legitimacy and denigrated all other types of argument. We explore three sources of tension or strains evident as contradictions in these texts: (1) between a rational experimenter's carefully following prescribed, logic-generated scientific practices and the investigator's artfully or intuitively designing research; (2) between social psychologists' missionary activities of proselytizing the experiment as the primary research method and social psychologists' apologies and insecurities expressed about using experiments; and (3) between the treatment of participants as docile and submissive versus portraying them as underhanded and damaging to the outcome of the research. In addition, we briefly reexamine the strain (4) between sober scientific experimentation and a playful "fun and games" approach to experimentation (Lubek & Stam, 1995).

Historiography↗