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PubMed1991

Pelvic inflammatory disease. Key treatment issues and options.

OBJECTIVE: --To examine available data regarding optimal antimicrobial therapy for pelvic inflammatory disease (PID) and to address selected treatment issues confronting clinicians caring for women with PID. DATA SOURCES: --Studies evaluated to help establish the Centers for Disease Control's 1989 Sexually Transmitted Diseases Treatment Guidelines and other reports published since 1985. A MEDLINE search of English-language literature was conducted using the indexing terms "pelvic inflammatory disease" or "pelvic infections" or "salpingitis" and "treatment". In addition, abstracts and bibliographies of articles and books were reviewed. STUDY SELECTION: --Studies were selected for detailed review if they evaluated the effectiveness of an antimicrobial regimen for treatment of PID. DATA EXTRACTION: --All studies were evaluated to determine the numbers of women treated and the percentage with clinical or microbiologic evidence of cure. DATA SYNTHESIS: --A variety of combination antimicrobial regimens are highly effective in providing clinical and microbiologic evidence of cure; few data are available to assess optimal therapy for prevention of late sequelae. Because PID is polymicrobial in cause, recommended antimicrobial regimens are broad-spectrum in coverage. CONCLUSIONS: --No single agent that provides sufficient coverage is currently available. Several combination regimens appear highly effective clinically even among women with tubo-ovarian abscess formation. Uncertainties regarding the effectiveness of antimicrobial therapy for prevention of late sequelae complicate decisions regarding the choice among regimens and the appropriateness of ambulatory treatment of women with PID. Pending better data, hospitalization should be strongly considered, where feasible, particularly for those women with PID desiring further childbearing. Sex partners of all women with PID should be treated.

Anti-Bacterial Agents↗
PubMed2002

Effects of parental style of interaction on language development in very young severe and profound deaf children.

AIMS: (1) To study the influence of different styles of parent-child interaction in the language development of very young deaf children. (2) To find out if there are differences in parent-child interaction between two groups of very young deaf children following an Aural/Oral or a Bilingual approach to education. METHODS: Subjects were selected from all deaf children in the County of Avon who were under 3 years of age at the time of first assessment, had severe or profound, bilateral, sensorineural hearing loss and no associated medical problems. There were 16 children and families at the start of the project but only 13 completed all the assessments. The Bristol Language Developmental Scales (BLADES) was used to assess both sign and spoken language development. Interaction was studied through analysis of contingency and book-reading applied to selected periods of 3 min from four videorecorded sessions, taken at 3 months intervals for a period of 1 year. RESULTS: From the 13 children studied, only seven presented with some degree of expressive language measurable by the BLADES. Analysis of contingency showed that parents present with higher percentage of both Direct Related Acts and ON then their children Acts (On Acts: where both individuals are involved in the same task). Regarding bookreading, it was observed that parents often attend to child initiatives and acknowledge most of them but they make little effort to expand or use the child's message as topic for further conversation. In the reduced sample of seven children with expressive language, those with better language development had parents with: (a) higher percentage of DR acts; (b) higher percentage of ON acts; (c) higher percentage of appropriate responses to child communicative initiatives. CONCLUSIONS: In this small group language development seems to be facilitated by encouraging child participation and using a more contingent and child centred interaction. No significant differences were found between oral and bilingual families in terms of quality of interaction.

Child, Preschool↗
PubMed2004

Different patterns of duplicate publication: an analysis of articles used in systematic reviews.

