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Consumers. Power to the patients.
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The Physicians' Desk Reference should not be held as a legal standard of medical care.
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End-of-life confusion in patients with cancer.
PURPOSE/OBJECTIVES: To review the literature on confusion at the end of life, provide accurate definitional and defining characteristics of confusion, and outline nursing strategies for its resolution. DATA SOURCES: Published articles, computerized databases, book chapters, reference lists from chapters and journal articles. DATA SYNTHESIS: As a major component of symptom distress in terminal care, confusion has not been defined clearly and therefore has not benefited from rigorous assessment and study as have other end-of-life symptoms. CONCLUSIONS: Increased knowledge about confusion that occurs in patients with widely metastatic cancer will assist in accurate symptom identification, early recognition, and timely management to reduce cognitive symptom distress at the end of life. Improved symptom resolution also can benefit family coping during terminal care. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can devise management protocols for confused patients that include screening criteria, pharmacologic interventions, environmental support, and prophylactic safety measures.
Descriptions of Reiter's disease in Mexican medical texts since 1578.
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The poisons information centre--its role and scope.
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DXplain on the Internet.
DXplain, a computer-based medical education, reference and decision support system has been used by thousands of physicians and medical students on stand-alone systems and over communications networks. For the past two years, we have made DXplain available over the Internet in order to provide DXplain's knowledge and analytical capabilities as a resource to other applications within Massachusetts General Hospital (MGH) and at outside institutions. We describe and provide the user experience with two different protocols through which users can access DXplain through the World Wide Web (WWW). The first allows the user to have direct interaction with all the functionality of DXplain where the MGH server controls the interaction and the mode of presentation. In the second mode, the MGH server provides the DXplain functionality as a series of services, which can be called independently by the user application program.
Peer reviewing and curating the health care information infrastructure: experiences and recommendations.
As part of a digital health sciences library's continuous quality improvement process, a digital textbook of common medical problems was created which contained links to authoritative medical information on the Internet for patients and health care providers. The accomplishments of this project were the: 1) Identification of 50 common medical problems, 2) Development of a methodology for identifying authoritative medical information related to these problems, 3) Creation of a digital textbook containing links to this information with a problem-based interface, 4) Development of a methodology to allow local peer review of this information, and 5) Evaluation of the use of the information and the local peer review methodology.
Short lever, specific contact articular chiropractic technique.
OBJECTIVE: To identify what has been theorized and/or written about the manual techniques generically classified as direct, but using specific contacts on short levers while using forces that may vary in speed and amplitude. DATA SOURCES: A search of the MEDLINE bibliographic database using MeSH key words (chiropractic/methods; osteopathic manipulation) was conducted. The Index to Chiropractic Literature and Chiropractic Research Abstracts Collection were searched through the past 10 yr using the key terms of chiropractic-methods; chiropractic techniques; manipulation, chiropractic; manipulation, osteopathic, manipulation, spinal; and manipulation, joint. A hand search of text-books was undertaken as well as review of the references included in books, monographs and collected papers. STUDY SELECTION: Studies in English were included, but it must be noted that these include publications that are not peer reviewed or refereed in any way. DATA EXTRACTION: Descriptions that discussed aspects of manipulative procedures with the appropriate characteristics were extracted by a single author. DATA SYNTHESIS: Very little was found or accessible using traditional methods of literature retrieval. Lack of common terminology as well as multiple technique systems developed in isolation contributed to the problem. Descriptions of characteristics for the attributes of techniques which use specific contacts on short levers are provided. The high-velocity, low-amplitude thrust technique is presented as one of the oldest and most widely used forms of manual medicine and remains one of the most frequently used forms of manual medicine. Derivation of applied forces as well as speculation as to the roll of specificity are discussed. CONCLUSIONS: This type of review is considered the first step in the evaluative process for a chiropractic technique procedure. It demonstrates that very little has been written in an accessible fashion relative to techniques which use specific contacts on short levers while applying forces that may vary in speed and amplitude. Statements made concerning the appropriateness or effectiveness consist of opinions only, with no reference to any form of injury or testing. The need for clinical trials and studies comparing different techniques is great.
Information sources for medical waste management.
