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PubMed1979

The principles of tomographic positioning with particular reference to skull tomography.

Because the principles of tomography relating to positioning have not been clearly understood it has generally been the practice to employ only basic positions when undertaking tomographic studies. The purpose of this paper is to outline tomographic positioning principles, and to integrate them in a simple positioning system for common usage. This has given rise to the need for a completely new set of technical terms which pertain to positioning for skull tomography. It is hoped to establish an understanding which will enable the radiographer to devise methods of demonstrating structures for which there are no text book references to act as a guide, and to assist the radiologist in the recognition of pseudo-shadows.

Ear, External↗
PubMed1993

[History of the term "tan" (phlegm) (II) -- studies of the term "tan" found in medical books before the Liang dynasty].

The first description of the term "tan" is found in the Shan Han Za Bing Lun published at the end of the later Han dynasty. This book refers to this term as a disorder of the cold fluid in the body. The meaning of this term was revised to a viscous fluid as the years went on. The term "tan" from the Zhou Hou Bai Yi Fang published in the Liang dynasty was the same sense of phlegm as that found in present works. Our studies showed that changes of the words used for the concept "phlegm" in Chinese medical books coincided with those in Chinese Buddhist literature. We suggested that the concept "phlegm" in Buddhist medicine influenced Chinese tradition medicine.

China↗
PubMedDate not supplied

[An analysis of the scientific publications of the A. A. Bogomolets Institute of Physiology of the Academy of Sciences of Ukraine].

Scientific publications from three sectors of the Institute have analyzed for the period since 1979 till 1988 inclusive. The analysis is based on data of annual reference books Science Citation Index (SCI) and lists of publications of each researcher of the Institute. It is shown that with almost equal numerical strength of researchers and similar number of publications the sector of molecular physiology contributed 43.6% to cited works 48.2% of these works are included into database of SCI. Such indices for the sectors of neurophysiology and physiology of visceral systems accounted for 33%, 33.4% and 23.4, 18.4% respectively. It is of interest that 47.5% of references to the cited works of the molecular physiology sector were made by foreign scientists and self-citation constituted 17.4%, while for the other sectors such indices had a reverse relationship. The problem on objectification of estimation of research is under discussion.

Academies and Institutes↗
PubMed1979

Representations of homosexuality in health science textbooks.

Discussions of homosexual behavior in 35 publications (textbooks, trade books, pamphlets) in the fields of health science and sex education were reviewed. Ten books referred to the subject. Major findings of the study were: homosexual behavior receives significant attention in only 1 of the 10 publications; discussions of homosexuality contain a number of hidden biases; a large number of factual errors can be identified in most publications; and most authors seem to believe that homosexual behavior may be tolerated during adolescence but, at the same time, should be a source of concern to teenagers.

Attitude↗
PubMed1995

[Establishing a quality assurance system in transfusion medicine exemplified by the Heidelberg University Blood Bank].

BACKGROUND: The 'Zweite Verordnung zur Anderung der Betriebsverordnung für pharmazeutische Unternehmer vom 13. Juli 1994' requires a quality assurance system for the manufacturing of blood products. METHODS: On the basis of national law and guidelines we worked out a concept for establishing a quality assurance system at a university blood bank and applied it to the university blood bank at Heidelberg. RESULTS: The quality assurance system of the university blood bank at Heidelberg is based on the components 'quality of structure', 'quality of process' and 'quality of result'. The internal standard is specified in written form for every aspect of structure, process and result by standard operating procedures (SOP). The SOP serve as a basis for the quality system manual and the laboratory reference books. The quality assurance system described here integrates a programme for carrying out internal quality audits as well as a concept for updating SOP at regular intervals. CONCLUSIONS: The concept underlying the quality assurance system of the university blood bank at Heidelberg allows continuous quality improvement in transfusion medicine; moreover, it offers the chance to integrate quality assurance in transfusion medicine in an interdisciplinary, patient-orientated, not only regional concept of quality assurance.

Blood Banks↗
PubMedDate not supplied

Clinicians' responses to direct-to-consumer advertising of prescription medications.

