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PubMed2001

A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention.

BACKGROUND: Most surgically sutured wounds heal without any complication. However, in some cases wound healing can be delayed due to the presence of infection or wound breakdown. This can result in the wounds becoming cavity wounds and thus necessitate healing by secondary intention. Other surgical wounds that are not sutured but left to heal by secondary intention include abscess cavities such as perianal abscesses or breast abscesses. Surgical wounds healing by secondary intention are thought to heal more slowly than wounds healing by primary intention, especially if infection is present or healing is compromised by factors such as decreased blood supply, poor nutritional status or a general suppression of the immune response. Such wounds may contain dead tissue and have a moderate or high level of exudate. Debridement involves the removal of devitalised, necrotic tissue or fibrin from a wound. There are many different methods that can be used to debride a wound, which are broadly classified as surgical/sharp, biosurgical, mechanical, chemical, enzymatic and autolytic. Although it is generally agreed that the management of surgical wounds which contain devitalised tissue and are healing by secondary intention requires debridement, it is not always clear as to what is the best method or agent to use. There is currently a large selection of products with debriding properties available on the market, which vary considerably in cost. It is important that the choice of both debriding method and product is based on the best scientific evidence available, taking into account both cost and effectiveness data. OBJECTIVES: The review had two main objectives: (1) To determine the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. (2) To evaluate the clinical effectiveness and cost-effectiveness of treating patients with surgical wounds healing by secondary intention at specialised wound care clinics as compared to conventional care. The review incorporated all debriding methods and any agent that is considered to have a debriding property. METHODS The following databases were searched using strategies designed specifically for each database: MEDLINE, EMBASE, CINAHL, HMIC (Health Management Information Consortium), CCTR via the Cochrane Library, the National Research Register (NRR), the NHS Economic Evaluation Database (NHS EED), and the Health Economic Evaluations Database (HEED). Additional references were identified through reviewing manufacturer and sponsor submissions made to NICE, the bibliographies of retrieved articles, and conferences proceedings on the Internet. Only randomised controlled trials (RCTs) or non-randomised controlled trials with concurrent controls and full economic evaluations were considered for inclusion. Only studies that evaluated some sort of debriding method or a specialised wound care clinic (a nurse with specialist training in wound care; care being provided by a multidisciplinary team; a fast-track referral system to other professions (e.g. dermatologist); or access to the latest health technology) were included in the review. Studies had to include participants with surgical wounds healing by secondary intention (e.g. cavity wounds, the consequences of wound dehiscence and abscesses) and report an objective measure of wound healing. Data were extracted by one reviewer and checked by a second. Quality assessment was conducted independently by two reviewers. Disagreements were resolved by consensus and, when necessary, by recourse to a third reviewer. The primary outcomes of interest were wound healing and cost. Results of data extraction and quality assessment were presented in structured tables and also as a narrative summary. In addition, where feasible, the results of individual studies were presented as forest plots. Studies were grouped according to the type of wound, debriding method and outcome measure used. RESULTS - CLINICAL EFFECTIVENESS: Seventeen trials met the inclusion criteria, all of which used the autolytic method of debridement. No studies were found that investigated sharp/surgical, biosurgical, mechanical, chemical or enzymatic debridement in the treatment of surgical wounds healing by secondary intention. No studies were found which investigated specialised wound care clinics that included the provision of care within a clinical setting (based in either primary or secondary care). The type of surgical wounds investigated by studies included in the review were those that had broken down postoperatively, perineal wounds resulting from proctolectomy or rectal excision, and those left open after pilonidal sinus excision or abscess incision, or wounds following a laparotomy. Four additional studies investigated treatment of postoperative wounds from toenail avulsions. (ABSTRACT TRUNCATED)

Clinical Trials as Topic↗
PubMed2003

Systematic review of endoscopic sinus surgery for nasal polyps.

