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PubMed2001

[Evidence-based medicine and the systematic review in perioperative medicine].

The aim of Evidence-based medicine (EBM) is the unbiased and systematic identification and synthesis of valid scientific data. These best-evidence data may then be used for clinical decision-making. The systematic review is the most important tool of EBM and gives a specific answer to a specific question. More than 200 systematic reviews have been published in perioperative medicine. They treat complications and risks related to anaesthesia, postoperative and labour analgesia, nausea and vomiting, regional anaesthesia, blood transfusion and fluids replacement, and resuscitation. The majority of these systematic reviews are of good quality. In the specific settings of perioperative medicine the number of systematic reviews has become so important that recommendations for evidenced-based strategies of prevention and therapy can be formulated.

Anesthesiology↗
PubMed2004

[Tick-borne human pathogenic microorganisms found in Europe and those considered nonpathogenic. Part I: Ticks and Viruses].

The importance of tick-borne encephalitis (TBE) and Lyme borreliosis-the main European tick-borne diseases-is steadily growing. This fact is due to many different factors including climate changes. However, across Europe many other human pathogenic viruses, bacteria, and parasites are found in ticks. This article gives an overview of tick-borne human pathogenic viruses present in Europe as well as those considered nonpathogenic. It also deals with the various species of vector-competent ticks. Among these ticks, viruses from 6 families encompassing 8 genera and 35 species are found,whereby the families Flaviviridae, Bunyaviridae, and Reoviridae with the genera flavivirus, nairovirus, and orbivirus are the most prevalent. Because of their special importance Omsk hemorrhagic fever, louping-ill disease, tick-borne encephalitis, and Crimean-Congo hemorrhagic fever are discussed in detail. Although West Nile virus is mainly transmitted to man by mosquitoes, it is discussed in detail, because West Nile fever has become a good example for a new and rapidly spreading vector-borne disease in the USA and for a recurrent one in Europe. Secondly, besides the mosquito-bird cycle an interesting tick--bird cycle is emerging. The overview clearly demonstrates that in Europe (particularly in Germany) tick-borne viruses, with the exception of TBE, constitute an extremely ignored research subject. This lack of attention is in contrast to their importance and results in a lack of necessary scientific data.

Adrenal Cortex Hormones↗
PubMed2004

[Current problems in determining children's nutritional needs].

Meeting children's nutritional needs is of fundamental importance for their immediate and later health, well-being, and performance. Age-adapted reference values of nutrient intake form the basis for analysis of the current situation and for policy planning, but for many nutrients they cannot be precisely defined due to inadequate scientific data. Therefore, such values are often extrapolated from adult reference values based on age-adapted mean body weight or body surface data, although such extrapolation does not reflect age-related physiological changes. There are considerable differences between various expert recommendations, in part also due to differences in definitions and underlying concepts for deriving reference values. Improvements and international harmonization are urgently needed. Nutritional needs of many children and adolescents are not adequately met at present. A particularly obvious indication is the epidemic-like increase of pediatric overweight and obesity, which could result in markedly increased prevalences of later metabolic syndrome, diabetes, and cardiovascular diseases. Contributing to increasing childhood obesity are low physical activity, changing eating culture and behavior, frequent consumption of high-fat foods with high energy density, and increasing portion sizes. Changes are urgently needed and might be achievable with close collaboration between scientists, public institutions, and industry.

Adolescent↗
PubMed2006

[Current issues of methicillin-resistant Staphylococcus aureus: epidemiology, diagnostics, prevention, and therapy].

Methicillin-resistant Staphylococcus aureus (MRSA) play an important role in hospitals today. Internationally and also within individual countries, its frequency differs considerably. Apart from routine microbiological diagnostics, screening at hospital admission is considered to be of great importance, either to introduce infection control measures as recommended by the Robert Koch Institute, or epidemiologically whether a patient was already colonized at admission. Despite the widespread opinion that patients with MRSA must be isolated in single rooms, no scientific data support that measure in the endemic setting. On the other hand, it is broadly accepted that standard infection control practices, predominantly hand disinfection, are clearly the basic requirement for preventing the transmission of pathogens.

