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At least 343 records · Page 19Linked to original sources
PubMed1994

[Samuel Hahnemann: a mystical empiricist. A study of the origin and development of the homeopathic medical system].

Homeopathy is the product of the time of its birth and systematization and its founder's cultural background. From the beginning, homeopathy looked in two directions at the same time. On the one hand, it looked towards scientific enquiry and empirical proof and, on the other, towards religion, metaphysics and mysticism. The origin of this lies in the double orientation of Hahnemann's work: while affirming a rational system of therapeutics based on observation, he also developed a metaphysical theory of illness as well as of the action of medicines.

Germany↗
PubMedDate not supplied

Dietary supplement users: demographics, product use, and medical system interaction.

BACKGROUND: Dietary supplements-defined as vitamins and minerals, herbal products, tissue extracts, proteins and amino acids, and other products-are purchased to improve health and prevent disease. Little has been published, however, about the characteristics of either the products or the people who use them. METHODS: Consecutive customers visiting two health food stores during a 15-day period were interviewed by telephone. They were asked about their use of dietary supplements, demographics, and their use of the established health care system. RESULTS: Of the 194 customers contacted, 136 (70.1 percent) completed the survey. Respondents took a total of 805 supplements, most often to prevent a health problem (84.3 percent). Herbal products were most commonly used. Garlic, ginseng, and Ginkgo biloba were the herbs most frequently used. Fifty products were found to have previously reported toxicities, including vitamin A, which 9 customers were taking in megadoses. Most customers were white (94.1 percent), female (75.7 percent), had at least 1 year of college education (70.6 percent), had health insurance (95.6 percent), and had a regular physician (85.3 percent). CONCLUSION: Most of the dietary supplements consumed appear to be safe, but 50 of 805 had previously reported toxicities including megadoses of vitamin A. Garlic, ginseng, and Ginkgo biloba were the most commonly ingested herbs, and the medical literature supports their effectiveness for some conditions in humans. Customers of two health food stores had average to above-average education and took dietary supplements to stay healthy. They used the conventional health care system but did not typically consult their physician about dietary supplements. The pattern of use suggests that physicians might not be adequately addressing preventive and wellness issues in discussions with their patients. Furthermore, physicians might need to learn about dietary supplements so they can communicate with patients about them.

Adult↗
PubMed2006

[Treatment of pediatric femur fractures by immediate reduction and spica cast application--clinical and economical feasibility in the Israeli medical system].

BACKGROUND: Pediatric femur fractures are common injuries necessitating immediate application of spica cast or surgical stabilization. Currently, neither conservative nor operative fixation shows superior results; nevertheless, operative intervention has become more common lately. The current study retrospectively investigates short term results of immediate spica cast application, as well as the economic consequences of this treatment. METHODS: All cases of pediatric (6 months - 6 years) femur fractures treated in a single medium-sized hospital during 3 years were reviewed. Characteristics of fracture treatment and economical aspects were analyzed. RESULTS: Twenty four patients (17 boys and 7 girls, mean age 2.5 years, range 9 months to 5.5 years), were treated during the study period by immediate closed reduction and spica cast application. Eleven patients were also treated for medical reasons. All cases achieved acceptable alignment and shortening after cast removal. Two patients were re-admitted to the hospital Emergency Room but no changes in treatment were needed, one patient needed re-reduction. Mean hospital stay was 2.75 days. Calculated cost of such treatment is estimated to be almost equal to the compensation given by insurance companies (based on hospital stay in Israel). CONCLUSIONS: Immediate application of spica cast for pediatric femur fractures, achieves its goals of appropriate fracture-alignment and acceptable complication rates. The authors believe that the compensation should be procedure-based and not hospital-stay based, in a way that will encourage higher efficacy of medical treatment and shortened hospital stay.

Casts, Surgical↗
PubMedDate not supplied

Women's health care: cross-cultural encounters within the medical system.

Women, particularly minority women, have inadequate health care and treatment outcomes caused by a number of extrinsic and intrinsic factors. Salient external systems factors addressed in this article include the lack of health insurance and the inadequate organization and delivery of health care services, for example, difficult-to-reach clinic locations and limited hours of operation. The multiple family roles of women often necessitate alterations in adherence and treatment activities to fulfill competing time and resource demands. Furthermore, culturally widespread lay therapeutic activities, and more culturally limited ethnomedical practices, are routinely employed by patients, yet often are unknown or not acknowledged by physicians. Internal factors, that is, beliefs and attitudes and their behavioral outcomes, are described for African-American, Latino-American, Haitian-American, Asian-American and Native American patients. Suggestions are made for the enhancement of interethnic physician-patient communication. The medical encounter is the nexus for many factors that influence the quality of women's health care.

Adolescent↗
PubMed1998

[Diabetology in the German medical system in 1998].

