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PubMed2000

Diuretics for respiratory distress syndrome in preterm infants.

BACKGROUND: Lung edema may complicate respiratory distress syndrome (RDS) in preterm infants. OBJECTIVES: The aim of this review was to assess the risks and benefits of diuretic administration in preterm infants with RDS. SEARCH STRATEGY: We used the standard search method of the Cochrane Neonatal Review Group. We searched Medline, Embase and the Cochrane Controlled Trials Register from the Cochrane Library, using the following keywords: and . In addition, we searched the abstract books of the American Thoracic Society and Pediatric Research Societies. SELECTION CRITERIA: We only included trials in which preterm infants with RDS and less than 5 days of age were randomly allocated to diuretic administration. Of those trials, we only included studies in which at least one of the following outcomes measures was evaluated: mortality, patent ductus arteriosus, hypovolemic shock, intraventricular hemorrhage, renal failure, duration of oxygen supplementation, duration of mechanical ventilation, need for oxygen supplementation at 28 days of life, oxygen supplementation at 36 weeks of postconceptional age (gestational age + postnatal age), length of stay, number of rehospitalizations during the first year of life, and neurodevelopmental outcome. 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. Any disagreement was resolved by discussion. MAIN RESULTS: Six studies met inclusion criteria. Studies available for this systematic review were all done before the current era of prenatal steroids, surfactant, indomethacin and fluid restriction. Furosemide administration had no long-term benefits. Furosemide-induced transient improvement in pulmonary function did not outweigh an increased risk for patent ductus arteriosus and for hemodynamic instability. REVIEWER'S CONCLUSIONS: There are no current data to support routine diuretic administration in preterm infants with RDS. Elective administration of furosemide or any diuretic to any patient with RDS should be carefully weighed against the risk of precipitating hypovolemia. In addition, elective administration of furosemide should be weighed against the risk of developing a symptomatic patent ductus arteriosus.

Diuretics↗
PubMed2004

[University qualifying work (dissertations), their current registration, electronic access and related technical, administrative and legal questions].

Many countries (USA, Australia, Canada, Latin America, Spain, France, SRN) have national or international systems (e.g. Networked Digital Library of Theses and Dissertations--NDLTD), which openly (NDLTD) or commercially (University Microfilm International--UMI) present up to 50% of master dissertations and doctoral theses in a full text form. Such systems are in agreement with legal regulations of the given country and the author is the only holder of the work--of the dissertation. Authors are at the same time informed that dissertation represents a university document, which presents results of the given scientific community and it should be therefore distributed free of charge. Presentation is also the matter of honour of the author and his university. In the contemporary Czech Auctorial Law (No. 121/2000 Sb.) dissertation is considered as not fully defined "Educational work" and from the practical point the duration of necessary storage is not solved. For the contemporary worldwide conversion to electronically presented dissertations, the necessary technical and library standards has been prepared with the first positive experience. The supplement of the Auctorial and University Law appears to be necessary. It is inevitable to be prepared for that situation before the Czech Republic will join EU.

Academic Dissertations as Topic↗
PubMed1992

The impact of the hospital library on clinical decision making: the Rochester study.

In these times of economic constraint, libraries of all types are under increasing pressure to evaluate their services. Hospital libraries face a particular challenge because the goals of the health care system demand that the relevance of library services to patient care be determined. The hospital librarians in Rochester, New York, responded to this challenge by developing a research project that explored the impact of library services on clinical decision making. A systematically sampled group of 448 physicians in the Rochester area agreed to participate in the study between September 1990 and March 1991. The physicians were asked to request some information related to a current clinical case and then to evaluate its impact on the care of their patients. Senior medical staff or administrators acted as study facilitators in each of the fifteen participating hospitals. As a result of the information provided by the library, 80% of the 208 physicians who returned their questionnaires said that they probably or definitely handled some aspect of patient care differently than they would have handled it otherwise. Changes in the following specific aspects of care were reported by the physicians: diagnosis (29%), choice of tests (51%), choice of drugs (45%), reduced length of hospital stay (19%), and advice given to the patient (72%). Physicians also said that the information provided by the library contributed to their ability to avoid the following: hospital admission (12%), patient mortality (19%), hospital-acquired infection (8%), surgery (21%), and additional tests or procedures (49%). The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues. In addition to confirming earlier research findings that information provided by hospital libraries is perceived by physicians as having a significant impact on clinical decision making, the results increase our store of scientific knowledge about the specific nature and extent of the impact of information provided by the hospital library.

