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PubMed1998

Persons with severe mental illness in jails and prisons: a review.

OBJECTIVE: The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained. RESULTS AND CONCLUSIONS: Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness. Offenders with severe mental illness generally have acute and chronic mental illness and poor functioning. A large proportion are homeless. It appears that a greater proportion of mentally ill persons are arrested compared with the general population. Factors cited as causes of mentally ill persons' being placed in the criminal justice system are deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, mentally ill offenders' difficulty gaining access to community treatment, and the attitudes of police officers and society. Recommendations include mental health consultation to police in the field; formal training of police officers; careful screening of incoming jail detainees; diversion to the mental health system of mentally ill persons who have committed minor offenses; assertive case management and various social control interventions, such as outpatient commitment, court-ordered treatment, psychiatric conservatorship, and 24-hour structured care; involvement of and support for families; and provision of appropriate mental health treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

Community treatment of severely mentally ill offenders under the jurisdiction of the criminal justice system: a review.

OBJECTIVE: Very large numbers of severely mentally ill persons now fall under the jurisdiction of the criminal justice system. A number of conditions are placed on those who are returned to the community, including specific ones related to treatment. This paper reviews the principles and practice of forensic outpatient mental health treatment. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1978, and all pertinent references were obtained. RESULTS AND CONCLUSIONS: Community treatment of severely mentally ill offenders who fall under the jurisdiction of the criminal justice system has important differences from treatment of nonoffenders, which focuses on alleviation of symptoms. Patients must comply with legal restrictions on their behavior, and treatment first addresses a patient's risk of harm to the community. Mentally ill offenders are often resistant to treatment. The mental health system may be disinclined to treat them due to their resistance and their criminal history, especially a history of violence. It is critical to identify a treatment philosophy that strikes a balance between individual rights and public safety and includes clear treatment goals, a close liaison between treatment staff and the criminal justice system, adequate structure and supervision, treatment staff who are comfortable with using authority, interventions for managing violence, incorporation of the principles of case management, appropriate and supportive living arrangements, and a recognition of the role of family members and significant others in treatment.

Case Management↗
PubMed1999

How to search for information on transcultural nursing and health subjects: Internet and CD-ROM resources.

With the proliferation of electronic resources available to search for subjects related to transcultural nursing and health, nurses must keep abreast of computer-based tools that enable them to quickly and efficiently obtain information on a variety of topics. This article provides suggestions for narrowing and focusing a search on transcultural nursing and related subjects using key terms indexed in the Cumulative Index to Nursing and Allied Health Literature, International Nursing Index, Medline, Index Medicus, and Psychological Abstracts/PsychLit. Information about accessing the Native American Resource Information Service, Education Resources Information Center, Infotrac/Expanded Academic Index, and Sociological Abstracts also is provided. In the article, selected examples of Internet sites of interest in transcultural nursing and health are identified with their universal resource locator, and they are annotated. Web sites for U.S. government agencies, organizations, and commercial groups that concern transcultural nursing and health are cited. Global transcultural health and nursing Internet resources also are included.

CD-ROM↗
PubMed1993

Insect repellent (N,N-diethyl-m-toluamide) cardiovascular toxicity in an adult.

OBJECTIVE: To describe a case of N,N-diethyl-m-toluamide (DEET)-induced cardiovascular toxicity in an adult and reviews other cases that have been reported in the published literature. Human and animal data available on DEET pharmacokinetics are reviewed and factors that predispose an individual to DEET toxicity are identified. DATA SOURCES: Case report information was obtained through personal contact with the patient during hospitalization and by telephone, and also from the patient's medical records. Computerized literature searches were conducted with the following systems to obtain medical literature on DEET toxicity: TOXLINE, International Pharmaceutical Abstracts, and MEDLINE. Index Medicus was searched manually. STUDY SELECTION: All reported cases of DEET toxicity in children and adults were reviewed. DATA EXTRACTION: Case reports were evaluated for the quantity of the DEET exposure (topical or oral), the clinical manifestations of the exposure, and the outcome of the exposure. DATA SYNTHESIS: This case is similar in some aspects to those already in the literature; however, very few cases of DEET toxicity in adults have been reported. Cardiovascular toxicity in humans related to DEET application has not been previously reported in the published medical literature. DEET exposure (topical or oral) results in a highly variable clinical course. Whether the outcome is death or recovery without sequelae is difficult to predict. CONCLUSIONS: Adults, as well as children, are at risk for toxicity from insect repellents. The use of highly concentrated DEET-containing insect repellents should be avoided to reduce the risk of toxicity in both children and adults. The consequences of DEET toxicity are variable and unpredictable.

