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PubMedDate not supplied

[Percentile graphs in the documentation of acetabular angle in children with hip dysplasia. A tool in the diagnosis and quality control of its treatment].

The acetabular index (AI; Hilgenreiner 1925) has proven to be a reliable parameter for the radiological diagnosis of developmental hip dysplasia (DDH). Age-dependent normal values and ranges of the AI are well documented. These data, however, have so far not been presented graphically in a way which would have made them suitable for patient data documentation on a routine basis (calculation of percentiles, time-axis with log scale, smoothing). We have therefore created graphs meeting these requirements, based on a previous examination of the AI of 719 girls and 428 boys (Tönnis and Brunken 1968). These graphs have meanwhile proven to be a useful and time-saving tool for the diagnosis as well as quality control of the treatment in children with DDH.

Acetabulum↗
PubMed1985

[First examination of neonates. Results of early diagnostic documentation].

There is an annual statistical evaluation of documentation, done since 1971, of an early disease diagnosis programme for children. At first examination of neonates in the years 1977-1981, sex-specific difference was low as regards data on pregnancies at risk, but definite and constant differences were recorded as regards psychic and social stress during pregnancy. Pregnancies at risk without any special features at birth were registered in 12.5%. In 58.4% of newborns no special features with regard to pregnancy or birth were recorded. In contrast to all other markers, final pelvic position was more frequent for girls than boys. The proportion of operative obstetric procedures has slowly fallen from 1977 to 1981. Cesarean section has recently been practised in 12.4%. With regard to birth weight of children, the documentation revealed a difference from the Federal Statistical Office, which showed a higher number of low-birth weight new-borns. Comparing the results with those of other German or foreign statistics, there is a strikingly high frequency of cesarean section in the Federal Republic of Germany.

Cesarean Section↗
PubMed2002

Reversal of Phen-Fen associated valvular regurgitation documented by serial echocardiography.

We report a case of anorexigen-associated moderate to severe aortic and mitral regurgitation in which the regression of lesions was marked and well documented over more than 2 years. The stability of our patient, as well as the degree of regression of regurgitation documented in our patient, and others, suggests it is prudent both to observe such patients and to avoid operation until such observation has been carried out.

Appetite Depressants↗
PubMed1998

Strategic planning in hospitals in two Australian states: an exploratory study of its practice using planning documentation.

Hospitals are under pressure to respond to new challenges and competition. Many hospitals have used strategic planning to respond to these environmental changes. This exploratory study examines the extent of strategic planning in hospitals in two Australian States, New South Wales and Victoria, using a sample survey. Based on planning documentation, the study indicated that 47% of the hospitals surveyed did not have a strategic or business plan. A significant difference was found in the comprehensiveness of the plans between the two States. Plans from Victorian hospitals had more documented evidence of external/internal analysis, competitor orientation and customer orientation compared with plans from New South Wales hospitals. The paper discusses the limitations of the study and directions for future research.

Data Collection↗
PubMed2001

Lack of seroconversion in a health care worker after polymerase chain reaction-documented acute hepatitis C resulting from a needlestick injury.

We present a case of documented acute hepatitis C that occurred in a health care worker who sustained a needlestick injury while caring for an individual who was infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV). According to the findings of third-generation serological assays performed during a follow-up of >1 year, the health care worker, who was treated with interferon-alpha (during weeks 2-6) and ribavirin (during weeks 5-9), did not develop antibodies against HCV, in spite of documentation of an HCV-specific T cell response.

Adult↗
PubMed2004

First documentation of in vivo and in vitro ivermectin resistance in Sarcoptes scabiei.

Ivermectin is increasingly being used to treat scabies, especially crusted (Norwegian) scabies. However, treatment failures, recrudescence, and reinfection can occur, even after multiple doses. Ivermectin resistance has been documented for some intestinal helminths in animals with intensive ivermectin exposure. Ivermectin resistance has also been induced in arthropods in laboratory experiments but, to date, has not been documented among arthropods in nature. We report clinical and in vitro evidence of ivermectin resistance in 2 patients with multiple recurrences of crusted scabies who had previously received 30 and 58 doses of ivermectin over 4 and 4.5 years, respectively. As predicted, ivermectin resistance in scabies mites can develop after intensive ivermectin use.

Adult↗
PubMed1999

Rewriting the "points to consider": the ethical impact of guidance document language.