Decision Making↗
PubMed1973

A film program in a teaching hospital.

The Martland Hospital Medical Library has for more than a year been conducting a 16mm film program for interns, residents, attending physicians, and nurses as an adjunct to continuing education. It was possible to run this project on a minimal budget because many films are available at little or no cost from governmental agencies, pharmaceutical companies, medical associations, and universities. The program is run on a departmental basis. Films for a department are selected by the chief resident in that department from a list which the librarian has prepared of available films in the specialty involved. The library orders and publicizes the films and transacts all business in connection with them. Films pertinent to clinical practice are preferred. The administration of this program is described in this paper, and a number of film catalogs are evaluated. Criteria for film selection are discussed.

Education, Medical, Continuing↗
PubMed1987

Copyright law: how it affects your hospital and you.

Nurse administrators, inservice educators, and other nursing supervisors need to be aware of how copyright law affects the use of educational materials in hospitals, medical centers, and nursing homes. The United States' Copyright Act of 1976, along with Congressional guidelines and federal rulings, have a great deal to say regarding photocopying, off-air videotaping, and use of materials borrowed from lending libraries. Examples of copyright infringement are given, with suggestions for avoiding them.

Administrative Personnel↗
PubMed1967

Establishing a medical library network for the Metropolitan Detroit Area.

Since 1962 the members of the loosely organized Detroit Medical Library Group have carried on a slow but steady self-examination program. They found a need to increase resources and developed a periodical exchange, then a need to identify these resources and did so by means of a serials list. More recently, a similar program for texts and monograph resources was begun. Data, more particularly that of the interlibrary loan process, is being gathered to show the flow within the area and the flow from outside to further identify the existing resources. They have made contact with the administrators of the biomedical institutions and gained their backing (a) to further study the makeup of the community and (b) to formulate an administrative structure through which these institutions can act. These activities are evidence of the beginning of a strong medical library network for the Metropolitan Detroit Area.

Catalogs, Library↗
PubMed1983

A coordinating center in a clinical trial: the Hypertension Detection and Followup Program.

Multicenter clinical trials are often larger and more complex than other methods of clinical inquiry. They tend to involve a number of research or clinical centers and several formal committees. In many of these trials a coordinating center is one of the participating organizational units. This article describes one such coordinating center, that of the Hypertension Detection and Follow-up Program (HDFP). In 1971 the HDFP Coordinating Center was established to assist in planning and implementing this National Heart, Lung, and Blood Institute (NHLBI)-sponsored, multicenter, community-based, randomized, controlled clinical trial. The HDFP Coordinating Center is a large, intricate organization comprised of personnel who perform a wide variety of functions. From 1972 to 1979 it supervised the adherence to a common protocol among the cooperating centers and reported the Program's progress to the various monitoring and review committees, the Steering Committee, and the NHLBI Program Office. The Program screened approximately 159,000 persons ages 30 to 69 years, identifying and following 10,940 hypertensive participants. It has been the responsibility of this Coordinating Center to institute, coordinate, and monitor the data-gathering activities of the study as a whole and to process, store, and analyze the large, multifaceted set of data that were collected.

Clinical Trials as Topic↗
PubMed1999

Human chorionic gonadotropin induces an inverse regulation of steroidogenic acute regulatory protein messenger ribonucleic acid in theca interna and granulosa cells of equine preovulatory follicles.

