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PubMed2002

[Guidelines for pharmacological primary prevention of cardiovascular diseases--who should be treated?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension and hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the first of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These recommendations were revised through discussions with a panel of physicians and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations, with a request for feedback on errors or shortcomings. RESULTS AND INTERPRETATION: The absolute risk of cardiovascular disease should be used as the basis for discussing with a patient whether drug treatment should be initiated. A 20% risk of developing angina or myocardial infarction over the next ten years is a reasonable threshold for considering treatment. The effects of antihypertensives for persons older than 80 years and of cholesterol-lowering drugs for persons older than 70 years are uncertain. Treatment of blood pressure above 170/100 mm Hg is recommended independent of the risk of cardiovascular disease.

Adult↗
PubMed2002

[Which antihypertensive drugs should be used in the primary prevention of cardiovascular disease?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the second of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These were revised through discussions with a panel of physicians, and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations. RESULTS AND INTERPRETATION: Thiazides should be first-choice drugs for the treatment of uncomplicated hypertension. Beta-blockers are a reasonable second choice. The treatment goal should be below 140/90 mm Hg. For combination therapy, thiazides and beta-blockers should be first choice. Diabetic patients should be treated aggressively with a diastolic blood pressure goal below 80 mm Hg. Angiotensin-II antagonists or angiotensin converting enzyme-inhibitors should be first choice drugs for diabetics with microalbuminuria. Patients with hypercholesterolaemia are not given a particular recommendation for choice of drug. Patients with asthma or chronic obstructive pulmonary disease should choose other drugs than beta-blockers. Thiazides should be avoided if the patient has, or has had, gout.

Antihypertensive Agents↗
PubMed2002

[Which cholesterol-lowering drugs should be used in the primary prevention of cardiovascular disease?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in developing a new set of recommendations. This is the last of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These were revised through discussions with a panel of physicians, and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations. RESULTS AND INTERPRETATION: Statins should be first-choice drugs for the treatment of hypercholesterolaemia. Total cholesterol below 5 mmol/l and/or LDL cholesterol below 3 mmol/l are the recommended treatment goals for persons at high risk of coronary heart disease.

Anticholesteremic Agents↗
PubMed1991

Medical reference filing systems.

Low priced shareware packages may be adequate for those whose main need is to index a collection of articles read in journals. Those who search the literature electronically will need a package able to import mass data. Pro-Cite is set up for bibliographic functions only, but Reference File and Notebook II can be used to index any kind of collection, with Reference File having the advantage of being memory-resident. Other reference filing databases being considered for purchase could be measured against those reviewed here.

Abstracting and Indexing↗
PubMed1988

Hazardous Substance Center: a poison center's workers right to know program.

Workers Right To Know (WRTK) legislation has been enacted in several states. It is landmark advocacy legislation for employees and communities who may be exposed to hazardous chemicals, but it is also a complex and costly problem for business, industry, and nonprofit organizations. The Hazardous Substance Center (HSC), a division of the Pittsburgh Poison Center, was created to develop and implement programs to enable the business community to comply with the requirements of WRTK legislation. Specifically, the HSC provides the client with a 24-hour toxicology resource which objectively assists employees in the interpretation of the health-related effects information on material safety data sheets (MSDS) and assists them and medical professionals in the management of acute and chronic exposures. A variety of online databases and reference materials are utilized to respond to these inquiries. Each case is documented using the AAPCC Report Form. Data is analyzed to identify trends which can be used to assist the client in complying with the educational component. The HSC also provides a labeling program to the client to identify and classify hazardous substances. The service is provided for an annual contractual fee and creates an additional source of poison center revenue.

Humans↗
PubMed1994

A meta-analysis of the effect of garlic on blood pressure.

OBJECTIVE: To undertake a systematic review, including meta-analysis, of published and unpublished randomized controlled trials of garlic preparations to determine the effect of garlic on blood pressure relative to placebo and other antihypertensive agents. DATA IDENTIFICATION: Studies were identified by a search of Medline and the Alternative Medicine electronic databases, from references listed in primary and review articles, and through direct contact with garlic manufacturers. STUDY SELECTION: Only randomized controlled trials of garlic preparations that were at least 4 weeks in duration were deemed eligible for inclusion in the review. DATA EXTRACTION: Data were extracted from the published reports by the two authors independently, with disagreements resolved by discussion. RESULTS: Eight trials were identified (all using the same dried garlic powder preparation (Kwai) with data from 415 subjects included in the analyses. Only three of the trials were specifically conducted in hypertensive subjects, and many had other methodological shortcomings. Of the seven trials that compared the effect of garlic with that of placebo, three showed a significant reduction in systolic blood pressure (SBP) and four in diastolic blood pressure (DBP). The overall pooled mean difference in the absolute change (from baseline to final measurement) of SBP was greater in the subjects who were treated with garlic then in those treated with placebo. For DBP the corresponding reduction in the garlic-treated subjects was slightly smaller. CONCLUSIONS: The results suggest that this garlic powder preparation may be of some clinical use in subjects with mild hypertension. However, there is still insufficient evidence to recommend it as a routine clinical therapy for the treatment of hypertensive subjects. More-rigorously designed and analysed trials are needed.