Administration, Cutaneous↗
PubMed1996

Do market components account for higher US prescription prices?

BACKGROUND: Although only 7-8% of US healthcare expenditures are spent on prescription drug products, the pharmaceutical industry's profitability and high cost of prescriptions to consumers make prescription drugs a visible target for reform. When compared with other products, it appears as if unfair pricing tactics are used. The pharmaceutical industry cites costs of research and development and a short patent life as justifiable grounds for high prices, but the reason why US drug prices appear to be so high has yet to be answered. OBJECTIVE: To examine identified components of the pharmaceutical industry that allow US prescription drugs to appear to be highly priced and to review the apparent factors that affect pricing policies for pharmaceuticals. DATA SOURCES: The literature was reviewed to identify current research regarding the pharmaceutical market. Sources included MEDLINE, Econolit, Business Periodical Index, International Pharmaceutical Abstracts, the Wall Street Journal, New York Times, and the F-D-C Pink Sheet. SUMMARY: Key factors account for the fact that US prescription drug prices are higher and that price discrimination occurs in the pharmaceutical industry within the US and among other countries. These factors include the unique market structure of the pharmaceutical industry, asymmetry of information, research and development costs, numerous channels of distribution and the differences among them, and government laws and regulations of prescription drugs. Pricing policies of pharmaceutical companies are based on manufacturing, promotion, and distribution costs; drug characteristics; and economic goals of the parent company.

Drug Costs↗
PubMed2004

Instructions to authors for case reporting are limited: a review of a core journal list.

BACKGROUND: Case reports are frequently published in the health care literature, however advice on preparing such reports using the "instructions to authors" pages of journals is alleged to be limited. However, to our knowledge, this has not been formally evaluated. As roles of case reports may vary according to the case and the clinical specialities, one might expect the advice to authors to vary according to journal clinical grouping. METHODS: We surveyed the current advice available to authors of case reports from 'instructions to authors' pages of a core collection of 249 journals ('Hague' list). These were examined and compared for advice or recommendation on writing case reports. Of these, 163 (65%) published case reports and provided instructions on this publication type. Data were extracted on items of style and content of case reports, using a piloted data extraction form. RESULTS: Journals that published case reports were grouped into medical (n = 81, 50%), surgical (n = 38, 23%) and generic or multidisciplinary (n = 44, 27%) categories. There was a difference among the medical, surgical and generic or multidisciplinary journals in the maximum number of words and pages allowed but no difference in the number of figures, tables, references, authors, abstract or synopsis, indexing or key words and consent. Additionally, there was no statistically significant difference among the three different categories of journals regarding the content of the case reports. CONCLUSIONS: Of the journals reviewed, we found that 'instructions to authors' pages provided limited and varied information for preparing a case report. There is a need for consensus, and more consistent guidance for authors of case report.

Editorial Policies↗
PubMedDate not supplied

Effectiveness of workplace rehabilitation interventions in the treatment of work-related upper extremity disorders: a systematic review.

The purpose of this systematic review was to evaluate the available evidence on workplace rehabilitation interventions for work-related upper extremity disorders (WRUEDs). The literature search identified a total of 811 abstracts from Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EMBASE databases. The abstracts were independently assessed by four reviewers and 53 full-text articles were identified. Twenty-one studies were then randomly allocated to two pairs of reviewers. Using a 24-item critical appraisal form, the reviewers evaluated the articles for quality and level of evidence. During this process, an additional 13 articles were discarded, resulting in eight studies. The effectiveness of these studies was limited by small sample sizes, lack of standardized outcome measures, and inadequate reporting of interventions and results. The findings of this review indicate that the evidence for workplace interventions for WRUEDs has not been established. This systematic review provides a rigorous analysis of workplace interventions for WRUEDs and emphasizes the need for further research in this area.

Humans↗
PubMed1998

Oral contraceptives and the risk of subarachnoid hemorrhage: a meta-analysis.

