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PubMed1998

Making do with fewer nurses in the United States, 1945-1965.

PURPOSE: To analyze the perceptions that nurses and hospital administrators had about the nursing shortage between 1945 and 1965 and the actions they took. Reasons nurses' wages remained low during this period of shortages and high demand were also examined to expand knowledge of nursing labor during a critical time in nursing history. METHOD: Historical analysis of primary and secondary sources generated between 1945 and 1965 including: (a) American Nurses' Association's (ANA) central files in Washington, DC; (b) ANA archives at the Mugar Memorial Library, Boston University; (c) official proceedings of the ANA's and American Hospital Association's (AHA) conventions; (d) nursing and hospital journals; (e) ANA and U.S. Government statistical documents and reports on the status of nursing labor; and (g) monographs on nursing, hospitals, the history of women's labor and the history of women in the 1940s, 1950s, and 1960s. FINDINGS: Hospital administrators and nurses disagreed on the causes of the nursing shortage and its remedies in the 20 years after World War II. Hospital managers believed the shortage occurred because many nurses left the work force to remain at home with their families. Nurses, however, identified low wages and deplorable working conditions as the cause. CONCLUSIONS: Hospital managers were successful at easing the shortage and controlling nursing costs by employing ancillary workers to replace RNs. Nurses took several different actions to deal with poor working conditions: initiating the ANA Economic Security Program, joining unions, and leaving hospital nursing.

History, 20th Century↗
PubMed2000

Single dose oral aspirin for acute pain.

BACKGROUND: Aspirin has been known to be an effective analgesic for many years and is commonly used throughout the world for many different pain conditions. It is important for both prescribers and patients to have the best possible information about the efficacy and safety of analgesics, and this need is reflected in patient surveys which show that postoperative pain is often poorly managed. We also need to benchmark relative efficacy and safety of current analgesics so that we can compare them with new analgesics. OBJECTIVES: To quantitatively assess the analgesic efficacy and adverse effects of a single-dose of aspirin in acute pain of moderate to severe intensity. SEARCH STRATEGY: Randomised trials were identified by searching Medline (1966 to March 1998), Embase (1980 to January 1998), the Cochrane Library (Issue 1,1998) and the Oxford Pain Relief Database (1950 to 1994). SELECTION CRITERIA: The inclusion criteria used were: full journal publication, postoperative pain or a mixture of postoperative and acute trauma pain, oral administration, adult patients, baseline pain of moderate to severe intensity, double-blind design, and random allocation to treatment groups which compared aspirin with placebo. DATA COLLECTION AND ANALYSIS: Summed pain relief or pain intensity difference over four to six hours was extracted, and converted into dichotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief. MAIN RESULTS: Seventy-two randomised single-dose trials met our inclusion criteria, with 3253 patients given aspirin, and 3297 placebo. Significant benefit of aspirin over placebo was shown for aspirin 600/650 mg, 1000 mg and 1200 mg, NNTs for at least 50% pain relief of 4.4 (4.0 to 4.9), 4.0 (3.2 to 5.4) and 2.4 (1.9 to 3.2) respectively. Single-dose aspirin 600/650 mg produced significantly more drowsiness and gastric irritation than placebo, with a number-needed-to-harm (NNH) of 28 (19 to 52) and 38 (22 to 174) respectively. Type of pain model, pain measurement, sample size, quality of study design, and study duration had no significant impact on the results. REVIEWER'S CONCLUSIONS: Aspirin is an effective analgesic for acute pain of moderate to severe intensity with a clear dose-response. Drowsiness and gastric irritation were seen as significant adverse effects even though the studies were single-dose. The pain relief achieved with aspirin was very similar milligram for milligram to that seen with paracetamol.

Acute Disease↗
PubMed2003

Organisational infrastructures to promote evidence based nursing practice.