The time- and gonadotropin-dependent regulation of steroidogenic acute regulatory protein (StAR) has not been characterized in vivo in preovulatory follicles of large monoovulatory species or sexually mature animals. The objectives of this study were to clone equine StAR and describe the regulation of its messenger RNA (mRNA) in equine follicles after the administration of an ovulatory dose of hCG. The screening of an equine follicle complementary DNA (cDNA) library with a mouse StAR cDNA probe revealed two forms of equine StAR that differ only in the length of their 3'-untranslated region (3'-UTR); a long form of 2918 bp and a short form of 1599 bp. The StAR long form cDNA contains a 5'-UTR of 117 bp, an open reading frame (ORF) of 855 bp, and a 3'-UTR of 1946 bp. Primer extension analysis showed that the cDNA clone lacked the first 10 bp of the primary transcript, giving a total of 127 bp for the complete StAR 5'-UTR. The ORF encodes a 285-amino acid protein that is 86-90% identical to StAR of other species characterized to date. The regulation of StAR mRNA in vivo was studied in equine preovulatory follicles isolated during estrus at 0, 12, 24, 30, 33, 36, and 39 h (n = 4-5 follicles/time point) after an ovulatory dose of hCG. Results from Northern blots showed no significant changes in StAR mRNA levels after hCG treatment when analyses were performed on intact follicle wall (theca interna with attached granulosa cells). However, Northern blots performed on isolated follicle cells revealed an unexpected regulation of StAR mRNA. In granulosa cells, StAR transcripts were undetectable at 0 h but were significantly increased at 30 h post-hCG, and this induction was associated with a rise in follicular fluid concentrations of progesterone (P < 0.05). In contrast, StAR mRNA levels were high in theca interna at 0 h, remained unchanged until 33 h post-hCG, and dropped dramatically thereafter (P < 0.05). Thus, this study describes the primary structure of equine StAR, documents the regulation of StAR mRNA in vivo in preovulatory follicles of a large monoovulatory species, and identifies a novel inverse regulation of StAR transcripts in theca interna and granulosa cells of equine follicles before ovulation.

5' Untranslated Regions↗
PubMed1990

Isolation and characterization of complementary DNA clones corresponding to genes induced in mouse epidermis in vivo by tumor promoters.

Complementary DNA clones representing genes in SENCAR mouse epidermis, the expression of which is induced 4 h after one topical application of the tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA) were isolated. Of 56 isolated complementary DNA clones, 32 were identified to be identical to either metallothioneins (MT-I and MT-II) or endogenous retroviral like (VL30) sequences. In situ hybridization and analysis of mRNA levels in cell fractions separated by density gradient centrifugation revealed that MT induction was restricted to keratinocytes in the basal cell layer. Immunohistochemistry and time-kinetic studies on mRNA levels in mouse epidermis showed that the increase in MT and VL30 RNAs coincide in time with a TPA-induced transient block in basal cell proliferation (3-12 h after TPA treatment). MT immunoreactivity and transcript levels had returned to control values at a time point (24 h after treatment) when epidermis is known to hyperproliferate. Treatment with other types of tumor promoters showed that MT-I and MT-II mRNAs were coordinately induced and indicated that sn-1,2-dioctanoylglycerol, 12-O-retinoylphorbol-13-acetate, and mezerein induced MT to a lesser degree than TPA. The calcium ionophore A23187 induced mRNA levels for MTs as well as VL30. VL30 and MT mRNA levels were not found to be elevated in epidermal tumors whereas the mRNA level corresponding to glyceraldehyde-3-phosphate dehydrogenase was elevated in tumors and induced by TPA with time-kinetics that correlate with a TPA-induced hyperproliferation. These complementary DNA clones provide useful tools in the study of the gene-regulating effects of TPA in a target tissue relevant for tumor promotion.

Administration, Topical↗
PubMed1986

Teaching with computers.

Various methods of using computers in education have been presented. Although the interesting file, interactive video, and bibliographic searches stand on their own, a far better approach is to integrate them, so that the radiologist learning new techniques in interventional procedures, for instance, could search the current literature quickly and easily for new articles using the bibliographic search facility and could review interesting cases from the teaching file that pertained to the lesson at hand. One very important attempt to integrate some of these teaching functions in conjunction with other aspects of medical school administration and research has been the Integrated Academic Information Management Systems (IAIMS) Program of the National Library of Medicine. This program stems from a report created by the Association of American Medical Colleges (AAMC), which was funded originally by the National Library of Medicine. This program has funded several teaching institutions to first plan for an integrated approach to medical information (Fig. 7) and then implement prototype systems. As medical image management systems become available (see the article entitled "Digital Image Management: Networking, Display, and Archiving"), they will be a major component of these information networks and will be most important for teaching purposes. Integrating the teaching components described earlier with the medical image management system will be most important.