Human gene transfer research has been under way for nearly 10 years, with few clinically significant results to date; yet public and professional expectations still run high. Exaggerated expectations and misconceptions about gene transfer research are attributable in part to the terminology used to describe this research, which is misleading but, in the absence of more precise language, is commonly used. In particular, use of the term "gene therapy" to describe gene transfer research and use of the term "patient" in place of "subject" tend to cause both professionals and the public to confuse research with proven effective treatment. Investigators preparing to engage in human gene transfer research must use the NIH guidance document, "The Points to Consider in the Design and Submission of Protocols for the Transfer of Recombinant DNA Molecules into the Genome of One or More Human Subjects," written by the Recombinant DNA Advisory Committee, to prepare for the submission of a research protocol. Several corrections in the terminology employed by this guidance document could help to avoid misconceptions about gene transfer research and clarify both the promise and the limits of the research enterprise for investigators and subjects.

Ethics, Medical↗
PubMed1996

U.S. patent documents on the Internet: an information resource for research in alternative and complementary medicine.

The US patent literature is a valuable source of information and research data relevant to studies in alternative and complementary medicine. Many patent publications contain detailed historical reviews, case reports, clinical trials, pilot studies, and basic biological research, any of which may give scientific insights, notwithstanding the controversies surrounding the issues of some patents, such as those of products of traditional medicinal plants. Much of the scientific, efficacy, and safety data necessary to obtain a patent is unpublished elsewhere. This paper gives an account of the recent experiment to make the full text of U.S. patents documents openly and freely available on the Internet, gives an example of browsing such a document from the AIDS Patents database, and provides examples of searching on-line on the Patents Abstracts database together with a miscellany of recent abstracts relevant to alternative and complementary medicine.

Complementary Therapies↗
PubMed1995

Occurrence and documentation of low-level bacteremia in a community hospital's patient population.

To document the incidence of low-level bacteremia in the patient population of this study, two blood culture sets were collected from symptomatic patients weighing more than 80 pounds. Each blood culture set consisted of a lysis-centrifugation tube and three bottles containing different culture broths, each inoculated with 10 mL blood. Pathogens from 63 (26.4%) and 48 (20.1%) of the 239 culture-positive patients were recovered from only one and two of the eight culture devices, respectively, representing low-level bacteremia. Isolates from another 60 (25.1%) of the 239 patients were recovered from all eight of the culture devices, representing high-level bacteremia. Whether patients had low-level or high-level bacteremia, there were mostly insignificant differences in the types of species recovered, in the percentages of patients for whom therapy was initiated or changed following the laboratory's reports, and in the clinical signs, symptoms, and characteristics of the patients. Clinically documented, low-level bacteremia is relatively common in this community hospital's patient population. Culturing of up to 80 mL of blood was required for detection of all pathogens from patients weighing more than 80 pounds.

Bacteremia↗
PubMed1982

A matrix technic for comprehensive methods documentation.

This article presents an approach to total documentation of clinical laboratory methods that is practical and comprehensive. Primary reference documents including the bench method, all aspects of instrumentation, calibration, quality control, safety, results, and reporting conventions and back-up research data are entered into a matrix by section. This system has proved to be of great utility particularly in meeting regulatory demands and for the use and orientation of staff technologists.

Blood Banks↗
PubMed1991

Munchausen syndrome by proxy documented by discrepant blood typing.

The authors describe a case of Munchausen syndrome by proxy, a form of child abuse, documented by use of routine blood bank serologic procedures. While immunohematologic testing has been used in the legal arena to resolve issues of disputed paternity and to investigate instances of criminal acts, the authors believe this to be the first documented application to this clinical disorder.

ABO Blood-Group System↗
PubMedDate not supplied

Infections due to Wangiella dermatitidis in humans: report of the first documented case from the United States and a review of the literature.

Wangiella dermatitidis, a normally saprophytic dematiaceous fungus, has rarely been reported as a cause of disease in humans. A review of the worldwide literature yielded eight validly documented cases of W. dermatitidis infections. Reported herein is a subcutaneous knee infection due to W. dermatitidis in a diabetic man with impaired T-cell function and cutaneous anergy. Repeated cultures of the lesion were positive for W. dermatitidis despite therapy with amphotericin B. It is believed that this represents the first well-documented case of infection due to W. dermatitidis in North America, although the fungus has previously been isolated from nature in several states. The current state of knowledge of this organism, based on previously reported cases and isolations from nature, are discussed. No curative medical therapy is known for this infection, but surgical excision seems to be the treatment of choice for circumscribed W. dermatitidis infections.

Adolescent↗
PubMed2001

A procedure for evaluation and documentation of susceptibility test methods using the susceptibility of Klebsiella pneumoniae to ciprofloxacin as a model.

