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PubMed2000

Carbamazepine for cocaine dependence.

BACKGROUND: Cocaine dependence has become a substantial public health problem, developing a significant number of medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. Although there is no consensus regarding how to treat cocaine dependence, effective pharmacotherapy has a potentially major role to play as part of a broader treatment milieu. The anti-convulsant carbamazepine, a tricyclic medication that is widely used to treat a variety of neurological and psychiatric disorder, has also been used for treatment of cocaine dependence, although its effectiveness has not been established. OBJECTIVES: To determine whether carbamazapine (CBZ) is effective on the treatment of cocaine dependence. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scan of reference list of relevant articles; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of carbamazepine drugs versus placebo on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Odds Ratios, weighted mean difference and number needed to treat were estimated. Qualitative assessments of the methodology of eligible studies were carried out using validated checklists. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. Where possible analysis was carried out according to the "intention to treat" principles. MAIN RESULTS: 5 studies were included in the review, with 455 people randomised. No differences were found regarding positive urine sample for cocaine metabolites. Scores on Spielberg State Anxiety Inventory slightly favoured carbamazepine, but didn't reach statistical significance. Dropouts were high in both groups up to 70% in the placebo group. Less dropout occurred in the Carbamazepine group (RR 0.87 95%CI 0.71-1.06). When no retention in treatment was due to side effects no differences were found. The number of participants presenting at least one side effect, reported in Kranzler (1995), was higher in the carbamazepine group (RR 4.33 95% CI 1.45-12.91). REVIEWER'S CONCLUSIONS: There is no current evidence supporting the clinical use of CBZ in the treatment of cocaine dependence. Larger randomised investigation must be considered taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence.

Anticonvulsants↗
PubMed2003

Drugs for preventing migraine headaches in children.

BACKGROUND: It has been estimated that about ten per cent of children between six and 20 years of age suffer from migraine. It is estimated that children with migraine lose one and a half weeks more schooling per year than their peers. Prophylactic drugs can be prescribed when children suffer from frequent or disabling headaches. OBJECTIVES: We aimed to describe and assess the evidence from controlled trials on the efficacy and tolerability of pharmacological agents taken on a regular basis to prevent the occurrence of migraine attacks and/or reduce the intensity of such attacks in children with migraine. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched from 1966 through 2002. Additional strategies for identifying trials included searching the reference lists of review articles and included studies and searching books related to headache. SELECTION CRITERIA: Prospective randomised controlled trials (RCTs) of self- or parent-administered drug treatments in children (under 18 years of age) who had received a diagnosis of migraine were included. DATA COLLECTION AND ANALYSIS: Two investigators extracted, assessed, and coded separately all data for each study, using a form that was designed specifically for the review. Any disagreement was resolved by discussion. Headache frequency standardised over 28 days was used as the primary outcome measure. Headache intensity, headache duration, amount of symptomatic treatment used, and headache indices were used as secondary outcome measures. Data were extracted from both parallel-group and crossover trials. Continuous and dichotomous data were used to calculate standardised mean differences (SMDs) and odds ratios (ORs), respectively. Numbers-needed-to-treat (NNTs) and numbers-needed-to-harm (NNHs) were also calculated. MAIN RESULTS: Thirty-eight studies were selected. Eighteen were excluded. Eleven preventive drugs were compared with placebo in a total of 15 studies. Drug-drug comparisons were made in just six studies. For only four drugs (L-5-hydroxytryptophan [L-5HTP], flunarizine, clonidine, and propranolol) were two or more studies selected. For only six drugs (trazodone, L-5HTP, propranolol, flunarizine, papaverine, and nimodipine) were data reported for effect on frequency. For no individual drug were comparable data reported in more than one study, thus meta-analysis was not possible. Two placebo-controlled studies showed a beneficial effect on the primary outcome measure, headache frequency. They were for the drugs propranolol and flunarizine. The propranolol study reported a dichotomous outcome (proportion of children responding), and it was possible to calculate a number-needed-to-treat to produce a two-thirds reduction in headache frequency (NNT = 1.5, 95%CI 1.15 to 2.1). The flunarizine study produced a SMD of 1.51 (95% confidence interval, -2.21 to -0.82), which was statistically significant in favour of flunarizine (p < 0.001). Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. The available studies on cyproheptadine, phenobarbitone, phenytoin, amitriptyline, carbamazepine, metoprolol, and piracetam were excluded for various reasons. REVIEWER'S CONCLUSIONS: Only one study each for propranolol and flunarizine were identified showing efficacy of these drugs as prophylactics of paediatric migraine. Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. Available studies on other commonly used drugs failed to meet our inclusion criteria. The quality of evidence available for the use of drug prophylaxis in paediatric migraine was poor. Studies were generally small, with no planning of sample size, so that for many drugs, despite the negative findings of this review, we do not have conclusive evidence of 'no effect'. There is a clear and urgent need for methodologically sound RCTs for the use of pings of this review, we do not have conclusive evidence of 'no effect'. There is a clear and urgent need for methodologically sound RCTs for the use of prophylactic drugs in paediatric migraine, starting with propranolol. These studies need to be adequately powered to investigate meaningful reductions in pain and suffering from a patient's perspective.

