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PubMed1998

[WinDiet. Support decision system for the assessment of nutritional status and diet prescription].

A "Sistema de Apoio à Decisão para Avaliação do Estado Nutricional e Prescrição de Dietas" called "WinDiet" was developed. The system was developed on a computer compatible to IBM-PC standard. For system processing procedures through the computer, that is, interpretation, compilation, table generation en others, it was selected the Delphi version 1.0 software, from Borland International, for its using facilities, data basis accomplishment, communication environment and mainly an ample availability of mathematic, impression and programming resources besides allowing for all the programming operations to be accomplished on Windows environment. Knowing the procedures for nutritional evaluation and diet prescription was possible by consulting to text books, periodicals and the area experts. This system allows for individual nutritional assessment applying the anthropometric methods such as weight, height, skinfold thickness measurings, the lab methods such as albumin, transferrin, height/creatinin index and others, the dietary methods by food consumption recall, and the clinical methods that give emphasis to pathological antecedents and indicative sings of nutritional status. The software also turns possible to prescribe and calculate diets from recommendation besides having an actual data basis which may be changed or modified. Yet it maintains the individual description from all evaluation and menus, emitting its complete reports. It was verified that it reduce significantly the working time and increase the precision of estimate and nutritional diagnosis. Thus, the WinDiet may be used in nutritionist's offices, ambulatories, hospitals as well as on nutritional researches and education.

Diet Therapy↗
PubMed2004

Factors affecting hypoglycemia awareness in insulin-treated type 2 diabetes: The Diabetes Outcomes in Veterans Study (DOVES).

OBJECTIVE: To identify clinical factors that affect hypoglycemia perception in type 2 diabetes. METHODS: Prospective observational study of 344 insulin-treated subjects randomly selected from pharmacy records at three large medical centers. At entry, subjects underwent an extensive psychological evaluation and then monitored their blood glucoses in their usual fashion for up to 52 weeks using a glucose meter capable of storing 1000 readings. For blood glucoses <or=3.33 mmol/l (60 mg/dl), subjects recorded the severity of symptoms in a log book. Symptoms were scored '0' if they were asymptomatic, '1' for symptoms that were mild-to-moderate, and '2' if the subject had a diminished level of consciousness or required the assistance of others. A mean blood glucose and mean symptom score were calculated for all hypoglycemic episodes detected by each patient. RESULTS: One hundred seventy-six subjects (51.2%) had a median of 4.5 hypoglycemic events during 42.5+/-8.0 weeks of follow-up. The mean hypoglycemic blood glucoses and mean symptom scores were modestly correlated (r=0.153; P=0.043). After adjusting for blood glucose, symptom scores were lower in the elderly and higher in subjects with higher diabetes knowledge scores, microvascular complications, and higher entry hemoglobin A1c. Multiple linear regression showed that the latter three factors were independently predictive of higher symptoms. CONCLUSIONS: Conventional clinical data may be useful in identifying patients with poor hypoglycemia perception. Patients with better long- and short-term glycemic control are at higher risk and may benefit from instruction on all aspects of hypoglycemia.

Aged↗
PubMed1997

History of mesenteric ischemia. The evolution of a diagnosis and management.

This article has traced the evolution of our knowledge of mesenteric ischemia from the initial stage of recognition of the condition and its manifestations, through the phase of treatment after the fact-resection of gangrenous intestine, to our present-day attempts to diagnose and treat the ischemic episode before death of the bowel and patient occurs. It is history from the authors' perspective, and because of limitations of space it is, perforce, highly selective. Hundreds of valuable contributions could not be included, and their omission in no way detracts from their importance. A number of surgeons, including Williams and Bergen in this country, Marston in England, Saegesser in Switzerland, and Kieny in France, have made mesenteric ischemia a major focus of their careers and have published extensively on it. The first book devoted to all aspects of mesenteric ischemia, Vascular Disorders of the Intestines edited by Boley, Schwartz, and Williams, was published in 1971. Since that time a number of books and monographs have chronicled progress in the field. Together these references make a good foundation for newly interested investigators in the subject. The results of diagnosis and management of mesenteric ischemia have improved significantly over the past 100 years but remain poor. The best part of the history of mesenteric ischemia remains to be written.

