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PubMed2006

The conceptualisation of health and disease in veterinary medicine.

BACKGROUND: The concept of health, as well as the concept of disease, is central in veterinary medicine. However, the definitions "health" and "disease" are not generally acknowledged by veterinarians. The aim of this study was to examine how the concepts "health" and "disease" are defined in veterinary textbooks. METHODS: Veterinary textbooks in several disciplines were investigated, but only textbooks with explicit definitions of the concepts were selected for examination. RESULTS: Eighty out of the 500 relevant books within veterinary medicine were written for non-veterinarians. Eight percent of the books had an explicit definition of health and/or disease. More frequently, textbooks written for non veterinarians did have definitions of health or disease, compared to textbooks written for professionals. A division of health definitions in five different categories was suggested, namely: 1. Health as normality, 2. Health as biological function, 3. Health as homeostasis, 4. Health as physical and psychological well-being and 5. Health as productivity including reproduction. CONCLUSION: Few veterinary textbooks had any health or disease definition at all. Furthermore, explicit definitions of health stated by the authors seemed to have little impact on how health and disease are handled within the profession. Veterinary medicine would probably gain from theoretical discussions about health and disease.

Disease↗
PubMedDate not supplied

Using buzz marketing to promote ideas, services, and products.

OBJECTIVE: To (1) discuss buzz marketing, contrast it with traditional forms of promotional communications, and provide guidelines for use and (2) describe a successful buzz-marketing program used by Sentara Healthcare to decrease overuse and inappropriate use of antibiotic medications. DATA SOURCES: An English-language-only literature search of ABI Inform, Lexus-Nexus, InfoTrac, and university library databases from 1980 to the present using the keywords buzz, word of mouth, opinion leader, and thought leader. Articles and books were cross referenced for other works of interest. STUDY SELECTION: Performed by the author for their contribution to an exploratory analysis of this topic. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Buzz marketing is an indirect communications method that has been used successfully in the promotion of a wide variety of products, services, and ideas. By identifying and cultivating nonmedia opinion leaders, the technique generates word-of-mouth communications between these early adopters of products and services and the early and late majority of people who tend to follow their lead. Opinion leaders can be categorized as ordinary or extraordinary, technical or social, and specialist or generalist, depending on the nature of their communications, expertise, and range of knowledge. Buzz marketing is most useful for ideas that are memorable, produce small changes in behavior that have big effects over time, and have the potential to reach a "tipping point" in terms of momentum among a target population. Pharmacists can use buzz marketing for promoting innovative services such as pharmaceutical care. A case study is presented on the use of buzz marketing by a health system for decreasing antibiotic resistance through lessening of public demand for antibiotics and support of physicians in prescribing the agents appropriately. CONCLUSION: Buzz marketing is a potent force in the promotion of pharmaceuticals and can be used by pharmacists. It works best when patients perceive the benefits of innovations. Providing samples and demonstrations of the innovation will foster positive perceptions. Innovations also spread better when they are compatible with the needs, desires, and preferences of individuals and can be adapted to the unique situation of the adopter.

Advertising↗
PubMed2006

Cervical screening during pregnancy.

UNLABELLED: A retrospective study done to assess the efficiency of cervical screening in the form of smear testing in pregnant population. We selected one hundred women who had undergone cervical screening during booking visit in one particular unit. Results of tests along with datas regarding age, parity and previous smear history was compiled. Results were compared with Western Health Board figures. 58% smears were normal, 6 % abnormal and 36% unsatisfactory. Although incidence unsatisfactory smears were very high, but incidence of abnormal cytology matched with standard. CONCLUSION: Pregnant women are no more likely than the general population to have a frankly abnormal smear. Despite its limitations we recommend antenatal screening does have a role in the absence of National Cervical Screening Programme.

Adult↗
PubMed1991

A comparison of biomedical databases.

Various published bibliographic and abstract services covering the period 1970-1988 were compared to analyze scope and coverage. A total of 7,281 articles and book titles (1,655 Soviet and 5,626 foreign) were selected on forty-one topics in different medical fields. The titles originated from three different samples but included all Soviet medical literature on the subjects. A distribution of biomedical serials from five databases is given by country, and twelve indices to assess the quality of biomedical databases are suggested.

Abstracting and Indexing↗
PubMed1995

Thrombosis and the pharmacology of antithrombotic agents.