BACKGROUND: The direct-to-consumer advertising (DTCA) of prescription medications is proliferating in the United States. The relationship between patient exposure to DTCA and the response of clinicians is not well understood. METHODS: A randomized postal survey of Arizona primary care provider physicians (n = 1080) and physician assistants (n = 704) was conducted. A questionnaire was created using a hypothetical patient scenario that varied according to the diagnosis of the patient (ie, hypertension, hypercholesterolemia, seasonal allergies, or obesity) and the type of informational exposure generating the patient's questions (ie, DTCA vs drug references such as Physicians' Desk Reference). Clinicians were randomly assigned 1 of 8 forms of the scenario and were asked standardized questions related to their responses when faced with the patient scenario. RESULTS: The response rate was 44% (40.5% of physicians and 49.3% of physician assistants). No statistically significant differences were found between the early and late responders or between responders and nonresponders. Relative to clinicians who received the "drug reference book" patient scenario, clinicians who received the DTCA patient scenario were more likely to become annoyed with a patient for asking for more information about medications (P =.003); less likely to answer the patient's questions (P =.03) or provide additional written information (P =.007); more likely to become frustrated (P =.003) and annoyed (P<.001) with the patient for asking to try a specific medication; and less likely to provide samples (P =.001) or a prescription (P<.001) for a specific medication. CONCLUSION: Clinicians are amenable to patients asking for drug information and medications, but they are less receptive to questions arising from DTCA.

Advertising↗
PubMed2003

Professor Ernst Fuchs (1851-1930): a defining career in ophthalmology.

Although his name is commonly recognized in conjunction with various corneal and anterior segment disorders, Ernst Fuchs' contribution to ophthalmology exceeds purely the delineation of ocular diseases and the detailed description of signs. Fuchs' collection of microscopic samples laid the foundation for anatomical and pathological understanding of blood vessels, muscles, and most other tissues of the eye. Additionally, Fuchs was able to pass on his unique knowledge, educating ophthalmologists at an international level. His textbook was, for many decades, the most extensively used reference book in the field of ophthalmology worldwide.

Austria↗
PubMed1981

Experimental evaluation of an interactive information processing aid for an emergency poison center.

In the recent literature, many studies have addressed the evaluation of the user interface in interactive systems. However, there are few theoretically based methodologies for this purpose. This study is an attempt to develop a methodology for examining the complex division of information processing labor between user and computer. A special concern was the computer-naive user searching for information using a self-teaching system. Our test bed was an emergency poison information center whose functioning depended on fast, accurate processing of patient and antidote data by a nurse. We augmented the nurses' traditional information support--a manual card file and reference books--with an interactive software system which summarized and suggested inferences from data on past successful treatment of patients. Analysis of recordings of user comments and user-system interactions showed that: (1) the support system should be more robust and have more "reasoning" power; and (2) the users' expressed information needs changed after the new support was introduced. From the results, we abstracted elements of an effective naive user-support system division of labor: (1) the support system should "actively" help the user's error recovery; (2) the system should have a sufficient knowledge base to allow "intelligent" conversation about the problem domain; and (3) the support system should allow the user to reconceptualize his information problem as his environment changes. Our method of recording user-system interactions and verbal protocols was time consuming, but did yield significant insight into the user-system division of labor. Also, considering the poison center as a living system, analysis of processing by the nurse and the traditional, the new, or an envisioned information support system showed that a highly dispersed associator and effective internal transducer promoted the functioning of the entire group.

Information Systems↗
PubMed2000

Educational skills and knowledge needed and problems encountered by continuing medical education providers.