CONTEXT: Duplicate publication is publication of an article that overlaps substantially with an article published elsewhere. Patterns of duplication are not well understood. OBJECTIVE: To investigate duplication patterns and propose a decision tree for classification. DATA SOURCES: We searched a comprehensive list of systematic reviews (1989 through August 15, 2002) in anesthesia and analgesia that is accessible on the Internet. We selected published full articles of duplicates that had been identified in these systematic reviews. Abstracts, letters, or book chapters were excluded. STUDY SELECTION AND DATA EXTRACTION: Authors of 56 (40%) of 141 systematic reviews acknowledged identification of duplicates. Duplication patterns were identified independently by all investigators comparing samples and outcomes of pairs of duplicates and main articles. Information on cross-reference, sponsorship, authorship, and publication characteristics was extracted from the articles. DATA SYNTHESIS: The 56 systematic reviews included 1131 main articles (129 337 subjects) and excluded 103 duplicates (12 589 subjects) that originated from 78 main articles. Sixty articles were published twice, 13 three times, 3 four times, and 2 five times. We identified 6 duplication patterns: (1A) identical samples and identical outcomes (21 pairs); (1B) same as 1A but several duplicates assembled (n = 16); (2) identical samples and different outcomes (n = 24); (3A) increasing sample and identical outcomes (n = 11); (3B) decreasing sample and identical outcomes (n = 11); (4) different samples and different outcomes (n = 20). The prevalence of covert duplicate articles (without a cross-reference to the main article) was 5.3% (65/1234). Of the duplicates, 34 (33%) were sponsored by the pharmaceutical industry, and 66 (64%) had authorship that differed partly or completely from the main article. The median journal impact factor was 1.8 (range, 0.1-29.5) for duplicates and 2.0 (range, 0.4-29.5) for main articles (P =.13). The median annual citation rate was 1.7 (range, 0-27) for duplicates and 2.1 (range, 0-31) for main articles (P =.45). The median number of authors was 4 (range, 1-14) for duplicates and 4 (range, 1-15) for corresponding main articles (P =.02). The median delay in publication between main articles and duplicates was 1 year (range, 0-7 years). CONCLUSIONS: Duplication goes beyond simple copying. Six distinct duplication patterns were identified after comparing study samples and outcomes of duplicates and corresponding main articles. Authorship was an unreliable criterion. Duplicates were published in journals with similar impact factors and were cited as frequently as main articles.

Analgesia↗
PubMed1991

The safety of team midwifery: the first decade of the Monash Birth Centre.

OBJECTIVE: To review the safety of team midwifery care, in terms of perinatal mortality, for pregnant women assessed at their first visit as being at low risk of complications. DESIGN: A cohort study. SETTING: Team midwifery unit (Birth Centre) in a tertiary hospital. PATIENTS: All women who made a booking and met the selection criteria at their first antenatal visit (3085), excluding those with spontaneous or induced fetal loss before 20 weeks (89) and those who withdrew at their own request to seek an alternative form of care (138); the 2858 remaining women gave birth to 2874 infants. MAIN OUTCOME MEASURES: Perinatal mortality rate; and birthweight specific perinatal mortality ratio with reference values being specific rates for birthweight in Victoria for 1984-1985. RESULTS: The perinatal mortality rate was 7.7 per 1000 births (95% confidence interval [CI] 4.8-11.6) for the whole cohort; for women beginning labour in the Birth Centre it was 1.3 per 1000 births (95% CI, 0.3-3.9). The birthweight standardised perinatal mortality ratio was 80 (95% CI, 50-122). CONCLUSION: Within this setting, with explicit criteria for booking and referral, and a framework for consultation, team midwifery care is as safe as the standard maternity care provided within the State.

Birth Weight↗
PubMed1991

Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model.

OBJECTIVE: --To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model. DATA SOURCES: --Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed. STUDY SELECTION: --Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis, and other measures. DATA EXTRACTION: --Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data. Data were classified by quality rating. DATA SYNTHESIS: --Historical findings were usually not statistically significant predictors of pelvic inflammatory disease, and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. CONCLUSIONS: --No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators.

Female↗
PubMed2003

Drugs for preventing migraine headaches in children.

