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PubMed2000

Diagnostic delay in amyotrophic lateral sclerosis: what scope for improvement?

The average time taken from symptom onset to diagnosis in motor neuron disease is many months and has shown no sign of improving despite the introduction of riluzole therapy. We performed a retrospective analysis of the time to diagnosis in 57 patients using a structured interview with the patients and/or their carers. In this cohort, studied in England and Wales, the mean time from onset to diagnosis was 16.2 months. An initial incorrect diagnosis, refusal to consider the diagnosis when it was suggested by the informed patient, failure to consider a neurological cause for the patient's symptoms, and failure to make early referral to a neurologist were the major factors leading to delayed diagnosis. Bulbar symptoms were more likely to lead to correct diagnosis than limb-onset features. Ten of our patients made the diagnosis by consulting reference books or the Internet before they were informed of it by their physician.

Amyotrophic Lateral Sclerosis↗

PubMed2003

[Non-pharmacological treatment of neurobehavioural disorders following severe traumatic brain injury. A commented literature review].

OBJECTIVES: Neurobehavioural disorders are a major public health problem and a daily challenge for neurological rehabilitation. This review presents the state of art in the field of traumatic brain injury regarding non-pharmacological treatments of neurobehavioral disorders. METHODOLOGY: Medline data base and main reference books going back for 15 years were searched. RESULTS: Prevention is based on information and counselling for a better coherence in the care and a better understanding of behaviour problems. Prevention of complications is based on adaptation of units and management (one-on-one care for example). Non-pharmacological treatment can be classified according to 3 approaches: (1) Behavioural approaches: with well-established procedures for each patient; (2) Holistic approaches: addressing both lesional and psychopathological as well as environmental features; (3) Psychotherapeutic approaches: either integrated to holistic programs, or adapted from classical psychotherapy, or systemic therapy. CONCLUSION: Practices trend to a convergence through a comprehensive approach: behaviour analysis and management of its neuropsychological, psychopathological and environmental components. Everybody will be able to pick out elements adaptable for his own practice.

Behavior Therapy↗

PubMed1984

Dermatology for the nondermatologist: a problem-oriented system.

We describe a logical and systematic approach to unknown dermatologic disease entities that utilizes a simple algorithm which, when properly applied, expeditiously narrows the differential diagnosis and provides a key to standard reference books. We find this algorithm system to be superior to the common and often frustrating exercise of leafing through the dermatologic atlas in search of a picture that matches the presenting rash.

Dermatology↗

PubMed2001

Screening of the anticoccidial effects of herb extracts against Eimeria tenella.

Ionophorous antibiotics have been popularly used in the treatment of avian coccidiosis. Tissue residue of these antibiotics may be found in poultry, we have sought safe alternative anticoccidial herbal materials for the control of avian coccidiosis. Efficacy of extracts from 15 different herbs, including Bupleurum chinese DC, Sophora flavescens Aiton, and Artemisia annua Linne was tested against Eimeria tenella. One-day-old broiler chicks were infected with a USDA reference book of E. tenella, and administered various herbal extracts. Survival rates, lesion scores, body weight gains, bloody diarrhea, and oocysts excretions were investigated at the first and the second week after infection. Bloody diarrhea in the S. flavescens and Sinomenium acutum treated groups was milder than that of the other infected groups. Survival rates in the groups treated with Ulmus macrocarpa (100%), Pulsatilla koreana, Torilis japonica, Artemisia asiatica and S. flavescens (90%) were higher than that of the infected control group (70%). Lesion scores in the groups treated with U. macrocarpa (1.40+/-1.14) or Pulsatilla koreana (1.60+/-1.82) were significantly lower than those of the infected control group (3.00+/-1.10). During the first week after infection, the weight gains in the groups treated with Quisqualis indica (232.9+/-43.5 g), S. flavescens (214.4+/-46.1 g) and S. acutum (211.3+/-29.4 g) were significantly higher than the infected control group (172.4+/-17.6 g). In conclusion, the data of the survival rates, bloody diarrhea symptoms, lesion scores, body weight gains and oocyst excretions indicate that the extract of S. flavescens was the most effective. P. koreana, S. acutum, U. macrocarpa and Q. indica were also effective. Further research on the above herbal materials will be carried out by the authors by chemical analysis of the extracts.