BACKGROUND: The purpose of this systematic review is to determine to what extent organisational infrastructures are effective in promoting the implementation of high quality research evidence on the effectiveness of nursing interventions. OBJECTIVES: To identify and summarize rigorous evaluations of organisational infrastructure developments aimed at promoting evidence based nursing practice. SEARCH STRATEGY: We searched: The Cochrane Library, MEDLINE, EMBASE, CINAHL, SIGLE, HEALTHLINE, National Research Register, Nuffield Database of Health Outcomes, NIH Databases up to August 2002. We hand searched the Journal of Advanced Nursing, Applied Nursing Research and Journal of Nursing Administration (to 1999), and checked the reference lists of articles obtained. We contacted experts in the field and relevant Internet groups. SELECTION CRITERIA: Randomized controlled trials, controlled clinical trials and interrupted times series studies of an entire or identified component of an organisational infrastructure development aimed at promoting effective nursing interventions. The participants were health care organisations comprising nurses, midwives and health visitors in hospital and community settings. DATA COLLECTION AND ANALYSIS: All identified papers were screened independently for relevance, design and outcome by two reviewers. MAIN RESULTS: No studies were sufficiently rigorous to be included in this systematic review. Seven case study evaluations were identified but excluded from the review because of poor design and lack of controls. REVIEWER'S CONCLUSIONS: 1. There are no clear implications for practice.2. Several conceptual models on organisational processes to promote evidence based practice have been described in published papers, and a number of organisational infrastructural interventions have been described in published papers. None have been evaluated properly. The next step in this field should be to conduct well planned evaluations of well planned interventions. 3. Interrupted and Complex Interrupted Times Series (ITS and CITS) designs should be adopted as a useful alternative to randomized controlled trials where such trials would be impractical. The health service cost of any infrastructure developments should be assessed in any evaluation. If possible, patient outcomes should be measured directly.

Efficiency, Organizational↗
PubMed2002

Aspirin in diabetic retinopathy. A systematic review.

Diabetes mellitus is a risk factor for eye disease that can lead to blindness. There have been both concerns that aspirin use might worsen diabetic retinopathy, as well as hopes that aspirin might be beneficial in treating it. We investigated whether there are beneficial effects of aspirin alone and in combination with other antiplatelet agents in the treatment of diabetic retinopathy, and the relative hazards for the development of high-risk proliferative retinopathy following aspirin treatment. We conducted a sensitive search for randomized controlled trials combined with index terms for identifying studies on aspirin treatment in diabetic retinopathy in the Cochrane Library (issue 4, 2001) and Medline (1966 to October, 2001). We examined randomized controlled clinical trials in diabetic patients with (non) proliferative diabetic retinopathy and aspirin treatment alone or in combination with dipyramidole versus placebo administration. Two independent reviewers judged trial eligibility, collected details of study population, interventions, and outcomes using a standard data extraction form. One reviewer assessed the quality of trial reporting. We identified six publications pertinent to our objective. Aspirin dosages ranged from 650 mg to 990 mg daily, the dose of dipyridamole, used in only one trial, was 225 mg per day. Studies lasted 8 weeks to 5 years. All trials showed that aspirin alone or in combination with dipyridamole neither lowered nor increased the risk of the development of diabetic retinopathy. The results suggest that there are no ocular contraindications to taking aspirin if required as part of a treatment for cardiovascular diseases or other medical indications.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Interactive query workstation: a demonstration of the practical use of UMLS knowledge sources.

The Interactive Query Workstation (IQW) has been developed to provide clinicians with a uniform program interface for retrieving medical-related information from various computer-based information resources. These resources can vary in content (bibliographic databases, drug information, general medical text databases), function (article retrieval, differential diagnosis, drug interaction detection, or drug dosage and administration information), and media formats (local hard disk, CD-ROM, local area network, or distant telecommunication link). IQW allows modular addition of new resources as well as extension of previously installed resources. The National Library of Medicine's three Unified Medical Language System (UMLS) Knowledge Sources, the Metathesaurus (Meta), the Semantic Network, and the Information Sources Map (ISM) have been incorporated into many aspects of IQW. Meta provides information about medical terminology and aids IQW in isolating the basic concepts from a clinician's question. The Semantic Network provides information about the categorization of concepts and possible relations between concepts. It also assists IQW in determining which queries are appropriate for a set of concepts contained in the clinician's question. The ISM provides information about the content available from a computer-based resources and aids IQW in selecting an appropriate resource from which to collect information. The computer-based resource selection is performed without user intervention. This interactive demonstration shows an environment which increases the accessibility of medical information to clinicians by utilizing the three UMLS Knowledge Sources.

Information Storage and Retrieval↗
PubMed1998

A phage display approach for rapid antibody humanization: designed combinatorial V gene libraries.