BACKGROUND: It has been estimated that about ten per cent of children between six and 20 years of age suffer from migraine. It is estimated that children with migraine lose one and a half weeks more schooling per year than their peers. Prophylactic drugs can be prescribed when children suffer from frequent or disabling headaches. OBJECTIVES: We aimed to describe and assess the evidence from controlled trials on the efficacy and tolerability of pharmacological agents taken on a regular basis to prevent the occurrence of migraine attacks and/or reduce the intensity of such attacks in children with migraine. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched from 1966 through 2002. Additional strategies for identifying trials included searching the reference lists of review articles and included studies and searching books related to headache. SELECTION CRITERIA: Prospective randomised controlled trials (RCTs) of self- or parent-administered drug treatments in children (under 18 years of age) who had received a diagnosis of migraine were included. DATA COLLECTION AND ANALYSIS: Two investigators extracted, assessed, and coded separately all data for each study, using a form that was designed specifically for the review. Any disagreement was resolved by discussion. Headache frequency standardised over 28 days was used as the primary outcome measure. Headache intensity, headache duration, amount of symptomatic treatment used, and headache indices were used as secondary outcome measures. Data were extracted from both parallel-group and crossover trials. Continuous and dichotomous data were used to calculate standardised mean differences (SMDs) and odds ratios (ORs), respectively. Numbers-needed-to-treat (NNTs) and numbers-needed-to-harm (NNHs) were also calculated. MAIN RESULTS: Thirty-eight studies were selected. Eighteen were excluded. Eleven preventive drugs were compared with placebo in a total of 15 studies. Drug-drug comparisons were made in just six studies. For only four drugs (L-5-hydroxytryptophan [L-5HTP], flunarizine, clonidine, and propranolol) were two or more studies selected. For only six drugs (trazodone, L-5HTP, propranolol, flunarizine, papaverine, and nimodipine) were data reported for effect on frequency. For no individual drug were comparable data reported in more than one study, thus meta-analysis was not possible. Two placebo-controlled studies showed a beneficial effect on the primary outcome measure, headache frequency. They were for the drugs propranolol and flunarizine. The propranolol study reported a dichotomous outcome (proportion of children responding), and it was possible to calculate a number-needed-to-treat to produce a two-thirds reduction in headache frequency (NNT = 1.5, 95%CI 1.15 to 2.1). The flunarizine study produced a SMD of 1.51 (95% confidence interval, -2.21 to -0.82), which was statistically significant in favour of flunarizine (p < 0.001). Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. The available studies on cyproheptadine, phenobarbitone, phenytoin, amitriptyline, carbamazepine, metoprolol, and piracetam were excluded for various reasons. REVIEWER'S CONCLUSIONS: Only one study each for propranolol and flunarizine were identified showing efficacy of these drugs as prophylactics of paediatric migraine. Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. Available studies on other commonly used drugs failed to meet our inclusion criteria. The quality of evidence available for the use of drug prophylaxis in paediatric migraine was poor. Studies were generally small, with no planning of sample size, so that for many drugs, despite the negative findings of this review, we do not have conclusive evidence of 'no effect'. There is a clear and urgent need for methodologically sound RCTs for the use of pings of this review, we do not have conclusive evidence of 'no effect'. There is a clear and urgent need for methodologically sound RCTs for the use of prophylactic drugs in paediatric migraine, starting with propranolol. These studies need to be adequately powered to investigate meaningful reductions in pain and suffering from a patient's perspective.

Adolescent↗
PubMed2002

[The pharmacology of cannabinoid derivatives: are there applications to treatment of pain?].

OBJECTIVE: To present the cannabinoid system together with recent findings on the pharmacology of these compounds in the treatment of pain. DATA SOURCES: Search through Medline database of articles published in French and English since 1966. Also use of other publications such as books on cannabis. STUDY SELECTION: All the relevant documents within the theme of this review were used. DATA EXTRACTION: All the data linked to the present topic were searched. DATA SYNTHESIS: Recent advances have dramatically increased our understanding of cannabinoid pharmacology. The psychoactive constituents of Cannabis sativa have been isolated, synthetic cannabinoids described and an endocannabinoid system identified, together with its component receptors and ligands. Strong laboratory evidence now underwrites anecdotal claims of cannabinoid analgesia in inflammatory and neuropathic pain. Sites of analgesic action have been identified in brain, spinal cord and the periphery, with the latter two presenting attractive targets for divorcing the analgesic and psychotrophic effects of cannabinoids. Clinical trials are now required, but are hindered by a paucity of cannabinoids of suitable bioavailability and therapeutic ratio. CONCLUSION: The cannabinoid system is a major target in the treatment of pain and its therapeutic potential should be assessed in the near future by the performance of new clinical trials.

Analgesics, Non-Narcotic↗
PubMed2006

Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan.

During the 2003 outbreak, severe acute respiratory syndrome (SARS) spread to more than 30 countries. Not only did it cause severe health problems but it also imposed a great psychological impact on the public. SARS emerged in Taiwan during April 2003. This study investigates the psychosocial impact and the associated factors of depression of the SARS epidemic in Taiwan when the epidemic had just been controlled. A total of 1552 respondents were recruited in the study by random selection from the telephone book. Demographic data, SARS experience, self-perceived health state, neighborhood relationships, and depression were surveyed by telephone interviewing. Respondents were grouped as 'impacted group' and 'non-impacted group' according to whether they or their friends and family had been quarantined, or suspected of being infected. The psychosocial impact and associated factors were compared between the two groups. The 'impacted group' had higher depressive levels, poorer neighborhood relationships, poorer self-perceived health, and a higher economic impact than the 'non-impacted group'. The poorer self-perceived health and economic impact factors were associated with depression. The neighborhood relationship factor was negatively associated with depression for the 'impacted group', but not for the 'non-impacted group'. The 'impacted group' had experienced greater psychosocial impact possibly due to the SARS impact, the economic downturn, poor self-perceived health conditions, and decreased social support systems. An appropriate mental health intervention to improve the self-perceived health condition, to provide instrumental and psychological support for the 'impacted group', and to decrease the stigmatization and discrimination from the public could have buffered the psychological impact from this epidemic disaster.