BACKGROUND: The objective of this study was to identify the training needs and difficulties encountered by continuing medical education (CME) providers in Quebec. METHODS: A questionnaire comprised of open-ended and closed questions was sent to 224 general practitioners across Quebec who organize CME meetings. To complement and validate the data, interviews were conducted with 18 physicians selected from this group, based on their years of experience with CME, and with the managers of two organizations involved in CME. RESULTS: The questionnaire response rate was 54%. Quantitative analysis was used to identify the main training needs expressed by CME providers affiliated with the Quebec Federation of General Practitioners, namely, methods for identifying needs (74%), group leadership techniques (69%), basic principles in adult education (69%), and organization of CME activities (66%). The main problems encountered by respondents in their duties are stimulating and maintaining the interest and participation of physicians in formal CME activities (52%), identifying and meeting physicians' educational needs (32%), and motivating physicians to get involved in any kind of CME initiative (18%). The interviews highlighted the wide disparity in the approaches used by CME providers when planning activities and the failure of providers to pass on relevant information to their successors. IMPLICATIONS: Based on the difficulties and the training needs identified, we were able to develop tools (structured training program, biannual newsletter, reference books, and resources) suited to the needs of general practitioners who organize CME activities.

Education, Medical, Continuing↗
PubMed1989

Prevalence of genotoxic chemicals among animal and human carcinogens evaluated in the IARC Monograph Series.

To determine whether genotoxic and non-genotoxic carcinogens contribute similarly to the cancer burden in humans, an analysis was performed on agents that were evaluated in Supplements 6 and 7 to the IARC Monographs for their carcinogenic effects in humans and animals and for the activity in short-term genotoxicity tests. The prevalence of genotoxic carcinogens on four groups of agents, consisting of established human carcinogens (group 1, n = 30), probable human carcinogens (group 2A, n = 37), possible human carcinogens (group 2B, n = 113) and on agents with limited evidence of carcinogenicity in animals (a subset of group 3, n = 149) was determined. A high prevalence in the order of 80 to 90% of genotoxic carcinogens was found in each of the groups 1, 2A and 2B, which were also shown to be multi-species/multi-tissues carcinogens. The distribution of carcinogenic potency in rodents did not reveal any specific characteristic of the human carcinogens in group 1 that would differentiate them from agents in groups 2A, 2B and 3. The results of this analysis indicate that (a) an agent with unknown carcinogenic potential showing sufficient evidence of activity in in vitro/in vivo genotoxicity assays (involving as endpoints DNA damage and chromosomal/mutational damage) may represent a hazard to humans; and b) an agent showing lack of activity in this spectrum of genotoxicity assays should undergo evaluation for carcinogenicity by rodent bioassay, in view of the present lack of validated short-term tests for non-genotoxic carcinogens. Overall, this analysis implies that genotoxic carcinogens add more to the cancer burden in man than non-genotoxic carcinogens. Thus, identification of such genotoxic carcinogens and subsequent lowering of exposure will remain the main goal for primary cancer prevention in man.

Animals↗
PubMedDate not supplied

Does physician uncertainty affect patient satisfaction?

Physicians may choose one of several strategies when initially uncertain about making a specific therapeutic recommendation. The authors investigated how patients' satisfaction is affected by disclosure of uncertainty and its attempted resolution during a clinical encounter. Three hundred and four patients awaiting appointments at a university hospital's ambulatory medical clinic were randomized to view one of five videotapes (VTs) of a patient seeking advice about antimicrobial prophylaxis for a heart murmur. In VT-1 and VT-2, the physician disclosed no uncertainty and prescribed therapy. In VT-3, VT-4, and VT-5, the physician openly conveyed uncertainty but then: (VT-3) prescribed antibiotics without resolving his uncertainty; (VT-4) consulted a reference book with the patient present, then prescribed; or (VT-5) checked a computer with the patient present, then prescribed. Patients rated their satisfaction with the physician on a standardized questionnaire. Differences in satisfaction between the five VTs were significant (p = 0.001), with the highest ratings found for VT-1 and VT-2, where no uncertainty was disclosed. The lowest ratings in satisfaction were found when the physician expressed but then ignored uncertainty (VT-3) or examined a textbook (VT-4). Global satisfaction was inversely and significantly correlated (r = -0.47) with the patients' perception of uncertainty in the physician. The manner in which clinical uncertainty is disclosed to patients and then resolved by the physician appears to affect patients' satisfaction.

Ambulatory Care↗
PubMed2003

[Mobile computing in anaesthesiology and intensive care medicine. The practical relevance of portable digital assistants].