Adolescent↗
PubMed2004

Assessing medical residents' usage and perceived needs for personal digital assistants.

Health care professionals need information delivery tools for accessing information at the point of patient care. Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices. An earlier study [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678] on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness, however, they were used frequently for accessing medical references and drug information [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Since this study was completed in 1995, hand-held computer technology has advanced rapidly, and between 26 and 50% of physicians currently use PDAs [Physician's use of hand-helds increases from 15% in 1999 to 26% in 2001: Harris interactive poll results, Harris Poll. 8-24-2002 (electronic citation); ACP-ASIM survey finds nearly half of U.S. members use hand-held computers: ACP-ASIM press release, American College of Physicians, 9-3-2002 (electronic citation)]. This use appears higher among residents, with one recent study finding that over two-thirds of family practice residencies use hand-held computers in their training programs [J. Am. Med. Inform. Assoc. 9 (1) (2002) 80]. In this study, we systematically evaluate PDA usage by residents in our institution using quantitative and qualitative methods. Our evaluation included a brief on-line survey of 88 residents in seven residency programs including primary care and specialty practices. The surveys were completed between 26 October 2001 and 30 April 2002. Follow-up interviews with 15 of the surveyed residents were then conducted between 24 April 2002 and 13 May 2002. The original contributions of this study are the evaluation of residents in primary and specialty programs and evaluation of both medical application software and the conventional personal organizational software (such as calendars and to-do lists). This evaluation was also conducted using significantly advanced hardware and software compared with previous studies [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Results of our survey and follow-up interviews of residents showed most residents use PDAs daily, regardless of practice or whether their program encourages PDAs. Uses include commercial medical references and personal organization software, such as calendars and address books. Concerns and drawbacks mentioned by these residents included physical size of the PDA and the potential for catastrophic data loss. Another issue raised by our results suggests that security and Health Information Portability and Accountability Act (HIPAA) compliance need to be addressed, in part by resident education about securing patient data on PDAs. Overall, PDAs may become even more widely used if two issues can be addressed: (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g. by educating residents about procedures to recover information from PDA backup files).

Academic Medical Centers↗
PubMed1996

Global increases in allergic respiratory disease: the possible role of diesel exhaust particles.

OBJECTIVE: Reading this article will enable the readers to recognize and evaluate i e potential relationship between allergic respiratory disease and polyaromatic hydrocarbons as air pollutants from industrial and automotive fuel sources. In this article we review the long-term trends in the prevalence of allergic airway diseases (rhinitis and asthma). We then examine the epidemiologic and other research data relating to the role that hydrocarbon fuel emissions may have had on allergic respiratory disease. DESIGN: Published literature on the relationship between specific air pollutants and trends in allergic respiratory disease were reviewed. Reports of research on pollutant effects on allergic antibody (IgE) were also studied. In both cases, the Melvyl-Medline database since 1975 was used for literature searches. Older references were identified from the bibliographies of relevant articles and books and with the help of the rare books collection at UCLA's Louis M. Darling Biomedical library. RESULTS: Examination of the historical record indicates that allergic rhinitis and allergic asthma have significantly increased in prevalence over the past two centuries. Although the reasons for this increase are not fully elucidated, epidemiologic data suggest that certain pollutants such as those produced from the burning of fossil fuels may have played an important role in the prevalence changes. Also important are studies showing that diesel exhaust, a prototypical fossil fuel, is able to enhance in vitro and in vivo IgE production. CONCLUSION: Increased levels of the compounds resulting from fossil fuel combustion may be partly responsible for the increased prevalence of allergic respiratory disease. If the nature of these compounds and the mechanisms by which they exacerbate allergic disease can be identified, steps can be taken to reduce the production or the impact of these allergy producing compounds.