Adolescent↗
PubMed1991

Body dysmorphic disorder: the distress of imagined ugliness.

OBJECTIVE: Body dysmorphic disorder, a preoccupation with an imagined defect in physical appearance, has a rich tradition in European psychiatry but has been largely neglected in the United States. Because this little-known disorder is probably more common than is generally realized and can have profound consequences, the author reviews its history, clinical features, and possible relationship to other psychiatric disorders. DATA COLLECTION: Data sources consisted of the MEDLINE database and relevant references in articles obtained from this search. Of 145 articles and books obtained, 100 were selected for inclusion in this review on the basis of how closely they conformed to the concept of body dysmorphic disorder as defined in DSM-III-R and how substantially they contributed to an understanding of the disorder's history, clinical features, or nosologic status. FINDINGS: Body dysmorphic disorder has been colorfully described in the European literature for more than a century. Although its concerns might sound trivial, this disorder can lead to social isolation (including being housebound), occupational dysfunction, unnecessary cosmetic surgery, and suicide. The most commonly associated psychiatric disorder appears to be depression. Although a definitive treatment does not exist, preliminary evidence suggests that serotonergic antidepressant medications may be useful. Whether body dysmorphic disorder is related to other psychiatric disorders, such as psychosis, mood disorder, social phobia, or obsessive-compulsive disorder, is unclear at this time. CONCLUSIONS: More research on the nosology, clinical features, and treatment response of body dysmorphic disorder is important, given the distress and impairment this often secret disorder can cause.

Antidepressive Agents↗
PubMed1983

Establishing a psychiatric library.

The amount of information in the psychiatric field has increased to such an extent that a specialized library is an essential part of the mental health facility. Guidelines are presented for establishing a psychiatric library, including staffing, budgeting, physical layout, and selection and handling of books, reference materials, journals and annuals, microfilm and microfiche, and audiovisuals. The expertise of the librarian is the single most important factor in determining the quality of the collection and the services provided, the author believes. Because of escalating costs, developing a cooperative library network of small, specialized mental health collections may be the most productive course for the future.

Humans↗
PubMed1998

Topotecan: a new topoisomerase I inhibiting antineoplastic agent.

OBJECTIVE: To review the pharmacologic, pharmacokinetic, therapeutic, and safety aspects of topotecan, a new antineoplastic agent, and to assess its role in the treatment of cancer. DATA SOURCES: MEDLINE database English language only, January 1990-March 1998; SmithKline Beecham Pharmaceuticals; published articles, books, and abstracts. STUDY SELECTION: Studies in humans with cancer, clinical case reports, open clinical trials, and controlled clinical studies. Efficacy studies were limited primarily to trials with at least 20 evaluable patients: DATA EXTRACTION: Relevant data were extracted only from published reports. Data were obtained from studies in both articles and abstracts. Only articles written in English were reviewed. DATA SYNTHESIS: Topotecan is an effective second- or third-line therapy for patients with advanced ovarian cancer and is comparable to ifosfamide, liposomal doxorubicin, and paclitaxel. Activity in combination with other agents and as a first-line agent is yet to be determined. Limited data indicate activity in small-cell lung cancer, cancers of the breast and uterus, and in nonlymphocytic leukemia. The dose-limiting toxicity is myelosuppression. CONCLUSIONS: Topotecan is an effective second-line agent for patients with unresponsive or relapsed cancer of the ovary. It appears to be similar to other active agents in patients with this disease status. Its ultimate role in ovarian cancer and other neoplasms awaits additional evaluation in combination with other agents and as first-line therapy.

Antineoplastic Agents↗
PubMedDate not supplied

The quest for professional recognition.

OBJECTIVES: To assess the progress clinical laboratory science has made toward achieving professional status. DATA SOURCES: Books, professional journals. STUDY SELECTION: Not applicable. DATA EXTRACTION: Survey of literature. DATA SYNTHESIS: Characteristics of clinical laboratory science as a profession were compared to a model of professionalization developed by Houle to assess the extent to which clinical laboratory science has acquired and refined selected attributes of a profession. CONCLUSION: Although clinical laboratory science has attained some of the characteristics associated with a profession, several critical issues must be addressed before it can achieve full professional status and recognition.

Certification↗
PubMedDate not supplied

[Cardiopulmonary resuscitation in pregnant women: peculiarities].

