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PubMed2005

[Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine].

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in neonatal surgery. The aim of this article is to make an update of the controversies about the therapeutic management (time of surgery and modalities of medical stabilization) of CDH, by means of a systematic and critical review of the best scientific evidence in bibliography. METHODS: Systematic and structured review of the articles about therapeutic management of CDH (surgery, mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation, surfactant, etc) published in secondary (TRIPdatabase, systematic review in Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). RESULTS: The main secondary information is found in The Cochrane Library: 3 systematic review in the Neonatal Group (one specific about the time of surgery, and two related to the use of nitric oxide and extracorporeal membrane oxygenation in neonatal severe respiratory failure). But we found the main relevant articles in Pubmed database, mainly published in Journal Pediatric Surgery and with some clusters of investigation (Congenital Diaphragmatic Hernia Study Group in Texas University and Buffalo Institute of Fetal Therapy in New York University). CONCLUSIONS: From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear, but delayed surgical (with pre-operative stabilization) has become preferred approach in many centers, and foetal surgery is not better than neonatal one. Opinion regarding the time of surgery has gradually shifted from early repair to a policy of stabilization and delayed repair. Because of associated persistent pulmonary hypertension and/or pulmonary hypoplasia in CDH, medical therapy is focused toward optimizing oxygenation while avoiding barotrauma, using gentle ventilation and permissive hypercarbia. High frequency oscillatory ventilation, inhaled nitric oxide and extracorporeal membrane oxygenation are used in severe cases, but these treatments do not clearly improve the outcome in neonates with CDH. The usefulness of surfactant and partial liquid ventilation are based in animal model experimentation, because the clinical trials in newborns are little and non-conclusive. Challenges for the future in this thematic area include the need for bigger and better trials of therapy in this field, with long-term outcomes among surviving children.

Evidence-Based Medicine↗
PubMed1987

Antenatal care in Belfast.

A questionnaire study of mothers' views of the antenatal care provided in Belfast showed general satisfaction. Retrospective examination of their charts however showed in some cases that insufficient attention was paid to the medical and obstetric history in the selection of type of care made by the women and their doctors. Some women with high risk factors were booked for shared care and some patients at low risk were booked for total hospital care. The reasons for this are unclear.The mothers felt that continuity of care and communication at the health centre were better than at the hospital. Analysis of the number of hospital attendances showed that shared care patients appeared to be making an excessive number of visits to hospital. Many total hospital care patients also admitted that they were attending their general practitioners. There appeared to be marked duplication of effort as a result of poor communication between patient, general practitioner and hospital.Alternative ideas for care are suggested - a more integrated system for sharing antenatal care, and the development of general practitioner units within the specialist obstetric hospital.

Attitude↗
PubMed1995

Pharmacologic profile of natural products used to treat psychotic illnesses.

Natural products have a long history of being the sources for therapeutic drugs in medicine. Investigations of natural products also have the potential for enhancing our understanding about the pathophysiology and treatment of various disorders. The screening assays described here were conducted on the phytochemical and pharmacological profiles of natural products used to treat psychotic illnesses in Korean traditional medicine, which are eligibly archived in Tongeuibogam, a traditional medicinal book in Korea. Two rounds of radioligand receptor binding assays on natural products demonstrated that many plants show potent selectivity to various receptors, especially monoamine receptors presumed to be involved in mental disorders. Further studies for the pharmacologic activity of active ingredients and in vivo behavioral profiles focusing on the central nervous system (CNS) effects are currently under way with these plant extracts. These investigations may lead to the development of new psychotropic drugs with no serious side effects, a major concern for modern psychopharmacology.

Animals↗
PubMedDate not supplied

Grieving and death rituals of Latinos.

PURPOSE/OBJECTIVES: To describe the grieving behaviors and selected death beliefs and rituals for two Latino groups: island Puerto Ricans and Mexican immigrants. DATA SOURCES: Published articles, book chapters, books, government documents, and clinical experience. DATA SYNTHESIS: Limited scientific research exists on the grieving process and beliefs about death of Latinos. Death is seen as an extension of life in some Latino cultures, a belief that seems to assist positively in the grieving process. Rituals and ceremonies to honor the dead still are practiced in many Latino cultures and are rooted partly in their cultural heritage. CONCLUSIONS: Nurses caring for Latinos with cancer can provide better care with an understanding of grieving behaviors observed early in the disease process and at the time of imminent death. IMPLICATIONS FOR NURSING PRACTICE: Culturally competent care can be given when beliefs and values about death are understood. Allowing Latino clients to grieve and honor the dead in a culturally appropriate way will enhance the nurse/client/family relationship.

Cultural Characteristics↗
PubMed2003

DNA book.