Humans↗
PubMed2005

Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery.

OBJECTIVE: To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients. RESEARCH METHODS AND PROCEDURES: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient. RESULTS: We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research. DISCUSSION: Obesity-related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.

Analgesia↗
PubMed2001

Suboptimal prescribing in older inpatients and outpatients.

Investigators searched Medline and HealthSTAR databases from January 1, 1985 through June 30, 1999 to identify articles on suboptimal prescribing in those age 65 years and older. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. The definitions for various types of suboptimal prescribing (polypharmacy, inappropriate, and underutilization) are numerous, and measurement varies from study to study. The literature suggests that suboptimal prescribing is common in older outpatients and inpatients. Moreover, there is significant morbidity and mortality associated with suboptimal prescribing for these older patients. Evidence from well-controlled studies suggests that multidisciplinary teams and clinical pharmacy interventions can modify suboptimal drug use in older people. Future research is necessary to measure and test other methods for tackling this major public health problem facing older people.

Aged↗
PubMed2003

The effects of clean indoor air laws: what do we know and what do we need to know?

Our objective was to review the research on the effects of public clean air laws on smoking rates, compare these effects to those found in studies on the impact of private worksite restrictions and derive estimates of the potential reductions in smoking rates that might be expected from the implementation of the two types of policies. Data sources were computerized databases, references identified from pertinent peer-reviewed journal articles and books, and suggestions by experts on tobacco control policy. Comprehensive public clean air laws have the potential to reduce prevalence and consumption rates of the entire population (including non-working and non-indoor working smokers) by about 10%. Studies on private worksite regulations also suggest that strong worksite restrictions have the potential to reduce the prevalence rate of the entire population by about 6% over the long-term and the quantity smoked by continuing smokers by 28%, depending on the length of time after the ban. Further research is needed on the effects of the different types of public clean air policies on the entire smoking population and on different sociodemographic groups, how the effects of public clean indoor air laws depend on private restrictions already in place, and how the effect of private restrictions depend on whether or not they are supported by public clean air laws.

Adolescent↗
PubMed1994

Pathological fire-setting 1951-1991: a review.

The purpose of this article is to review the whole literature on pathological fire-setting and related fields since 1951 in order to present a state of the art picture of our contemporary knowledge about this phenomenon. Papers were initially selected by using a Medline search. From the articles obtained in this way the references had to be pursued, because many relevant papers and books in this research field of different scientific and practical disciplines are not listed in conventional literature services. Finally, only those contributions were selected which provided new information when published, by original research, theoretical interpretation or practical implications. The last forty years have brought a growing body of data and understanding--especially concerning pathological fire-setting by children--etiology, and therapy, which often proves successful. The situation remains unclear for arson by psychologically disturbed adults and we still have a poor understanding of arson without apparent motive. There is a conflict of opinion as to whether adult fire-setters are suitable for therapy and therapeutic efforts dealing with psychologically disturbed adults are rare. With increasing knowledge about child fire-setting and its successful treatment, etiological and therapeutic models for adult fire-setting behaviour may be developed. Research into the latter area should focus on both biographical and social conditions of development from childhood on as well as biological measures. Both will be reviewed here.

Adolescent↗
PubMedDate not supplied

Healthy skin for women: a review of common conditions and therapies.