OBJECTIVE: The objective of this study is to estimate the risk of subarachnoid hemorrhage produced by oral contraceptive use. METHODS: Studies published since 1960 were identified using MEDLINE, Cumulated Index Medicus, Dissertation Abstracts On-line, and bibliographies of pertinent articles. Two independent reviewers screened published cohort and case-control studies that evaluated the risk of subarachnoid hemorrhage associated with oral contraceptives. Eleven of 21 pertinent studies met predefined quality criteria for inclusion in the meta-analysis. Relative risk (RR) estimations evaluating subarachnoid hemorrhage risk in oral contraceptive users compared with nonusers were extracted from each study by two independent reviewers. Study heterogeneity was assessed by design type, outcome measure (mortality versus incidence), exposure measure (current versus ever use), prevailing estrogen dose used, and control for smoking and hypertension. RESULTS: The overall summary RR of subarachnoid hemorrhage due to oral contraceptive use was 1.42 (95% CI, 1.12 to 1.80; p = 0.004). When the two study results failing to control for smoking were excluded from the analysis, a slightly greater effect was seen, with an RR of 1.55 (95% CI, 1.26 to 1.91; p < 0.0001). In the six studies controlling for smoking and hypertension the RR was 1.49 (95% CI, 1.20 to 1.85; p = 0.0003). High-estrogen oral contraceptives appeared to impart a greater risk than low-dose preparations in studies controlling for smoking, but the difference was not significant (high-dose RR, 1.94; 95% CI, 1.06 to 3.56; low-dose RR, 1.51; 95% CI, 1.18 to 1.92). CONCLUSIONS: This meta-analysis of observational studies suggests that oral contraceptive use produces a small increase in the risk of subarachnoid hemorrhage.

Case-Control Studies↗
PubMed1994

[An experimental study on a chemosensitivity test with alginate microcapsule. Feasibility of in vivo succinic dehydrogenase inhibition test].

A new chemosensitivity test was evaluated by the MTT colorimetric asay with human tumor cell lines encapsulated in alginate microcapsules with semipermeable membranes. The proliferation of KATOIII in the microcapsules rapidly increased on the 4th day after the encapsulation. The change expressed on the proliferation curve of the encapsulated KATOIII was approximately 2 days behind the proliferation of the suspension culture. The encapsulated cell number reversed and further proliferation was recognized after the 12th day. After the incubation for 5 hours of encapsulated KATOIII with the medium supplemented with 0.5% MTT, a blue formazan crystal formation was observed radiating around the cells in the capsules. MTT assay depends on the cellular reduction of the absorbance spectra at 540 nm (OD540nm), for complete solubilization of the formazan by DMSO. The formazan formation was observed more significantly in serum medium culture than in serum free medium. In MIT assay when 0.1 mol succinic acid was added, OD540nm of encapsulated KATOIII increased by approximately 50% and its sensitivity also increased greatly. In comparison the results of MTT assay for encapsulated KATOIII and MKN28 with suspended cells under the same conditions (0.1, 1, 10 micrograms/ml of MMC and ADR, 0.5, 5, 50 micrograms/ml of 5FU, 10, 30, 50 micrograms/ml of CDDP), the calculated inhibition index (%) with encapsulated cells were similar to the percentages obtained in the former MTT assay. In this study with microcapsules, the formazan formation in the capsules and the absorbance were macroscopically inhibited when the drug concentration was increased. The encapsulated KATOIII, which was implanted intraperitoneally into rat with a 16-gauge needle, was recovered at a rate of 70.8% on the 8th day and at a rate of 54.5% on the 16th day. The recovered encapsulated KATOIII proliferated remarkably forming cell clots on the 8th day after implantation. Incubation with MTT promoted formazan formation and sufficient cell viability was recognized. The Tegafur concentration in the intraperitoneal microcapsules and the microcapsules containing KATOIII after the intravenous administration of Tegafur was similar to the intrahepatic level. The 5FU level in the microcapsules containing KATOIII was higher than that in the capsules alone. In an attempt to conduct an in vivo chemosensitivity test, encapsulated KATOIII and MKN28 were intraperitoneally implanted, 4 mg/kg of MMC, ADR and CDDP, and 75mg/kg of 5FU were intravenously administered on the 2nd and 4th days after the implantation. On the 6th day, MTT assay was performed on the recovered microcapsules containing cells and the inhibition index was calculated.(ABSTRACT TRUNCATED AT 400 WORDS)

Alginates↗
PubMed1995

Systemic oxygen delivery and consumption in dogs with heartworm disease.