We propose herein a new method of DNA distribution, whereby DNA clones or PCR products are printed directly onto the pages of books and delivered to users along with relevant scientific information. DNA sheets, comprising water-soluble paper onto which DNA is spotted, can be bound into books. Readers can easily extract the DNA fragments from DNA sheets and amplify them using PCR. We show that DNA sheets can withstand various conditions that may be experienced during bookbinding and delivery, such as high temperatures and humidity. Almost all genes (95%-100% of randomly selected RIKEN mouse cDNA clones) were recovered successfully by use of PCR. Readers can start their experiments after a 2-h PCR amplification without waiting for the delivery of DNA clones. The DNA Book thus provides a novel method for delivering DNA in a timely and cost-effective manner. A sample DNA sheet (carrying RIKEN mouse cDNA clones encoding genes of enzymes for the TCA cycle) is included in this issue for field-testing. We would greatly appreciate it if readers could attempt to extract DNA and report the results and whether the DNA sheet was shipped to readers in good condition.

Animals↗
PubMed2000

Home intravenous antibiotics for cystic fibrosis.

BACKGROUND: Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks, which is usually administered in hospital, affecting health costs and quality of life for patients and their families. It is not known whether patients receiving intravenous treatment at home have better or equivalent health outcomes, if costs are reduced or if it is preferred than in-hospital treatment. Home treatment requires training to patients and carers and usually needs a few previous days in hospital. OBJECTIVES: To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as in-patient intravenous antibiotic therapy and if it is preferred by patients and/or families. SEARCH STRATEGY: References to trials were obtained from the specialist cystic fibrosis trials register held by the editorial base of the Cochrane Cystic Fibrosis and Genetic Disorders Group. Handsearching of the abstracts books of all Spanish Conferences on cystic fibrosis and the last European Conference (Stockholm, 2000) was carried out by authors. SELECTION CRITERIA: Randomised controlled trials where home intravenous antibiotic treatment for patients with cystic fibrosis was compared with in-hospital intravenous antibiotic treatment, including adults and children with cystic fibrosis. All kinds of antibiotics and regimens administered intravenous were included. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS: One study was included with 17 patients aged 10 to 41 years with an infective exacerbation by Pseudomonas aeruginosa. All their 31 admissions were analysed as independent events. Outcomes were measured at 21 days of follow-up after initiation of treatment. Home patients had fewer investigations performed than hospital patients (p<0.002) and general activity was higher in the home group. No differences were found for clinical outcomes, adverse events, complications of intravenous lines or line changes or time to next admission. Home patients received less low-dose home maintenance antibiotic. Quality of life measures showed no differences for dyspnoea and emotional state, but fatigue and mastery were worse for home patients, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions. Home therapy was cheaper for families and the hospital. Indirect costs were not determined. REVIEWER'S CONCLUSIONS: The current evidence is restricted to one small study. It suggests that in the short term home therapy does not harm patients and in general reduces social disruptions. The decision to attempt home treatment should be based on an individual basis and appropriate local resources. More research is urgently required.

Adult↗
PubMed2004

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children.

BACKGROUND: Anti-leukotrienes agents are currently being studied as alternative first line agents to inhaled corticosteroids in mild to moderate chronic asthma. OBJECTIVES: To compare the safety and efficacy of anti-leukotriene agents with inhaled glucocorticoids (ICS) and to determine the dose-equivalence of anti-leukotrienes to daily dose of ICS. SEARCH STRATEGY: We searched MEDLINE (1966 to Aug 2003), EMBASE (1980 to Aug 2003), CINAHL (1982 to Aug 2003), the Cochrane Airways Group trials register, and the Cochrane Central Register of Controlled Trials (August 2003), abstract books, and reference lists of review articles and trials. We contacted colleagues and international headquarters of anti-leukotrienes producers. SELECTION CRITERIA: Randomised controlled trials that compared anti-leukotrienes with inhaled corticosteroids during a minimal 30-day intervention period in asthmatic patients aged 2 years and older. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality or trials and extracted trial data. The primary outcome was the rate of exacerbations requiring systemic corticosteroids. Secondary outcomes included lung function, indices of chronic asthma control, adverse effects and withdrawal rates. MAIN RESULTS: 27 trials (including 1 trial testing two protocols) met the inclusion criteria; 13 were of high methodological quality; 20 are published in full-text. All trials pertained to patients with mild to moderate persistent asthma. Only 3 trials focused on children and adolescents. Trial duration varied from 4 to 37 weeks. In most trials, daily dose of ICS was 400 mcg of beclomethasone or equivalent. Patients treated with anti-leukotrienes were 65% more likely to suffer an exacerbation requiring systemic steroids [Relative Risk 1.65; 95% Confidence Interval (CI) 1.36 to 2.00]. Twenty six (95% CI: 17 to 47) patients must be treated with anti-leukotrienes instead of inhaled corticosteroids to cause one extra exacerbation. Significant differences favouring ICS were noted in secondary outcomes where()the improvement in FEV(1) reached 130 mL [13 trials; 95% CI: 50, 140 mL ]. Other significant benefits of ICS were seen for symptoms, nocturnal awakenings, rescue medication use, symptom-free days, and quality of life. Anti-leukotriene therapy was associated with 160% increased risk of withdrawals due to poor asthma control. Twenty nine (95% CI 20 to 48) patients must be treated with anti-leukotrienes instead of inhaled corticosteroids to cause one extra withdrawal due to poor control. Risk of side effects was not different between groups. REVIEWERS' CONCLUSIONS: Inhaled steroids at a dose of 400 mcg/day of beclomethasone or equivalent are more effective than anti-leukotriene agents given in the usual licensed doses. The exact dose-equivalence of anti-leukotriene agents in mcg of ICS remains to be determined. Inhaled glucocorticoids should remain the first line monotherapy for persistent asthma.

