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PubMed2004

[Music as a symptom].

The contents of this presentation are the consequence o reading the book Infectious Diseases and Music where the authors Drs. Gomis and Sánchez describe the infections suffered by more than fourty composers or interpreters. Although infections were more prevalent, intense psychological repercussions were also frequent. Reviewing the biographies of Bach, Mozart, Schubert and Beethoven I have selected some specially dramatic paragraphs of letters addressed for relatives and friends describing their intense and permanent physical and psychological disturbances which probably influenced the contents and style of their creations. Depression, anxiety and specially bipolar conditions with frequent and intense maniac phases were common but not exclusive to composers. Other artists and painters or poets also complained of similar disturbances. During their maiac states the artists perceive sounds and visual stimuli as well as their personal experiences with increased intensity and liveliness. Language is more fluid and their creativity and productivity become more powerful.

History, 18th Century↗
PubMed2001

Use of videotapes for viewing at home to inform choice in Down syndrome screening: a randomised controlled trial.

A randomised trial was carried out to assess the effect of a Down syndrome screening video on test uptake, knowledge and psychological stress. A total of 2000 women referred for antenatal care were allocated to two equal groups: one to be sent a video to their home, before their hospital booking visit, and a control group. All women also received screening information in the form of a leaflet before booking and from a midwife at booking. The video had no effect on the screening uptake rate: 638/993 (64.2%) and 652/1007 (64.7%) in the video and control groups, respectively. Women were requested to return the video for reuse in other pregnancies and 612 (62%) did so. A subset of 1200 women were selected to be posted at 17-19 weeks' gestation a self-completed questionnaire to assess the psychological endpoints. Knowledge of screening was increased in the video group with a mean score of 7.3 compared with 6.7 in the controls, a statistically significant difference (t=3.24, p=0.0005). There were no significant differences between the groups in specific worries about abnormalities in the baby, and general anxiety. We conclude that a video can increase knowledge without affecting the uptake of the test, or psychological stress.

Anxiety↗
PubMed2005

Understand the "fine print" when selecting the correct codes for patient admissions from clinic to hospital.

How should a physician code and bill for services when a patient is seen in the clinic and then is directly admitted to the hospital? The correct answer is not as straightforward as it might at first seem because of needing to understand what amounts to the "fine print" in the Current Procedural Terminology (CPT) book code description. It also depends on whether or not the physician subsequently had face-to-face contact with the patient in the hospital. According to the CPT book, "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g. physician's office) all evaluation and management services (E/M) provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission s/he provided in the other sites of service as well as in the inpatient setting." At first, this wording could lead physicians and coders to conclude that their only recourse is to "roll up" the level of service provided in the clinic with the additional documentation necessary to admit a patient to the hospital to determine the code for "Initial Hospital Care", CPT 99221-99223. However, it has been noted that the description in the CPT book under initial hospital care has "fine print" in the statement the "codes are used to report the first hospital inpatient encounter with the patient by the admitting physician." "Encounter" is commonly understood to mean a "face to face" encounter between the physician and patient in the hospital setting. But, what if the physician does not go to the hospital to see the patient on the same date that s/he saw the patient in the clinic? Because a face to face encounter in the hospital did not occur, it would be inappropriate to use any of the "Initial Hospital Care" CPT 99221-99223 codes. Rather, the services of the clinic visit should be billed as "new" or "established" patient office visit on the date seen and the initial hospital service would be billed on a following date when the physician actually sees the patient in the hospital setting.

Ambulatory Care Facilities↗
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↗
PubMed2000

Complications of tube thoracostomy in trauma.

OBJECTIVE: To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. METHODS: A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125,000 new patients/year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. RESULTS: Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. CONCLUSION: This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.

Adult↗
PubMed1997

[Unearathed ancient pulsological books and theoroy of "three parts with nine palpation sites"].

Textual research is made on the evolution of the theory of "three parts with nine palpation sites" in TCM. It is concluded that the theory, having received the influence of ancient astrology and arithmatics, was sprouted in the Eastern Han Dynasty and still is valid today. It further points out that the arrangement of channel order, and selection of channel title were all influenced by the theory of "Three Parts with Nine Palpation Sites".

China↗
PubMed2006

Antibiotics for treating community acquired pneumonia in people with sickle cell disease.

