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PubMed1996

A review and critique of common herbal alternative therapies.

Patients' uses of herbal therapies warrant close scrutiny by providers. With the current proliferation of lay literature on herbal remedies and the wide availability of such products in health foods and other such stores, more people are relying on herbal and less conventional therapies for a wide variety of problems. Guidance in safe and effective use is needed. Only nine herbs are approved by the Food and Drug Administration for selected applications, so that any lay press book or article that touts the benefits of an herbal remedy must be considered in light of the scientific literature for patient safety. Judging safety and efficacy becomes particularly difficult with the current lack of standardization and regulation of herbal products. German Commission E provides a review of some of the more than 1,400 herbal drugs; this review may be useful in evaluating such therapies. This article provides an overview of the current status of herbal therapies in the United States, a review of selected commonly used herbs by popular claims and scientific information, and relevant safety and efficacy data.

Beverages↗
PubMed2000

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease.

OBJECTIVES: The aim of this review is to assess the risks and benefits of diuretics acting on distal segments of the renal tubule (distal diuretics) in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess changes in need for oxygen or ventilatory support and effects on long-term outcome, and secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy. SEARCH STRATEGY: We used the standard method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or ¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1999, issue 2). In addition, we hand searched several abstract books of national and international American and European Societies. SELECTION CRITERIA: We included in this analysis trials in which preterm infants with or developing CLD and at least five days of age were all randomly allocated to receive a distal diuretic (i.e., a diuretic acting on the distal renal tubule). Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review. Primary outcome variables included changes in need for respiratory support and oxygen supplementation, mortality, bronchopulmonary dysplasia (BPD), death or BPD, chronic lung disease at 36 weeks of postconceptional age (gestational age + postnatal age), length of stay, and number of rehospitalizations during the first year of life. Secondary outcome variables included pulmonary mechanics and potential complications of therapy. DATA COLLECTION AND ANALYSIS: We used the standard method for the Cochrane Collaboration which is described in the Cochrane Collaboration Handbook. Two investigators extracted, assessed and coded separately all data for each study, using a form that was designed specifically for this review. Any disagreement was resolved by discussion. We combined parallel and cross-over trials and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula. MAIN RESULTS: Of six studies fulfilling entry criteria, most focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review, or the potential complications of diuretic therapy. In preterm infants > 3 weeks of age with CLD, a four-week treatment with thiazide and spironolactone improved lung compliance and reduced the need for furosemide. Thiazide and spironolactone decreased the risk of death and tended to decrease the risk for lack of extubation after 8 weeks in intubated infants. There is no evidence to support the hypothesis that adding spironolactone to thiazide or that adding metolazone to furosemide improves the outcome of preterm infants with CLD. REVIEWER'S CONCLUSIONS: In preterm infants > 3 weeks of age with CLD, acute and chronic administration of distal diuretics improve pulmonary mechanics. Chronic administration of diuretics (thiazide with spironolactone) reduces mortality in intubated patients. Large studies are needed to assess (1) whether chronic diuretic administration improves mortality, duration of oxygen dependency, ventilator dependency, length of hospital stay and long-term outcome in patients without long-term toxicity and (2) whether adding spironolactone to thiazides or adding metolazone to furosemide has any beneficial effect.

Chronic Disease↗
PubMed2001

Mood disorders associated with interferon treatment: theoretical and practical considerations.

OBJECTIVE: To review the theoretical and clinical aspects of mood disorders associated with interferon treatment and discuss their management. DATA SOURCES: Pertinent and selected laboratory/clinical studies, review articles, letters, abstracts, and book chapters on behavioral and mood-related adverse effects of interferons published in English-language journals in the past two decades were identified by MEDLINE (June 1980-June 2000) and manual searches. DATA SELECTION AND DATA EXTRACTION: All of the publications identified were reviewed, and the relevant data were included. Studies not using criteria for psychiatric diagnosis or instruments for psychiatnc monitoring were excluded. DATA SYNTHESIS: Clinical observations and limited research data suggest that interferon treatment may be associated with mood disorders. Mood-related symptoms induced by interferons emerge in a few days or weeks and tend to be dose dependent. Their severity may necessitate discontinuation of interferon therapy and/or the use of antidepressant or antimanic agents. The mechanisms responsible for inducing or exacerbating mood disorders in interferon-treated patients have not been elucidated. There is limited evidence implicating alterations in the serotonin system. CONCLUSIONS: While interferon therapy may trigger or induce mood-related symptoms, preexisting or stable concurrent mood disorders in remission do not necessarily constitute a contraindication to treatment with interferons. Mood disorders associated with interferon treatment can present clinical challenges. However, they may promote our understanding of mood disorders in the context of the current biologic theories of depression and mania.