OBJECTIVE: To provide an overview of the current state of knowledge regarding the physiology of hemostasis, the pathophysiology of thrombosis, and the pharmacology of antithrombotic agents. DATA SOURCES: A MEDLINE search was conducted to identify pertinent literature published since 1984. Recently published textbooks devoted to the subjects of hematology, hemostasis, and thrombosis also were reviewed, particularly their bibliographies. The bibliographies of selected review articles also were reviewed. STUDY SELECTION: As the amount of literature was vast, only the most significant and noteworthy published studies were reviewed. Review articles and book chapters authored by researchers of international reputation also were reviewed. DATA EXTRACTION: Identified studies from the primary literature and selected reviews were analyzed carefully. Information regarding hemostasis, thrombosis, and antithrombotic drugs was extracted. Particular attention was given to data regarding drugs currently available or soon to be available on the US market. DATA SYNTHESIS: Knowledge regarding the regulation of blood coagulation has expanded substantially in recent years. Hemostasis involves the dynamic interplay of numerous intravascular constituents, including the vessel wall, circulating procoagulants and anticoagulants, platelets, and fibrinolytic proteins. Thrombosis is the abnormal formation of a clot within the vascular system. When sufficiently large, thrombi can prevent the flow of blood and nutrients to vital tissues. Thrombosis is associated with many common diseases and is among the leading causes of death in developed countries. Many drugs are now available to prevent the formation and propagation of thrombi. These agents work by different pharmacologic mechanisms and are useful in different clinical situations. CONCLUSIONS: Thrombosis research has increased our understanding of the pharmacology of antithrombotic drugs and promoted the discovery of new agents targeted more specifically toward the critical steps in pathologic clot formation. New agents have the potential for greater efficacy and fewer adverse effects. An increased understanding of hemostasis, thrombosis, and the pharmacology of antithrombotic drugs should enable the clinician to use these agents appropriately.

Animals↗
PubMedDate not supplied

Random dot stereoacuity of preschool children. ALSPAC "Children in Focus" Study Team.

PURPOSE: Commercially available book-format random dot stereopsis tests for children are quick and simple to use, but provide accurate measurement of stereoacuity only in children age 5 years or older. Alternative methods for preschool children provide only pass/fail information or require lengthy laboratory-based protocols. To address the need for a quick and accurate measure of random dot stereoacuity in the preschool age range, we developed a new book-format random dot stereoacuity test. METHODS AND RESULTS: A total of 25 potential shapes for the new test were evaluated in a group of 43 healthy full-term children aged 3 years +/- 2 months. Eleven shapes that were identified successfully by more than 95% of the 3-year-olds were selected to be incorporated into the preschool stereotest. The preschool random dot stereotest books were administered to more than 1000 normal children and pediatric patients in multiple settings: a research laboratory (Retina Foundation SW), a population screening project (University of Bristol, UK), eye clinics (Children's Medical Center, Dallas, Tex), and a day care center (Federal University, São Paulo, Brazil). Randot, Lang 1, Frisby, or Titmus stereoacuity tests also were administered. Orthoptic or ophthalmic examinations were obtained for all children as a gold standard. Outcome measures were success rate and concordance with the clinical examination. Sensitivity, specificity, and accuracy exceeded 0.90 both in clinical and screening settings. CONCLUSIONS: The preschool random dot books had a higher success rate than other tests in the preschool age range and provided accurate measurement of stereoacuity in the 3- to 5-year-old age range.

Child, Preschool↗
PubMedDate not supplied

Racial, religious, and national origin intermarriage in the U.S.: review of selected theory, method, and research.

"This article summarizes the intermarriage literature with special reference to books and articles in the social sciences. The literature is partitioned into theoretical approaches, conceptualization and operationalization, computational formulas used in the reporting of intermarriage, general findings on the extent and types of intermarriage, [and] correlates of and attitudes toward racial, religious and national origin intermarriage. The authors conclude that a variety of theories and methods have [been] and continue to be employed to investigate this phenomenon. Among the findings reported are that racial intermarriages are least prevalent and national origin intermarriages the most prevalent in the United States."

Americas↗
PubMed2003

Melanin-based plumage coloration and flight displays in plovers and allies.