OBJECTIVES: To provide a systematic review of the clinical effectiveness of endoscopic sinus surgery (ESS) for the removal of nasal polyps. DATA SOURCES: Searches of electronic databases, websites and reference lists were made to identify relevant studies. REVIEW METHODS: An extensive search was performed to identify all articles where FESS is used for the excision of nasal polyps. Two reviewers independently screened articles for inclusion according to predefined criteria. Comparative studies were included if they were primary research, focused on FESS for the removal of nasal polyps, reported patient relevant outcomes and were published in English. In addition, case series studies were included if they met the above criteria and enrolled more than 50 patients with polyps. Data were then extracted by one reviewer and checked by a second. A structured form was used to assess the internal and external validity of included studies. Comparative data were reported where available. Excluded case series and case reports were grouped and described. A group of nine ear, nose and throat (ENT) experts were selected, then using the literature and their own experience, they generated a list of priority research questions. Existing economic evaluations were sought and described. RESULTS: Of the 33 studies included, the randomised controlled trials and controlled trials reported overall symptomatic improvement that ranged from 78 to 88% for FESS compared with 43 to 84% for similar techniques (including polypectomy, Caldwell-Luc and intranasal ethmoidectomy). Disease recurrence was 8% for FESS compared with 14% for Caldwell-Luc and polyp recurrence was 28% for endoscopic ethmoidectomy compared with 35% for polypectomy. Revision surgery was reported in one study only and was the same for FESS and Caldwell-Luc procedures. Percentage of overall complications was reported in only one comparative study and was 1.4% for FESS compared with 0.8% for conventional procedures. The case series studies reported overall symptomatic improvement for patients with nasal polyps ranging from 37 to 99% (median 89%). For the mixed patient groups (with and without polypoid disease) overall symptomatic improvement ranged from 40 to 98% (median 88%). Total complications in the case series studies ranged from 22.4 to 0.3% (median 6%). CONCLUSIONS: The majority of studies report that symptoms improve following FESS with relatively few complications; however, only a small proportion of evidence is comparative. Results from non-comparative studies do not inform the choices that need to be made by ENT surgeons and commissioners. Health economics data are also lacking and therefore cannot inform these decisions. FESS may offer some advantages in effectiveness over comparative techniques, but there is enormous variation in the range of results reported and there are severe methodological limitations. There is a clear need for quality-controlled trials in order to answer questions regarding the effectiveness of FESS. A number of priority research questions from a selection of ENT surgeons within the UK are identified and presented.

Endoscopy↗
PubMed2006

Expression patterns and action analysis of genes associated with blood coagulation responses during rat liver regeneration.

AIM: To study the blood coagulation response after partial hepatectomy (PH) at transcriptional level. METHODS: After PH of rats, the associated genes with blood coagulation were obtained through reference to the databases, and the gene expression changes in rat regenerating liver were analyzed by the Rat Genome 230 2.0 array. RESULTS: It was found that 107 genes were associated with liver regeneration. The initially and totally expressing gene numbers occurring in initiation phase of liver regeneration (0.5-4 h after PH), G0/G1 transition (4-6 h after PH), cell proliferation (6-66 h after PH), cell differentiation and structure-function reconstruction (66-168 h after PH) were 44, 11, 58, 7 and 44, 33, 100, 71 respectively, showing that the associated genes were mainly triggered in the forepart and prophase, and worked at different phases. According to their expression similarity, these genes were classified into 5 groups: only up-, predominantly up-, only down-, predominantly down-, up- and down-regulation, involving 44, 8, 36, 13 and 6 genes, respectively, and the total times of their up- and down-regulation expression were 342 and 253, respectively, demonstrating that the number of the up-regulated genes was more than that of the down-regulated genes. Their time relevance was classified into 15 groups, showing that the cellular physiological and biochemical activities were staggered during liver regeneration. According to gene expression patterns, they were classified into 29 types, suggesting that their protein activities were diverse and complex during liver regeneration. CONCLUSION: The blood coagulation response is enhanced mainly in the forepart, prophase and anaphase of liver regeneration, in which the response in the forepart, prophase of liver regeneration can prevent the bleeding caused by partial hepatectomy, whereas that in the anaphase contributes to the structure-function reorganization of regenerating liver. In the process, 107 genes associated with liver regeneration play an important role.

Animals↗
PubMed2006

Differentiation of normal skin and melanoma using high resolution hyperspectral imaging.