Although many hospital professionals now have personal access to online databases, popular communications services may not have the full range of electronic services needed for technical problem solving. Librarians are practiced at cross-disciplinary technical research and so health professionals may be best served by consulting an experienced database search analyst so that important information is not accidentally missed. Additionally, many commercially produced databases have repackaged and redistributed data developed by NIOSH and other federal agencies, data that are readily available in the public sector. The cost of accessing or purchasing commercial databases is usually higher than for federal databases, though commercial products use the federal databases to develop their products. Public agencies should always be consulted to obtain the most current information issued by those bodies and also because a variety of free and low-cost support materials may be available. Because of the expense of routinely consulting electronic databases when comparable printed materials may be available at a lower cost, a small reference collection of books, journals, and audiovisuals may be desirable. A selective print reference collection is found in Appendix A.
A review of risk factors for child pedestrian injuries: are they modifiable?
PURPOSE: To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES: (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION: All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT: Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION: Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS: A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS: Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.
Essential books and journals in clinical neuropsychology: an Australian perspective.
To assist in the identification of key professional resources for neuropsychologists, 214 Australian clinical neuropsychologists were asked to identify "essential" reference materials. Fifty members of the Australian College of Clinical Neuropsychologists returned useable surveys. Forty-three respondents provided information about which clinical neuropsychology books and journals they considered essential and why. Results showed 15 books, including 3 Australian books, and 31 journals were included in the essential reading list of at least 10% of this sample. Compared to similar previous surveys (predominantly conducted overseas and mostly over 10 years ago), the results of this survey suggest that, Australian neuropsychologists have similar views about the top ranking books and journals in clinical neuropsychology as their overseas counterparts. An exception to this general trend may be the status of reference books containing norms, which appear to be growing in perceived importance. Importantly, the results of this survey may be used to help practitioners identify key professional resources in the area of clinical neuropsychology.
What clinical information resources are available in family physicians' offices?
BACKGROUND: When faced with questions about patient care, family physicians usually turn to books in their personal libraries for the answers. The resources in these libraries have not been adequately characterized. METHODS: We recorded the titles of all medical books in the personal libraries of 103 randomly selected family physicians in eastern Iowa. We also noted all clinical information that was posted on walls, bulletin boards, refrigerators, and so forth. Participants were asked to describe their use of other resources such as computers, MEDLINE, reprint files, and "peripheral brains" (personal notebooks of clinical information). For each physician, we recorded how often the resources were used to answer clinical questions during 2 half-day observation periods. RESULTS: The 103 participants owned a total of 5794 medical books, with 2836 different titles. Each physician kept an average of 56 books in the office. Prescribing references (especially the Physicians' Desk Reference) were most common (owned by 100% of the participants), followed by books on general internal medicine (99%), adult infectious disease (89%), and general pediatrics (83%). Books used to answer clinical questions were more likely to be up to date (copyright date within 5 years) than unused books (74% vs 27%, P <.001). Items posted on walls included drug dosage charts and pediatric immunization schedules. Only 26% of the physicians had computers in their offices. CONCLUSIONS: Drug-prescribing textbooks were the most common type of book in family physicians' offices, followed by books on general internal medicine and adult infectious diseases. Although many books were relatively old, those used to answer clinical questions were generally current.
Books on health policy and health reform: how is nursing represented?
The recent national debate on health care reform stimulated publication of a large number of books on the topic. A selected review of books published during the height of the health reform debate (1993 and 1994) is reported in this article. A total of 35 books written by authors from 13 different disciplinary perspectives were reviewed to determine how the nursing profession was represented in discussions of health system reform. The books were categorized according to title, author affiliation, purpose of the book, and the number and category of references to nursing. Seven categories of reference to nursing emerged from the analysis. Approximately on half of the books contained no references to nursing, 39 per cent had less than 10 references to nursing, and only four books had more than 10 references to nursing. The books with the greatest number of references were further analyzed and compared regarding thematic presentation of reform issues. A discussion of the importance of documentation of nursing in the health policy process, along with recommendations for improved dissemination of nursing perspectives for a redesigned health care system, is included.
Care of the pregnant asthmatic.