This review main purpose is to show nursing the present knowledge about cardiopulmonary resuscitation (CPR) in pregnant women because of the scarce information published by Spanish Nursing Publications. The bibliographical research was made using both the Medline (from January 1982 to March 1998) and Index de Enfermería databases. There, we can find 32 references from which only 23 were selected (all of them belong to the Medline database) in spite of 3 chapters that had already been selected from other different books. Although maternal cardiac arrest rarely happens during pregnancy, it is very important for sanitary staff to be familiarized with the specifics thecnics and equipment (ultrasound and cardiotocograph monitoring). This review describes the physiological changes that take place during pregnancy and have an incidence into CPR. The article also includes the conclusions about the checked papers and the peculiarities that have to be taken into account in each CPR, such as the fetal viability evaluation, right CPR position, airway and breathing, desfibrillation, external cardiac compression and use of pharmacologic therapy and intravenous fluids. Moreover, there is a special mention of the perimortem cesarean delivery features: antecedents, foetus-maternals consequences and managements, due to the fact that this surgical operation should be included inside the CPR protocols of the pregnant.

Cardiopulmonary Resuscitation↗
PubMed1992

[Alimentary factors and gastric cancer: design of a hospital based case-control study].

One of the most widely used design in etiologic research is the case-control study. In the present work the methodology used in the design of a case-control study, performed in a hospital setting, which objectives was to verify etiological hypothesis related with food-intake and gastric adenocarcinoma and 234 controls from the population--188 selected through a randomized selection on the phone book and 46 following neighborhood criteria--are studied. The methodology and the development of the field work are described, with a special interest in the possible bias incurred during its design and development.

Adenocarcinoma↗
PubMed2004

[Historical compendium of physical activity and sport].

The Historical Compendium of Physical Activity and Sport analyses, from a scientific perspective, past events in the array of tasks or manoeuvres comprising body movement, in a setting of human liberty and creative capacity. Sport is examined as a result of the evolution of games and in a context of these games. This book contemplates sports, whose selection criteria have included specific features of their individual or team qualities, or combat or opposition characteristics, or those related to their artistic features or to instrumentation or adaptation, or other connotations. 1st authors are 36 professors, from the universities of Barcelona, (Central), Granada, Jaen, Las Palmas de Gran Canaria, León, Madrid (Complutense), Málaga, Murcia, Oviedo, País Vasco, Salamanca, Valencia and Zaragoza.

Humans↗
PubMed1986

Erythrocyte rigidity in healthy patients and patients with cardiovascular disease risk factors.

The normal values for erythrocyte rigidity as measured by the "Selective Erythrocyte Rigidometer" were derived from a group of 275 apparently healthy subjects without risk factors. These individuals were randomly selected from an address book. The normal values ranged from 0.83-1.19 (median: 1.01). Quality control was conducted throughout the study and the analytical reliability was verified (day-to-day coefficient of variation VCd was 7.5%; coefficient of variation in series VCs was 3.1%). Inter- and intraindividual fluctuations in erythrocyte rigidity in the 8.3% and 6.1% ranges respectively were found in 20 apparently healthy subjects in the course of a 6-month study. No relationship was found between either age or sex and erythrocyte rigidity. Significantly higher erythrocyte rigidity values were found in patients with risk factors however; this applies to hypertensive patients, patients with diabetes mellitus, but also to apparently healthy subjects who were either overweight or smokers. Patients with disordered lipometabolisms on the other hand did not show any change in erythrocyte deformability when compared with healthy subjects.

Adult↗
PubMed1996

Skin cancer prevention, early detection, and management: current beliefs and practices of Australian family physicians.

The primary aim of this study was to examine Australian family physicians' beliefs and practices in relation to skin cancer prevention, early detection, and management. These factors were assessed by a mail-out survey, which was completed by 97 family physicians (69% return rate) randomly selected from the telephone book. Family physicians perceived that issues relating to the prevention and early detection of melanoma and other skin cancers were part of the role of family physicians. Furthermore, family physicians were rated as the most appropriate group for screening (100%; N = 94) and providing skin cancer education to the general public (96%; N = 93). Factors that discouraged family physicians from screening their patients included lack of time (32%; N = 31), forgetting (26%, N = 25), lack of financial incentive (20%; N = 19), and not being familiar with the patient's screening history (14%; N = 14). The family physicians sampled felt least confident in deciding whether changes are malignant (45%; N = 44), in diagnosing a melanoma (39%; N = 38), and in diagnosing a dysplastic nevus (33%; N = 32). While two-thirds of family physicians believed they currently detected 90 to 100% of their patients with melanoma, 93% felt that they should detect this proportion under ideal conditions, and 75% indicated that they should detect this proportion even given the existing constraints of their practice. The results indicate the need for formal training for family physicians in skin cancer prevention, early detection, and management issues, in order to bridge the gap between what family physicians believe they should be doing and their current practice.

Adult↗