Anti-Bacterial Agents↗
PubMed2007

[Electronic documentation of injuries of the hand with a semantic network: effective and efficient methods for the documentation of clinical and administrative processes].

BACKGROUND: An efficient medical documentation is mandatory for a trauma-oriented department in the DRG environment. Besides the continuously increasing clinical/administrative demands, the additional documentation for quality assurance, clinical studies, and research requires additional efforts. Standard solutions are only partially effective. Especially in hand surgery there is a high demand for sophisticated clinical documentation, represented by a wide variety of classifications in diagnosis and therapy. The standard documentation tools lack accuracy. The development of a software tool that defines administrative/business processes and simultaneously generates clinical and administrative information was the goal of this project. METHODS AND RESULTS: With a standard medical terminology, an innovative semantic network, and a completely new graphical user interface, it was possible to develop and introduce a software program specifically adjusted for hand surgery. This program facilitated for the first time a single-stage acquisition of clinically relevant scientific data and the simultaneous generation of DRG, quality assurance, and administrative data relevant for the hospital's revenues. CONCLUSIONS: The newly developed software tool is a step forward into a new dimension of medical software, obviating the need for multi/documentation and significantly improving the quality of clinically relevant medical data.

Computer Graphics↗
PubMed2001

[Medical ethics of heroin prescription by physicians].

Due to increasing public health and social issues as secondary problems of opiate dependence (e.g. mortality, risk of HIV- and hepatitis infection, high rate of criminal activities) heroin prescription to opiate addicts has been suggested. Scientific data do not yet allow a solid evaluation of this treatment. As generally accepted, the main criteria for an ethical evaluation of new treatments are a) beneficence (duty to help patients further their important and legitimate interests), b) respect for the patient's autonomy and c) social justice in the allocation of the limited resources of the health care system. Ethical problems of heroin prescription relate to the differentiation between medical concern for the individual patient's health and the public interests in reducing social problems, the problematic capability of addicts of a balanced evaluation of heroin prescription and economic considerations of the costs of heroin prescription in comparison with other forms of treatment of opiate addiction, especially methadone maintenance treatment.

Contraindications↗
PubMed1999

Clinical doses of fluoxetine and cerebral blood flow in healthy volunteers.

RATIONALE: Of the specific serotonin reuptake inhibitors (SSRIs), fluoxetine is perhaps the most widely used. Anecdotal reports, mostly in the non-medical press, have suggested that it may positively affect psychological functioning and enhance quality of life in the absence of overt psychiatric disorder. Such wide-spread use in not supported by scientific data. OBJECTIVE: This prospective single blind study examined the effects of long term administration of clinical doses of fluoxetine on cerebral blood flow (CBF) in healthy volunteers. METHODS: Fifteen healthy subjects were examined by Tc99m HMPAO SPECT after 2 weeks of placebo administration and then after 6 weeks of fluoxetine, administered at 20 mg per day. Blood for fluoxetine and norfluoxetine plasma levels was drawn to ensure compliance. Tc99m HMPAO uptake was analyzed by the region of interest approach, normalized to the cerebellum, and by statistical parametric mapping (SPM). RESULTS: No statistically significant differences between the two conditions were detected by both techniques. Correlation analysis between fluoxetine and norfluoxetine plasma levels and rCBF yielded no statistically significant values. CONCLUSION: Our findings suggest a differential effect of fluoxetine on CBF under the following conditions: (i) mental health versus psychiatric illness; (ii) acute versus long term administration. Our findings further emphasize the importance of longitudinal studies in elucidating the physiology of the normal brain as well as the pathophysiology of psychiatric disorders.

Adult↗
PubMedDate not supplied

Management for postoperative complications of breast augmentation by injected polyacrylamide hydrogel.