We investigated the use of high resolution hyperspectral imaging microscopy to detect abnormalities in skin tissue using hematoxylin eosin stained preparations of normal and abnormal skin, benign nevi and melanomas. A goal of this study was to provide objective data that could be utilized by any researcher; and form the beginnings of a reference spectral data base. All spectral characterizations were acquired in percent transmission, and absorption, with contiguous wavelength acquisition between 400 and 800 nm; and a spectral resolution of approximately 1 nm. Biopsy sections were characterized with varying sample thickness, staining and magnification in order to determine their impact on spectral characterizations. Spectra were classified using spectral waveform cross correlation analysis, an algorithm that is linearity invariant. Classified spectra were incorporated into spectral libraries; and all spectra acquired from the field of view were correlated with library spectra to a quantified, user determined, confidence threshold (minimum correlation coefficient). The results revealed that all skin conditions in our initial data sets could be objectively differentiated providing that staining and section thickness was controlled. We also demonstrated that it is likely that a reference spectral library database could be created to include bioinformatics and cluster analysis. This would assist multiple laboratories to participate in the input and retrieval of target spectral information.

Biopsy↗
PubMedDate not supplied

Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature.

OBJECTIVE: Estimate effectiveness of goal setting for nutrition and physical activity behavior change, review the effect of goal-setting characteristics on behavior change, and investigate effectiveness of interventions containing goal setting. DATA SOURCE: For this review, a literature search was conducted for the period January 1977 through December 2003 that included a Current Contents, Biosis Previews, Medline, PubMed, PsycINFO, and ERIC search of databases and a reference list search. Key words were goal, goal setting, nutrition, diet, dietary, physical activity, exercise, behavior change, interventions, and fitness. STUDY INCLUSION AND EXCLUSION CRITERIA: The search identified 144 studies, of which 28 met inclusion criteria for being published in a peer reviewed journal and using goal setting in an intervention to modify dietary or physical activity behaviors. Excluded from this review were those studies that (1) evaluated goal setting cross-sectionally without an intervention; (2) used goal setting for behavioral disorders, to improve academic achievement, or in sports performance; (3) were reviews. DATA EXTRACTION AND SYNTHESIS: The articles were categorized by target audience and secondarily by research focus. Data extracted included outcome measure, research rating, purpose, sample, sample description, assignment, findings, and goal-setting support. RESULTS: Thirteen of the 23 adult studies used a goal-setting effectiveness study design and eight produced positive results supporting goal setting. No adolescent or child studies used this design. The results were inconclusive for the studies investigating goal-setting characteristics (n = 7). Four adult and four child intervention evaluation studies showed positive outcomes. No studies reported power calculations, and only 32% of the studies were rated as fully supporting goal setting. CONCLUSIONS: Goal setting has shown some promise in promoting dietary and physical activity behavior change among adults, but methodological issues still need to be resolved. The literature with adolescents and children is limited, and the authors are not aware of any published studies with this audience investigating the independent effect of goal setting on dietary or physical activity behavior. Although, goal setting is widely used with children and adolescents in nutrition interventions, its effectiveness has yet to be reported.

Diet↗
PubMedDate not supplied

The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs.

PURPOSE: The purpose of this review is to determine whether incentive-based programs conducted at worksites increase participation and long-term smoking cessation rates. METHODS: Published studies of workplace smoking cessation programs involving incentives and competition were identified through all available years up to winter of 1992 in MEDLINE (1966-1992), Psychlit (1967-1992), Smoking and Health (1960-1992), and Combined Health Information (1973-1992) computer databases and article reference lists. Programs were considered incentive programs when they involved either cash or other prizes paid to the participant for quitting smoking. Incentive competition programs typically involve groups contesting for prizes by having the greatest smoking cessation rates. Thirty studies were found, out of which 15 quasi-experimental and experimental studies are reviewed. The 15 studies that did not have comparison groups were excluded from this report. RESULTS: Only eight studies had a comparison group in which the effects of incentives and competition were separated from the effects of other interventions. Only one study separated the effects of competition from incentives. Five of these studies evaluated smoking rates after six months, and three after 12 months from the program start. Three of these studies showed that incentives increased participation rates, and five enhanced smoking reduction. No study showed, however, that incentives and/or competition enhanced smoking cessation past six months. CONCLUSIONS: It appears that incentives/competition may be useful for increasing participation and smoking reduction. Further research needs to be conducted to determine whether incentives and/or competition enhance long-term quit rates, and what are the most effective types of incentive procedures.