Animals↗

PubMed1998

A survey from the literature of plants used to treat scorpion stings.

A catalogue of plants used to treat envenomation by scorpions has been compiled from a comprehensive range of over 30 reference books and review papers. Details of the parts used and the method of use are given, as well as the geographical source. The possible pharmacological and chemical basis of the use of some of the plants listed is discussed and compared with plants used to treat envenomation by snakes.

Animals↗

PubMed1996

Rehabilitation of the cancer patient at home.

OBJECTIVES: To provide a framework for considering home nursing care of the cancer patient within the context of cancer rehabilitation and to briefly review various aspects of cancer rehabilitation. DATA SOURCES: Review articles and reference books of current and classic works that discuss cancer rehabilitation. CONCLUSIONS: Rehabilitation is an important concept that should transcend cancer care in all settings, and one that naturally fits with home care. The effects of cancer and cancer treatment on the individual's quality of life, eg, psychological and social factors, sexual functioning, nutrition, fitness and exercise, symptom management, and physical disabilities are important considerations in the rehabilitation needs of persons with cancer. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the home health nurse to promote optimal functioning of cancer patients in their home environment. Assessment of the cancer patient's rehabilitation needs, skilled interventions, establishment of realistic goals, and coordinating care between members of the rehabilitation team are major responsibilities.

Activities of Daily Living↗

PubMed1998

Oncologic emergencies in the patient with lymphoma.

OBJECTIVES: To provide a brief overview of the oncologic emergencies most commonly occurring in lymphoma patients. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: As a result of their malignancy and the treatments they receive, lymphoma patients are at an increased risk for the development of the following oncologic emergencies: superior vena cava syndrome, cardiac tamponade, sepsis, acute tumor lysis syndrome, and increased intracranial pressure. If not recognized and treated quickly, these complications can be deadly. With appropriate medical and nursing management, these emergencies either can be prevented or their complications minimized. IMPLICATIONS FOR NURSING PRACTICE: An awareness of which patients are at risk for these complications and the pathophysiology of each emergency will assist nurses in the implementation of treatment measures.

Bacteremia↗

PubMed1998

Chemotherapy of astrocytomas: an overview.

OBJECTIVES: To provide an overview of the use of chemotherapy in the treatment of malignant brain tumors, with an emphasis on malignant gliomas. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: Chemotherapy has primarily been used in a adjuvant setting after radiation therapy for primary brain tumors. This focus has not had a significant effect on survival. In an effort to more effectively treat the tumor, innovative chemotherapy treatments have been developed. These include the use of neoadjuvant chemotherapy, changes in timing of administration, new classes of chemotherapeutic agents, new routes of delivery, and augmentation of the body's own immune system to treat the tumor. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the oncology nurse caring for the patient with a malignant brain tumor to gain knowledge of the disease process, side effect management, and the most up-to-date treatment regimens.

Antineoplastic Agents↗

PubMed2004

Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland.