Polyacrylamide hydrogel, a new biomaterial, has been used for injected breast augmentation in China since 1997. A series of 30 patients with various complications after injected polyacrylamide hydrogel visited the author's department. Most of these patients had undergone injection of both breasts. The average age of the patients was 27.6 years, and the time of consultation for the complications was from 3 to 36 months postopertively. Nearly all the patients had breast lumps and other common complications including breast pain, disfigurement, and infection. Ultrasound examination showed diffuse, irregular, anechoic zones of mammary tissue. Pathologic results indicated inflammatory cell infiltration and fibrous capsular formation. An open suction technique and partial mastectomies via periareolar incisions were performed for the all patients. Most of their symptoms were relieved after removal of the polyacrylamide hydrogel. Only one patient had undergone immediate breast reconstruction with implants, whereas five patients had received breast implants secondarily via an axillary incision. The authors conclude that polyacrylamide hydrogel should be prohibited for injected breast augmentation before more scientific data are available about the long effect of the gel in breast tissue.

Acrylic Resins↗
PubMed2002

Carrying capacity as "Informed Judgment": the values of science and the science of values.

Contemporary park and wilderness carrying capacity frameworks rely on formulation of standards of quality, which are defined as minimum acceptable resource and social conditions. Formulation of standards of quality involves elements of both science and values, and both of these elements must be integrated into informed judgments on the part of park and wilderness managers. That is, managers must ultimately make value-based judgments about the maximum acceptable level of visitor-caused impacts to the resource base and the quality of the visitor experience. However, such judgments should be as informed as possible by scientific data on the relationships between visitor use and resulting impacts and the degree to which park and wilderness visitors and other interest groups judge such impacts to be acceptable. Such information represents the "values of science" to managing carrying capacity in parks and wilderness. A growing body of literature has begun to address the corresponding "science of values," and how this type of information might be integrated in park and wilderness management. Visitor-based research has employed normative theory and techniques to explore the acceptability of a range of resource and social impacts related to visitor use, and findings from these studies are being integrated into a body of knowledge and applied in management decision-making. Conceptual and methodological extensions of the normative approach are currently being explored in a variety of park and wilderness contexts, and new theoretical and empirical approaches are being adapted to address trade-offs inherent in carrying capacity. In these ways, the science of values is progressing to meet the opportunities and challenges of the values of science to park and wilderness management. The concept of carrying capacity, along with the theoretical and methodological approaches described in this paper, can be extended to a large number of natural resource and environmental issues.

Conservation of Natural Resources↗
PubMed2001

Science, policy, stakeholders, and fish consumption advisories: developing a fish fact sheet for the Savannah River.

In recent years there has been a startling rise in the issuance of fish consumption advisories. Unfortunately, compliance by the public is often low. Low compliance can be due to a number of factors, including confusion over the meaning of advisories, conflicting advisories issued by different agencies, controversies involving health benefits versus the risks from consuming fish, and an unwillingness to act on the advisories because of personal beliefs. In some places, such as along the Savannah River, one state (South Carolina) had issued a consumption advisory while the other (Georgia) had not, although at present, both states now issue consumption advisories for the Savannah River. Herein we report on the development of a fish fact sheet to address the confusing and conflicting information available to the public about consuming fish from the Savannah River. The process involved interviewing fishers to ascertain fishing and consumption patterns, evaluating contaminant levels and exposure pathways, discussing common grounds for the provision of information, and consensus-building among different regulatory agencies (US Environmental Protection Agency, South Carolina Department of Health and Environmental Control, Georgia Department of Natural Resources) and the Department of Energy. Consensus, a key ingredient in solving many different types of "commons" problems, was aided by an outside organization, the Consortium for Risk Evaluation with Stakeholder Participation (CRESP). The initial role for CRESP was to offer scientific data as a basis for groups with different assumptions about risks to reach agreement on a regulatory response action. The process was an example of how credible science can be used to implement management and policies and provide a basis for consensus-building on difficult risk communication issues. The paper provides several lessons for improving the risk process from stakeholder conflicts, through risk assessment, to risk management. It also suggests that consensus-building and risk communication are continuing processes that involve assimilation of new information on contaminants and food-chain processes, state and federal law, public policy, and public response.