Humans↗
PubMed1982

Skin cancer comic book: evaluation of a public educational vehicle.

A 16-page 4-color comic book was developed as part of a multimedia public education campaign designed to improve skin cancer knowledge and prevention/detection behavior. A concentrated comic book distribution to each of 8,000 households in a predominantly Caucasian area was preceded and followed by personal interviews with 300 residents randomly selected from this area. In households reading the comic book (N-122), respondents reported the following changes as a direct result of readership--avoidance of sun exposure between 10 am and 2 pm (44.3%), use of sunscreens with SPF 8 and over (38.5%), skin self-examination (34.4%), and use of protective clothing (29.5%). To a lesser extent nonreaders also showed positive increases, suggesting exposure to other educational efforts of the skin cancer campaign. Over 90% of the readers felt that the comic book was easy to read, easy to understand, and interesting. The comic book appealed less to males and to those above the age of 50 years.

Adolescent↗
PubMed2006

Nursing research in Ireland.

This review presents an analysis of research published by Irish nurses during the period 1990-2005. The analysis is the first effort made to identify the main characteristics of Irish nursing research. Overall, 213 published studies were identified for consideration, from which, 152 were included in the review. The studies were published in 60 journals, 4 books, and 8 research reports. Journal articles selected from 6 journals accounted for 52%. Inclusion criteria were quality of research design, sampling (including sample size), data analysis, scientific merit, and authorship. Each article was analyzed based on this schema. The major areas of research identified included clinical practice (56%) (e.g., medical surgical, mental health, intellectual disability, and maternal and child), nursing management and professional issues (19%), and nursing education (25%).

Authorship↗
PubMed2000

What's the basis for treating infections your way? Quality assessment of review articles on the treatment of urinary and respiratory tract infections in older people.

OBJECTIVE: To assess the quality of readily available review articles on urinary and respiratory tract infections in older people. METHODS: Data sources were articles identified by MEDLINE search (1988-1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles. RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 +/- 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one-quarter of these clinical trials actually comprised primarily an older population. CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence-based practice guidelines, are needed.

Geriatrics↗
PubMed2001

Dopamine agonists for cocaine dependence.

BACKGROUND: Cocaine is a major drug of abuse. Cocaine dependence is a common and serious condition, which has become nowadays a substantial public health problem. There is a wide and well documented range of consequences associated to chronic use of this drug, such as medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. Therapeutic management of the cocaine addicts includes an initial period of abstinence from the drug. During this phase the subjects may experience, besides the intense craving for cocaine, symptoms such as depression, fatigue, irritability, anorexia, and sleep disturbances. It was demonstrated that the acute use of cocaine may enhance dopamine transmission and chronically it decreases dopamine concentrations in the brain. Pharmacological treatment that affects dopamine could theoretically reduce these symptoms and contribute to a more successful therapeutic approach. OBJECTIVES: To evaluate the efficacy and acceptability of dopamine agonists for treating cocaine dependence. SEARCH STRATEGY: We searched: The Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (from 1966 - 2000), EMBASE (from 1980 - 2000), LILACS (from 1982 - 2000), PsycLIT (from 1974 - 2000), Biological Abstracts (1982 to 2000). Reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of dopamine agonists on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: Twelve studies were included, with 587 participants randomised. Amantadine and Bromocriptine were compared to placebo in most of trials. In two studies amantadine was directly compared to bromocriptine, while amantadine was compared to desipramine, an antidepressant in three. The main efficacy outcome presented was positive urine sample for cocaine metabolites, with no significant differences between interventions. When retention in treatment was assessed as an acceptability measure, it was found a similar rate of patients remaining in treatment in both placebo and active drugs. There were no significant differences in trials where participants had primary cocaine dependence or had additional diagnosis of opioid dependence and/or were in methadone maintenance treatment. REVIEWER'S CONCLUSIONS: Current evidence does not support the clinical use of dopamine agonists in the treatment of cocaine dependence. Given the high rate of dropouts in this population, clinicians may consider adding psychotherapeutic supportive measures aiming to keep patients in treatment.