OBJECTIVES: To explore the types of drug information used by pharmacists in daily practice, their needs and wishes concerning drug information and their opinions about future changes of pharmacy practice. METHODS: Postal survey to a random sample of 223 (26% out of 859) community pharmacies from the German-speaking part of Switzerland. The 48-item questionnaires were processed automatically with the Cardiff TELEform-Software. In addition, a telephone-survey to a random sample of 20 non-responders was performed in order to test for non-response bias. RESULTS: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information used to solve all kinds of drug related problems. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for paediatrics, phytotherapy, drugs during pregnancy/lactation and for therapy guidelines. According to 35% of the pharmacists, the importance of offering drug information to customers will increase in the future. Most of the pharmacists are not afraid that Internet pharmacies would replace them. CONCLUSIONS: The results show that the majority of the community pharmacists are only partially satisfied with the sources of drug information currently available. The Internet still plays a minor role for solving drug-related problems in daily practice, even though the available infrastructure makes the community pharmacies able to use the Internet more frequently. The pharmacists need more websites tailored to their needs. The pharmacists have clear visions about possible future developments. They do, however, have to adopt quickly to the changes ahead in order to remain competitive.

Drug Information Services↗

PubMed2004

Dopamine dysfunction in borderline personality disorder: a hypothesis.

Research on the biological basis of borderline personality disorder (BPD) has focused primarily on the serotonin model of impulsive aggression. However, there is evidence that dopamine (DA) dysfunction may also be associated with BPD. Pertinent research and review articles, identified by Medline searches of relevant topics, books, references from bibliographies, and conference proceedings from 1975 to 2003, were reviewed. Evidence of DA dysfunction in BPD derives from the efficacy of traditional and atypical antipsychotic agents in BPD, and from provocative challenges with amphetamine and methylphenidate of subjects with the disorder. In addition, human and animal studies indicate that DA activity plays an important role in emotion information processing, impulse control, and cognition. The results of this review suggest that DA dysfunction is associated with three dimensions of BPD, that is, emotional dysregulation, impulsivity, and cognitive-perceptual impairment. The main limitation of this hypothesis is that the evidence reviewed is circumstantial. There is no study that directly demonstrates DA dysfunction in BPD. In addition, the therapeutic effects of antipsychotic agents observed in BPD may be mediated by non-DA mechanisms of action. If the stated hypothesis is correct, DA dysfunction in BPD may result from genetic, developmental, or environmental factors directly affecting specific DA pathways. Alternatively, DA dysfunction in BPD may be a compensatory response to alterations in the primary neural systems that control emotion, impulse control, and cognition, and that are mediated by the brain's main neurotransmitters, glutamate, and GABA, or in one or more other neuromodulatory pathways such as serotonin, acetylcholine, and norepinephrine.

Animals↗

PubMed2002

Torture and its neurological sequelae.

BACKGROUND: Refugees and asylum seekers continue to enter the United States and the European Union in record numbers. Some have estimated that between 5-35% of all refugees have suffered torture in their countries of origin. Although general practitioners and specialized physicians are likely to encounter victims of torture as patients, few providers are familiar with the health problems that may affect this patient population. PURPOSE: :To provide neurologists, neurosurgeons, and rehabilitation medicine physicians with basic knowledge about survivors of torture that can help in the diagnosis, treatment, and referral of such patients. METHODS: A MEDLINE (1966-October 2001) search using keywords torture and sequelae (nervous system diseases and brain injuries) was conducted. Other data sources included books, reference lists, online resources and expert opinion. FINDINGS: :Forms of torture that may affect the nervous system include beatings, gunshot wounds, stab wounds, asphyxiation, prolonged suspension and electrocution. Victims of torture commonly experience neurological symptoms such as headaches, vertigo, loss of consciousness and dizziness during and after torture. A successful and meaningful clinical interaction with a survivor of torture includes avoiding retraumatization, building trust, spelling out any limits on confidentiality, and above anything else, establishing empathy with the patient. CONCLUSIONS: Neurological sequelae of torture can be devastating physically and psychologically. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique and must focus on avoiding retraumatization and helping the victim reintegrate into society as quickly as possible.

Comorbidity↗

PubMed2001

In the case of the fabella a comparison view of the other knee is unlikely to be helpful.