The development of a new strategy for antibody humanization is described. This strategy incorporates key recognition sequences from the parental rodent antibody into a phage display-based selection strategy. The original sequences of the third complementarity-determining regions (CDRs) of heavy and light chains, HCDR3 and LCDR3, were maintained and all other sequences were replaced by human sequences selected from phage-displayed antibody libraries. This approach was applied to the humanization of mouse mAb LM609 that is directed to human integrin alphav beta3 and has potential applicability in cancer therapy as an antiangiogenic agent. We demonstrate this approach (i) provides a rapid route for antibody humanization constraining the content of original mouse sequences in the final antibodies to the most hypervariable of the CDRs; (ii) generates several humanized versions with different sequences at the same time; (iii) results in affinities as high as or higher than the affinity of the original antibody; and (iv) retains the antigen and epitope specificity of the original antibody. The production of multiple humanized variants may present advantages in the selection of antibodies that are more readily expressed on a large scale and could be important in therapeutic regimens that call for long-term treatment with antibodies in which antiidiotypic responses might be avoided by administration of alternative antibodies.

Amino Acid Sequence↗
PubMed2005

Breast cancer risk with postmenopausal hormonal treatment.

This review was designed to determine from the best evidence whether there is an association between postmenopausal hormonal treatment and breast cancer risk. Also, if there is an association, does it vary according to duration and cessation of use, type of regimen, type of hormonal product or route of administration; whether there is a differential effect on risk of lobular and ductal cancer; and whether hormone treatment is associated with breast cancers that have better prognostic factors? Data sources for the review included Medline, the Cochrane Database of Systematic Reviews (Cochrane Library, 2005) and reference lists in the identified citations. Eligible citations addressed invasive breast cancer risk among postmenopausal women and involved use of the estrogen products with or without progestin that are used as treatment for menopausal symptoms. Abstracted data were demographic groupings, categories of hormone use, categories of breast cancer, two-by-two tables of exposure and outcome and adjusted odds ratios, relative risks (RRs) or hazard rates. Average estimates of risk were weighted by the inverse variance method, or if heterogeneous, using a random effects model. The average risk of invasive breast cancer with estrogen use was 0.79 [95% confidence interval (95% CI) = 0.61-1.02] in four randomized trials involving 12 643 women. The average breast cancer risk with estrogen-progestin use was 1.24 (95% CI = 1.03-1.50) in four randomized trials involving 19 756 women. The average risks reported in recent epidemiological studies were higher: 1.18 (95% CI = 1.01-1.38) with current use of estrogen alone and 1.70 (95% CI = 1.36-2.17) with current use of estrogen-progestin. The association of breast cancer with current use was stronger than the association with ever use, which includes past use. For past use, the increased breast cancer risk diminished soon after discontinuing hormones and normalized within 5 years. Reasonably adequate data do not show that breast cancer risk varies significantly with different types of estrogen or progestin preparations, lower dosages or different routes of administration, although there is a small difference between sequential and continuous progestin regimens. Epidemiological studies indicate that estrogen-progestin use increases risk of lobular more than ductal breast cancer, but the number of studies and cases of lobular cancer remains limited. Among important prognostic factors, the stage and grade in breast cancers associated with hormone use [corrected] do not differ significantly from those in non-users, but breast cancers in estrogen-progestin users are significantly more likely to be estrogen receptor (ER) positive. In conclusion, valid evidence from randomized controlled trials (RCTs) indicates that breast cancer risk is increased with estrogen-progestin use more than with estrogen alone. Epidemiological evidence involving more than 1.5 million women agrees broadly with the trial findings. Although new studies are unlikely to alter the key findings about overall breast cancer risk, research is needed, however, to determine the role of progestin, evaluate the risk of lobular cancer and delineate effects of hormone use on receptor presence, prognosis and mortality in breast cancer.

Breast Neoplasms↗
PubMed2000

[An archivist in a laboratory].

The article presents the results of French archival research concerning scholarly and scientific archives. The article points out that the subject-matter is of interest to historians of science and learning as well as archivists employed in research institutions. It is stressed that the concept of "scholarly/scientific archives" refers to three kinds of archives: the archives of institutions responsible for research administration, of those conducting research, as well as the archives of scholars and scientists themselves. The article presents material on the archives of the Academie des Sciences as well as other research institutions, such as the Museum d'histoire naturelle, the Conservatoire des Arts et Metiers, the Ecole Polytechnique, the Institut Pasteur and the Observatoire astronomique. Special attention is devoted to the establishment, gathering and arrangement of the archival materials of those institutions. The next part of the article deals with the issue of the archives of Polish scholars to be found in French archival literature. It identifies the places where such materials are stored and discusses the archival materials relating to Polish researchers and scholars that are stored at the library of the Institut de France, the Bibliotheque nationale, the central library of the Museum d'histoire naturelle as well as other research institutions. The next part of the article is devoted to problems of evaluating materials created in the course of currently conducted research. It is pointed out that archival material produced by the activities of research institutions consist of (i) administrative documents and (ii) documents concerned with course of research work itself. It is stressed in the article that unpublished research materials and working materials are ducuments of a very controversial kind, and do not lend themselves easily to precise and rational criteria of assessment. The article also points out that it is difficult to work out a general framework of criteria for the assessment of scholarly and scientific documents. In conclusion, it is stressed that the work on scholarly and scientific archives that has been produced in a joint effort by French history of science and learning and by French archival science, testifies to the wealth and diversity of French research activity, both as regards the work of individual scholars and scientists, as well as French research institutions. This work serves to underlie the role and achievements of science and learning in the creation of cultural heritage.