Amantadine↗
PubMed1994

Issues in the selection and development of therapies in alcoholism treatment matching research.

There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Alcoholism↗
PubMed1999

Comparison of intrauterine and intracervical insemination with frozen donor sperm: a meta-analysis.

OBJECTIVE: To determine whether artificial insemination with frozen donor sperm yielded a higher pregnancy rate per cycle by intracervical (ICI) or intrauterine (IUI) techniques. A meta-analysis was performed. DATA IDENTIFICATION: A computerized MEDLINE search of the English-language literature on artificial insemination with donor sperm was performed and augmented by a review of meeting abstract books and references in published papers. STUDY SELECTION: Only prospective randomized studies that reported monthly fecundity rates for IUI and ICI with frozen donor sperm were included. DATA ANALYSIS: Seven studies were identified. The odds ratios (OR) and 95% confidence intervals (CI) were determined with use of the general estimating equation method for the three studies for which raw data could be obtained. For the remaining four studies, the OR and CI were assessed with use of the published summary data. A random-effects meta-analysis was then performed. RESULT: Intrauterine insemination resulted in a significantly higher monthly fecundity rate with a common OR of 2.4 (CI 1.5-3.8). CONCLUSION: On the basis of this meta-analysis of the seven prospective studies, IUI results in higher pregnancy rates than ICI for frozen donor insemination.

Cervix Uteri↗
PubMed1998

Current concepts of fetal growth restriction: part I. Causes, classification, and pathophysiology.

OBJECTIVE: To update basic concepts and management strategies of fetal growth restriction (FGR). DATA SOURCE: An English literature search was conducted for pertinent articles related to FGR from 1976 to 1997. Original research articles, review articles, and book chapters were reviewed. METHODS OF STUDY SELECTION: This study was divided into two parts. For this article, both human data and animal data pertinent to understanding causative factors, pathogenesis, clinical type, and pathophysiology were included. To perform a meaningful comparison, the concept of investigators and their methods of investigation were critically compared between the two study periods: 1976-1985 and 1986-1997. TABULATION, INTEGRATION, AND RESULTS: Older concepts involving basic principles of FGR based on animal models during the first study period were integrated with new research findings obtained from human FGR during the second study period. By comparative analysis of older animal data and new human data, current concepts of FGR were synthesized. CONCLUSION: Fetal growth restriction affects a heterogenous group of infants. Despite development of new technology for investigation, many older basic concepts related to FGR are still fundamentally sound. However, new investigations directly performed on human fetuses are a useful expansion of the older concepts.

Animals↗
PubMed1999

Allergic inflammation in upper and lower airways.

OBJECTIVE: The primary reason for this review is to discuss the relationship between upper and lower airways at various levels with the emphasis on common pathophysiologic mechanisms, and how treatment of the upper airways will benefit the lower airways. DATA SOURCES: The main source of information is derived from original articles and books, with an extensive bibliography included. STUDY SELECTION: Studies were derived almost exclusively from articles and reviews in peer-reviewed journals. RESULTS: The prevalence of rhinitis and asthma are both increasing. Common to both the upper and lower airways are the triggers, many of the inflammatory cells and mediators, and the treatment modalities. By contrast, there are organ-specific differences in the reaction to various stimuli in the nose or lung, with each organ manifesting its own vocabulary of response. CONCLUSIONS: There are meaningful relationships between upper and lower airways at various levels of our understanding. Differential responses to medications help us better understand pathogenic mechanisms in rhinitis and asthma. Further, treatment of the upper airways provides additional benefit to the lower airways.