Blood Pressure↗
PubMedDate not supplied

Garlic as a lipid lowering agent--a meta-analysis.

Garlic supplements may have an important role to play in the treatment of hypercholesterolaemia. To determine the effect of garlic on serum lipids and lipoproteins relative to placebo and other lipid lowering agents, a systematic review, including meta-analysis, was undertaken of published and unpublished randomised controlled trials of garlic preparations of at least four weeks' duration. Studies were identified by a search of MEDLINE and the ALTERNATIVE MEDICINE electronic databases, from references listed in primary and review articles, and through direct contact with garlic manufacturers. Sixteen trials, with data from 952 subjects, were included in the analyses. Many of the trials had methodological shortcomings. The pooled mean difference in the absolute change (from baseline to final measurement in mmol/l) of total serum cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol was compared between subjects treated with garlic therapy against those treated with placebo or other agents. The mean difference in reduction of total cholesterol between garlic-treated subjects and those receiving placebo (or avoiding garlic in their diet) was -0.77 mmol/l (95% CI: -0.65, -0.89 mmol/l). These changes represent a 12% reduction with garlic therapy beyond the final levels achieved with placebo alone. The reduction was evident after one month of therapy and persisted for at least six months. In the dried garlic powders, in which the allicin content is standardised, there was no significant difference in the size of the reduction across the dose range of 600-900 mg daily. Dried garlic powder preparations also significantly lowered serum triglyceride by 0.31 mmol/l compared to placebo (95% CI: -0.14, -0.49).(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1995

An analysis of the paper-based health record: information content and its implications for electronic patient records.

An analysis of paper-based charting was carried out at Sunnybrook Health Sciences Center as a prelude to developing a strategic plan to implement an electronic patient record. A relational model of the Sunnybrook paper chart was developed, describing each of its forms in terms of specific data fields. Three hundred and forty nine different forms are in current use at Sunnybrook, containing 64 types of data fields such as Patient Demographics, Vital Signs, and Doctor's Orders. The extent of data field duplication at the level of hospital forms was significant. A Patient Demographics field was present on all forms and on all pages of a patient's chart, as would be expected. Twenty seven other fields were duplicated on more than ten different forms, including Working Diagnosis which was present on 110 forms, History of Past Illness on 42 forms, and History of Present Illness on 32 forms. Current Medications were recorded on 32 forms and Allergy fields were present on 29 separate forms. Only five data fields of the total 64 were present on only one form. The duplication of data fields within complete patient charts was then examined to confirm that data field duplication was occurring within the actual healthcare delivery process. Using the relational model of the charting system, 143 acute care in-patient encounters were abstracted into the database. The charts were selected randomly from each of the hospital inpatient services. The numbers and types of forms within each chart were recorded, amounting to 18,654 physical pages and using 165 of the different forms. The average in-patient encounter within the model was 130.4 pages long, with a minimum of 27 pages, a maximum of 559 pages, and containing on average 25.8 different forms. The duplication of data fields within actual charts followed a pattern similar to the duplication found on the forms. Initial diagnosis was present on an average of 20.4 pages within the charts, with a minimum of 2 pages and a maximum of 152 pages containing this data field. Other frequently occurring data fields included History of Past Illness present on an average of 12.2 pages per chart, History of present illness on 10.2 pages per chart, and allergies on an average of 9.1 pages per chart. The results obtained through the examination of Sunnybrook charts should be generalizable to most paper-based systems. This study did not measure the workload associated with duplicating chart data. however, the magnitude of the duplication seen in this study leaves little doubt that significant amounts of time could be saved with appropriate modification of health care delivery processes. Multiple copies of the same data field within a database are referred to as aliases of each other. This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care. A growing recognition of the costs and risks of data replication within paper-based charting systems is driving the healthcare industry toward Electronic Patient Record systems. Better quality patient care data, provided by computerized records, is likely to be necessary but not sufficient to improving the efficiency and effectiveness of the healthcare system. Intelligent application of this information will be essential.

Medical Records↗
PubMed1996

Macromolecular structure information and databases. The EU BRIDGE Database Project Consortium.

The current status and future outlook of macromolecular structure databases and information handling, with particular reference to European databases, are reviewed. Issues concerning the efficiency with which data are represented, validated, archived and accessed are discussed in view of the fast growing body of information on structures of biological macromolecules.