Follow-Up Studies↗
PubMed2002

Rheumatic disorders in Sub-saharan Africa.

OBJECTIVE: To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision. DATA SOURCES: Medline, (English, French). Pre-Medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full. CONCLUSIONS: The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and South Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements. Suggestions made to address the challenge posed by the burden of rheumatic disorders.

Adult↗
PubMed1993

Cognitive behavioral techniques for hypertension: are they effective?

PURPOSE: To assess by analysis of published controlled trials the efficacy of cognitive behavioral therapies (such as biofeedback, relaxation, meditation) for essential hypertension. DATA IDENTIFICATION: Randomized controlled trials published in the English language between 1970 and 1991 identified from the MEDLINE database and bibliographic references from these articles. STUDY SELECTION: Limited to studies involving randomized assignment to a treatment group consisting of one or more cognitive behavioral interventions or a concurrent control group consisting of no therapy, a waiting list, regular monitoring, or placebo intervention. RESULTS OF DATA SYNTHESIS: Although we identified more than 800 published works, only 26 met entry criteria. We identified a number of methodologic short-comings, including small sample size, inconsistencies regarding baseline blood pressure determinations and types of control groups, and the possibility of confounding by multiple noncognitive cointerventions (diet, exercise) and expectancy (the placebo effect). In meta-analyses involving 1264 patients, differences in mean blood pressure reduction varied according to the duration of baseline blood pressure measurements and type of control groups studied. In 16 comparisons involving baseline periods of more than 1 day, with patients (n = 368) assigned to either a cognitive therapy or a placebo intervention (sham biofeedback, "pseudo-meditation"), systolic and diastolic blood pressures decreased by 2.8 mm Hg (95% CI, -0.8 to 6.4) and 1.3 mm Hg (CI, -1.3 to 3.8), respectively. These changes were neither statistically nor clinically significant. CONCLUSION: Cognitive interventions for essential hypertension are superior to no therapy but not superior to credible sham techniques or to self-monitoring alone. The literature on this subject is limited by a variety of methodologic inadequacies. No single cognitive behavioral technique appears to be more effective than any other.

Behavior Therapy↗
PubMed1999

[Expert systems and automatic diagnostic systems in histopathology--a review].

In this decade, the pathological information system has gradually been settled in many hospitals in Japan. Pathological reports and images are now digitized and managed in the database, and are referred by clinicians at the peripherals. Tele-pathology is also developing; and its users are increasing. However, in many occasions, the problem solving in diagnostic pathology is completely dependent on the solo-pathologist. Considering the need for timely and efficient supports to the solo-pathologist, I reviewed the papers on the knowledge-based interactive expert systems. The interpretations of the histopathological images are dependent on the pathologist, and these expert systems have been evaluated as "educational". With the view of the success in the cytological screening, the development of "image-analysis-based" automatic "histopathological image" classifier has been on ongoing challenges. Our 3 years experience of the development of the pathological image classifier using the artificial neural networks technology is briefly presented. This classifier provides us a "fitting rate" for the individual diagnostic pattern of the breast tumors, such as "fibroadenoma pattern". The diagnosis assisting system with computer technology should provide pathologists, especially solo-pathologists, a useful tool for the quality assurance and improvement of pathological diagnosis.

Expert Systems↗
PubMed1999

Clinical effectiveness of pneumococcal vaccine. Meta-analysis.