Plovers and their allies exhibit an impressive diversity of melanin-based plumage patterns ranging from non-melanized to completely melanized species. We use phylogenetic comparative methods to test whether melanization has evolved in relation to sexual selection for attracting mates, to selection for signalling territory defence, or to natural selection for camouflage. First, according to sexual-selection theory, melanized plumage has evolved to amplify the courtship displays of males. As predicted by this hypothesis, we found that males with aerial displays had more melanized plumage than males of ground-displaying species. In addition, sexual dimorphism in melanization was greater in species with display flights than in species with ground displays. Second, melanization may have evolved through social interactions to signal competitive ability in territory defence. We did not find evidence for this hypothesis, since breeding density was unrelated to the melanization of either sex. Finally, melanized plumage may camouflage the incubating parent. The latter hypothesis was not supported, since melanization was unrelated either to the darkness of nest substrate or the extent of vegetation cover. Taken together, our results are most consistent with the sexual-selection hypothesis, and suggest that melanized plumage has evolved to enhance the aerial displays of male plovers.

Animal Communication↗
PubMed2001

Heparins and mechanical methods for thromboprophylaxis in colorectal surgery.

BACKGROUND: Colorectal surgery implies higher risk of postoperative thromboembolic complications as deep venous thrombosis (DVT) and pulmonary embolism (PE) than general surgery. The best prophylaxis in general surgery is heparin and graded compression stockings. No systematic review on combination prophylaxis or on thrombosis prophylaxis in colorectal surgery has been published. OBJECTIVES: To compare the incidence of postoperative thromboembolism after colorectal surgery using prophylactic methods focussing on heparins and mechanical methods alone and in combinations. SEARCH STRATEGY: Electronic searches was performed in MEDLINE, EMBASE back to 1970. Abstract books from major congresses were handsearched as were reference lists from previously performed reviews. SELECTION CRITERIA: RCT or CCT comparing prophylactic interventions and/or placebo. Outcomes were ascending venography, 125 I-fibrinogen uptake test, ultrasound methods, pulmonary scintigraphy. Studies, using thermographic methods, other isotopic methods, plethysmographic methods, and purely clinical methods as the only diagnostic measure were excluded. 558 studies were identified - 477 were excluded. Only 3 of the identified studies focused exclusively on colorectal surgery. Studies of general surgery contain considerable numbers of colorectal patients. The authors of 66 studies in general and/or abdominal surgery were contacted for retrieving the results from the colorectal patients. Answers were received from very few. 19 studies entered this review. DATA COLLECTION AND ANALYSIS: All studies and all data extraction were performed independently by at least two of the authors. Outcome was deep venous thrombosis and/or pulmonary embolism. Analysis of bleeding complications were unfeasible. 12 meaningful outcomes were analysed by means of the fixed effects model with Peto Odds Ratios. MAIN RESULTS: Heparins versus no treatment: Any kind of heparincompared to no treatment or placebo (comparison 07.03, 11 studies). Heparin is better in preventing DVT and/or PE with a Peto Odds ratio at 0.32 (95% Confidence Interval 0.20-0.53) Unfractionated heparin versus low molecular weight heparin (comparison 08.03, 4 studies). The two treatments were found equally effective in preventing DVT and/or PE with a Peto Odds ratio 1.01 (95% Confidence Interval 0.67-1.52). Mechanical methods (comparison 10.3, 2 studies). The combination of graded compression stockings and LDH is better than LDH alone in preventing DVT and/or PE with a Peto Odds ratio at 4.17 (95% Confidence Interval 1.37-12.70). REVIEWER'S CONCLUSIONS: The optimal prophylaxis in colorectal surgery is the combination of graduated compression stockings and low-dose unfractionated heparin. The unfractionated heparin can be replaced with low molecular weight heparin.

Anticoagulants↗
PubMed1999

Pharmacokinetics during pregnancy: evidence-based maternal dose formulation.

OBJECTIVE: To review the literature regarding how drug pharmacokinetics differ between pregnant and nongravid women. DATA SOURCES: Articles published between 1963 and 1997 were retrieved from the database of the National Library of Medicine for review, using the key words "pregnancy," "pharmacokinetics," and "human." Additional articles and book chapters were identified from the bibliographies of articles retrieved. METHODS OF STUDY SELECTION: Articles had to include primary data that were not previously published. Data abstracted from articles meeting the inclusion criteria included: sample size, estimated gestational age, area under the curve, volume of distribution, maximum plasma concentration, steady-state concentration, half-life, time to maximum plasma concentration, clearance, and data from nonpregnant controls. TABULATION, INTEGRATION, AND RESULTS: Of more than 1000 articles published, 61 articles and book chapters reported relevant pharmacokinetic data, such as those listed, based on primary data. Only two studies synthesized pharmacokinetic data into guidelines for individualized clinical regimens. CONCLUSION: Available data regarding the pharmacokinetics of therapeutic regimens during pregnancy do not provide clinically relevant guidelines for the formulation of therapy for individual patients. Pharmacokinetic investigations during pregnancy that produce evidence-based guidelines for treating individual patients were identified as a major area of need. Minimum requirements are recommended for reporting pharmacokinetic studies in obstetrics.