Academies and Institutes↗
PubMed2006

Prenatal administration of progesterone for preventing preterm birth.

BACKGROUND: Preterm birth is the major complication of pregnancy associated with perinatal mortality and morbidity and occurs in up to 6% to 10% of all births. Administration of progesterone for the prevention of preterm labour has been advocated. OBJECTIVES: To assess the benefits and harms of progesterone administration during pregnancy in the prevention of preterm birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Specialised Register of Controlled Trials (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2004), MEDLINE (1965 to January 2005), EMBASE (1988 to August 2004), and Current Contents (1997 to August 2004). SELECTION CRITERIA: All published and unpublished randomised controlled trials, in which progesterone was given by any route for preventing preterm birth. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by two authors. Results are presented using relative risk with 95% confidence intervals. MAIN RESULTS: For all women administered progesterone, there was a reduction in the risk of preterm birth less than 37 weeks (six studies, 988 participants, relative risk (RR) 0.65, 95% confidence interval (CI) 0.54 to 0.79) and preterm birth less than 34 weeks (one study, 142 participants, RR 0.15, 95% CI 0.04 to 0.64). Infants born to mothers administered progesterone were less likely to have birthweight less than 2500 grams (four studies, 763 infants, RR 0.63, 95% CI 0.49 to 0.81) or intraventricular haemorrhage (one study, 458 infants, RR 0.25, 95% CI 0.08 to 0.82). There was no difference in perinatal death between women administered progesterone and those administered placebo (five studies, 921 participants, RR 0.66, 95% CI 0.37 to 1.19). There were no other differences reported for maternal or neonatal outcomes. AUTHORS' CONCLUSIONS: Intramuscular progesterone is associated with a reduction in the risk of preterm birth less than 37 weeks' gestation, and infant birthweight less than 2500 grams. However, other important maternal and infant outcomes have been poorly reported to date, with most outcomes reported from a single trial only (Meis 2003). It is unclear if the prolongation of gestation translates into improved maternal and longer-term infant health outcomes. Similarly, information regarding the potential harms of progesterone therapy to prevent preterm birth is limited. Further information is required about the use of vaginal progesterone in the prevention of preterm birth.

17-alpha-Hydroxyprogesterone↗
PubMed2003

Generation and characterization of LymphoStat-B, a human monoclonal antibody that antagonizes the bioactivities of B lymphocyte stimulator.

OBJECTIVE: To identify and characterize a fully human antibody directed against B lymphocyte stimulator (BLyS), a tumor necrosis factor-related cytokine that plays a critical role in the regulation of B cell maturation and development. Elevated levels of BLyS have been implicated in the pathogenesis of autoimmune diseases. METHODS: A human phage display library was screened for antibodies against human BLyS. A human monoclonal antibody, LymphoStat-B, specific for human BLyS was obtained from the library screening and subsequent affinity optimization mutagenesis. The antibody was tested for inhibition of human BLyS in vitro and in an in vivo murine model. Additionally, the consequences of BLyS inhibition were tested in vivo by administration of LymphoStat-B to cynomolgus monkeys. RESULTS: LymphoStat-B bound with high affinity to human BLyS and inhibited the binding of BLyS to its 3 receptors, TACI, BCMA, and BLyS receptor 3/BAFF-R. LymphoStat-B potently inhibited BLyS-induced proliferation of B cells in vitro, and administration of LymphoStat-B to mice prevented human BLyS-induced increases in splenic B cell numbers and IgA titers. In cynomolgus monkeys, administration of LymphoStat-B resulted in decreased B cell representation in both spleen and mesenteric lymph nodes. CONCLUSION: A fully human monoclonal antibody has been isolated that binds to BLyS with high affinity and neutralizes human BLyS bioactivity in vitro and in vivo. Administration of this antibody to cynomolgus monkeys resulted in B cell depletion in spleen and lymph node. This antibody may prove therapeutically useful in the treatment of autoimmune diseases in humans.