Chronic Disease↗
PubMed1983

Bibliotherapy: an adjunct to care of patients with problems of living.

Bibliotherapy, or the selected use of reading as an adjunct to the treatment of medical and psychological problems, has a long history in the library science literature. However, the use of bibliotherapy by practicing physicians has not been significant. Many patients who see family physicians are candidates for bibliotherapy as adjunctive treatment. In the past five years numerous well-written books that address various patient problems of living have been made available. The authors surveyed a variety of health care specialists in the Denver area to develop a reading list for people with life problems. These problems have been categorized under the following headings: dealing with life crises and transitions, parents and children, parenting, coping with illness and disability, death and dying, lifestyle modification, sexuality, and coping with feelings. The resulting annotated bibliography may be used as a guide for practicing physicians who feel that appropriate reading material may be beneficial to their patients with such problems.

Adjustment Disorders↗
PubMed2000

Decision making and end-of-life care in critically ill children.

OBJECTIVES: 1) To comment on the medical literature on decision making regarding end-of-life therapy, 2) to analyze the data on disagreement about such therapy, including palliative care, and withholding and withdrawal practices for critically ill children in the pediatric intensive care unit (PICU), and 3) to make some general recommendations. DATA SOURCES AND STUDY SELECTION: All papers published in peer-reviewed journals, and all chapters on end-of-life therapy, or on conflict between parents and caregivers about end-of-life decisions in the PICU were retrieved. RESULTS: We found three case series, three systematic descriptive studies, two qualitative studies, four surveys, and many legal opinions, editorials, reviews, guidelines, and book chapters. The main determinants of end-of-life decisions are the child's age, premorbid cognitive condition and functional status, pain or discomfort, probability of survival, and quality of life. Risk factors in persistent conflict between parents and caregivers about end-of-life care include a grave underlying condition or an unexpected and severe event. CONCLUSION: Making decisions about end-of-life care is a frequent event in the PICU. Children may need both intensive care and palliative care concurrently at different stages of their illness. Disagreements are more likely to be resolved if the root cause of the conflict is better understood.

Child↗
PubMed2004

Views on sexuality in croatian medieval sources.

We analyzed attitudes towards sexuality during the medieval period in Croatia. For that purpose we investigated numerous medical and literary texts, statutes, and specific natural philosophical work entitled "Lucidar". Contrary to medical books, which had a low impact on the broader community, literary texts were important in spreading messages on sexuality, as well as in shaping medieval mentality and creating sexual taboos. Consequently, a specific perspective and culture influenced rules and practices for community protection, as well as various levels of social systems. Within the three large groups of sources, we selected those typical both in their content (ideas) and forms, and representative in shaping attitudes toward sexuality on our territory. The first group of sources (examples from literary genres) were identified as an important vehicle in transferring messages of morality, moral obligation and sexuality in general. Deeply rooted in Christianity they became a pattern according to which the way of life and value were measured, a specific view toward sexuality was shaped, and notions of stigma and taboo articulated.

Attitude↗
PubMed2004

Socio-demographic determinants of anaemia in pregnancy at primary care level: a study in urban and rural Oyo State, Nigeria.