Portable digital assistants (PDAs) may be of value to the anaesthesiologist as development in medical care is moving towards "bedside computing". Many different portable computers are currently available and it is now possible for the physician to carry a mobile computer with him all the time. It is data base, reference book, patient tracking help, date planner, computer, book, magazine, calculator and much more in one mobile device. With the help of a PDA, information that is required for our work may be available at all times and everywhere at the point of care within seconds. In this overview the possibilities for the use of PDAs in anaesthesia and intensive care medicine are discussed. Developments in other countries, possibilities in use but also problems such as data security and network technology are evaluated.

Ambulances↗
PubMed2004

[Consumer health web service at DIMDI].

The German Institute of Medical Documentation and Information (DIMDI) extended its Internet services targeted at patients in order to meet the rising interest of the public for understandable, high-quality medical information. Medical terminology is made clear to nonprofessionals by voluminous reference books such as the Roche Encyclopedia of Medicine. By using free offers, such as the possibilities to search in up-to-date medical literature and studies, laypersons can find valuable and quality assured information on their fields of interest. Graphic and film material, which is offered in the virtual medical video shop (VVFM), covers the en-tire spectrum of specific medical fields and brings the areas of prevention, diagnostics, therapy, aftercare as well as nursing care up for discussion. It is easy to find physicians, hospitals, and self-help groups. Future plans include an extension of the offer to a substantial database-supported information portal for health-related subjects, which will provide the public with simple and speedy access to the health information of the DIM-DI and other trustworthy providers under one interface.

Community Participation↗
PubMed2006

Predictors of antisocial behaviour in children with attention deficit hyperactivity disorder.

INTRODUCTION: Antisocial behaviour is an important adverse outcome of ADHD. The aim of this review is to examine what is known about the clinical, genetic and environmental factors that contribute to the link between ADHD and antisocial behaviour. METHODS: Electronic literature searches for the years 1980-2004 and examination of key reference books were undertaken. RESULTS: ADHD symptom severity and pervasiveness predict the development of antisocial behaviour. Genetic factors contribute substantially to the risk of developing both problems, although specific genes that influence the development of antisocial behaviour in ADHD have yet to be identified. Some of these genetic effects may be indirectly mediated through environmental risk (gene-environment correlation) or by increasing individual susceptibility to specific environmental adversity (gene-environment interaction). Antisocial behaviour in children with ADHD is also linked with family adversity as well as peer rejection, although some of this adversity may arise as a result of the child's symptoms. CONCLUSION: Despite the increased risk of antisocial outcomes in those with ADHD, relatively little is known about what risk factors and mechanisms contribute to the link between both these problems. Given the need for appropriate intervention and prevention strategies and targeting resources, more research is needed in this area.

Antisocial Personality Disorder↗
PubMed1992

Simplification of antibiotic dose adjustments in renal insufficiency: the DREM system.

Many clinicians, unassisted by reference books, are unable to make the required dose adjustment of antibiotics needed when a patient has renal insufficiency. We describe the DREM (dosing in renopathy by easy-to-use multipliers) system, which simplifies the understanding and the process of dose adjustment. DREM is a two-step process: Cockcroft and Gault estimation of creatinine clearance (CLcr) from age, sex, and serum creatinine and calculation of the adjusted dose or dosing interval by multipliers. If the normal dose is multiplied by the dose multiplier (CLcr/100) and the dosing interval by the interval multiplier (100/CLcr), the adjusted dose and interval, respectively, are obtained. Theoretical trough concentrations calculated with the DREM system correlated closely (r = 0.9) with actual concentrations obtained from doses calculated by the Hull and Sarubbi method in 23 patients. With DREM, gentamicin or tobramycin trough concentrations above 2 micrograms/ml were less likely to occur. The DREM system is a simple and easily remembered method for dose adjustments of certain anti-infective agents in renal insufficiency. Dose estimates with this method are reasonably accurate and compare favourably with other standard methods of correction.

Anti-Bacterial Agents↗
PubMed1995

Extrapolation of physiological parameters for physiologically based simulation models.