Animals↗
PubMed2000

Thrombotic thrombocytopenic purpura treatment in year 2000.

BACKGROUND AND OBJECTIVE: For several decades clinicians worldwide considered TTP a severe and frustrating therapeutic problem. Fortunately, however, the prognosis of TTP patients has greatly benefited from the use of plasma manipulation techniques, particularly plasma-exchange (PE), so that the overall rate of complete responses currently ranges between 70-85% and may even exceed these figures. Despite this dramatic improvement, a number of questions remain concerning the best treatment for TTP patients. Analyzing acquired data and discussing future perspectives, this review will address the following key issues: is PE really the treatment of choice for TTP and what is the role of PE with cryosupernatant? what is the role of all the drugs which are commonly combined with PE, antiplatelet drugs and steroids in particular? what, if any, is the role of cytotoxic agents, especially vincristine? is there a treatment for PE-resistant patients? does secondary TTP need different treatments? DESIGN AND METHODS: The authors have been involved in the study and treatment of TTP for years; furthermore, they extensively searched the PubMed database of the National Library of Congress through the Internet. INTERPRETATION AND CONCLUSIONS: PE remains the treatment of choice for TTP. A large randomized trial now in progress will assess whether exchange with cryosupernatant plasma can improve treatment efficacy. The administration of antiplatelet drugs in combination with PE was fiercely debated over the past years but seems indicated both in acute TTP and as a prophylactic treatment to prevent relapses. It appears that steroids cannot be avoided, especially in light of the latest findings on TTP pathogenesis, but only specific trials will assess the optimal cortisone type and dose. Presently, different treatments can be suggested only to patients failing to respond to PE, while no specific therapy can be indicated for secondary TTP, which usually has a very poor prognosis. Finally, we would like to stress that only international co-operative (multicenter) trials on large series of patients will be able to shed light on a still obscure, if fascinating, disease. Our hope and wish is that the new century will see TTP among the diseases defeated by man's clever mind and heart.

Adrenal Cortex Hormones↗
PubMed2005

Ritodrine in the treatment of preterm labour: a meta-analysis.

BACKGROUND & OBJECTIVES: Results on the effect of ritodrine in the treatment of preterm labour are different all over the world. Therefore, a concrete conclusion cannot be drawn from a single randomized control trial (RCT). In this study, we selected a large number of RCTs worldwide on the treatment of preterm labour comparing ritodrine and placebo or magnesium sulfate and by applying meta-analysis, evaluated the effect of ritodrine in the treatment of preterm labour. METHODS: We searched and identified 20 RCTs about ritodrine versus placebo, and ritodrine versus magnesium sulphate in the main medical data resources (MEDLINE, PubMed, CBMdisc, Cochrane Library and EMBASE) from January 1970 to December 2001 published in English and Chinese literature. We abstracted data about delay of gestation, gestational age at delivery, birth weight, severe neonatal respiratory system diseases, perinatal deaths, and administration to contraction-ceased interval, etc. RESULTS: The odds ratio (OR) of 1 day (d) delay in 10 RCTs on ritodrine in preterm labour versus placebo was 2.95 (95%CI 2.15, 4.04), and OR of 2d delay was 1.91 (95%CI 1.49, 2.45), both differences were statistically significant. There were no significant difference on the OR of birth > or =37 wk, birth weight > or =2500 g, severe respiratory morbidity and perinatal mortality. The OR of 2d delay of four RCTs from abroad on ritodrine versus magnesium sulphate was 1.56 (95%CI 0.62, 3.94), and OR of 7d delay was 1.45 (95%CI 0.80, 2.62), both without significant difference. But the combined estimated rate difference (CERD) of side effects interruption rate was 12 per cent with significant difference. There were six Chinese RCTs on ritodrine and magnesium sulphate. The OR of 1d delay was 3.95 (95%CI 1.98, 7.88), and OR of neonatal death was 0.45 (95%CI 0.22, 0.93), both with significant difference. The average administration to contractionceased interval were 2.5 and 6.3 h, respectively, with CERD being -4.2 h. INTERPRETATION & CONCLUSION: In treating preterm labour, ritodrine can significantly prolong a short interval more quickly but with relatively more side effects than magnesium sulphate. Stratified RCTs for different gestational ages and different labour stages should be designed for further study.