Computer-Assisted Instruction↗
PubMed2001

Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials.

PURPOSE: To test the hypothesis that albumin administration is not associated with excess mortality. DATA SOURCES: Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists. STUDY SELECTION: Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin. DATA EXTRACTION: Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated. DATA SYNTHESIS: Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced. CONCLUSIONS: Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.

Albumins↗
PubMed1975

A medical librarian's bag of tricks: coordinating books and media.

The development of a coordinated program of print and nonprint materials in the Library of the College of Medicine and Dentistry of New Jersey is traced. Fundamental to creating a successful program is a good staff, freedom to grow, and strong administrative support. A positive and aggressive attitude on the part of librarians is an important ingredient in increasing utilization of media.

Audiovisual Aids↗
PubMed2005

Microarray studies of psychostimulant-induced changes in gene expression.

Alterations in the expression of multiple genes in many brain regions are likely to contribute to psychostimulant-induced behaviours. Microarray technology provides a powerful tool for the simultaneous interrogation of gene expression levels of a large number of genes. Several recent experimental studies, reviewed here, demonstrate the power, limitations and progress of microarray technology in the field of psychostimulant addiction. These studies vary in the paradigms of cocaine or amphetamine administration, drug doses, route and also mode of administration, duration of treatment, animal species, brain regions studied and time of tissue collection after final drug administration. The studies also utilize different microarray platforms and statistical techniques for analysis of differentially expressed genes. These variables influence substantially the results of these studies. It is clear that current microarray techniques cannot detect small changes reliably in gene expression of genes with low expression levels, including functionally significant changes in components of major neurotransmission systems such as glutamate, dopamine, opioid and GABA receptors, especially those that may occur after chronic drug administration or drug withdrawal. However, the microarray studies reviewed here showed cocaine- or amphetamine-induced alterations in the expression of numerous genes involved in the modulation of neuronal growth, cytoskeletal structures, synaptogenesis, signal transduction, apoptosis and cell metabolism. Application of laser capture microdissection and single-cell cDNA amplification may greatly enhance microarray studies of gene expression profiling. The combination of rapidly evolving microarray technology with established methods of neuroscience, molecular biology and genetics, as well as appropriate behavioural models of drug reinforcement, may provide a productive approach for delineating the neurobiological underpinnings of drug responses that lead to addiction.

Amphetamines↗
PubMed1996

Anaphylactoid reactions to methotrexate.

BACKGROUND: Methotrexate is a chemotherapeutic agent frequently utilized for the treatment of malignant, rheumatic, and pulmonary diseases. Although this agent has been extensively used for more than 45 years, there are few reports of immediate systemic hypersensitivity reactions. The reported immediate reactions include anaphylaxis, urticaria, and hepatitis. However, these reactions have been reported to occur only after some prior exposure to methotrexate. No immediate hypersensitivity reactions to methotrexate have been reported during the initial exposure. We describe two patients who developed immediate systemic hypersensitivity reactions during the initial administration of methotrexate. METHODS: The clinical outcomes of two patients treated by the Hematology/Oncology department at a tertiary care military medical center are described. The National Library of Medicine in Bethesda, Maryland, was electronically searched for the literature review. RESULTS: Patient 1, a 30-year-old male with localized high grade osteosarcoma of the left distal femur, developed generalized pruritus, urticaria, angioedema, and pharyngeal edema within 10 minutes of receiving the initial administration of intravenous high-dose methotrexate. No other pharmaceutical agents, such as antiemetics, were found to cause symptoms on rechallenge. The severity of this reaction precluded continuation of methotrexate therapy. Patient 2, a 23-year-old male with localized high grade osteosarcoma of the right distal tibia, developed pruritus and urticaria within 30 minutes of receiving the initial administration of intravenous high dose methotrexate. This patient, like most patients with immediate hypersensitivity reactions to methotrexate, developed recurrent symptoms during rechallenge of this agent despite prophylactic premedication. CONCLUSIONS: Unlike prior reports in our literature, our cases demonstrate that anaphylactoid reactions can occur during the initial exposure to methotrexate. Clinicians must be prepared to treat potentially life-threatening reactions with both the initial and subsequent doses of methotrexate.