Masses of organs and fluids, pulmonary ventilation and cardiac output and its distribution are the basic input data used in physiologically based pharmacokinetic models. Since these parameters are rarely measured in pharmacokinetic studies, the values found in reference books or extrapolated to meet the specific exposure conditions are used in the models. In this review of the extrapolation of pertinent physiological parameters, power equations for scaling across mammals, adjustments to body build (lean body mass) and physical activity of humans and their significance for risk assessment of human exposure to solvents using animal data are assessed.

Animals↗
PubMed2005

A case study on identification of airborne organic compounds and time courses of their concentrations in the cabin of a new car for private use.

The cabin of an automobile can be considered to be a part of the living environment because many people spend long periods of time during business, shopping, recreation or travel activities. However, little is known about the interior air contamination due to organic compounds diffusing from the interior materials used in the interior of automobiles. In the present study, the compounds in the interior air of a new car were identified, and the time courses of their concentrations were examined for over 3 years after the delivery (July, 1999). A total of 162 organic compounds, involving many aliphatic hydrocarbons and aromatic hydrocarbons, were identified. High concentrations of n-nonane (458 microg/m(3) on the day following delivery), n-decane (1301 microg/m(3)), n-undecane (1616 microg/m(3)), n-dodecane (716 microg/m(3)), n-tridecane (320 microg/m(3)), 1-hexadecene (768 microg/m(3)), ethylbenzene (361 microg/m(3)), xylene (4003 microg/m(3)) and 2,2'-azobis(isobutyronitrile) (429 microg/m(3)) were detected, and the sum of the concentrations determined for all compounds excluding formaldehyde (TVOC) was approximately 14 mg/m(3) on the day after the delivery. The concentrations of most compounds decreased with time, but increased with a rise of the interior temperature. The TVOC concentration in the next summer (July, 2000) was approximately one-tenth of the initial concentration. During the 3-year study period, the TVOC concentrations in summer exceeded the indoor guideline value (300 mug/m(3)) proposed by [Seifert B. Volatile organic compounds. In: Maroni M, Seifert B, Lindvall T, editors. Indoor air quality. A comprehensive reference book. Air quality monographs, vol. 3. Netherlands: Elsevier Science; 1995. p. 819-21]. The interior temperature and days lapsed after delivery were the main factors affecting the interior concentrations of most compounds according to multiple linear regression analysis. The results of this study offer useful fundamental data for investigations on air pollution in automotive cabins due to the organic compounds diffusing from the interior materials.

Air Pollution, Indoor↗
PubMedDate not supplied

Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles.

BACKGROUND AND OBJECTIVES: Since its advent more than 50 years ago, the use of discography has been mired in controversy. The purpose of this review is to provide a clinical overview of lumbar discography and discogenic back pain, with special emphasis on determining the accuracy of discography and whether or not the procedure improves outcomes for surgery. METHODS: Material for this review was obtained from a MEDLINE search conducted from 1951 thru September 2004, bibliographic references, book chapters, and conference proceedings. RESULTS: Based on a large number of comparative studies, plain discography is less accurate than magnetic resonance imaging in diagnosing lumbar herniated nucleus pulposus and comparable or slightly more sensitive in detecting degenerative disc disease. For disc degeneration, CT discography remains the gold standard for diagnosis. There are very few studies comparing surgical outcomes between patients who have undergone preoperative provocative discography and those who have not. What little evidence exists is conflicting. Before disc replacement surgery, approximately half the studies have used preoperative discography. A comparison of outcomes did not reveal any significant difference between the 2 groups but none of the studies was controlled, and they used different outcome measures, follow-up periods, and surgical techniques. Because all intradiscal electrothermal therapy (IDET) studies have used discography before surgery, no conclusions can be drawn regarding its effects on outcome. CONCLUSIONS: Although discography, especially combined with CT scanning, may be more accurate than other radiologic studies in detecting degenerative disc disease, its ability to improve surgical outcomes has yet to be proven. In the United States and Europe, there are inconsistencies in the use of lumbar discography such that it is routinely used before IDET, yet only occasionally used before spinal fusion.

Costs and Cost Analysis↗