Anti-Asthmatic Agents↗
PubMed1996

Steroid-resistant asthma: evaluation and management.

LEARNING OBJECTIVES: Reading this article will reinforce the reader's knowledge of the definition, pathophysiology, differential diagnosis, and treatment of the steroid-resistant asthmatic patient. DATA SOURCES: Prospective and retrospective data from the authors' experience were evaluated. In addition, a Medline database was searched from 1981, using the key words "asthma," "glucocorticoids," and "glucocorticoid resistance" with the restrictions of English language and human subjects. Relevant articles referenced in retrieved sources and current texts on severe asthma were also utilized. STUDY SELECTION: Data source abstracts, pertinent articles, and book chapters meeting the objectives were critically reviewed. RESULTS: Although rare, individuals with steroid-resistant asthma are often the most difficult-to-manage asthmatic patients in that they have severe disease yet fail to respond to glucocorticoids. To make the diagnosis of steroid-resistant asthma, the patient must fail to respond to a 7 to 14-day course of daily prednisone as measured by less than a 15% improvement in morning prebronchodilator FEV1 following the glucocorticoid course. Ongoing inflammation is thought to play a major role in the pathogenesis of steroid-resistant asthma, and recent studies have demonstrated diminished glucocorticoid receptor to glucocorticoid, or diminished glucocorticoid receptor to DNA binding as possible mechanisms for diminished glucocorticoid responsiveness. Alternative asthma therapies such as methotrexate, cyclosporine, and intravenous gammaglobulin are often used in this group of asthmatic patients. CONCLUSIONS: The patient with steroid-resistant asthma presents several challenges. These individuals often display many of the sequelae of long-term systemic glucocorticoid use while achieving little therapeutic benefit. Prior to making the diagnosis of steroid-resistant asthma, diseases that can contribute to poor control of asthma must be ruled out, and noncompliance issues addressed. Alternative asthma therapies are often used; however, they also carry the potential for adverse effects, and have not been thoroughly studied in this population of asthmatic patients.

Anti-Asthmatic Agents↗
PubMedDate not supplied

Medication management in primary and secondary schools.

OBJECTIVE: To summarize present knowledge about medication management in primary and secondary schools; to place this knowledge in its drug use and organizational contexts; and to provide a foundation for studying the problem and developing policy- and practice-level interventions aimed at alleviating it. To offer recommendations for practitioners, policy makers, and health professions educators aimed at improving the situation. DATA SOURCES: MEDLINE database (1966-1998); International Pharmaceutical Abstracts database (1977-1998); complete Medscape full-text search; contents of the Journal of School Nursing and the Journal of School Health (1966-present). STUDY SELECTION: We reviewed 95% of all articles, books, and reports identified using the search terms elementary school, middle school, junior high school, high school, primary school, secondary school, school nurse, school health, and schoolchildren. DATA EXTRACTION: The literature on this topic includes background material describing the nature of the problem and its political and organizational context and implying its significance; summaries of regulations, guidelines, and recommendations regarding medication management in the schools; and empirical studies. Few articles address pharmacist involvement in medication management in schools. DATA SYNTHESIS: Although approaches to this important problem vary widely, a set of core medication management guidelines is identifiable. Formal research is sparse, but it shows that medication use is widespread in schools and carries significant therapeutic and safety consequences. CONCLUSION: Pharmacists and school nurses must cross professional borders if they wish to play a role in solving this important drug therapy problem. Pharmacists can provide therapeutic and contextual perspectives on the problem, while school nurses can implement solutions within the schools.

Child↗
PubMed2002

The Surgical Research Society of Australasia.

BACKGROUND: The Surgical Research Society of Australasia (SRS) was established in 1961. The main intent was to promote surgical research, especially by young surgeons. The 50th Scientific Meeting of the SRS is due to be held in 2002. METHODS: Selected information was extracted from the programme books for the scientific meetings of the SRS, while historical material was retrieved from the Records and Archives Unit of the Royal Australasian College of Surgeons. RESULTS: There have been 48 scientific meetings of the SRS between 1962 and 2000 inclusive, which have included the presentation of 1627 free papers. Forty-one percent of the presenters (325/784) have done so on more than one occasion. The content of the presentations reflects the changing nature of surgical research during the last several decades. CONCLUSIONS: The SRS has achieved its original intent of promoting surgical research.