Databases, Factual↗
PubMed1998

Cardiovascular evaluation of lowland gorillas.

OBJECTIVE: To design a diagnostic protocol that uses appropriate techniques, including ultrasonography, to assess cardiovascular health and detect primary cardiac diseases in gorillas and to establish a database of reference values for cardiac measurements in clinically normal gorillas. DESIGN: Prospective study. ANIMALS: 5 adult male lowland gorillas from 11 to 18 years old. PROCEDURE: A complete cardiac evaluation was performed on anesthetized gorillas, including physical examination, thoracic radiography, electrocardiography, echocardiography, blood pressure determination, CBC, serum biochemical analyses, and serologic assay for viral diseases. Standard cardiac measurements were made from images collected during ultrasonography. RESULTS: Cardiac measurements derived from ultrasonographic images were consistent with those considered normal in human beings. Results of other diagnostic tests were also considered normal. CLINICAL IMPLICATIONS: Cardiac disease is the primary cause of mortality in old captive gorillas. The technique used here provided excellent evaluation of cardiac function. Use of these techniques will allow early detection of cardiac disease, making treatment or medical management possible.

Animals↗
PubMed1998

Can hospital discharge diagnosis be used for surveillance of bacteremia? A data quality study of a Danish hospital discharge registry.

OBJECTIVE: To assess the data quality of septicemia and sepsis registration in a hospital discharge registry in the County of Northern Jutland, Denmark. DESIGN: Comparison of data from the discharge registry of an 880-bed, public, urban hospital in the County of Northern Jutland with data from a computerized bacteremia database at the regional department of clinical microbiology. SETTING: Urban hospital with approximately 45,000 admissions per year. PATIENTS: The study included 406 episodes of bacteremia in the bacteremia database and 83 discharges with the diagnosis of septicemia registered in the hospital discharge registry between January 1, 1994, and December 31, 1994. INTERVENTIONS: None. RESULTS: Eighteen episodes were registered in both the hospital discharge registry and the bacteremia database. Using the bacteremia database as reference standard, the sensitivity for the diagnosis of septicemia in the hospital discharge registry was 4.4% (18/406; 95% confidence intervals [CI95, 2.4%-6.4%]). By review of hospital records, we estimated the positive predictive value of septicemia registration in the hospital discharge registry as 21.7% (18/83; CI95, 12.8%-30.5%). No blood culture had been obtained in 44.4% (36/81; CI95, 33.6%-55.3%) of the cases with a discharge diagnosis of septicemia. In 33.3% (27/81; CI95, 23.1%-43.6%), the discharge diagnosis of septicemia was given, although blood cultures were negative. CONCLUSIONS: The hospital discharge registry revealed numerous misclassifications, and the system was found not suited for surveillance of, or research in, bacteremia at present.

Bacteremia↗
PubMed1989

Review of Papyrus bibliographic database software.

Papyrus is an inexpensive bibliographic database which provides some features not found in other similar packages. Its flexibility in handling references of many types and formats, its capacity for integration with manuscripts prepared with word processors, its capacity for importing references from national databases and its ability to perform microcosmic literature searches are attractive features. Because Papyrus has tackled a complex task, mastery of the intricacies of the program may present a substantial challenge to novice computer users. Although the manipulation of an existing customized bibliographic database would seem to be attractive for any researcher or author who prepares manuscripts for publication, the optimal use of the program also requires an extensive commitment of time and labor for the initial entry of all pertinent references into the database. While this could be accomplished gradually in conjunction with the preparation of individual manuscripts, the creation of a complete file of references could require hundreds of hours of labor. Individual authors, as well as larger research groups, should be prepared for this type of commitment before acquiring the Papyrus system.

Bibliographies as Topic↗
PubMed2002

Evaluation of the ability of seven herbal resources to answer questions about herbal products asked in drug information centers.

STUDY OBJECTIVE: To evaluate the ability of seven widely known herbal references and electronic databases to answer questions about herbal products asked at drug information centers. DESIGN: Cross-sectional study. SETTING: Five academic and institutional drug information centers. METHODS: Fifty-seven herbal-related questions were obtained from academic and institutional drug information centers. Seven herbal references and electronic databases were evaluated for their ability to answer these 57 questions: The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, 1st edition; Physicians' Desk Reference (PDR) for Herbal Medicines, 2001 edition; Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 4th edition; The Lawrence Review of Natural Products, 2001; Natural Medicines Comprehensive Database (electronically updated, 2001); The Natural Pharmacist (electronically updated, 2001); and AltMedDex (electronically updated, 2001). RESULTS: Natural Medicines Comprehensive Database outperformed all other products evaluated, providing direct answers to 61% of questions. AltMedDex and The Natural Pharmacist performed similarly to one another, answering 49% and 44% of questions, respectively. The Lawrence Review of Natural Products, PDR for Herbal Medicines, The Complete German Commission E Monographs, and Tyler's Honest Herbal were the least helpful in providing direct answers to the questions (24%, 21%, 11%, and 9%, respectively). CONCLUSION: Natural Medicines Comprehensive Database, AltMedDex, and The Natural Pharmacist outperformed all other evaluated herbal references and electronic databases in their ability to answer questions about herbal products posed in clinical practice.

