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PubMed2004

From both sides now: librarians' experiences at the Rocky Mountain Evidence-Based Health Care Workshop.

The Colorado Health Outcomes (COHO) Department of the School of Medicine at the University of Colorado Health Sciences Center (UCHSC) coordinates the Rocky Mountain Evidence-Based Health Care (EBHC) Workshop, which has been held annually since 1999. The goals of the workshop include helping participants-physicians, pharmacists, health care policy makers, journalists and librarians-learn and apply skills for critically appraising medical research literature and for effective use of evidence-based information resources. Participants are encouraged to share ideas and to plan local services and instruction for those working in clinical settings. Each year, librarians from UCHSC Denison Memorial Library participate as faculty by teaching searching skills (PubMed, Cochrane Library, ACP Journal Club, etc.), providing support to small groups, and staffing two computer labs. In 2002, Denison Library received a National Network of Libraries of Medicine (NN/LM) MidContinental Region Impact Award to fund the attendance of three health sciences librarians from the MidContinental Region, an academic education librarian, a clinical medical librarian, and a department librarian. In this paper, the participating librarians share the lessons they learned about how health care practitioners approach evidence-based practice. The participating librarians also share how they incorporated these lessons into their support of evidence-based practice related to teaching about evidence-based resources, assisting health care practitioners with developing answerable questions, enhancing the clinician-librarian partnership, and assisting practitioners in selecting evidence-based resources for quick answers to clinical questions.

Awards and Prizes↗
PubMed2026

Efficacy, acceptability, and related outcomes of pharmacological interventions for acute bipolar mania: a systematic review and dose-related network meta-analysis across different age groups.

BACKGROUND: Acute bipolar mania carries negative social and economic consequences. We investigated the comparative efficacy/response/acceptability of pharmacological interventions for acute bipolar mania, considering dose effects across different age groups. METHODS: We conducted a network meta-analysis (NMA) to search for randomized controlled trials (RCTs) comparing pharmacological interventions with one another or placebo in acute bipolar mania patients, indexed in PubMed/MEDLINE, Embase, Web of Science, and Scopus (from inception through 2025.12.24). Co-primary outcomes were change in manic symptoms/response/and acceptability. Tolerability/remission and rate of adverse events were secondary outcomes. Confidence-In-Network-Meta-Analysis was likewise appraised. RESULTS: 113 RCTs, encompassing 49 distinct treatment combinations, included 20,666 participants. Sensitivity analysis retaining only low-risk-of-bias studies and excluding outliers for possible effect modifiers indicated that risperidone 3 mg/day(SMD = -7.57;95%C.I. = -8.25;-5.85); tamoxifen 160 mg/day(SMD = -1.73;95%C.I. = -2.32;-1.13); rivastigmine 3 mg/day(SMD = -1.13;95%C.I. = -1.06;-0.58); haloperidol 30 mg/day(SMD = -0.96;95%C.I. = -1.25;-0.75); valproate 750 mg/day(SMD = -0.76;95%C.I. = -1.48;-0.58); tamoxifen 40 mg/day(SMD = -0.75;95%C.I. = -1.41;-0.59); celecoxib 400 mg/day(SMD = -0.74;95%C.I. = -1.20;-0.38); paliperidone extended-release 12 mg/day(SMD = -0.62; 95%C.I. = -0.91;-0.32); olanzapine 15 mg/day(SMD = -0.59;95%C.I. = -0.60;-0.38); olanzapine 20 mg/day(SMD = -0.52;95%C.I. = -0.66;-0.38); risperidone 4 mg/day(SMD = -0.53;95%C.I. = -0.76;-0.29); allopurinol 600 mg/day(SMD = -0.54;95%C.I. = -0.67;-0.22); cariprazine 12 mg/day(SMD = -0.49;95%C.I. = -0.66;-0.33); risperidone 4.2 mg/day(SMD = -0.46;95%C.I. = -0.75;-0.17); lithium 1500 mg/day(SMD = -0.42;95%C.I. = -0.57;-0.28); ziprasidone 160 mg/day(SMD = -0.49;95%C.I. = -0.68;-0.31); asenapine 20 mg/day(SMD = -0.38;95%C.I. = -0.53;-0.22); haloperidol 8 mg/day(SMD = -0.34;95%C.I. = -0.63;-0.05); aripiprazole 15 mg/day(SMD = -0.33;95%C.I. = -0.61;-0.06) outperformed placebo. Ziprasidone 160 mg/day, celecoxib 200 mg/day, asenapine 20 mg/day, and asenapine 10 mg/day proved more efficacious than placebo in children. No statistically significant differences were reported between treatments and placebo for response/remission/acceptability/tolerability, and manic/hypomanic switch. A meta-regression of efficacy effect sizes against the adapted AMSTAR-Plus content scores showed that larger SMDs were associated with lower AMSTAR scores, indicating lower study quality, warranting further caution for such large efficacy estimates. CONCLUSIONS: Our findings are consistent with previous NMAs and current guidelines, expanding the current knowledge base while concurrently appraising different drugs, doses, and age groups.