The fabella is a common normal ossicle lying behind the knee. An experienced observer is unlikely to consider it to be an abnormality but, if there is uncertainty in the mind of the referring clinician, a comparison view of the other knee might be requested. This would be a useful decision if the bone in question was present on the other side in close to 100% of people. The incidence of the fabella was studied in the local population and it was found that it was bilateral in only 63% of people. This percentage is lower than that reported elsewhere (81-85%).1-4 Therefore, there was no reason to X-ray the opposite side to confirm that the ossicle in question was a fabella. If the local incidence of fabella had been a little lower, say 50%, it would have meant that tossing a coin would have been just as reliable as a "comparison view". Therefore, in case of doubt, the best advice seems to be to refresh the memory by consulting a reference book of normal variants and to take comparison views sparingly.

Humans↗

PubMed1998

Establishment of a reference collection of additives and an analytical handbook of reference data to support enforcement of EU regulations on food contact plastics.

A collection has been made of additives that are required as analytical standards for enforcement of European Union legislation on food contact plastics. The 100 additives have been characterized by mass spectrometry, infra-red spectroscopy and proton nuclear magnetic resonance spectroscopy to provide reference spectra. Gas chromatographic retention times have been recorded to facilitate identification by retention index. This information has been further supplemented by physico-chemical data. Finally, chromatographic methods have been used to indicate the presence of any impurities in the commercial chemicals. Samples of the reference substances are available on request and the collection of spectra and other information will be made available in printed format and on-line through the Internet. This paper gives an overview of the work done to establish the reference collection and the spectral atlas, which together will assist enforcement laboratories in the characterization of plastics and the selection of analytical methods for additives that may migrate.

Chromatography, Gas↗

PubMed1998

Medicinal plants and Alzheimer's disease: Integrating ethnobotanical and contemporary scientific evidence.

The use of complementary medicines such as plant extracts in dementia therapy, varies according to the different cultural traditions. In orthodox Western medicine, contrasting with that in China and the Far East for example, pharmacological properties of traditional cognitive or memory enhancing plants have not been widely investigated in the context of current models of Alzheimer's disease. An exception is Ginkgo biloba in which the ginkgolides have antioxidant, neuroprotective, and cholinergic activities relevant to Alzheimer's disease mechanisms. The therapeutic efficacy of Ginkgo biloba extracts in Alzheimer's disease in placebo-controlled clinical trials is reportedly similar to currently prescribed drugs such as tacrine or donepezil and, importantly, undesirable side effects of Ginkgo biloba are minimal. Old European reference books (eg, medical herbals) document a variety of other plants such as Salvia officinalis (sage) and Melissa officinalis (balm) with memory improving properties, and cholinergic activities have recently been identified in extracts of these plants. Precedents for modern discovery of clinically relevant pharmacological activities in plants with long-established medicinal use include, for example, the interaction of alkaloid opioids in Papaver somniferum (Opium poppy) with endogenous opiate receptors in the brain. With recent major advances in understanding the neurobiology of Alzheimer's disease, and as yet limited efficacy of so-called rationally designed therapies, it may be timely to re-explore historical archives for new directions in drug development. This article considers not only the value of an integrative traditional and modern scientific approach to developing new treatments for dementia, but also in the understanding of disease mechanisms. Long before the current biologically based hypothesis of cholinergic derangement in Alzheimer's disease emerged, plants now known to contain cholinergic antagonists were recorded for their amnesic and dementia-inducing properties.

Alzheimer Disease↗

PubMed2005

Botanical and dietary supplements for menopausal symptoms: what works, what does not.