Animals↗
PubMed1999

Pregnancy: A contraindication?

According to David L. Sackett evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external evidence from systematic research. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopic procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is available. To find an answer to the question of whether pregnancy is a contraindication for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no "scientific" data about endoscopic surgery during pregnancy, but gynecologists representing the "real world" seem to have no fear of the procedure for their patients. Between the two extremes, performing laparoscopic operations during pregnancy might be advantageous for maximal patient-friendly surgery, but considering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader may decide that the subject on endoscopic surgery in pregnancy is still open.

Appendectomy↗
PubMed2000

[The new WHO classification of malignant lymphoma. After "REAL" a further step on the road to a worldwide consensus].

For decades, rival classification systems for malignant lymphoma that were hardly even comparable have existed side by side: the Kiel Classification has so far been used in the German-speaking parts of Europe and the "Working Formulation" mainly in the USA. At the beginning of the 1990's it became possible to overcome this unsatisfactory situation, when pathologists in the Old and New Worlds joined forces to elaborate a new classification for lymphoma, the Revised European-American Lymphoma (REAL) Classification, based on current scientific data. One new feature is the absence of a malignancy grading that is applicable to more than one entity. The system centres on the definition of distinct lymphomatous diseases that can be diagnosed with a high degree of reproducibility. Morphological and clinical characteristics are used for diagnosis, but so, consistently, are immuno-phenotypical and molecular genetic ones. An international cooperative study has confirmed the high reproducibility and clinical practicability of this tentative classification system. An international panel of pathologists appointed by the World Health Organization has updated the REAL classification, which is expected to be published in the updated version in 2001 under the title New WHO Classification. The articles that follow are based on the new WHO classification.

Europe↗
PubMed2006

Transurethral microwave thermotherapy for the treatment of BPH: still a challenger?

Minimally invasive therapies for treatment of benign prostatic hyperplasia (BPH) compete with the gold standard transurethral resection of the prostate (TURP). Comparisons of efficacy and safety have broadened the knowledge of different treatment modalities. Concerns of quality of life such as unaltered sexual function as well as cost considerations drive the market to develop techniques of lower level invasiveness. Among the competitors the office based transurethral microwave thermotherapy (TUMT) provides the broadest scale of scientific data. Numerous manufacturers sell various modifications of this technology. According to different clinical studies TUMT proved to be an effective, safe, and durable therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. However, TURP still holds the steadier long-term results and is more effective to reduce obstruction as well as other LUTS.

Humans↗
PubMed2000

[Atrial fibrillation--frequency control or cardioversion?].

Atrial fibrillation is the most common arrhythmia in need of treatment in clinic and practice. Nevertheless, many principles of therapy for the treatment of atrial fibrillation are based still at present on empirical principles but not on knowledge obtained in proved clinical trials. So far scientific data are not sufficient for therapy recommendation "cardioversion or rate control". At present this question is examined in randomized clinical trials; however, the results will not be available until at least the year 2000. Currently, the therapy strategy (cardioversion versus rate control) is decided individually. Doing this the complaints of the patients and the principle "nihil nocere" mainly determine the decision.

Anti-Arrhythmia Agents↗
PubMed2003

Micronutrient deficiencies. Hohenheim Consensus Conference.

OBJECTIVE: The aim of this study was to consider the risk of micronutrient deficiencies and approaches for intervention, and to summarize existing knowledge and identify areas of ignorance. DESIGN: Experts from a range of relevant disciplines received and considered a series of questions related to aspects of the topic. INTERVENTION: The experts met and discussed the questions and arrived at a consensus. CONCLUSION: Though healthy balanced diet is available for the general European population, a few defined groups are at risk of micronutrient deficiencies. In addition, the intake of specific micronutrients such as iron, folic acid, vitamin D and vitamin B12 are often marginal. To overcome these deficiencies, either selected micronutrients or a mixture of different micronutrients might be recommended. However, to define and detect micronutrient deficiencies, specific biomarkers are only available for a few micronutrients (e. g. vitamin D, folic acid, vitamin C, iron). The definition of a risk group, based on scientific data, might be an appropriate way to justify intervention with supplements.