Treatment of asthma in the pregnant female poses a dilemma for the physician who must select medications that will effectively suppress maternal bronchospasm but that will not jeopardize the fetus. To compound the practitioner's problem, the inability to perform human studies with asthma drugs has led the pharmaceutical companies to formally list precautions against the use of antiasthmatic drugs during pregnancy in the Physician's Desk Reference (PDR), a book which is available to the lay public and is often introduced in medicolegal suits as the primary reference for standard of care. This article provides the clinician with the current recommended treatments that are considered acceptable during pregnancy based on the published evidence involving animal studies and the cumulative human experience that is reported in the English language medical literature.
Common variable immunodeficiency: diagnosis and management.
OBJECTIVE: Common variable immunodeficiency is a heterogeneous syndrome characterized by humoral immunodeficiency, recurrent bacterial infections, and a variety of immunologic abnormalities. The goal of this article is to review the pathogenesis, clinical manifestations, diagnosis, and management of common variable immunodeficiency. DATA SOURCES: References are limited to the English language literature. Sources include computerized databases and bibliographies of recent articles and books. STUDY SELECTION: References that made important contributions to our understanding of the pathogenesis, clinical manifestations, diagnosis, and treatment of this disease were selected for inclusion in this review. RESULTS AND CONCLUSION: Common variable immunodeficiency is an idiopathic state of immune dysregulation that results in impaired antibody synthesis and the development of recurrent bacterial infections. This syndrome is also associated with a variety of autoimmune and neoplastic disorders. Effective management of these patients includes intravenous immunoglobulin replacement, vigorous treatment of infections, and readiness to promptly evaluate and treat unusual autoimmune and neoplastic complications should they appear.
Meditation therapy for anxiety disorders.
BACKGROUND: Anxiety disorders are characterised by long term worry, tension, nervousness, fidgeting and symptoms of autonomic system hyperactivity. Meditation is an age-old self regulatory strategy which is gaining more interest in mental health and psychiatry. Meditation can reduce arousal state and may ameliorate anxiety symptoms in various anxiety conditions. OBJECTIVES: To investigate the effectiveness of meditation therapy in treating anxiety disorders SEARCH STRATEGY: Electronic databases searched include CCDANCTR-Studies and CCDANCTR-References, complementary and alternative medicine specific databases, Science Citation Index, Health Services/Technology Assessment Text database, and grey literature databases. Conference proceedings, book chapters and references were checked. Study authors and experts from religious/spiritual organisations were contacted. SELECTION CRITERIA: Types of studies: Randomised controlled trials. TYPES OF PARTICIPANTS: patients with a diagnosis of anxiety disorders, with or without another comorbid psychiatric condition. Types of interventions: concentrative meditation or mindfulness meditation. Comparison conditions: one or combination of 1) pharmacological therapy 2) other psychological treatment 3) other methods of meditation 4) no intervention or waiting list. Types of outcome: 1) improvement in clinical anxiety scale 2) improvement in anxiety level specified by triallists, or global improvement 3) acceptability of treatment, adverse effects 4) dropout. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers using a pre-designed data collection form. Any disagreements were discussed with a third reviewer, and the authors of the studies were contacted for further information. MAIN RESULTS: Two randomised controlled studies were eligible for inclusion in the review. Both studies were of moderate quality and used active control comparisons (another type of meditation, relaxation, biofeedback). Anti-anxiety drugs were used as standard treatment. The duration of trials ranged from 3 months (12 weeks) to 18 weeks. In one study transcendental meditation showed a reduction in anxiety symptoms and electromyography score comparable with electromyography-biofeedback and relaxation therapy. Another study compared Kundalini Yoga (KY), with Relaxation/Mindfulness Meditation. The Yale-Brown Obsessive Compulsive Scale showed no statistically significant difference between groups. The overall dropout rate in both studies was high (33-44%). Neither study reported on adverse effects of meditation. AUTHORS' CONCLUSIONS: The small number of studies included in this review do not permit any conclusions to be drawn on the effectiveness of meditation therapy for anxiety disorders. Transcendental meditation is comparable with other kinds of relaxation therapies in reducing anxiety, and Kundalini Yoga did not show significant effectiveness in treating obsessive-compulsive disorders compared with Relaxation/Meditation. Drop out rates appear to be high, and adverse effects of meditation have not been reported. More trials are needed.