Analgesics↗
PubMed2006

Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis.

BACKGROUND: People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often. OBJECTIVES: To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis. SEARCH STRATEGY: We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.Date of the most recent search: August 2005. SELECTION CRITERIA: All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy and/or toxicity, in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS: The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies. MAIN RESULTS: Eleven studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, weighted mean difference (WMD) 0.33 (95% confidence interval (CI) -2.81 to 3.48); forced vital capacity, WMD 0.29 (95% CI -6.58 to 7.16); % weight for height, WMD -0.82 (95% CI -3.77 to 2.13); body mass index, WMD 0.00 (95% CI -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, WMD -8.20 (95% CI -15.32 to -1.08), but showed no difference in adults, WMD 3.25 (95% CI -1.82 to 8.33). AUTHORS' CONCLUSIONS: Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children.

Adolescent↗
PubMed2001

Psychological therapies for thalassaemia.

BACKGROUND: Thalassaemia is a group of genetic blood disorders characterised by the absence or reduction in the production of haemoglobin. Severity is variable from less severe anaemia, through thalassaemia intermedia, to profound severe anaemia (thalassaemia major). In thalassaemia major other complications include growth retardation, bone deformation, and enlarged spleen. Blood transfusion is required to treat severe forms of thalassaemia, but this results in excessive accumulation of iron in the body (iron overload), removed mostly by a drug called desferrioxamine through 'chelation therapy'. Non-routine treatments are bone marrow transplantation (which is age restricted), and possibly hydroxyurea, designed to raise foetal haemoglobin level, thus reducing anaemia. In addition, psychological therapies seem appropriate to improving outcome and adherence to medical treatment. OBJECTIVES: To examine the evidence that in patients with thalassaemia, psychological treatments improve the ability to cope with the condition, and improve both medical and psychosocial outcome. SEARCH STRATEGY: The Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Also, searches on the Internet were performed. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of psychological intervention to no (psychological) intervention in patients with thalassaemia. DATA COLLECTION AND ANALYSIS: No trials of psychological therapies were found in the literature for inclusion at the present time. MAIN RESULTS: There are no results to be reported at present. REVIEWER'S CONCLUSIONS: As a chronic disease with a considerable role for self-management, psychological support seems appropriate for managing thalassaemia. However, no conclusions can be made about the use of specific psychological therapies in thalassaemia from the information currently available. This systematic review has clearly identified the need for well designed, adequately-powered, multicentre, randomised controlled trials assessing the effectiveness of specific psychological interventions for thalassaemia.

Adaptation, Psychological↗
PubMed2003

Valproate for acute mood episodes in bipolar disorder.