Adult↗
PubMed1995

Cellular mechanisms involved in morphine-mediated suppression of CTL activity.

Based on a plethora of data from many laboratories, we have proposed the following mechanisms by which morphine alters immune homeostasis and immunocompetence in vivo (Fig. 2). Specifically, the administration of morphine subcutaneously via routing through blood interacts directly with opioid receptors on cells of the immune system or on receptors within the central nervous system. Although there is currently no evidence to support the direct involvement of morphine on lymphocyte opioid receptors, in vitro studies show the existence of functional, naloxone-sensitive opioid receptors (25). In addition, pharmacological and biochemical characterization of lymphocyte opioid receptors has been shown to be consistent in many instances, with the profile of neural-derived opioid receptors (25-27). Finally, recent molecular studies using oligonucleotide primers specific for the delta-class opioid receptor cloned from NG-108-15 cells (28) have been used in reverse transcription-polymerase chain reactions to generate a 400 bp product in SL which has 100% sequence homology with a published opioid receptor cloned from a brain library (35). However, future studies are necessary to establish the role of lymphocyte opioid receptors following the in vivo administration of opioids (e.g. fentanyl, methadone, and morphine). Since the administration of morphine subcutaneously appears to predominately interact with brain opioid receptors (3) located in the mesencephalon (5), other neuroendocrine systems become candidates for activation and subsequent direct modulation of immune function: (i) the HPA axis and (ii) the sympathetic nervous system (SNS).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Treatment for women with postpartum iron deficiency anaemia.

BACKGROUND: Postpartum anaemia is associated with breathlessness, tiredness, palpitations and maternal infections. Blood transfusions or iron supplementation have been used in the treatment of iron deficiency anaemia. Recently other anaemia treatments, in particular erythropoietin therapy, have also been used. OBJECTIVES: To assess the clinical effects of treatments for postpartum anaemia, including oral, intravenous or subcutaneous iron/folate supplementation and erythropoietin administration, and blood transfusion. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 May 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), Current Contents and ACP Journal Club (from inception to March 2003). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing therapy for postpartum iron deficiency anaemia (oral, intravenous or subcutaneous administration of iron, folate, erythropoietin or blood transfusion) with placebo, another treatment or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Six included RCTs involving 411 women described treatment with erythropoietin or iron as their primary interventions. No RCTs were identified that assessed treatment with blood transfusion. Few outcomes relating to clinical maternal and neonatal factors were reported: studies focused largely on surrogate outcomes such as haematological indices. Overall, the methodological quality of the included RCTs was reasonable; however, their usefulness in this review is restricted by the interventions and outcomes reported. When compared with iron therapy only, erythropoietin increased the likelihood of lactation at discharge from hospital (1 RCT, n = 40; relative risk (RR) 1.90, 95% confidence interval (CI) 1.21 to 2.98). No apparent effect on need for blood transfusions was found, when erythropoietin plus iron was compared to treatment with iron only (2 RCTs, n = 100; RR 0.20, 95% CI 0.01 to 3.92), although the RCTs may have been of insufficient size to rule out important clinical differences. Haematological indices (haemoglobin and haemocrit) showed some increases when erythropoietin was compared to iron only, iron and folate, but not when compared with placebo. REVIEWERS' CONCLUSIONS: There is some limited evidence of favourable outcomes for treatment of postpartum anaemia with erythropoietin. However, most of the available literature focuses on laboratory haematological indices, rather than clinical outcomes. Further high-quality trials assessing the treatment of postpartum anaemia with iron supplementation and blood transfusions are required. Future trials may also examine the significance of the severity of anaemia in relation to treatment, and an iron-rich diet as an intervention.

Anemia, Iron-Deficiency↗