In 1990, instruction of diabetic patients was not recognised by health insurance providers in Germany, and a practitioner received no remuneration for training patients. Moreover, no physicians specialised in diabetology were recognised by health insurance providers. Specialised diabetology was performed exclusively in hospitals. Physicians conducting their practice in offices and interested in caring for diabetic patients were in a rather difficult situation. In 1991, remuneration was provided for the first time in Germany for therapeutic training of Type 2 (non-insulin-dependent) diabetic patients. Health insurance providers paid physicians DM 60 per patient for 4 class sessions. Since 1993, physicians in the Brandenburg region have been receiving DM 250 per patient for 5 class sessions (thus DM 1,000 for a group of 4 patients) to provide therapeutic training for Type 2 diabetic patients on conventional insulin therapy. This programme has been assessed in two reported studies: one showing that this ambulatory programme is as efficient as training in a hospital and the other evaluating the setting up the Brandenburg programme. However, the number of patients receiving training in medical offices has remained inadequate (around 250,000 patients in total). In 1997/98, in order to improve this situation, a health insurance group, the VdAK/AEV (representing nearly half of the insured persons in Germany), raised fees for physicians from DM 60 to 200 per patient for the training of diabetic patients. Moreover, a book for patients (the "passport for diabetic persons" provided by the German Association of Diabetology) is distributed to patients during the training courses and reimbursed by the insurers. Within a few years in nearly all regions of Germany, diabetologists practising in medical offices have succeeded in obtaining special contracts for performance of ambulatory diabetology. This development began in East Germany but has now spread to most regions of West Germany. In 1998, an annual examination for diabetic patients was established for preventive purposes. Thus, remuneration is related to precise disease documentation (feet, nephropathy, retinopathy). This model is currently being evaluated in Wolfsburg for all diabetic patients covered by the insurers of Volkswagen AG. The first results expected in 1999 will be useful in extending this preventive examination to other regions of Germany.

Diabetes Mellitus↗
PubMed1994

[Giacomo Andrea Diacomini, the medical systems and the origins of experimental pharmacology].

Giacomo Andrea Ciacomini was Professor of Physiology, Pathology and General Therapeutics in the University of Padua (1824-1849); follower of systematic medicine, he followed vitalistic theories. For him diagnosis-identification of diseases and therapy are closely related and diseases are due to an excess or a loss of stimulations. About quinine, generally administered in fevers at high doses as a tonic-stimulant drug, Giacomini believed that it has a depressant activity, an action verified by him on rabbits, an early example of exerimental pharmacology in Italy (1840). Thus, Giacomini performed empirical studies, and the real differences between systematic and scientific medicine are in the different approach to the relationship between empirical observations and theoretical hypotheses.

History, 19th Century↗
PubMed2005

Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation.

BACKGROUND: The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high-dose to standard-dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional. METHODS: The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: 'low SB user' sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and 'high SB user' sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min. RESULTS: Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse (r = - 0.579 P = 0.018) from initiation of ACLS (r = - 0.685 P = 0.003) and from first epinephrine (r = - 0.611 P = 0.012) to SB administration. Mean ROSC rate in the 'high SB user' sites was 33.5% (CI = 30.0-37.0) compared to 25.7% (CI = 23.1-28.4) in the 'low SB user' sites. In the 'high SB user' sites, hospital discharge rate was 5.3% (CI = 3.6-7.0) compared to 3% (CI = 2.0-4.0) in the 'low SB user' sites, and 5.3% (CI = 3.6-7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2-3.0) in the 'low SB user' sites. Collapse to ACLS interval was 8.5 min (CI = 8.1-9.0) in the 'high SB user' sites compared to 10.2 min (CI = 9.8-10.6) in the 'low SB user' sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5-7.5) compared to 9.7 min (CI = 9.3-10.2). Multivariate regression analysis found that belonging to 'high SB user' sites independently increased the chances for ROSC (OR 1.36, CI 1.08-1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23-3.86). CONCLUSIONS: Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long-term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.

Acidosis↗
PubMed1995

Primary corneal graft failure. A national reporting system. Medical Advisory Board of the Eye Bank Association of America.

OBJECTIVES: To describe a national eye banking registry and to assess the effects of donor age, cause of donor death, time from death to procurement, storage time, and distance between the points of recovery and transplantation on the reported occurrence of primary corneal graft failure. DESIGN: We performed a retrospective case-control study to estimate the odds ratios of five donor factors for cases of primary graft failure voluntarily reported to a national registry using controls from selected eye banks. We also performed a nested case-control cohort study to compare cases of primary graft failure that occurred in both corneas from the same donor with those of nonmated corneas in which primary graft failure was reported to assess odds ratios for the same donor factors. PATIENTS: One hundred forty-seven patients developed primary graft failure in penetrating keratoplasty transplantations performed between January 1, 1991, and December 31, 1993. These cases were reported to the Adverse Reaction Registry of the Eye Bank Association of America, Washington, DC. Controls included 7240 donor corneas distributed by nine eye banks during 1992. RESULTS: Of the 147 donor corneas that developed primary graft failure, 17 (12%) were obtained from donors who were aged 70 years and older, 39 (27%) came from donors who died of trauma, 13 (9%) had a cadaver time longer than 12 hours, 10 (7%) had a storage time longer than 7 days, and 38 (26%) were distributed outside the eye bank's region. Compared with controls, these donor corneas were more likely to have a storage time longer than 7 days (odds ratio, 2.4; 95% confidence limits, 1.2 and 4.6) and to come from donors aged 70 years and older (odds ratio, 2.4; 95% confidence limits, 1.4 and 4.0). The 22 corneas (15%) in which primary graft failure occurred in both recipients from the same donor were 8.5 times (95% confidence limits, 1.1 and 51.5) more likely to be preserved beyond 1 week than were nonmated corneas with primary failure but were not from significantly older donors. Logistic regression analysis showed that the association between prolonged storage time and primary graft failure in mated corneas remained significant even when the analysis was controlled for other donor factors. CONCLUSIONS: No clearly defined donor or eye banking factor accounted for most cases of primary graft failure, although prolonged corneal storage and advanced donor age may increase its risk. Ophthalmologists are urged to report to their eye bank all cases of primary graft failure and other adverse events that might be attributable to donor eye tissue.

Adult↗