BACKGROUND: Bipolar disorder is a common debilitating illness, characterised by acute affective episodes with full or partial inter-episode remission. Effective and acceptable treatment of acute episodes is required. Valproate has become a leading adjunctive and alternative mood stabilising treatment to lithium in bipolar disorder. OBJECTIVES: To determine the efficacy and acceptability of valproate in the treatment of acute episodes of bipolar disorder. SEARCH STRATEGY: The search included the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registrar (CCDANCTR), the Cochrane Controlled Clinical Trials Register (CCTR), reference lists of relevant papers and books, and contact with authors of trials, experts and pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials comparing valproate with placebo, other mood stabilisers and antipsychotic medication in the treatment of any bipolar affective episode. Participants were of both sexes, of all ages, with a diagnosis of bipolar affective disorder approximating to ICD 10 Code F31 and DSM IV 296. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed independently by two reviewers blind to the authorship and source of papers. Ten randomised controlled trials were found comparing valproate with other interventions in mania. None was found examining its use in depression or mixed affective episodes. Data were extracted on the main outcome 'failure to respond by the end of the study' assessed by a less than 50% reduction in the Young Mania Rating Scale or the SADS-S mania scale. Three trials (316 participants) compared valproate with placebo. Three trials (158 participants) compared valproate with lithium. Two trials (363 participants) compared valproate with olanzapine. One trial (36 participants) compared valproate with haloperidol. Two trials (59 patients) compared valproate with carbamazepine. Acceptability of treatment was estimated using the outcome measure 'total number of subjects withdrawing from the study'. Three trials (321 patients) contributed to the comparison between valproate and placebo, two studies (144 patients) contributed to the comparison with lithium. One study (30 patients) provided data on this outcome in the comparison between valproate and carbamazepine. Pooled relative risks (with 95% confidence intervals) were calculated using fixed effect approaches. MAIN RESULTS: Valproate was more efficacious than placebo (RRR 38%; RR 0.62; 95% C.I. 0.51 to 0.77) in the treatment of mania. There was no significant difference between valproate and lithium (RRI 5%; RR 1.05; 95% C.I. 0.74-1.50) or between valproate and carbamazepine (RRR 34%; RR 0.66; 95% C.I. 0.38 to 1.16). Valproate was less effective than olanzapine (failure to achieve clinical response; RRI 25%; RR 1.25, 95% C.I. 1.01 to 1.54; average of 2.8 point less change on the Mania Rating Scale (95% CI 0.83 to 4.79). There were no significant differences in acceptability as measured by total number of subjects withdrawing from the study. There were significant differences in the side effect profiles of valproate and olanzapine, with more sedation and weight gain on olanzapine. REVIEWER'S CONCLUSIONS: There is consistent, if limited, evidence to suggest that valproate is an efficacious treatment for acute mania. Valproate may be less effective than olanzapine but may cause less sedation and weight gain. More well designed, randomised controlled trials investigating the relative efficacy and acceptability of valproate in the treatment of the full range of acute affective episodes occurring in bipolar disorder are required.

Antimanic Agents↗
PubMed2006

Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis.

BACKGROUND: Lower respiratory tract infection with Pseudomonas aeruginosa (P. aeruginosa) occurs in most people with cystic fibrosis. Once chronic infection is established, P. aeruginosa is virtually impossible to eradicate and is associated with increased mortality and morbidity. Early infection may be easier to eradicate. OBJECTIVES: To determine whether antibiotic treatment of early P. aeruginosa infection in children and adults with cystic fibrosis eradicates the organism and improves clinical and microbiological outcome. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: May 2004 SELECTION CRITERIA: We included randomised controlled trials of people with cystic fibrosis, in whom P. aeruginosa had recently been isolated from respiratory secretions. We compared combinations of inhaled, oral or intravenous antibiotics with placebo or usual treatment (or both) or other combinations of inhaled, oral or intravenous antibiotics. We excluded non-randomised trials, cross-over trials, and those utilising historical controls. DATA COLLECTION AND ANALYSIS: Both authors independently assessed selected trials, assessed methodological quality and extracted data. MAIN RESULTS: The search identified 15 trials. Three trials (69 participants) were eligible for inclusion. There is evidence from two randomised controlled trials, of questionable methodological quality, that treatment of early P. aeruginosa infection with inhaled tobramycin results in microbiological eradication of the organism from respiratory secretions more often than placebo and that this effect may persist for up to 12 months, however incomplete data from one of the trials precludes an accurate analysis. One randomised controlled trial of oral ciprofloxacin and nebulised colisitin versus usual treatment was identified. This trial was of poor methodological quality. The results suggested treatment of early infection results in microbiological eradication of P. aeruginosa more often than usual treatment, after two years, RR 0.24 (95% CI 0.06 to 0.96). There is insufficient evidence to determine whether antibiotic strategies for the eradication of early P. aeruginosa decrease mortality or morbidity, improve quality of life, or are associated with adverse effects compared to placebo or standard treatment. AUTHORS' CONCLUSIONS: From the three trials included in this review, there is some evidence that antibiotic treatment of early P. aeruginosa results in short-term eradication but it remains uncertain whether there is clinical benefit to people with cystic fibrosis.

Anti-Bacterial Agents↗
PubMed1997

Oxytocin and its receptor in pregnancy and parturition: current concepts and clinical implications.