Administration, Inhalation↗
PubMed2005

Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.

BACKGROUND: Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. OBJECTIVES: To establish the effectiveness of prophylactic anticonvulsants in patients with chronic subdural haematoma, for both pre- and post-operative periods. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, LILACS, the American Association of Neurological Surgeons Database and abstract books of conference proceedings of the European Association of Neurosurgical Societies. We also searched the references of all identified studies. SELECTION CRITERIA: Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: No trials met the inclusion criteria for the review. MAIN RESULTS: No randomised, controlled trials were identified. AUTHORS' CONCLUSIONS: No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. Non-controlled studies came up with conflicting results. There is an urgent need for well-designed randomised controlled trials.

Anticonvulsants↗
PubMed1999

Prescription data as a tool in pharmacotherapy audit (II). The development of an instrument.

In many countries, prescription data are used as an instrument to provide feedback on prescribing. This article describes the development and implementation of a computer program as a tool for pharmacotherapy audit meetings and it illustrates the possibilities of such a program. The program was developed to support the optimisation of prescribing in the various stages of behavioural change. It enables pharmacists to make sophisticated overviews of prescribing by physicians in their audit group and furthermore, pharmacists can conduct drug utilisation studies or pharmaco-epidemiological studies in their own patient population. Forty percent of Dutch pharmacies have purchased the computer program since its introduction; it was distributed together with a technical handbook and a course book, which elaborated on the types of graphs available and their interpretation. An educational course was developed regarding the optimal selection and interpretation of graphs. Examples of prescription data as a tool to support various aims of audit meetings are given. The program is acknowledged as a welcome contribution to pharmacotherapy audit and to the pharmacists' advisory role in pharmacotherapy.

Attitude of Health Personnel↗
PubMed2002

A descriptive analysis of research methods classes in departments of kinesiology and physical education in the United States.

Research training takes many forms and is generally a part of graduate education. A common and important aspect of research training is the introductory research methods class offered by many departments. The purpose of this study was to examine the content, process, and instructors of introductory research methods classes in departments of kinesiology and physical education in the United States. A survey was designed and extensively pilot tested. The sample was selected from all departments offering graduate degrees in the United States. Among the many results, the data indicate that one book was required reading in more than half the classes and class size averaged about 19 students. A number of objectives were statedfor most classes, with understanding research, applying research to professional situations, critiquing the research literature, and planning research indicated most often. Quantitative design and analysis topics were emphasized more strongly than qualitative design and analysis topics. Professors indicated that more than half the class time was spent lecturing and most grades were based on exams, preparation of a research proposal, and regular assignments. The professors were relatively experienced, had a variety ofspecialty areas, and were reasonably productive researchers. The trends suggest that alternative research methodologies have not been quickly added to the research methods curriculum.

Curriculum↗
PubMed1999

Mind and action.

The author argues that Cutting's Principles of psychopathology (1997) is a remarkable compendium of ideas on psychopathology and philosophy, and offers a valuable resource for those interested in this area. There is, however, a marked contrast between the way in which Cutting views philosophy (as a source of ideas) and the way contemporary philosophy views itself (as being about the skills of deepening understanding and arriving at original ideas through the application of analytical and critical thinking skills). In addition, Cutting's survey of the philosophy literature is highly selective and is concentrated largely on pre-World War II philosophy. As a result of both these features, the book underemphasises the potential value of philosophy for psychopathology. It is argued in this paper that philosophy provides strategies for inquiry into the nature of the mind and its pathologies, rather than being merely a source of ideas. This point is made in more detail by exploring the contrast between the approach Cutting adopts and the approach used by both Karl Jaspers and in recent work on the philosophy of psychopathology, specifically K.W.M. Fulford (1989). Although the author of this paper is entirely in agreement with Cutting's general view (that psychopathology is underpinned by philosophy), it is argued that he does not take his exploration far enough to extract from his survey the fundamental underlying implications for psychopathology-that psychopathology is inherently evaluative and normative in its stance, but that this aspect is rendered opaque, currently, by psychopathology's status as an empirical science.