OBJECTIVE: To review common dermatologic conditions that may be of particular concern to women throughout their lives, including acne, contact dermatitis, skin conditions of pregnancy, dry skin, and sun-related skin damage. DATA SOURCES: Articles identified through a search of MEDLINE and pharmacology and dermatology textbooks using the terms women, dermatology, skin, acne, skin cancer, sunscreens, pregnancy, melanoma, basal cell carcinoma, dermatitis, cosmetic dermatitis, dry skin (xerosis), actinic keratosis, oral contraceptives, and striae. Additional references were identified from the bibliographies of retrieved articles and book chapters. DATA SYNTHESIS: A number of skin conditions may be of particular concern to women throughout their lives. Acne, which may be particularly troublesome during the teenage years and young adulthood, and skin conditions that are common during pregnancy may be influenced by hormonal changes that occur at different life stages. Skin conditions that are influenced by the environment include contact dermatitis, dry skin, and sun-related skin damage, including actinic keratosis, carcinoma, and melanoma. Many of these conditions are amenable to nonpharmacologic therapy and over-the-counter treatments, whereas others require prescription pharmacotherapy. Pharmacists are in an ideal position to advise women about the appropriate management of these conditions and to identify lesions that require additional assessment. CONCLUSION: Pharmacists can make valuable contributions to patients' self-care of the skin by recommending products, educating patients about skin health, and counseling patients about prescription medications. Gaining a greater understanding of skin conditions that are of particular concern to women can prepare pharmacists to make these contributions.

Acne Vulgaris↗
PubMed2004

The first successful separation of conjoined twins in 1689: some additions and corrections.

The surgical separation of a pair of conjoined twins in the year 1689 by Johannes Fatio was the subject of a recent article in this journal. The reference used as publication of the case was Fatio's book, Der Arzney Doctor, Helvetisch-Vernuftige Wehe-Mutter, published in 1752, although the case was presented in literature by three earlier sources. Two articles were published in the Miscellanea Curiosa sive Ephemeridum Medico-Physicarum Germanicarum Academiae Imperialis Leopoldinae Naturae Curiosorum in 1689 by Emanuel Konig and another in 1690 by Theodor Zwinger who described and illustrated the case in detail. Besides these articles, a Flug Blatt was published on the case between 1689 and 1695. Fatio copied the engraved plate in his book from Konig's engraving. These two sources should be cited as the first publications on the successful separation of Elisabet and Catherina, and not Fatio's book from 1752.

General Surgery↗
PubMed2006

[Palliative care in cancer: elements for debating the guidelines].

The aim of this study was to present elements for debating guidelines on palliative care programs for cancer. A literature survey searched various databases (MEDLINE, LILACS, and Cochrane Library), homepages of palliative care organizations, publications by renowned authors in this area, reference textbooks on the subject, relevant articles cited by these books, and the thesis/dissertation database of CAPES (the Brazilian Coordinating Body for Training University Level Personnel). The data were grouped into four thematic categories: symptomatic palliation, organization of services, psychosocial characteristics, and spiritual characteristics. The article then proceeds to discuss cancer as a public health problem and its impact on individuals, the concept of palliative care and its context in health care, program models and their guidelines, death and dying, and care and caregivers. The study concludes by discussing the challenges for the Brazilian National Health System in structuring end-of-life programs as a consequence of the population's aging and increasing cancer incidence.

Attitude of Health Personnel↗
PubMed1997

[Phenomenology as a methodologic reference: sharing the experience of women who search for the prevention of cervical cancer].

The article has the purpose to bring out the experience of having phenomenology as a methodological reference and Martin Heidegger's philosophical thinking expressed in the book entitled ¿Being and Time, used by nursing in order to understanding women who search for the prevention of cervical cancer as well as to analyse teh programs offered to women.

Existentialism↗
PubMed2004

[Cognitive-behavioral therapy in prevention of depression relapses and recurrences: a review].

OBJECTIVES: To revise theories and the available evidence about Cognitive Behavioral Therapy (CBT) role on the relapse and recurrence prevention of depressive episodes. METHODS: Review of random and controlled clinical trials that investigated CBT efficacy on the relapse and recurrence prevention of depressive episodes. The following databases were used: Medline, Lilacs, Cochrane, Biosis and Embase. The reference sections of the selected articles, review articles and specialized books were consulted. RESULTS: Fifteen studies with different experimental design were found, several with methodological problems. The majority of them compared CBT with antidepressants at the acute treatment phase. In 12 studies CBT significantly lowered the relapse/recurrence rate. Recent papers pointed to the CBT usefulness for treating residual depressive symptoms as a recurrence prevention strategy. CONCLUSION: CBT was effective for the depression relapse reduction. Its relationship with antidepressants as a prevention tool and CBT strategies (using it only in the acute phase, or during acute and maintenance phases, or after antidepressants withdrawal as a maintenance treatment, or focusing residual symptoms) need to be better investigated.