OBJECTIVE: To present our current understanding of oxytocin and its receptors during pregnancy and parturition and their potential clinical applications. DATA SOURCES: A MEDLINE search was conducted for pertinent articles from 1966 to October 1996 related to oxytocin and its receptor and their clinical implications during pregnancy and parturition. Review articles, book chapters, and published trials were also searched. METHODS OF STUDY SELECTION: Only references in English that were deemed relevant were used. When possible, human data and sometimes animal data pertinent to understanding the interaction of oxytocin and its receptors were selected. TABULATION, INTEGRATION, AND RESULTS: Oxytocin is synthesized in the hypothalamus and in many reproductive tissues during pregnancy, whereas the receptors are synthesized in reproductive tissues. The genes for oxytocin and its receptors are on chromosomes 20 and 3, respectively. Oxytocin and its receptors are regulated by sex steroids and by oxytocin itself. The paracrine and autocrine mechanisms regulating oxytocin and its receptor within the fetoplacental-uterine unit are central to the control of uterine contractions and parturition. Such current understanding provides the basis for appropriate oxytocin regimens to induce or augment labor, to inhibit preterm labor by blockade of oxytocin receptors, and to achieve cervical ripening. CONCLUSION: Advances in our knowledge of oxytocin and its receptor have provided rational and sound principles for current concepts about their role in parturition, the appropriate use of oxytocin to stimulate the pregnant uterus or ripen the cervix, and the use of oxytocin antagonist to inhibit uterine contractions and preterm labor.

Chromosomes, Human, Pair 20↗
PubMed2001

Acquisition of 3-dimensional shapes from images.

Advances in computer vision have started to infiltrate the specialty of orthodontics. During the past few years, a number of new products have appeared that are capable of extracting the 3-dimensional (3-D) structure of an object just by "looking." Examples include laser scanners for creating 3-D models of the face, and hand-held scanners for creating virtual models of the teeth. Such noninvasive methods will surely evolve rapidly and be applied to a multitude of diagnostic and therapeutic modalities, changing the way we think and practice. This article introduces the basic principles behind such technology so that we can better appreciate its advantages, limitations and possibilities. From the large number of methods for acquiring 3-D shapes from images, 4 were selected and are described below. For more comprehensive coverage, see the book by Klette et al (1).

Humans↗
PubMed1980

Management of subclavian vascular injuries.

Greater civilian use of firearms and improved transportation and resuscitation of the injured have provided our institutions with an increasing experience with subclavian vascular injuries. Ninety-three patients with subclavian vascular injuries are presented and two time periods are compared. Principles of management gained from the earlier experience have been utilized with a decline in mortality to 4.7% among the patients admitted with a palpable pulse or blood pressure. Successful treatment as before still lies in the recognition of the severity of the injury, rapidity of preparation for operation, and adequacy of surgical exposure. Recent trends have included an increased reliance on selective arteriography when the patient is stable, extensive use of the 'book' thoracotomy as a primary incision, preoperative and intraoperative autotransfusion, and a more frequent use of interposition grafting for vascular repair. Primary arterial repair was seldom accomplished; most patients required segmental resection with end-to-end anstomosis or interposition grafts.

Adolescent↗
PubMed1994

Effect of epidural analgesia for labor on the cesarean delivery rate.

OBJECTIVE: To use meta-analysis to evaluate the effect of epidural analgesia on the cesarean delivery rate. DATA SOURCES: The MEDLINE data base was searched for articles published in English between January 1981 and April 1992. We also interviewed experts and conducted a bibliographic follow-up and manual review of recent journals published from April to July 1992. METHODS OF STUDY SELECTION: We excluded articles with irrelevant titles, and those case studies, book chapters, or articles that did not provide primary and relevant data. Two hundred thirty articles were read, including articles that reported on women of standard obstetric risk and on cesarean delivery rates for an epidural group and for a concurrent no-epidural group. These criteria yielded six studies for a primary analysis and two others for a secondary analysis. DATA EXTRACTION AND SYNTHESIS: The sample size of the epidural and no-epidural groups and the number of cesareans within each group were extracted. Tests of homogeneity were conducted. The pooled cesarean delivery risk difference as a result of epidural analgesia was estimated. The cesarean rate for women undergoing epidural analgesia was ten percentage points greater than for no-epidural women (P < .05). More than a nine percentage point increase was shown for cesarean deliveries for dystocia (P < .05), when pooling either all studies or only randomized studies. CONCLUSIONS: The results of this meta-analysis strongly support an increase in cesarean delivery associated with epidural analgesia. Further research should evaluate the balance between analgesia associated with the use of epidurals, and postpartum morbidity and costs associated with cesarean deliveries.

Analgesia, Epidural↗