Humans↗
PubMed2001

From proteomics to genomics.

Presently, science is moving from genomics to proteomics in order to get insight into the functional network of gene expression. Actually however, proteomics is much older than genomics and dates back to the introduction of the two-dimensional gel electrophoresis technique (2-DE) independently by Klose and O'Farrell. Based on this approach almost all cellular proteins can be separated. New developments in mass spectrometry allowed identification of single spots in the 2-DE protein pattern, including the underlying genes. Joachim Klose has focused his pioneering 2-DE studies on mouse models with special emphasis on quantitative protein variants. According to him, proteins are living molecules exhibiting a characteristic protein phenotype.

Animals↗
PubMed2004

A general approach to Bayesian networks for the interpretation of evidence.

Bayesian networks (BNs) are mathematically and statistically rigorous techniques for handling uncertainty. The field of forensic science has recently attributed increased attention to the many advantages of this graphical method for assisting the evaluation of scientific evidence. However, the majority of contributions that relate to this topic restrict themselves to the presentation of already "constructed" BNs, and often, only a few explanations are given as to how one obtains a specific BN structure for a given problem. Based on several examples, the present paper will therefore attempt to explain in more detail some guiding considerations that might be helpful for the elicitation of appropriate structures for BNs.

Bayes Theorem↗
PubMed2005

Poison control centers in developing countries and Asia's need for toxicology education.

Poison control centers (PCCs) in developing countries have been set up in response to the challenge of decreasing mortality and morbidity from poisoning. The services range from poison information to actual clinical treatment mostly of acute cases. Lately, PCCs have expanded from their traditional role to one that actively engages in community health studies, toxicovigilance along with treatment of chronic poisoning. Recognizing that types of poisoning and specific needs may vary from country to country, toxicology education that addresses these unique regional issues has become more necessary. Toxicology education, both formal and informal, exists in various stages of development in Asia. Clearly, there are gaps that need to be addressed especially in areas where there are no poison centers or where strengthening is necessary. Collaboration between PCCs in developing countries can help augment available resources including human, analytical and technical expertise. The critical mass of trained toxicologists will fill in the demand for clinical and regulatory specialists and educators as well. This paper highlights the experiences and resources available to the Philippine and Malaysian poison centers and the strengths generated by networking and collaboration. The role of Asia Pacific Association of Medical Toxicology (APAMT) as the Science NGO representative to the Intergovernmental Forum on Chemical Safety (IFCS) forum standing committee in promoting chemical safety at the regional level will be discussed. The "Clearinghouse on the Sound Management of Chemicals", a platform for engaging multi-stakeholder and interdisciplinary partnerships, will be described as a possible model for capacity building to advance chemical safety through education and training not only in developing countries in Asia but globally as well.

Asia↗
PubMed1976

Computer-aided-instruction in the emergency department.

The Massachusetts General Hospital Laboratory of Computer Science created a library of computer-aided-instruction (CAI) programs in 1972. An experimental network of Cai programs, made possible by National Library of Medicine (NLM) support, was set up in July 1972, operating over commercial communication lines. Programs developed by Massachusetts General, Ohio State University and the University of Illinois Medical College were made available to users with terminals in about 36 cities through a local telephone number. During the first two years of the program over 80 institutions participated. A trial of the Massachusetts General programs, in conjunction with the Continuing Education Committee of the American College of Emergency Physicians, was conducted in five representative community hospitals. The hospitals put up the cost of the terminals and the telephone charges. Results of the study showed that 12 of the 40 (30%) emergency physicians in the target population took 10 or more programs. They gave the programs a favorable overall rating--1.6 on a scale of 1 (strongly positive) to 5 (strongly negative).

Computer-Assisted Instruction↗
PubMed1996

An Analysis of Craniocentric and Oculocentric Coding Stages in a Neural Network Model of the Saccadic System.