BACKGROUND: Approximately two thirds of women who reach menopause develop menopausal symptoms, primarily hot flashes. Hormone therapy long was considered the first-line treatment for vasomotor symptoms. However, given the results of the Women's Health Initiative (WHI), many women are reluctant to use exogenous hormones for symptomatic treatment and are turning to botanicals and dietary supplement (BDS) products for relief. Despite the fact that there is limited scientific evidence describing efficacy and long-term safety of such products, many women find these natural treatments appealing. Perimenopausal and postmenopausal women are among the highest users of these products, but 70% of women do not tell their healthcare providers about their use. Compounding this issue is the fact that few clinicians ask their patients about use of BDS, largely because they have not been exposed to alternative medical practices in their training and are unfamiliar with these products. METHODS: This paper reviews the botanicals and dietary supplements commonly used in menopause (such as black cohosh, red clover, and soy products) as well as the available data on efficacy and safety. We searched the MEDLINE database from 1966 to December 2004 using terms related to BDS and menopausal symptoms for perimenopausal or postmenopausal women. Abstracts from relevant meetings as well as reference books and websites on herbal supplements were also searched. Randomized, controlled trials (RCTs) were used if available; open trials and comparison group studies were used when RCTs were not available. RESULTS AND CONCLUSIONS: The evidence to date suggests that black cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly mood disorders. Phytoestrogen extracts, including soy foods and red clover, appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease. St. John's wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition. Other commonly used botanicals have limited evidence to demonstrate safety and efficacy for relief of symptoms related to menopause.

Diet↗

PubMed2003

The effect of age on the use of health and self-care information: confronting the stereotype.

PURPOSE: Given stereotypes of older adults, there is the perception that older adults will not use health information technologies. One concern is that practitioners might shy away from providing older patients with health information, and in particular, computerized information. The study's primary objective was to evaluate whether a health information intervention had a differential effect for people of different ages. DESIGN AND METHODS: Quasi-experimental survey data from an assessment of a communitywide informational intervention were used. People were asked about their use of medical reference books, telephone advice nurses, or computers for health information in the past few months. In total, 5,909 surveys were completed. RESULTS: The data show that older adults were no less likely (and were sometimes more likely) to use health information as a result of the intervention than younger adults. For telephone advice nurses and computers, the effect of the intervention was not significantly different for the different age groups. Yet, compared with persons 18-29 years of age, those over the age of 65 had a 17-percentage point increase in using a self-care book. IMPLICATIONS: We find convincing evidence to counter the stereotype that older adults are resistant to trying new health information technologies.

Adolescent↗

PubMed2005

History of Interdepartmental Committee on Nutrition for National Defense: course of events and nutrition methodology in typical surveys.

It was my good fortune to help brief many of the survey teams on dietary methods and to serve on 2 survey teams. Dr. Arnold E. Schaefer, executive director of the International Committee on Nutrition for National Defense (ICNND), dictated his reflections, which I edited, for the symposium, "Reflections of Dr. Arnold E. Schaefer." The course of events in a typical ICNND nutrition survey were described. This included the following: 1) protocol, 2) organization of survey team, appropriate for the country, 3) briefing of team members, 4) provision of needed equipment and supplies, and 5) planning the survey with the host country. The advance mission visit usually included Dr. Frank Berry, assistant secretary of Defense for Health and the ICNND executive director, who briefed local government officials about the survey. The supply and the equipment needs included clinical and laboratory equipment, reference books and supplies needed for routine physical examinations, dietary studies, and laboratory determinations. Host countries provided 1) personnel to serve on survey teams, 2) logistical support, and 3) unbiased random population samples for clinical and dietary studies. The methods of measuring dietary intake used are described in the manual. Measuring the nutrient intake of military personnel is usually much less difficult than of civilians. The food preparation and consumption (recipe) and food composite analysis methods were most commonly used. The diet questionnaire used for civilians, recorded amounts of specific foods consumed the previous day (24-h recall). During the Ecuador survey, Combs and Wolfe obtained similar results with the recipe, the food composite, and the 24-h recall methods in the same 28 families.

Health Education↗

PubMedDate not supplied

Teaching the use of data resources.

Reading a client's medical record is a skill that can be taught to nursing students. This is an example of a self-paced module to familiarize students with their textbook and reference books, with what is in the medical record, and with how the nurse uses the medical record.

Clinical Competence↗