To investigate systemic oxygen (O2) transport, we calculated the oxygen delivery index (Do2I), oxygen consumption index (Vo2I) and oxygen extraction ratio (ER) in dogs with heartworm (HW) disease. The Do2I was 770 +/- 331 ml/min/kg in dogs mildly affected with pulmonary HW disease showing respiratory signs, mild anemia and mild cardiac insufficiency (n = 34); 238 +/- 155 ml/min/kg in dogs with ascitic pulmonary HW disease (n = 7); and 577 +/- 320 ml/min/kg in dogs with caval syndrome (CS) which survived (n = 15) or died (n = 7) after surgical HW removal. The Do2I was lower (P < 0.01) in all HW-infected groups, especially in ascites and CS-non-surviving dogs, than in HW-free dogs (n = 11, 1041 +/- 264 ml/min/kg). The Vo2I was higher in some mildly affected dogs (161 +/- 88 ml/min/kg), and lower (P < 0.01) in ascitic dogs (45 +/- 53 ml/min/kg) than in HW-free dogs (123 +/- 44 ml/min/kg). The ER was higher (P < 0.01) in all HW-infected groups than in HW-free dogs. The Do2I correlated significantly with Vo2I (r = 0.84, P < 0.01), and the Vo2I correlated significantly with ER (r = 0.48, P < 0.01). The Do2I correlated significantly with arterial O2 tension (r = 0.33), serum LDH (r = -0.46) and CK (r = -0.46) activities, serum urea nitrogen (UN, r = -0.32) and lactic acid (LA, r = -0.39) concentrations and cardiac index (r = 0.64).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Treatment of bleeding oesophageal varices: a meta-analysis.

BACKGROUND: Since some trials conducted over these last 15 years have not included enough patients, while others comparing the same therapies have produced conflicting results, the true efficacy of various treatments is poorly defined. AIM: The aim of the study was to critically review all randomized trials for acute variceal bleeding to verify the efficacy of therapies in terms of either control of bleeding or of short-term survival. METHODS: Results of randomized trials were collected from Index Medicus and abstracts from gastroenterology and hepatology societies and compared. Major end-results were overall mortality and rate of bleeding control. RESULTS: Control of bleeding--vasoactive (vasopressin, terlipressin, somatostatin) drugs were shown to be significantly better than placebo, H2 antagonists, or no treatment. Moreover, a weak trend in favour of somatostatin was found. Sclerotherapy was shown to be significantly better than conventional therapy. SHORT-TERM MORTALITY: Conventional meta-analysis showed a marginal improvement in short-term mortality when comparing vasoactive drugs with placebo, H2 blockers or no treatment at all. CONCLUSION: Vasoactive therapy is more effective than conservative measures in controlling bleeding, sclerotherapy being even more so. Moreover, sclerotherapy shows a significant improvement in short-term survival compared with conventional therapy.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Hemodialysis 1912-1945: no medical technology: before its time: part I.

W. J. Kolff's development of the first clinical dialysis device was a remarkable achievement in the absence of any previous extensive laboratory or experimental data. An examination of the four decades before the emergence of dialysis provides a unique occasion to see how science and medical technology evolved relative to the growth of complex bodies of knowledge. Dialysis emerged from the development of six distinct scientific and medical knowledge bases: 1) mechanical forces (diffusion and convection); 2) anticoagulants (hirudin and heparin); 3) membranes (collodion and cellophane); 4) kidney physiology; 5) serum and urine analysis; and 6) clinical perceptions and treatment. Each area progressed independent of the others and at different rates of speed. Basic sources of information were found in Index Medicus, Biological Abstracts, and Chemical Abstracts between 1900 and 1945. These references were surveyed for articles and the main reference works that delineated historic stages in each. With a critical mass of knowledge, Kolff envisioned a technologic solution to specific clinical needs. His work is illustrative of how medical science and practitioners work in a dynamic manner drawing from a wide array of scientific areas to meet clinical needs.

Cellophane↗
PubMedDate not supplied

Hemodialysis 1912-1945: no medical technology before its time: part II.

W. J. Kolff's development of the first clinical dialysis device was a remarkable achievement in the absence of any previous extensive laboratory or experimental data. An examination of the four decades before the emergence of dialysis provides a unique occasion to see how science and medical technology evolved relative to the growth of complex bodies of knowledge. Dialysis emerged from the development of six distinct scientific and medical knowledge bases: 1) mechanical forces (diffusion and convection); 2) anticoagulants (hirudin and heparin); 3) membranes (collodion and cellophane); 4) kidney physiology; 5) serum and urine analysis; and 6) clinical perceptions and treatment. Each area progressed independent of the others and at different rates of speed. Basic sources of information were found in Index Medicus, Biological Abstracts, and Chemical Abstracts between 1900 and 1945. These references were surveyed for articles and the main reference works that delineated historic stages in each. With a critical mass of knowledge, Kolff envisioned a technologic solution to specific clinical needs. His work is illustrative of how medical science and practitioners work in a dynamic manner drawing from a wide array of scientific areas to meet clinical needs.

Heparin↗