Journal Article↗
PubMed2005

Answering multiple-choice questions in high-stakes medical examinations.

OBJECTIVES: To examine whether changing initial answers during a multiple-choice question (MCQ) test in medicine brings about better overall test results, as has been shown in other academic fields. METHODS: A total of 36 answer books from the German Second National Medical Board Examination, with 580 MCQs (where 1 answer out of 5 must be selected), were used for analysis. RESULTS: We confirmed that high-stakes MCQ test scores in medicine did indeed improve when students changed their answers once. Further changes of answers did not improve the scores. CONCLUSIONS: In written, high-stakes medical examinations, we recommend that students be encouraged, after further reflection, to change their answers in MCQ tests for questions for which they had previously had doubts about the answers.

Choice Behavior↗
PubMed1997

A review of risk factors for child pedestrian injuries: are they modifiable?

PURPOSE: To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES: (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION: All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT: Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION: Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS: A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS: Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.

Accidents, Traffic↗
PubMed1995

The comprehensibility of Australian educational literature for patients with asthma.

BACKGROUND: Education of patients with asthma is aimed at improving their knowledge, skills and attitudes, and thus compliance and control. Patient information pamphlets play a role in education, medication information and informed consent processes, and must be understood. We assessed the comprehensibility of Australian pamphlets on asthma. METHOD: 50 Australian pamphlets on asthma (written in English for adults) were selected from the Asthma Foundation, a teaching hospital in South Australia, the pharmaceutical industry, the National Asthma Campaign and specialist books and journal articles. The Australian Rix readability formula was used to estimate the grade of reading difficulty, and thus comprehensibility, of these patient information pamphlets (grade 1 = most comprehensible; grade 12 = most difficult). RESULTS: The mean grade of reading difficulty of the 50 patient information pamphlets was 8 (SD, 1.4; range, 6-11). One-third were written at or above grade 9 and two-thirds were at or above grade 8. CONCLUSION: As recent educational attainment data suggest that up to 52% of 15-69-year-olds in Australia comprehend text at or below grade 7, a substantial number of pamphlets on asthma are beyond the reading and comprehension abilities of many of their target population.

Adolescent↗
PubMed1994

The importance of placebo effects in pain treatment and research.

OBJECTIVE: To estimate the importance and implications of placebo effects in pain treatment and research from the existing literature, with emphasis on their magnitude and duration, the conditions influencing them, and proposed explanations. DATA SOURCES: English-language articles and books identified through MEDLINE (1980 through 1993) and PsycLIT (1967 through 1993) database searching, bibliography review, and expert consultation. STUDY SELECTION: Articles were included if they pertained to the review objectives. RESULTS: Placebo response rates vary greatly and are frequently much higher than the often-cited one third. Placebos have time-effect curves, and peak, cumulative, and carryover effects similar to those of active medications. As with medication, surgery can produce substantial placebo effects, and this possibility is commonly overlooked in case series reports on back surgery. Individuals are not consistent in their placebo responses, and a placebo-responder personality has not been identified. Models advanced to explain placebo effects emphasize the role of anxiety, expectations, and learning. CONCLUSIONS: Placebo effects influence patient outcomes after any treatment, including surgery, that the clinician and patient believe is effective. Placebo effects plus disease natural history and regression to the mean can result in high rates of good outcomes, which may be misattributed to specific treatment effects. The true causes of improvements in pain after treatment remain unknown in the absence of independently evaluated randomized controlled trials.

Dose-Response Relationship, Drug↗
PubMed2005

[Experience on clinical application of acupoints in the remained book of the Illustrations of Moxibustion in Dunhuang Caves].

The Illustrations of Moxibustion, a remained book in Dunhuang Caves, is now available the earliest monograph of moxibustion methods since having writing in our country. In this paper, the points selected and therapeutic methods in The Illustrations of Moxibustion are used for treatment of typical cases of cerebral palsy, rheumatoid arthritis, diarrhea due to gastroenteritis, impotence, premature, diabetes, asthma and so on to explore characteristics of using points, find out the law, test and verify the actual effect and find guiding values for modern clinic, indicating that The Illustrations of Moxibustion can be applied for treatment and rehabilitation of many kinds of refractory diseases with unique therapeutic effects and practical significance.

Acupuncture Points↗