We have shown earlier in a neural network study of the saccadic system, how retinal error an efference copy signal of eye position may give rise to distributed coding of target position in craniocentric coordinates at one level, and of motor error in oculocentric coordinates at another stage. In the present paper, the coding properties of units in the model's two hidden layers were investigated, in order to understand at a more abstract level, how they handle their inputs and how the two different target representations at subsequent stages emerge. In particular, we hoped to understand better how craniocentric and oculocentric target representations can be constructed by merging a retino-topically coded visual signal and recruitment-coded eye position information. In the first hidden layer, we found that inputs from both visual and oculomotor signals were nicely matched in showing similar directional selectivity. Computationally, the net input of each hidden unit can be represented by the dot product between a fixed sensitivity vector, embodied by the unit's input weights, and the two-dimensional input signal encoded by the population activity. Scaling of the resulting total net input signal through a sigmoidal nonlinearity then yields the activity of the hidden unit. The fact that the sensitivity vectors for retinal and oculomotor signals in the first hidden layer were roughly aligned and matched in amplitude is the basic underlying principle for a rough craniocentric coding at this level. Units in the second hidden layer represent motor error. This can similarly be understood on the basis of the previously mentioned dot product characterization of the hidden unit's connectivity. The combined process of tuned projection and compression by the unit's sigmoidal nonlinearity also captures the gain-field properties of units in the first hidden layer. Our study suggests that the approach underlying the present analysis of an artificial network may be a useful tool to describe real networks and to allow a direct comparison of simulated and neurophysiological data. Copyright 1996 Elsevier Science Ltd.

Journal Article↗
PubMed1997

Threshold-dependent Limit Cycles in a Nonlinear Network Model.

A mathematical model of the dynamics of a neural network, in which synaptic strength varies simultaneously with activation, is analyzed. This feedback network, with infinite-gain transfer function, is described by a system of ordinary differential equations. It is shown that the resulting discontinuous nonlinear dynamical system has multiple stable periodic solutions. The existence of these periodic attractors depends critically on the value of the threshold parameter; and by varying the threshold the network can be made to cycle through a sequence of attracting states. Copyright 1997 Elsevier Science Ltd.

Journal Article↗
PubMed1993

Primary prevention of malignant melanoma in the Stockholm Cancer Prevention Programme.

Malignant melanoma is the most rapidly increasing tumour in Sweden. Sunburns in childhood and adolescence are considered a major risk factor. The Stockholm Cancer Prevention Programme addresses strategies to establish sun awareness in the population of Stockholm county by using existing networks of standardized child health and preschool services, educational systems including schools, colleges of nursing sciences and preschool teaching (integration of sun awareness in curricula, and in a new syllabus for environmental theory), the Federation of Swedish Pharmacies, and media. Health education is designed for key persons in these organizations and the media, who in turn diffuse sun awareness via their respective organizations. The education programme only deals with primary prevention by behavioural changes in exposure to UV rays, ie excessive exposure to sun, and it is primarily intended to raise sun awareness. Experiences have shown that information diffusion was good in spite of limited staff resources.

Adolescent↗
PubMed2000

Is telemedicine a subset of medical informatics?

Informatics has a key characteristic of a new discipline in a technically transient environment--there is no universal definition of it. This is not surprising, given its complex and diverse nature. In a broad sense informatics is the interface between developing technologies and the decision sciences, in particular clinical sciences. Telemedicine has no universally accepted definition either. Telemedicine requires the use of electronic communication networks for the transmission of information and data related to the diagnosis and treatment of, as well as education about, medical conditions. The debate ensues over whether it is or is not a subset of medical informatics. The care of the elderly diploma programme is a telemedicine project within the department of family medicine at the University of Alberta; it is a distance learning programme directed towards educating and training physicians in rural Alberta. This project provided us with the practical experience of addressing both informatics and telemedicine issues jointly.

Aged↗
PubMed2006

A framework for local accountability for patient safety.

Despite numerous publications outlining the magnitude of patient safety issues, the literature provides limited strategies for organizations to develop comprehensive, effective patient safety programs. Hamilton Health Sciences (HHS) has created a framework to foster local accountability called Patient Safety Triads and Networks. The Networks operationalize patient safety initiatives, develop knowledge and improve patient safety culture in a collaborative interdisciplinary team model. They have proven to be an effective way to support patient safety at the local level and to integrate organizational and local work on patient safety.

Humans↗
PubMedDate not supplied

The design and development of hypertext courseware for CAL in diagnostic radiography.