Australia↗
PubMed1992

The oral mucosa as a mirror of general health or disease.

There is a close relationship between general health/disease and oral mucosal reactions. Many diseases show unspecific or specific changes which may evolve throughout the course of the disease but the mucosal reaction may also constitute the initial clinical sign of the disease. Among the broad spectrum of conditions/diseases, three have been selected for this review--HIV/AIDS, Sjögren's syndrome and lichen planus. They illustrate how general disease may be mirrored in the oral mucosa. An attempt has been made to describe the scientific frontiers and to select pertinent key or review articles or books from among the huge amount of literature published in recent years.

Disease↗
PubMed1993

Negative social events, stress, and health in Hong Kong.

STUDY OBJECTIVE: To investigate the association, if any, between negative social events and physical illness. DESIGN: Comparison of major social events and indices of disease. SETTING-Hong Kong, 1962 to 1985. SUBJECTS: Patients treated in hospital for attempted suicide, coronary heart disease, and diabetes mellitus. MEASUREMENTS AND MAIN RESULTS: Major events were selected from the annual Hong Kong Year Book, and grouped in one of 18 categories by a panel of 10 assessors. Weights were assigned to each category according the likely stress produced. Individual events were then scored and multiplied by the category weights to produce an overall stress score from which a total stress score for each year was derived. Annual stress scores were then compared with hospital attendance rates for the three medical conditions. CONCLUSIONS: The study has shown that: (1) the stress induced in the community by major negative social events in Hong Kong had been increasing; and (2) this stress is associated with attempted suicide but not with diabetes mellitus or coronary heart disease.

Adult↗
PubMed1992

Serum albumin concentrations: who needs them?

OBJECTIVE: To examine the multiple factors that influence serum albumin concentrations and to discuss settings in which the monitoring of such concentrations provides clinically useful information. DATA SOURCES: Original investigations, review articles, books, and abstracts published in English. STUDY SELECTION: Studies pertaining to factors affecting serum albumin concentration were chosen based on general applicability. Recommendations related to the appropriate monitoring of albumin concentrations were based on studies performed in the clinical setting with direct applicability to patient care. DATA EXTRACTION: Data on factors affecting serum albumin concentration were extracted from studies that resulted in similar conclusions regardless of assay technique. Appropriate indications for albumin monitoring were derived from studies demonstrating direct clinical relevance. DATA SYNTHESIS: A number of factors may influence serum albumin concentration and ultimately affect interpretation of the concentration. Serum albumin concentrations generally are useful in the institutional setting shortly after admission or preoperatively to determine patient prognosis. Albumin concentrations have limited merit for predicting the free fractions of various hormones, electrolytes, and drugs. When used as an indicator of nutritional support, albumin concentrations are most helpful when measured over longer periods in relatively stable patients. CONCLUSIONS: Serum albumin determinations should be limited to those situations in which the concentrations are likely to provide clinically useful information. Such situations are limited.

Bromcresol Green↗
PubMed1990

The Asian Mother and Baby Campaign (the Leicestershire experience).

Leicestershire was one of the 10 districts selected for inclusion in the Asian Mother and Baby Campaign, a campaign undertaken to help overcome the problems experienced by Asian women during pregnancy. To achieve this aim eight linkworkers were allocated to this district for a two year period. A local evaluation was undertaken using general practices with evidence of a higher than average perinatal risk. Linkworkers were distributed equally between the hospital and community setting. Women from the selected practices were interviewed at three points; booking for ante-natal care, following delivery and at the post-natal visit. It was found that the linkworkers provided a much needed interpreter service but were less successful in imparting health education knowledge to Asian women. In fact improvement in health education knowledge only occurred in women with a good understanding of English. A surprising finding was that there is still a very large proportion (approximately 50%) of Asian women in Leicestershire who are unable to communicate in English and are not therefore able to make full use of the available services.

Asia↗