Aging↗
PubMed2006

Polycystic ovary syndrome: etiology and pathogenesis.

OBJECTIVE: To provide a review of the pathogenesis of polycystic ovary syndrome. DESIGN: Literature survey. RESULT(S): Three major pathophysiologic hypotheses have been proposed to explain the clinical findings of polycystic ovary syndrome (PCOS) related to three major laboratory findings: the LH hypothesis, the insulin hypothesis and the ovarian hypothesis. Although the presence of many small follicles with a high androgen to estrogen ratio was first thought to represent a high rate of follicular atresia in polycystic ovaries, recent studies have demonstrated that the granulosa cells are viable and able to respond to FSH stimulation with normal increases in estradiol production. Thus, a new hypothesis has arisen that FSH activity is somehow blocked at the ovarian level. CONCLUSION(S): PCOS is a syndrome involving defects in primary cellular control mechanisms that result in the expression of chronic anovulation and hyperandrogenism. In this syndrome, the relation between the various parameters is of particular interest. These relations constitute the cornerstone of the pathogenesis of PCOS. The fact that the pathogenesis of PCOS has not yet been clarified, despite the plethora of relative information, may be the result of a general way of thinking in the interpretation of several scientific data, and especially those that refer to biochemical phenomena. The use of the various models of the theory of chaos, that permits a concrete approach for the interpretation of data, may constitute an optional procedure for the future understanding of the association of different parameters and their disturbances in the pathogenesis of the polycystic ovary syndrome.

Female↗
PubMed2006

Effects of unilateral vocal cord paralysis on objective voice measures obtained by Praat.

Unilateral vocal cord paralysis (VCP) affects the objective properties of voice by diminished neurologic control and degenerative changes in laryngeal tissue. The goal of this study was to compare the acoustic parameters of VCP patients with control volunteers using the software Praat. Acoustic analysis results of 18 unilateral VCP patients were compared with age and sex matched 72 normal adult volunteers. Comparison of acoustic analysis results of male and female VCP patients with their age and sex matched control groups revealed statistically significant difference in jitter, shimmer, and noise-to-harmonics ratio values (P < 0.01) in both groups. There were no differences in mean fundamental frequency and intensity values. We conclude that these differences were in accordance with the results obtained by commercially available voice analysis programs. This study reflects the first results obtained with Praat software in VCP patients. Using the software Praat, is free and easy, that supports the clinician to rely on objective scientific data.

Adult↗
PubMed2006

Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy.

OBJECTIVE: The objective of this study is to look for evidence based or scientific guidelines for selection of newborns with congenital cytomegalovirus (CMV) infection that might benefit from treatment with ganciclovir. MATERIALS AND METHODS: A literature search was conducted involving the MEDLINE database and the Cochrane Collaboration Library. Abstracts were reviewed to select pertinent articles dealing with ganciclovir therapy in neonates. References from selected articles as well as from reviews were screened for additional relevant articles. In total, 13 case reports (16 patients in all), three descriptive uncontrolled studies (20 patients in all), two randomized dose-comparative studies (54 patients in all) and one randomized controlled study (42 patients) were identified. OBSERVATIONS: All reported patients presented with central nervous system manifestation of CMV infection. Only the randomized controlled study showed a reduction of hearing deterioration in the treated group. Published predictors of hearing loss in congenitally CMV infected children allow identification of candidates that might benefit from treatment. Studies so far are promising but of insufficient number to make evidence based recommendations about indications for treatment of congenital CMV. As such, studies are very difficult to conduct and treatment of infants at high risk of hearing loss may appear justified. There is scientific data to help clinicians in selecting a subgroup of infants that is at higher risk of hearing deterioration and therefore might benefit the most from ganciclovir therapy.

Antiviral Agents↗