OBJECTIVE: To determine the clinical effectiveness of pneumococcal vaccine. DATA SOURCES: Computerized searches of MEDLINE, EMBASE, and SCISEARCH databases were performed, reference lists of retrieved articles were reviewed, and first authors of published studies were contacted. STUDY SELECTION: Studies of use of pneumococcal vaccines in adults were included if the study design was a randomized or quasi-randomized controlled trial and at least one of the following clinical outcomes was reported: vaccine-type systemic pneumococcal infection, systemic pneumococcal infection, vaccine-type pneumococcal pneumonia, pneumococcal pneumonia, non-vaccine-type pneumococcal pneumonia. SYNTHESIS: Study quality was assessed and descriptive information concerning the study populations, interventions, and outcome measurements was extracted for 13 trials involving more than 65,000 patients. Estimates of vaccine efficacy, based on a meta-analysis of randomized and quasi-randomized trials, were determined for clinical outcomes. CONCLUSIONS: Vaccination with pneumococcal polysaccharide vaccine can be expected to reduce the risk of systemic infection due to pneumococcal types included in the vaccine by 83% and systemic infection due to all pneumococci by 73%. We found no evidence that the vaccine was less efficacious for the elderly, institutionalized people, or those with chronic disease.

Adolescent↗
PubMed2000

[Epidemiology of in-line skate injuries: state of the art].

During the last decade, in-line skating has become an increasingly popular activity. Along with the number of reports, highlighting the number of injuries and their degree of severity, in-line skating injuries have to be considered a growing public health issue. The objective of this work is to report epidemiological knowledge about in-line skate injuries and ways of prevention. A thorough search of all reports and publications on the subject was performed through the Medline database and in references of selected publications. There are numerous case series studies and several observational ones, most of them undertaken in North America. In-line skates are used for recreation, sports, and transportation, in a variety of settings (parks, streets, bike path, etc.) and by most of age groups (5 to 71 years, median generally about 15). The most common site of injury is the wrist and forearm, although other parts of the body can be severely injured. Age, sex, physical training level, formal instruction level, lack of wearing of protective gear, skating location, may be risk factors for injury. Some preventive measures were proposed by a number of research workers (information campaigns, wearing of protective gear, instruction, laws, etc.). Several preventive attempts were undertaken but no one was appraised. In-line skates are used by all age groups and for a variety of activities. In-line skating is related to a great number of factors, such as cultural, social, geographic, urban and behavioural factors. Therefore, groups at risk for injury are very different. Emergence of an important type of injury should lead to the development of analytic epidemiological studies, based on particular groups of in-line skaters, in order to describe them, to identify and quantify risk factors and to design preventive measures, and then to appraise their efficiency.

Accidents, Traffic↗
PubMed2001

Clinical decision-making for caries management in root surfaces.

This report presents the results of an evidence-based approach to obtaining the best available information on the natural history, prevalence, incidence, diagnosis, and treatment of root caries. Searches of electronic databases produced 807 references; from these and from citations in the selected articles, a final 161 references were used. We found that the information on the natural history of the disease does not provide practitioners with probabilities of, or time estimates for, progression of the disease through stages. For patients aged thirty and older, the prevalence of root caries is roughly 20 to 22 percent less than a person's age. Severity reaches over one lesion by age fifty, two lesions by age seventy, and just over three lesions for those seventy-five and older. About 8 percent (odds of 1:11) of the population would be expected to acquire one or more new root caries lesions in one year. The accuracy of current systems of diagnosis is unknown, although color has been shown to have little validity. Using the criteria of "softness" to define active lesions has been validated by the presence of microbes in the lesion. One strong study and other studies with weaker design or shorter duration add consistent support for the use of fluorides in the remineralization of root caries. Every three-month application of chlorhexidine varnish was shown to be efficacious in one arm of one study. Evidence for restoration of root caries is tentative since the studies were of limited design and duration.

Adult↗
PubMed2002

Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis.

OBJECTIVE: We assessed the efficacy of S-adenosylmethionine (SAMe), a dietary supplement now available in the Unites States, compared with that of placebo or nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis (OA). STUDY DESIGN: This was a meta-analysis of randomized controlled trials. DATA SOURCES: We identified randomized controlled trials of SAMe versus placebo or NSAIDS for the treatment of OA through computerized database searches and reference lists. OUTCOMES MEASURED: The outcomes considered were pain, functional limitation, and adverse effects. RESULTS: Eleven studies that met the inclusion criteria were weighted on the basis of precision and were combined for each outcome variable. When compared with placebo, SAMe is more effective in reducing functional limitation in patients with OA (effect size [ES] =.31; 95% confidence interval [CI],.099-.520), but not in reducing pain (ES =.22; 95% CI, -.247 to.693). This result, however, is based on only 2 studies. SAMe seems to be comparable with NSAIDs (pain: ES =.12; 95% CI, -.029 to.273; functional limitation: ES =.025; 95% CI, -.127 to.176). However, those treated with SAMe were less likely to report adverse effects than those receiving NSAIDs. CONCLUSIONS: SAMe appears to be as effective as NSAIDs in reducing pain and improving functional limitation in patients with OA without the adverse effects often associated with NSAID therapies.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