Adrenergic beta-Agonists↗
PubMed2005

Building research administration applications for the academic health center: a case study.

The academic health center information environment is saturated with information of varying quality and overwhelming quantity. The most significant challenge is transforming data and information into knowledge. The University of Cincinnati Medical Center's (UCMC) focus is to develop an information architecture comprising data structures, Web services, and user interfaces that enable individuals to manage the information overload so that they can create new knowledge. UCMC has accomplished much of what is reported in this article with the help of a four-year Integrated Advanced Information Management Systems (IAIMS) operation grant awarded by the National Library of Medicine in 2003. In the UCMC vision for knowledge management, individuals have reliable, secure access to information that is filtered, organized, and highly relevant for specific tasks and personal needs. Current applications and tool sets will evolve to become the next generation knowledge management applications or smart digital services. When smart digital services are implemented, silo applications will disappear. A major focus of UCMC's IAIMS grant is research administration. Testing and building out existing and new research administration applications and digital services is underway. The authors review UCMC's progress and results in developing a software architecture, tools, and services for research administration. Included are sections on the evolution to full integration, the impact of the work at UCMC to date, lessons learned during this research and development process, and future plans and needs.

Academic Medical Centers↗
PubMed1991

Molecular cloning and nucleotide sequence of complementary DNA encoding rabbit alpha 1-acid glycoprotein.

Alpha 1-acid glycoprotein (AGP) complementary DNA clone has been isolated from an acute phase rabbit liver library. Complete and full-length nucleotide sequence of this cDNA has been determined. The cDNA contains 35 nucleotides 5' untranslated region followed by 606 nucleotides of coding region and a 112 nucleotides 3' untranslated region. Comparison of this sequence with that of human, rat and mouse reveals a high degree of homology with human alpha 1-AGP. Northern blot analysis of messenger RNA for alpha 1-AGP in normal and acute livers demonstrates remarkable induction of transcription of this gene in rabbit in response to acute inflammation by the administration of turpentine. Such a response of AGP gene expression makes it a major member of the acute phase responsive genes in rabbit liver.

Amino Acid Sequence↗
PubMed1974

The health information specialist: a new resource for hospital library services and education programs.

Growing pressures for more effective education programs at community hospitals demand better and more responsive hospital library resources and services. It is suggested that, with a modest amount of additional training and support, a community hospital librarian can play a key role in (1) improving the effectiveness of the hospital's library services and resources, (2) assisting hospital educators with the task of developing, implementing, and evaluating education programs, and (3) facilitating coordination of health information resources and services with all aspects of hospital education programs. An expanded, more active role, that of the Health Information Specialist, is suggested for hospital librarians. A one-week training program for librarians and special orientation for hospital educators and administrators plus followup field consultation for all three is described and proposed as an implementation strategy to provide the background and impetus needed to help hospital librarians evolve and expand their functional role into that of a Health Information Specialist.

Health Education↗
PubMedDate not supplied

Evaluating quality-of-life and health status instruments: development of scientific review criteria.

The Medical Outcomes Trust is a depository and distributor of high-quality, standardized, health outcomes measurement instruments to national and international health communities. Every instrument in the Trust library is reviewed by the Scientific Advisory Committee against a rigorous set of eight attributes. These attributes consist of the following: (1) conceptual and measurement model; (2) reliability; (3) validity; (4) responsiveness; (5) interpretability; (6) respondent and administrative burden; (7) alternative forms; and (8) cultural and language adaptations. In addition to a full description of each attribute, we discuss uses of these criteria beyond evaluation of existing instruments and lessons learned in the first few rounds of instrument review against these criteria.

Health Status↗
PubMed2000

Treatment of acute otitis media in patients with a reported penicillin allergy.

Otitis media occurs commonly in children, and is usually treated with an antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media. As he had previously experienced a rash after the administration of a penicillin, the medication order was switched from amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine whether or not this intervention was appropriate, references were found using Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues to be addressed included the need for antibiotics in acute otitis media, the comparative efficacy and tolerability of antimicrobial agents and the reliability of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be first-line agents in the treatment of acute otitis media owing to their efficacy, safety and cost, with neither drug being significantly better than the other. The need to treat otitis media with antibiotics remains controversial. Reported penicillin allergies were found to be an unreliable indicator of a potentially serious reaction. In conclusion, it was found that treatment with TMP/SMX was an appropriate intervention.

Acute Disease↗