Anaemia in pregnancy is a serious condition contributing to maternal mortality, morbidity and fetal morbidity. Data however available on this condition in Nigeria is mainly hospital based and biased towards women with high-risk pregnancies. This study was carried out to determine the prevalence of anaemia and identify sociodemographic factors contributing to anaemia among low risk pregnant women attending primary care facilities. Five hundred and ninety seven pregnant women attending randomly selected primary care centres in urban and rural areas in Oyo State, Nigeria were enrolled and followed up till delivery of their babies. One hundred and ninety six (32.8%) of the mothers were anaemic. Prevalence of anaemia decreased with increasing maternal age in both urban and rural areas. Regression analysis showed that urban mothers (P = 0.003) and those who booked late in pregnancy (P = 0.048) were significantly more likely to be anaemic. Mothers with birth intervals 24 -35 months and women between the ages 20-29 years (P = 0.011) had a lower risk for anaemia. Prevalence of anaemia in pregnancy is still high in Nigeria. Effort should be made to ensure that mothers attend antenatal clinic early. Longer birth spacing should be encouraged through the use of effective contraception.

Adult↗
PubMed1997

The effect of chain membership on hospital costs.

OBJECTIVE: To compare the cost structures of hospitals in multihospital systems and independently owned hospitals. DATA SOURCES: The American Hospital Association's Annual Survey from 1990 for data on hospital costs and attributes. Area characteristics came from the Area Resource File, and the Medicare case-mix index came from the Health Care Financing Administration. Data on wages are from the Bureau of the Census' State and Metropolitan Area Data Book. The Guide to Hospital Performance from HCIA, Inc. provided data on quality of care. STUDY DESIGN: Separate cost functions were estimated for chain and independent hospitals. Hybrid translog cost functions included measures of outputs, input prices, and hospital and area characteristics. The estimation method accounted for the simultaneous determination of costs and chain membership, and for any nonrandom selection of hospitals into chains. Several economic cost measures were calculated to compare the cost structures of the two types of hospitals. DATA EXTRACTION METHODS: Data from all sources were merged at the hospital level to form the study sample. PRINCIPAL FINDINGS: Hospitals in multihospital systems were less costly than independently owned hospitals. Among independent hospitals, for-profits had the highest costs. There were no statistically significant differences in costs by ownership among chain members. Economies of scale were enjoyed in both types of hospitals only at high volumes of output, while economies of scope occurred at all volumes for chain hospitals, but only at low and medium volumes for independent hospitals. CONCLUSIONS: This study provides support for the idea that growth of the multihospital system sector can provide a market solution to the problem of constraining costs. It does not, however, support the property rights theory that proprietary hospitals are more efficient than nonprofit hospitals.

Cost Control↗
PubMed2001

Reading time evidence for enriched composition.

Verbs like 'begin' and 'enjoy' appear to semantically select a complement that expresses an activity or an event (Jackendoff, R. (1997). The architecture of the language faculty. Cambridge, MA: MIT Press; Pustejovsky, J. Cognition 41 (1991) 47; Pustejovsky, J. (1995). The generative lexicon. Cambridge, MA: MIT Press). When these verbs occur with a complement that does not directly denote either an activity or an event (e.g. '... began the book' or '... enjoyed the book'), the complement must be type-shifted from an object to an activity to conform to the verb's semantic restrictions. We report an experiment in which self-paced reading times were found to be longer for complements that required type-shifting than for complements that directly matched the semantic restrictions of the matrix verb. This finding is argued to provide on-line evidence for a type of enriched lexical processing posited in recent lexical semantic research.

Adult↗
PubMed1998

The uterine capacity measured by the total twin birth weight and duration of twin pregnancy.