[Bipolar I disorder in France: prevalence of manic episodes and hospitalisation-related costs].

Bipolar disorder is a chronic, highly disabling illness. However, few studies have evaluated the economic impact of this illness. The objective of this study was to estimate: 1) the annual number of manic episodes in patients with bipolar I disorder, and 2) the costs of hospitalisations related to manic episodes in France. We only included data on bipolar I disorder, as there is greater consensus and better documentation for this subgroup of patients with bipolar disorder. The prevalence of manic episodes was estimated using published epidemiological data. A computerised literature search was performed using the traditional scientific and medical databases. Additional epidemiological references were identified from published studies and textbooks. For hospitalisation data, we used the statistics of the Medical Information Department of a large psychiatric hospital in Paris for the year 1999. We estimated the annual number of manic episodes in France based on: 1) the lifetime prevalence of bipolar I disorder, 2) the average cycle duration, 3) the proportion of rapid cycling patients, and 4) the proportion of depressive vs. manic episodes for patients with bipolar I disorder. In order to estimate the prevalence of bipolar I disorder, we conducted a random effects meta-analysis using published international data. Results of the meta-analysis, which was based on a total of 62 736 patients, showed the lifetime prevalence of bipolar I disorder to be 0.82% [95% CI: 0.42, 1.21]. Applied to the adult population in France, this prevalence implies that the number of persons who have ever experienced a bipolar I -disorder is approximately 390,000 [95% CI: 200,000, 575,000]. Few studies provide information on the duration of cycles in patients with bipolar I disorder. Available estimates suggest the cycle duration to be approximately 12 months. Regarding the proportion of rapid cyclers, data from the meta-analysis by Tondo et al. show that 18% of patients with bipolar disorder experience at least four episodes of mood disorder per year. Finally, based on findings provided by cohort studies, the number of depressive episodes appears to be roughly equal to the number of manic episodes during the course of bipolar disorder. A rapid cycling rate of 18% and a cycle duration of 12 months imply that, on average, among 100 bipolar patients, 18 will have a 3-month cycle duration and 82 a 14-month cycle duration. Given an equal proportion of manic and depressive episodes, the annual number of manic episodes would then be 68 for a cohort of 100 bipolar patients (0.68 episode per patient per year). Applying this figure to the estimate of the total number of patients with bipolar I disorder in France suggests that the annual number of manic episodes in France is 265,000 [95% CI: 136,000, 391,000]. Based on data from a psychiatric hospital in Paris, the proportion of manic episodes that require hospitalisation was estimated to be around 63% with an average length of stay of 32.4 days. Hence the annual number of hospitalisations for manic episodes in France is estimated to be 167 000 [95% CI: 86 000, 246 000] and the hospitalisation-related costs 1,3 billion euros approximately. Our review of literature highlights the lack of medical and economic data at the national level on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France. Given the lifetime prevalence of bipolar I disorder which may be as high as 3% among adults, further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar disorder in France.

Adolescent↗
PubMed2003

WASP--a generic web-based, interactive, patient simulation system.

Computer based patient case simulation systems have during the recent years been introduced in medical education to allow students to "meet" more cases that are educationally optimized and adapted to the actual learning situation. However, three major problems exist with most computer based case simulation systems today: They are expensive to develop, experienced multimedia developers are needed for the development and teachers/clinicians can not develop and adjust cases to fit their own specific educational needs. The WASP project (Web-Activated Simulation of Patients) tries to solve these three problems, and still allow very realistic and highly-interactive simulations of clinical cases, delivered and edited via the Web. WASP is based on experience from a number of national and international visualization and simulation projects. Most important case simulation features are available, including: interactive history taking, complete physical examination (inspection, auscultation, palpation, percussion, vitals, neurological exams etc.), complete lab section including chemical labs, X-ray, MRI, ultrasound, CT, phys lab, pharmacology lab, pathology lab etc.), diagnosis and differentials, therapy, interactive session feedback and integrated references and online database sources.