Educational software has been designed and developed for training within the field of diagnostic radiography and is particularly concerned with the science and technology of diagnostic X-rays. The material has been structured into hypertext networks and as such allows interactive exploration of the available information. The courseware development platform was Microsoft Windows and authoring was accomplished using the constructional tool kit ToolBook. The resulting CAL package is highly graphical in nature with a user interface designed to meet the 'friendliness' demands of the end user group. Mechanisms for navigation through, and orientation within, the hypertext have also been established which support two levels of user activities. By changing the level of user freedom, students using the system as a learning tool are restricted to more structured routes than experienced staff using the courseware as an information resource. An aim of this work has been to provide interactive educational activities to support the main courseware, and consequently a novel application has been developed using dynamic data exchange (DDE) and the spreadsheet software Excel. Through a ToolBook front end students can interactively alter an X-ray spectrum by changing the operating conditions of a simulated X-ray tube.

Computer Graphics↗
PubMed2006

A breaking strategy for topoisomerase IIbeta/PARP-1-dependent regulated transcription.

While diverse enzymatic activities are required for transcriptional initiation, a central question remains whether additional enzymatic activities involved in other cellular processes may also be critical for regulated gene activation. Recently, we reported that signal-dependent activation of gene transcription requires topoisomerase IIbeta (Topo IIbeta)-dependent, nucleosome-specific, transient double-stranded DNA break formation with subsequent activation of poly(ADP-ribose) polymerase-1 (PARP-1) enzymatic function, which causes local changes of chromatin architecture (Ju et al., Science 2006; 312:1798-802). Here, we discussed that possible molecular mechanism underling Topo IIbeta/PARP-1/DNA-PK network in transcriptional initiation and many intriguing issues remain to be solved in the future.

Animals↗
PubMed2002

The institutionalization of public health training and the health sciences.

The health of the population is determined by a number of ecological determinants in addition to medical care. Therefore a close relationship exists with the social and political context in a society. With regard to the health care system, schools of public health as institutions for training, research, and services have to focus on four main deficits in the area of information, prevention, social gradients, and the regulation of health care delivery. A task profile derives which comprises (a) training for research and services, (b) monitoring population health and setting of priorities, (c) applied research on public health, (d) consulting the decision makers, and (e) intervention and public accountability. How to perform in these areas has to be related to basic ethical principles, notably, equity, participation, subsidiarity, sustainability, and efficiency. Furthermore, international trends in modern education have to be considered as for the European Union in the Bologna Declaration of 1999, with reference to academization and internationalization of advanced studies. The resulting institutional profile of modern schools of public health is characterized by their academic basis, interdisciplinarity, and multi-professionality. The paradigm of the New Public Health is an equal merger of medical and social sciences, a predominantly postgraduate study program, an international scope, close links to the government, local networks with service institutions, and a focus on contemporary health issues. In the former socialist economies of Central and Eastern Europe a regional collaboration beyond borders (the concept of regionality) is apt to support the achievement of international standards of excellence for newly developing schools of public health.

Education, Public Health Professional↗
PubMedDate not supplied

Anticoagulation clinics: the Italian experience.

BACKGROUND AND OBJECTIVE: The clinical quality of oral anticoagulant therapy (OAT) depends on how successful physicians and patients are in achieving and maintaining levels of anticoagulation capable of preventing thromboembolic events without increasing the risk of hemorrhagic complications. Concerning the patient, education and compliance are the major problems. As for the physician, on the other hand, the management of patients receiving OAT is a complex task that requires frequent laboratory testing, dosage regulation, prompt diagnosis and treatment of thromboembolic and hemorrhagic events. It requires educated and skilled personnel and a well-organized framework of services. Anticoagulation clinics, which provide patient education, close monitoring of prothrombin time and continuous clinical surveillance, may help in improving the overall quality of OAT. INFORMATION SOURCES: The authors have been working in this field contributing, original papers. In addition, the material examined in this article includes articles published in the journals covered by the Science Citation Index and Medline. STATE OF ART AND PERSPECTIVES: The concept of a coordinated network of medical services specifically devoted to the control of OAT was developed in the Netherlands following the model created by the late Professor Jordan, who in 1949 founded the first thrombosis center at the University of Utrecht. Many other anticoagulant clinics were organized on, a voluntary basis in the following decades in the Netherlands. The Dutch Federation of Thrombosis Centers was founded in 1971 and each affiliated Center is formally recognized and supported by the central Government. Today, there is a nation-wide system of regionally centralized anticoagulant control for outpatients and home patients that counts approximately 70 anticoagulant clinics (thrombosis centers), covering more than 90% of the country. Similar global approaches to the management of patients receiving OAT were proposed in other countries. In the 1950's, a group of internists and surgeons at the University of Michigan, USA, developed a unit specifically devoted to the diagnosis and treatment of thromboembolic disease, and proposed common strategies, teaching and research programs. In 1959, Sevitt and Gallagher were the first to propose a formal recognition of an anticoagulant unit in Great Britain. Finally, the Italian Federation of Centers for the Surveillance of Anticoagulant (FCSA) therapies was founded in 1989. Nowadays, Italian anticoagulation clinics operating in the framework of the FCSA are still voluntary organizations which provide a specific medical service by continuously reorganizing the personnel, structures and resources available to meet increasing demands. Since OAT has a profound social impact, its control should not be left to the good will of dedicated people, but should instead represent a specific task of the public health system. The achievement of a formal recognition of federated centers is essential for their growth, but the unavoidable increase of the expenses needed to support anticoagulation clinics is difficult to bear in a public care system which is currently facing a substantial reduction of financial resources. In a fixed health care budget, a redistribution of existing resources is the only possible solution, but to achieve this goal, public authorities have to be convinced that the management of OAT in specific anticoagulation clinics is cost-effective. A more accurate estimate of costs is needed and should be performed by the FCSA. Finally, the FCSA should strengthen its contacts with patient organizations and other scientific associations in order to develop common action strategies for improving the quality of OAT.