BACKGROUND: As a consequence of their condition, people with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community-acquired pneumonia. Many different bacteria can cause this infection and antibiotic treatment is generally needed to resolve it. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. OBJECTIVES: To determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with sickle cell disease suffering from community-acquired pneumonia. SEARCH STRATEGY: We searched The Group's Haemoglobinopathies Trials Register (December 2005), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 4, 2005), MEDLINE (1966 to December 5th, 2005), EMBASE (1974 to December 7th, 2005), and LILACS (1982 to December 2005). Date of most recent search: December 2005 SELECTION CRITERIA: We searched for published or unpublished randomized controlled trials. DATA COLLECTION AND ANALYSIS: We intended to summarise data by standard Cochrane Collaboration methodologies, but no eligible randomized controlled trials were identified. MAIN RESULTS: We were unable to find any randomized controlled trials on antibiotic treatment approaches for community-acquired pneumonia in people with sickle cell disease. AUTHORS' CONCLUSIONS: We were unable to identify randomized controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. Randomized controlled trials are needed to establish the optimum antibiotic treatment for this condition.

Anemia, Sickle Cell↗
PubMed2006

Quality of life after spinal cord injury: a meta-synthesis of qualitative findings.

STUDY DESIGN: Meta-synthesis of qualitative research. OBJECTIVES: To identify, compare and synthesize the factors found to contribute to, or detract from the experience of a life worth living following spinal cord injury (SCI). METHODS: Published articles were identified from the Medline, CINAHL and Sociological Abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour and quality. The key themes that emerged from the data were summarized, compared and synthesized. RESULTS: The search located 64 papers and four books, of which seven papers met the review criteria for relevance and rigour, and in which 10 main concepts were identified: (1) body problems, (2) loss, (3) relationships, (4) responsibility for, and control of one's life, (5) occupation, and ability to contribute, (6) environmental context, (7) new values/perspective transformation, (8) good and bad days, (9) self-worth, (10) self-continuity. CONCLUSIONS: This study demonstrates the utility of synthesizing qualitative research to provide a greater depth of insight into the factors that contribute to, and detract from, quality of life (QOL) after SCI. It also provides a more nuanced understanding of the experience of QOL following SCI than is achievable by quantitative methods. Future qualitative research is required to probe further the concepts and connections identified in this study, and to identify how rehabilitation services might best address these issues.

Health Status Indicators↗
PubMed1993

"Running the vicious cycle backward" and other systems solutions to nursing problems.

Peter Senge's book, The Fifth Discipline: The Art and Practice of the Learning Organization, is a business bestseller. The fifth discipline refers to systems thinking, a conceptual framework for making the full pattern of complex, interrelated actions clearer and helping people see how to change them. This article summarizes selected key concepts from Senge's work and explains how nurse executives can use systems thinking to gain a deeper understanding of the forces operating in recurrent situations and identify opportunities for leverage to benefit patients, staff, and healthcare organizations.

Humans↗
PubMed2004

Ophthalmic techniques described by Serefeddin Sabuncuoğlu (1385-1468 AD).

Serefeddin Sabuncuoğlu (1385-1468 AD) was a Turkish surgeon who lived in the Ottoman Empire during the fifteenth century, a time of progressive expansion. When in his eighties, he wrote Cerrahiyyetü'l-Haniyye, which means Imperial Surgery. His book is the first example of an illustrated surgical textbook in the Turkish-Islamic medical literature. The importance of his book rests upon the inclusion of colour miniatures of the surgical procedures, incisional techniques and instruments, all drawn by Sabuncuoğlu himself. Only three hand-written copies exist, two of which were originally written by the author and are currently exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts of it are still suspected to be missing. At present, the book consists of three chapters divided into 193 known sections. The sections deal with all fields of surgery including ophthalmology, and cite relevant Greek, Arabic and Persian textbooks. In this historical article the sections of Cerrahiyyetü'l-Haniyye pertinent to ophthalmology are critically reviewed, including a selection of the coloured drawings.

Eye Diseases↗
PubMed2004

Use of ophthalmic medications during pregnancy.