Education, Medical, Undergraduate↗
PubMed2006

Developing a virtual community for health sciences library book selection: Doody's Core Titles.

PURPOSE: The purpose of this article is to describe Doody's Core Titles in the Health Sciences as a new selection guide and a virtual community based on an effective use of online systems and to describe its potential impact on library collection development. SETTING/PARTICIPANTS/RESOURCES: The setting is the availability of health sciences selection guides. Participants include Doody Enterprise staff, Doody's Library Board of Advisors, content specialists, and library selectors. Resources include the online system used to create Doody's Core Titles along with references to complementary databases. BRIEF DESCRIPTION: Doody's Core Titles is described and discussed in relation to the literature of selection guides, especially in comparison to the Brandon/Hill selected lists that were published from 1965 to 2003. Doody's Core Titles seeks to fill the vacuum created when the Brandon/Hill lists ceased publication. Doody's Core Titles is a unique selection guide based on its method of creating an online community of experts to identify and score a core list of titles in 119 health sciences specialties and disciplines. RESULTS/OUTCOME: The result is a new selection guide, now available annually, that will aid health sciences librarians in identifying core titles for local collections. EVALUATION METHOD: Doody's Core Titles organizes the evaluation of core titles that are identified and recommended by content specialists associated with Doody's Book Review Service and library selectors. A scoring mechanism is used to create the selection of core titles, similar to the star rating system employed in other Doody Enterprise products and services.

Book Selection↗
PubMed2006

Functional annotation and analysis of Korean patented biological sequences using bioinformatics.

A recent report of the Korean Intellectual Property Office (KIPO) showed that the number of biological sequence-based patents is rapidly increasing in Korea. We present biological features of Korean patented sequences though bioinformatic analysis. The analysis is divided into two steps. The first is an annotation step in which the patented sequences were annotated with the Reference Sequence (RefSeq) database. The second is an association step in which the patented sequences were linked to genes, diseases, pathway, and biological functions. We used Entrez Gene, Online Mendelian Inheritance in Man (OMIM), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Ontology (GO) databases. Through the association analysis, we found that nearly 2.6% of human genes were associated with Korean patenting, compared to 20% of human genes in the U.S. patent. The association between the biological functions and the patented sequences indicated that genes whose products act as hormones on defense responses in the extra-cellular environments were the most highly targeted for patenting. The analysis data are available at http://www.patome.net.

Base Sequence↗
PubMed2006

[Diagnostic value of patient history and physical examination in elderly patients with urinary incontinence; a literature review].

OBJECTIVE: To assess the validity of patient history and physical examination in elderly patients in the diagnosis ofvarious types of urinary incontinence. DESIGN: Literature review. METHOD: Articles on the diagnosis of urinary incontinence in elderly patients (patient history and/or physical examination versus urodynamic testing) were identified using PubMed, Picarta (a Dutch database) and the reference lists of the articles found. Articles were published between January 1970 and August 2005. The applicability and quality of the articles were assessed using the relevant Cochrane criteria. 'Sufficient diagnostic evidence' was defined as a positive likelihood ratio > 5 and a negative likelihood ratio < 0.02. RESULTS: 5 studies met the eligibility criteria; 4 were performed in the second-line setting and 1 in a general population. All 5 studies involved women aged 55 years or older. None of the 5 studies found a positive or negative likelihood ratio for providing sufficient diagnostic evidence for various types of urinary incontinence. In the study conducted in a general population, the positive and negative likelihood ratios for the presence of stress incontinence according to patient history and physical examination were 3.23 and 0.40, respectively. CONCLUSION: Few adequate studies have been reported on the validity of clinical evaluation in the diagnosis of urinary incontinence in older women, and no studies have been conducted in men. The validity of clinical evaluation has been demonstrated only in the diagnosis of stress incontinence in older women.

Aged↗