Ambulatory Care Facilities↗
PubMed2026

Comparative effectiveness of percutaneous coronary intervention strategies for coronary small-vessel disease: a network meta-analysis of randomized trials.

BACKGROUND: Coronary small-vessel disease (SVD) remains challenging for percutaneous coronary intervention (PCI) because small lumens magnify restenosis and ischemic risk. Multiple devices are available, yet their comparative performance is uncertain. This study evaluated and ranked PCI strategies for SVD. METHODS: A systematic review and network meta-analysis was conducted in accordance with PRISMA. PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched from inception to 15 August 2025. Eligible studies were English-language randomized controlled trials enrolling adults with angiographic SVD defined as reference vessel diameter ≤3.0 mm, comparing PCI strategies, and reporting target lesion revascularization (TLR), binary restenosis (BR), or myocardial infarction (MI). A frequentist random-effects network meta-analysis generated odds ratios (ORs) with 95% confidence intervals (CIs) and treatment rankings using the surface under the cumulative ranking curve (SUCRA). RESULTS: Thirty-nine trials including 14,503 patients met the criteria. For TLR (37 studies; 11,980 patients), the highest SUCRA values were observed with sirolimus-eluting stents (SES 90.1%), zotarolimus-eluting stents (ZES 83.9%), and everolimus-eluting stents (EES 82.2%). For BR (32; 6,468), SES, ZES, and paclitaxel-coated balloons (DCB-PTX) ranked highest (95.0%, 80.0%, and 78.3%). For MI (37; 11,602), SES, DCB-PTX, and ZES ranked highest (79.0%, 78.7%, and 68.5%). Representative effects showed SES reduced TLR versus bare-metal stents (BMS) (OR, 0.25; 95% CI, 0.15-0.43) and MI versus BMS (OR, 0.41; 95% CI, 0.21-0.79). Conventional approaches such as BMS, plain old balloon angioplasty (POBA), and gold-plated balloon angioplasty (GPBA) ranked lowest across outcomes. CONCLUSION: SES provides the most consistent clinical benefit for coronary SVD. ZES, EES, and DCB-PTX are effective alternatives in selected settings, whereas BMS, POBA, and GPBA are less effective. These findings offer comparative evidence to guide device selection in SVD.

Humans↗
PubMed2006

[Application of Bayesian network in syndrome differentiation system of traditional Chinese medicine].

The concept of syndrome in traditional Chinese medicine (TCM) is a nonlinear, open and complicated huge system. Syndrome differentiation in TCM belongs to cognitive and noetic science. To establish a new syndrome differentiation system based on the key elements of the syndrome is necessary for TCM practitioners to promote differentiation ability and reach consensus on differentiation method. With combination of experience and computation models, the Bayesian network was used in the study of the relationship between the key elements of syndrome and the symptoms, and the relationship among different key elements, in which the computing diagnosis result was identical to the result from an experienced TCM doctor. The study showed that Bayesian network is a good method to deal with the information of symptoms and signs for syndrome differentiation, but it is also not to reflect comprehensively the thinking ability of TCM doctors in doing syndrome differentiation.

Bayes Theorem↗