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PubMed2006

Atopic eczema: what's new?

Atopic eczema (AE) is a chronic inflammatory skin disease characterized by recurrent intense pruritus and a typical age-related distribution of skin lesions. Several new aspects with regard to the pathogenetic background as well as strategies for prevention, diagnosis and treatment of AE have emerged. There are ongoing studies on genetic susceptibility loci, as well as environmental and nutritional factors associated with an increase or a decrease of AE lesions. The atopy patch test is now available for identification of allergens in aeroallergen-triggered AE. New topical therapies, such as the calcineurin inhibitors, have broadened the therapeutic armamentarium substantially. In order to increase knowledge and coping strategies, patient education programs have been launched. Learning objective Upon completing this paper, the reader should be aware of new developments in AE, especially on nomenclature, prevention strategies, diagnostic tests, as well as therapeutic options.

Animals↗
PubMed2006

What is genetic information, and why is it significant? A contextual, contrastive, approach.

Is genetic information of special ethical significance? Does it require special regulation? There is considerable contemporary debate about this question (the 'genetic exceptionalism' debate). 'Genetic information' is an ambiguous term and, as an aid to avoiding conflation in the genetic exceptionalism debate, a detailed account is given of just how and why 'genetic information' is ambiguous. Whilst ambiguity is a ubiquitous problem of communication, it is suggested that 'genetic information' is ambiguous in a particular way, one that gives rise to the problem of 'significance creep' (i.e., where claims about the significance of certain kinds of genetic information in one context influence our thinking about the significance of other kinds of genetic information in other contexts). A contextual and contrastive methodology is proposed: evaluating the significance of genetic information requires us to be sensitive to the polysemy of 'genetic information' across contexts and then examine the contrast in significance (if any) of genetic, as opposed to nongenetic, information within contexts. This, in turn, suggests that a proper solution to the regulatory question requires us to pay more attention to how and why information, and its acquisition, possession and use, come to be of ethical significance.

Communication↗
PubMed2005

The HLA Dictionary 2004: a summary of HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1 alleles and their association with serologically defined HLA-A, -B, -C, -DR and -DQ antigens.

This report presents serological equivalents of HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5 and -DQB1 alleles. The dictionary is an update of that published in 2001. The data summarize equivalents obtained by the World Health Organization Nomenclature Committee for Factors of the HLA System, the International Cell Exchange (UCLA), the National Marrow Donor Program (NMDP), recent publications and individual laboratories. This latest update of the dictionary is enhanced by the inclusion of results from studies performed during the 13th International Histocompatibility Workshop and from neural network analyses. A summary of the data as recommended serological equivalents is presented as expert assigned types. The tables include remarks for alleles, which are or may be expressed as antigens with serological reaction patterns that differ from the well-established HLA specificities. The equivalents provided will be useful in guiding searches for unrelated haematopoietic stem cell donors in which patients and/or potential donors are typed by either serology or DNA-based methods. The serological DNA equivalent dictionary will also aid in typing and matching procedures for organ transplant programmes whose waiting lists of potential donors and recipients comprise mixtures of serological and DNA-based typings. The tables with HLA equivalents and a questionnaire for submission of serological reaction patterns for poorly identified allelic products will be made available through the WMDA web page (http://www.worldmarrow.org) and, in the near future, also in a searchable form on the IMGT/HLA database.

Alleles↗
PubMed1998

Random allocation or allocation at random? Patients' perspectives of participation in a randomised controlled trial.

OBJECTIVES: To explore trial participants' understandings of randomisation. DESIGN: In this exploratory study, which used qualitative research methods, in-depth, semistructured interviews were carried out with 20 participants from the CLasP randomised controlled trial. Interviews were recorded on audio tape and fully transcribed. Data were analysed by comparing transcripts and describing emergent themes, using a grounded theory approach. SETTING: The CLasP study comprises three linked multicentre, pragmatic randomised controlled trials evaluating the effectiveness and cost effectiveness of laser therapy, standard surgery, and conservative management for men with lower urinary tract symptoms or urinary retention, or both, related to benign prostatic disease. SUBJECTS: 20 participants in the CLasP study were interviewed. Sampling was purposeful: men were included from each of the treatment arms, the two major centres, and at different points in the trial. INTERVENTIONS AND OUTCOME MEASURES: Interviews used a checklist of topics to encourage participants to describe their experiences. Narratives concerning randomisation were compared to identify common themes, retaining the context of the discussion to allow detailed interpretation. RESULTS: Most participants recalled and described aspects of randomisation, such as the involvement of chance, comparison, and concealed allocation. Many found the concept of randomisation difficult, however, and developed alternative lay explanations to make sense of their experiences. Inaccurate patient information and lay interpretations of common trial terms caused confusion. CONCLUSIONS: The provision of clear and accurate patient information is important, but this alone will not ensure consistent interpretation of concepts such as randomisation. Patients may need to discuss the purposes of randomisation in order to understand them fully enough to give truly informed consent.