The objective of this study was to answer the question whether there is the relation between the uterine capacity, estimated by the total birth weight of fetuses, and the duration of twin gestation. The material for researches contains data received from the books of births and case records concerning the pregnant who gave births to twins in the Institute of Obstetrics and Gynecology of the Medical University in Lódź between 1970-1998. The final analysis concerned only gestations lasting more than 29 weeks, without any complications (excluding prematurity and the growth-discordant twins), and when gestational age was exactly known. The selected group was finally composed of 188 pairs of twins. The analyses considered relations between total birth weight of twins, the sex of newborn babies, parity, and the duration of gestation. The duration of the analyzed twin pregnancies was 35.6 weeks, including primiparous with 35.8 weeks, and multiparous--35.1 weeks. In the group of male-male twin pairs the average duration of pregnancy was 35.7 weeks, in unlike-sexed pairs--35.6 weeks, and in female-female pairs--35.5. In the group of the primiparous having male-male twin pairs the average duration of pregnancy was 35.1 weeks, unlike-sexed pairs--36.4 weeks and female female pairs--36.6 weeks, while in the group of multiparous relatively: 36.4, 35.4, 35.0 weeks. The total birth weight of the specific pairs of twins was from 2270 g to 6900 g (average 4794 g), while in 92% < 5500 g. In the primiparous group it was 4908.1 g. and in the multiparous group--4663.1 g. Analyzing the total twins' weight according to the fetal gender and parity it was found that in primiparous with male-male twins--4715.3, unlike-sexed--5271.6 and female-female--4967.5, whereas in multiparous relatively: 4961.5, 4692.6, 4414.0. The shortening of twin pregnancies was caused by the following factors: total body mass achieved by fetuses was > 5500 g, presence of male sex in twin pregnancies (only in primiparous), and also the multiparity.

Birth Weight↗
PubMedDate not supplied

Eye injuries in Canadian amateur hockey.

Two studies, one retrospective (1972 to 1973) and one prospective (1974 to 1975), CONcerning eye injuries incurred by hockey players were conducted by the Canadian Ophthalmological Society with questionnaires to its members. Responses to the questionnaires were analyzed by age, type of injury, cause (i.e., hockey stick, puck, or other means), and results to visual acuity. The results were also designated by organized or unorganized participation. Almost 300 eye injuries were reported in each study. In the first study, 13.7% of the injured players became legally blind as a result of the injury; in the second study, 16% became legally blind. Organized hockey produced more injuries than unorganized hockey. The majority of the injuries were caused by the hockey stick. The injuries were both intraocular and extraocular. The group of 11- to 15-year olds received the highest number of injuries, and the older age group had the higher incidence of blindness. Studies have led to setting more rigid standards, altering rules of the game, and selecting face protectors for hockey players. Older players who care for their equipment prefer the plastic shield face protectors, and the younger players (who complain of fogging and scratching of the plastic) prefer mesh protectors through which neither the stick nor the puck can penetrate. New high sticking (above the shoulder level) rules were included in the 1976 official rule book for Canadian amateur hockey.

Adolescent↗
PubMed2002

Soy formulas and nonbovine milk.

BACKGROUND: Cow's milk allergy is frequently observed during the first year of life when nutritional requirements are critical. In those cases where breast-feeding is not available, a safe and adequate substitute to cow's milk should be offered. OBJECTIVE: The primary aim of this review is to evaluate the clinical use of milk derived from vegetable proteins, such as soy, or from animals such as goat, mare, or donkey, or elemental diet in children with cow's milk allergy. METHODS: MEDLINE searches were conducted with key words such as soy, goat's milk, donkey's milk, mare's milk, and elemental diet. Additional articles were identified from references in books or articles. Original research papers and review articles from peer-reviewed journals were chosen. RESULTS: Soy formulas are nutritionally adequate and can be used in children with immunoglobulin E-mediated nongastrointestinal manifestations of cow's milk allergy. Goat's milk is as allergenic as cow's milk. Mare's milk and donkey's milk may be used in selected cases of cow's milk allergy after appropriate modification to make them suitable for human infants. Elemental diets are usually restricted to the most severe cases of cow's milk allergy (ie, sensitivity to extensively hydrolyzed protein formulas). CONCLUSIONS: Vegetable formulas obtained from soy and milk derived from other mammals, such as mare or donkey, homemade preparations, and elemental diet may represent valid alternatives for children with cow's milk allergy. Extensive clinical trials are needed on the safety profile of any alternative mammal-derived milk. The choice of alternative milk should take into account the clinical profile of the child allergic to cow's milk, particularly as concerns age, severity of symptoms, degree of sensitivity to cow's milk proteins, and any multiple food allergies.