Antidepressive Agents↗
PubMed1978

A survey of parent training manuals.

Twenty-six commercially available parent training manuals were surveyed with the goal of providing helpful information to the professional for selection of manuals. Included were manuals for parents as well as manuals for professionals for use in conducting individual or group treatment. The following information was given for all manuals: the characteristics of the target populations for whom the manuals were intended, readability levels, use made of technical language, provision of glossary, organization and format of the book, availability of supplementary materials such as leaders' guides, and references to reviews by other authors. In an additional section, the research literature dealing with evaluation of these manuals was reviewed and summarized as a means of acquainting the reader with the available scientific information on their effectiveness. A report on the status of each manual in terms of evaluation was provided in tabular form. The evaluation of manuals by conduct of empirical research to determine their usefulness to the consumer was emphasized.

Journal Article↗
PubMed2005

The clinical domains of psychosomatic medicine.

BACKGROUND: The psychosomatic evidence that has consolidated over the past decades provides the ideal background for dealing with the new needs that emerge in current medical practice. METHOD: A review of the psychosomatic literature, using both MEDLINE and manual searches, was performed. Search terms were psychosomatic, psychosomatic medicine, mind-body medicine, and biopsychosocial. Medical journals and books in English were also searched manually. Articles, with particular reference to review articles, which were judged to be relevant to clinical practice, were selected. RESULTS: The following aspects were found of particular clinical interest: assessment of psychosocial factors affecting individual vulnerability (life events, chronic stress and allostatic load, well-being, and health attitudes), evaluation of psychosocial correlates of medical disease (psychiatric disturbances, psychological symptoms, illness behavior, and quality of life), application of psychological therapies to medical disease (lifestyle modification, treatment of psychiatric comorbidity, and abnormal illness behavior). CONCLUSION: A psychosomatic approach may be crucial in managing patients with unexplained somatic symptoms and in identifying psychological distress that cannot be diagnosed by psychiatric categories. Furthermore, it may contribute to recovery and rehabilitation by specific interventions.

Adaptation, Psychological↗
PubMed1977

The literature and history of internal medicine: an annotated bibliography.

This bibliography includes 58 books on the history of various medical subspecialties and general reference works useful in obtaining historical and biographical material relevant to internal medicine and related areas. In addition to a brief review of the contents of each volume, information is included on their publication and availability. It is designed to serve as an introduction to the history of internal medicine as well as a source of reference.

Bibliographies as Topic↗
PubMed1987

Alcohol abuse in the New Testament.

The New Testament is similar to the Old Testament in terms of some fundamental attitudes towards alcohol. St Paul, for example, in the spirit of the Old Testament, unequivocally condemns drunkenness but recommends the consumption of wine in moderate amounts. Nevertheless, there are significant differences in emphasis between the two documents. Wine is referred to as God's gift in six of the books from the Old Testament, and no such description is offered in the New Testament. Total abstention seems acceptable only under exceptional circumstances in the Old Testament, while it is implicitly extolled through the exemplary role of John the Baptist in the New Testament. Finally, penalties for drunkards, including loss of salvation, are proportionally more frequent and comprehensive in the New Testament.

Alcoholism↗
PubMed1986

EARS: Electronic Access to Reference Service.

Electronic Access to Reference Service (EARS) is a front end to the Health Sciences Library's electronic mail system, with links to the online public catalog. EARS, which became operational in September 1984, is accessed by users at remote sites with either a terminal or microcomputer. It is menu-driven, allowing users to request: a computerized literature search, reference information, a photocopy of a journal article, or a book. This paper traces the history of EARS and discusses its use, its impact on library staff and services, and factors that influence the diffusion of new technology.

Libraries, Medical↗