OBJECTIVES: To review potential risks of eye medications to the mother and her foetus. DATA SOURCES: PubMed search for all relevant articles (1966 to 2003). STUDY SELECTION: All types of publication that documented potential risks of eye medications during pregnancy. The following key words were used: pregnancy, fetus, teratogenicity, eye, ocular, ophthalmic, glaucoma, antibiotics, anti-inflammatory, and corticosteroids. DATA EXTRACTION: All relevant articles including original articles, review papers, case studies, and relevant book chapters were extracted and reviewed. DATA SYNTHESIS: Whether ophthalmic medications can be used during pregnancy is a very important issue; yet, limited information on the subject exists in the literature. Topically applied eye medications that give rise to systemic side-effects are of particular concern to both patients and doctors. Various ophthalmic anti-infective preparations and ophthalmic corticosteroids have shown to cause teratogenicity in animal studies. Furthermore, anti-glaucoma drugs pose potential risks to the foetus if they are absorbed systemically. This article examines the association between the main groups of ophthalmic medication and their possible adverse effects on the mother and the foetus. Recommendations for the treatment of pregnant patients with eye diseases are also discussed. CONCLUSION: The risk of giving ophthalmic drugs to pregnant women is low. Doctors should be cautious when prescribing drugs for pregnant women and consult experts in the field when in doubt.

Adrenal Cortex Hormones↗
PubMed2006

Mapping the general literature of American nursing.

OBJECTIVES: As part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies core journals cited by general or "popular" US nursing journals and the indexing services that cover the cited journals. METHODS: Three journals were selected for analysis: American Journal of Nursing, Nursing 96-98, and RN. The source journals were subjected to a citation analysis of articles from 1996 to 1998, followed by an analysis of database access to the most frequently cited journal titles. RESULTS: Cited formats included journals (63.7%), books (26.6%), government documents (3.0%), Internet (0.5%), and miscellaneous (6.2%). Cited references were relatively current; most (86.6%) were published in the current decade. One-third of the citations were found in a core of 24 journal titles; one-third were dispersed among a middle zone of 94 titles; and the remaining third were scattered in a larger zone of 694 titles. Indexing coverage for the core titles was most comprehensive in PubMed/MEDLINE, followed by CINAHL and Science Citation Index. CONCLUSIONS: Results support the popular (not scholarly) nature of these titles. While not a good source for original research, they fulfill a key role of disseminating nursing knowledge with their relevantly current citations to a broad variety of sources.

Abstracting and Indexing↗
PubMed1997

Collapsed ultraendurance athlete: proposed mechanisms and an approach to management.

OBJECTIVE: To review the common conditions causing collapse in ultraendurance athletes, to propose appropriate treatment protocols for the more common medical conditions that are encountered, and to provide practical guidelines for the management of the medical facilities at these endurance events. DATA SOURCES: Books published on the subject, abstracts of the American College of Sports Medicine Annual Congress dealing with the subject over the last 5 years, and electronic search of the Medline and Current Contents databases (last searched May 1995). German articles were included in the search criteria. STUDY SELECTION: Articles dealing generally with the management of medical facilities at endurance events were chosen. Articles dealing more specifically with the common medical conditions encountered at these events were then sourced and included in this review. DATA EXTRACTION: Multiple reader extraction of relevant data. DATA SYNTHESIS: A practical guideline to the management of the medical facility at an endurance event is detailed, expanding specifically on the nature of the conditions causing collapse during or after endurance exercise with a proposed classification of causes of collapse for optimizing immediate management and management protocols for specific conditions such as heatstroke, hyponatremia, hypoglycemia, exercise-associated collapse, and muscle cramps. CONCLUSION: The most commonly encountered medical condition at endurance athletic events is collapse after the event. The popular view that all persons who collapse have dehydration-induced hyperthermia has been challenged. Here we extend that argument and provide diagnostic and management protocols and propose a triage system that considers the most common causes of collapse in ultraendurance athletes. These protocols can optimize the efficient and safe management of large numbers of collapsed ultraendurance athletes. It is proposed that these protocols can optimize the efficient and safe management of large numbers of collapsed ultra endurance athletes.

Adult↗
PubMedDate not supplied

Generics: what's in a name?

Historically, the most common intervention performed by physicians has been the writing of a prescription. Often the prescription was a combination of active agents and an inactive base. This art is no longer practiced in the United States. Currently, most prescriptions are written for specific "drugs." As the prescription is being written, the physician must decide to administer a brand-name or a generic equivalent. Generics are a class of medications prescribed for reasons of economy, and the physician and the patient expect that the therapeutic effect will be exactly the same as for the brand-name. Bioequivalence of specific agents can be assessed using the FDA's Orange Book. In addition to bioequivalence, many other scientific, ethical, and economic issues should be considered before a decision is made. Prescribing vigilance is necessary, because in many instances available information is often controlling or insufficient to support rational decisions. Brand-names, rather than generics, should be selected when the therapeutic index is narrow or if the likelihood of generic switching is high. The paper will discuss all aspects of the subject.