Animals↗
PubMed1992

A clinical librarian program in the intensive care unit.

OBJECTIVES: Clinical decision-making in the intensive care setting frequently requires the physician to obtain additional resource information. Physicians typically consult with colleagues, use personal medical books or files, or use library materials. Clinical librarians may also be used. This study evaluates the effectiveness of an ongoing clinical librarian program in the intensive care setting. DESIGN/SETTING: During a 3-month period, house officers in the medical and coronary ICUs in a major teaching hospital asked the clinical librarian 66 patient-care questions. Attached to the information selected by the clinical librarian was a questionnaire asking how the information was applied. MAIN RESULTS: There was an overall response rate of 65.1%. House officers indicated that the information: a) aided in diagnosis (37.2%), b) contributed to a better understanding of the therapy (51.2%), and c) resulted in improved patient management (30.2%). In some instances, the information was multibeneficial. The clinical librarian spent an average of 47 mins/question, and accumulated an average computer charge of $3.59. Personnel and on-line charges over the 3-month study period averaged $45/question. CONCLUSIONS: Clinical librarian programs may deliver patient-specific information in a timely, cost-effective manner. This information has an impact in the intensive care setting.

Connecticut↗
PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with herbal medicine. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of herbal medicines; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pre-tested form and summarized descriptively. RESULTS: From a total of 79 potentially relevant reviews pre-selected in the screening process 58 met the inclusion criteria. Thirty of the reports reviewed ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews. Most reviews judged the available evidence as promising but definitive conclusions were rarely possible. CONCLUSIONS: Systematic reviews are available on a broad range of herbal preparations prescribed for defined conditions. There is very little evidence on the effectiveness of herbalism as practised by specialist herbalists who combine herbs and use unconventional diagnosis.

Herbal Medicine↗
PubMed2004

Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column.

OBJECTIVE: The objective of part 1 of this study is to redefine the Letournel anterior column on the basis of developmental and adult pelvic skeletal anatomy. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected patients with acetabular fracture or fracture-dislocations admitted to a level I trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The discrepancy between the Letournel definition of the anterior and posterior columns became readily apparent. Standard text books of anatomy and surgical anatomy were referenced relative to the embryologic and adult components of the acetabulum. RESULTS: The anterior column is redefined with its superior border being the anatomic arcuate and iliopectineal lines, thereby coinciding with the superior border (arcuate line) of the Letournel posterior column. CONCLUSION: Redefinition of the anterior column eliminates diagnostic ambiguity of the Letournel elementary anterior column fracture as well as the Letournel associated anterior column or wall with hemitransverse fracture. The redefined anterior column is integral to the CT-based classification described in part 2 of our study.

Acetabulum↗
PubMed1996

Preconception genetic counseling.

The purpose of this chapter has not been to be all-inclusive, but to raise awareness of the benefits of preconception consultation in the prevention of birth defects. If there is to be a significant decrease in the incidence of congenital malformations, it will come only by intervention that occurs prior to organogenesis, and that opportunity is lost by the first prenatal visit. For the practitioner interested in a more in-depth analysis of the subject of preconception counseling, the two books listed as supplementary reading provide a wealth of information essential to the care of the patient planning a pregnancy.

Congenital Abnormalities↗
PubMed1971

Creating the library itself: collection, staff, and space.

It is stressed that many points must be settled between the librarian and the planners. Relationships between the library and the medical school and the university library should be made clear. The librarian must be intimately involved with the architect, with the selection of faculty, and with the planning of curriculum. Consideration is given to problems of collection building in the areas overlapping with other institutions and of journal collections. Cataloging is considered, and the need to develop accounting procedures.

Book Collecting↗
PubMed2001

Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales.

The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced.

Adult↗