Attitude to Health↗
PubMed1983

Whole-brain death reconsidered.

The author, a philosopher, suggests that the concept of death should be left as it is 'in its present indeterminate state', and that we ought to reject attempts to define death in terms of whole-brain death or any other type of brain death, including cerebral death and 'irreversible coma'. Instead of 'fiddling with the definition of death' clear rules should be established specifying 'what can be appropriately done to whom when'.

Brain Death↗
PubMed1993

Gradient-echo MR imaging: techniques and acronyms.

This overview briefly traces the history and nomenclature of gradient-recalled-echo (GRE) techniques used in magnetic resonance (MR) imaging. GRE sequences, which are now offered commercially by 11 major manufacturers of MR imagers, are presented to illustrate their structural similarities and subtle differences in implementation. A classification scheme is proposed for these sequences employing a vendor-independent nomenclature. A glossary of GRE abbreviations and acronyms found in the current MR marketplace also is presented.

Abbreviations as Topic↗
PubMedDate not supplied

The diagnosis of delirium and DSM-IV.

This paper reviews the history of the development of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) using the diagnostic category of delirium as an example. It also attempts to show how clinical practice and experience has molded the current conceptualization of delirium in DSM-IV. The paper presents the process and options the DSM-IV Work Group on Organic Disorders pursued in developing the DSM-IV criteria for the diagnosis of delirium, particularly in relation to ICD-10.

Delirium↗
PubMed1988

Personality disorders in DSM-III and DSM-III-R: convergence, coverage, and internal consistency.

Although many sections of DSM-III-R reflect few changes from DSM-III, the diagnostic criteria for the personality disorders involve more substantial revisions. This study examined the impact of DSM-III-R revisions in terms of convergence with DSM-III, the diagnostic coverage of patients with personality disorders, and the internal consistency of the personality disorder criteria sets. The results demonstrated a substantial divergence between DSM-III and DSM-III-R diagnoses, increased coverage accompanied by a large increase in overlap among personality disorders, and internal consistency estimates of DSM-III-R criterion sets comparable to those in DSM-III.

Adult↗
PubMed1991

Results of a survey of forensic psychiatrists on the validity of the sadistic personality disorder diagnosis.

OBJECTIVE: The purpose of this study was to determine how often forensic psychiatrists evaluated individuals with sadistic personality disorder; their views about the usefulness of the diagnosis; the frequency of certain childhood factors; and the sensitivity and specificity of the individual diagnostic criteria. METHOD: A questionnaire to be answered anonymously was sent to all of the 1,390 members of the American Academy of Psychiatry and the Law. Two hundred seventy-nine usable questionnaires were returned for data analysis. RESULTS: Approximately 50% of the respondents had, at some time, evaluated in a forensic setting a subject who exhibited behavior that met the criteria for the disorder. Four percent of the cases seen in the preceding year by those respondents who had ever seen a case would have met the criteria for the disorder. Most of the forensic psychiatrists who had experience with the disorder believed that the diagnosis is useful for a variety of clinical and forensic purposes, but most also believed that the category has significant potential for being misused in legal settings. Almost all cases described by the respondents involved male patients, and there was frequently a history of childhood abuse and parental loss. The diagnostic criteria in these cases had high sensitivity and specificity. CONCLUSIONS: In forensic settings the diagnosis of sadistic personality disorder is probably not rare. The results of this study suggest that the diagnosis has both descriptive and construct validity and that further study of the disorder with the DSM-III-R diagnostic criteria is needed.

Antisocial Personality Disorder↗
PubMed1993

Religious content in the DSM-III-R glossary of technical terms.

The authors reviewed Appendix C of DSM-III-R, Glossary of Technical Terms, for its references to religion. Religion was referred to more frequently in this glossary than it is in psychiatric research. The authors conclude that although the Glossary uses religion in constructive or cautionary reminders, the high rate of illustrative case examples of psychopathology that involve religion in the Glossary indicates cultural insensitivity in interpreting religion.

Humans↗