Cross-Sectional Studies↗
PubMed2003

Phyto-oestrogen levels in foods: the design and construction of the VENUS database.

The objective of the Vegetal Estrogens in Nutrition and the Skeleton (VENUS) project was to evaluate existing data on dietary exposure to compounds with oestrogenic and anti-oestrogenic effects present in plant foods as constituents or contaminants, and to identify and disseminate in vitro and in vivo methodologies to analyse the effects of such compounds on bone. To permit the assessment of exposure to isoflavones in European populations (Italy, the UK, Ireland, The Netherlands), the VENUS database of phyto-oestrogen levels in foods was established. Data on the isoflavone (genistein and daidzein) content of 791 foods, including almost 300 foods commonly consumed in Europe, were collected. Levels of coumestrol, formononetin and biochanin A in a limited number of foods were also included. Lignan levels (secoisolariciresinol and matairesinol) in 158 foods were incorporated into the database, which also contains information on the references sourced for the compositional data, on the analytical methods used by each author and on the number of foods analysed in each reference. The VENUS database was constructed in Microsoft Access 2000, which is widely available as part of Microsoft Office Professional. This paper outlines the procedures used for the selection and evaluation of existing literature data for incorporation into the database. In addition, the design of the database is described, along with the data entry and quality control procedures used in its construction. Limitations of the data are discussed and guidelines for its use are provided.

Database Management Systems↗
PubMed2000

Rapid access to infrared reference spectra of arbitrary organic compounds: scope and limitations of an approach to the simulation of infrared spectra by neural networks

Substance identification by infrared spectroscopy is performed by comparison of the experimental spectrum with a reference spectrum from a printed compilation or a database. If the analyzed compound can not be found in a database the corresponding reference spectrum has to be simulated. In order to achieve this, several reasonable candidates of structures for the compound at hand have to be conceived and for all these, infrared spectra have to be developed. The simulated spectrum that is most similar to the experimental suggests the correct structure. A rapid spectrum prediction method based on neural networks has been developed that supplies reference spectra for any organic compound. The scope and limitations of this method will be discussed on a test set of 16 compounds representing a broad range of organic chemistry.

Journal Article↗
PubMed2000

The SWISS-PROT protein sequence database and its supplement TrEMBL in 2000.

SWISS-PROT is a curated protein sequence database which strives to provide a high level of annotation (such as the description of the function of a protein, its domains structure, post-translational modifications, variants, etc.), a minimal level of redundancy and high level of integration with other databases. Recent developments of the database include format and content enhancements, cross-references to additional databases, new documentation files and improvements to TrEMBL, a computer-annotated supplement to SWISS-PROT. TrEMBL consists of entries in SWISS-PROT-like format derived from the translation of all coding sequences (CDSs) in the EMBL Nucleotide Sequence Database, except the CDSs already included in SWISS-PROT. We also describe the Human Proteomics Initiative (HPI), a major project to annotate all known human sequences according to the quality standards of SWISS-PROT. SWISS-PROT is available at: http://www.expasy.ch/sprot/ and http://www.ebi.ac.uk/swissprot/

Animals↗
PubMedDate not supplied

Wheat gliadin: digital imaging and database construction using a 4-band reference system of agarose isoelectric focusing patterns.

An isoelectric focusing method using thin-layer agarose gel has been developed for wheat gliadin. Using flat-bed units with a third electrode, up to 72 samples per gel may be analyzed. Advantages over traditional acid polyacrylamide gel electrophoresis methodology include: faster run times, nontoxic media, and greater sample capacity. The method is suitable for fingerprinting or purity testing of wheat varieties. Using digital images captured by a flat-bed scanner, a 4-band reference system using isoelectric points was devised. Software enables separated bands to be assigned pI values based upon reference tracks. Precision of assigned isoelectric points is shown to be on the order of 0.02 pH units. Captured images may be stored in a computer database and compared to unknown patterns to enable an identification. Parameters for a match with a stored pattern may be adjusted for pI interval required for a match, and number of best matches.

Databases, Factual↗
PubMed1996

Networking consumer health information: bringing the patient into the medical information loop.

The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need; to provide access to the database via a dial-up network server and a toll-free telephone number; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project; describes the major systems and technical issues encountered; and discusses the outcomes, impact, and envisioned enhancements.

CD-ROM↗