Chemistry, Pharmaceutical↗
PubMed2005

Hepatitis B vaccination in heart transplant candidates.

BACKGROUND: Various options have been proposed to expand the limited heart donor pool, including candidate vaccination permitting use of hepatitis B core antibody-positive (HbcAb(+)) donors. From 2001 to 2004, 263 potential heart donors were turned down due to hepatitis B core antibody positivity. In 2001, we initiated a protocol of a routine vaccination against hepatitis B virus (HBV) at transplant evaluation. The efficacy of HBV vaccination in patients with advanced heart failure is not known. METHODS: A single-center retrospective chart review was completed for patients who successfully completed the 3-dose HBV vaccine series and hepatitis B surface antibody (HBsAb) post-vaccination titer. We reviewed post-vaccine quantitative titers, patient characteristics and donor serologies. Seroconversion was defined as a HBsAb titer >10 mIU/ml. RESULTS: Twenty-nine patients had a complete vaccine series with HBsAb quantitative titers. Thirteen patients seroconverted on the initial attempt. Sixteen were non-seroconverters. Of these, 6 were transplanted prior to repeat series with titers, 7 remain wait-listed awaiting complete repeat series, and 3 completed a repeat series, of whom 2 seroconverted. None of the Status 1B patients seroconverted. Seroconverters had higher ejection fractions (EFs), lower serum creatinine levels and higher functional status. CONCLUSIONS: HBV vaccination of patients with advanced heart failure was successful in approximately 50% of patients and was most successful in Status 2 patients. Early initiation of the vaccine series may increase utilization of HBcAb(+) donors. HBV vaccination is unlikely to benefit Status 1 patients.

Adult↗
PubMed1999

Physical therapy for the equine back.

Before a physical therapy and rehabilitation program is suggested, the end requirement must be considered. All physiotherapeutic machines are subject to laboratory screening. In the United States, the approval of the Food and Drug Administration is required; in the United Kingdom, certification by the National Physics Laboratory has been required by law since January 1996. Laboratory experiments are continually conducted to examine and evaluate the effects on tissues of varied electrical waveforms, low-intensity electrical currents, sound waves, and light rays delivered by a variety of therapeutic apparatuses. It is interesting to note that the tissues used for this work are derived from the rabbit, rat, and chick embryo. If these investigative procedures demonstrate benefit to tissue behavior following trauma in laboratory animals, they are then considered to be of benefit to humans. Surely, it must follow that equal benefit is to be derived by other species with similar tissues. Despite veterinarian prejudice to the contrary and by careful case selection rather than random application, horses can profit from the application of electrotherapy and derive benefit from rehabilitation; thus, an informed physical therapist should be considered a useful member of a "care" team. Because no two cases are ever the same, it is impossible to write a "recipe" book stating exactly the dosage, treatment time, or applications per week or per day. Success depends on an in-depth assessment of individual needs followed by an informed choice of therapy. In the case of physical therapy, this necessitates the use of the appropriate modality at the appropriate time, always taking into account the fact that tissue is living and is therefore in a continually changing state. The art of the physical therapist is to read the situation each time a patient is seen and to proceed according to the findings of the moment. The author regrets that there are no double-blind trials to quote or published research available to substantiate rehabilitation methods. The therapy principles relating to proprioceptive input, cortical re-education, muscle recoordination, and atrophy following both micro- and macrotrauma have been transferred in field work from humans to horses.

Animals↗
PubMed2002

Social phobia: overview of community surveys.

OBJECTIVE: Social phobia has in recent years been recognized as a considerable public health concern. This paper presents an overview of community studies that have estimated the prevalence of social phobia, its subtypes, and specific social fears in the adult general population. Sociodemographic findings are also summarized. METHOD: Forty-three epidemiological studies from 1980 to the present were located in electronic databases and by complementary searches of citations in journal articles and book chapters. RESULTS: Recent surveys estimate the lifetime prevalence of social phobia at about 7-13% in Western countries. However, prevalence rates vary considerably and are prone to several influencing methodological variables such as the diagnostic criteria, diagnostic threshold, assessment method, number of situational probes, and prevalence period selected by the researcher. CONCLUSION: Although there are difficulties in delineating social phobia from subsyndromal social anxiety or shyness, social phobia is even when narrowly defined remarkably common in the general population.

Adult↗
PubMed1995

Genetics brought to book.

The British House of Commons has produced a telling document on the future of genetics.

Advisory Committees↗