A new procedure for the evaluation and documentation of susceptibility test methods is described. To illustrate the procedure, four basically different susceptibility test methods were examined in a routine laboratory. The test parameter detection of decreased susceptibility to ciprofloxacin (breakpoint MIC 0.25 mg/L) among 94 selected isolates of Klebsiella pneumoniae was used. In addition to comparison of frequency histograms and regression analysis, the accuracies of the susceptibility test methods were determined using the receiver operating characteristic procedure. For each of the methods, the sensitivity (SN), specificity (SP), positive predictive value (PV+) and negative predictive value (PV-) for detection of decreased susceptibility to ciprofloxacin were calculated and plotted against a range of ciprofloxacin inhibition zones determined by the various susceptibility test methods or MICs determined by the Etest (Etest MICs). The results illustrate the accuracy and the robustness of the methods, which can be used to expose the need for training and instruction of laboratory staff. It becomes possible to optimize and justify the choice of inhibition zone breakpoints or Etest MIC breakpoints according to the SN and SP of the method employed. Furthermore, the consequences of adjustments of these breakpoints on the PV+ and PV- can be analysed and related to different clinical and epidemiological situations. We believe that our approach can be used as a model for the evaluation and documentation of susceptibility test methods in general.

Anti-Infective Agents↗
PubMed1997

Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented by angiography.

In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis > or = 70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis < or = 30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group 1 presented more frequently with single-vessel disease (83% vs 35%, P < 0.0001) and with more distal lesions (55% vs 23%, P < 0.0001). Over a mean follow-up period of 8.6 years, one fatal and eight non-fatal cases of myocardial infarction were observed in Group 1. The majority of patients in Group 1 were treated medically: only 24 (35%) underwent myocardial revascularization, usually by coronary angioplasty. There was no significant difference in the incidence of combined major cardiac events (cardiac death, non-fatal myocardial infarction) in patients with normal exercise scintigraphy, with or without documented coronary artery disease (Groups 1 and 3), while the incidence was higher in Group 2. However, while the mortality remained very low in Group 1, the incidence of non-fatal myocardial infarction was not different from that of Group 2, where most patients underwent revascularization procedures. In conclusion, patients with coronary artery disease and a normal exercise thallium-201 myocardial scintigram usually have mild coronary lesions (single-vessel disease, distal location) and good long-term prognosis, with a low incidence of cardiac death.

Adult↗
PubMed1997

Epicardial right atrial free wall mapping in chronic atrial fibrillation. Documentation of repetitive activation with a focal spread--a hitherto unrecognised phenomenon in man.

BACKGROUND: Previous studies have shown that atrial fibrillation of recent onset in man is based on a varying number of simultaneously present activation waves reentering either themselves or each other. In the present study, right atrial activation during chronic atrial fibrillation in man was studied. METHODS AND RESULTS: In 16 patients with chronic atrial fibrillation multiple epicardial recordings of 8 s each were made at the right atrial posterior free wall and at the appendage using a 20 x 35 mm electrode array with 56 bipolar measurement points. The preferable activation pattern of each recording and the propagation direction, cycle length and conduction velocity of individual activation waves within each recording were determined. Activation was characterized by unorganised activation with several simultaneously present activation waves: inconsistent preferable activation pattern (n = 5), predominantly organised activation with either frequent episodes of uniform activation: consistent preferable activation pattern (n = 7) or frequent episodes of activation with focal spread; focal preferable activation pattern (n = 4). Random re-entry was frequently documented in recordings with the inconsistent preferable activation pattern and less frequently in recordings with the consistent and focal preferable activation pattern. Complete re-entry circuits were rarely documented. The median fibrillation cycle length was 146, 159 (P < 0.05) and 165 ms (not significant) and the mean conduction velocity during uniform activation was 64, 67 and 83 cm. s-1 (not significant) in recordings with the inconsistent, consistent and focal preferable activation pattern, respectively. CONCLUSIONS: During chronic atrial fibrillation in man, right atrial free wall activation ranges from disorganised activation with multiple co-existing activation waves to predominantly organised activation characterized by either uniform activation consistent with the presence of large re-entry circuits or repetitive activation of unknown mechanism and focal spread.

Aged↗
PubMed1998

Study size and documentation to detect injection-related hepatitis C in prison.

We used existing data on hepatitis C prevalence, injection-related hepatitis C transmission and needle use in prisons and new data on infectiousness, to estimate the size of study required to detect injection-related hepatitis C in UK prisons. A pilot study of 500 prisoners followed for 10 weeks would have a 65% chance of detecting a hepatitis C seroconversion, conservatively assuming one injection per prisoner per week, and a 3% transmission rate per injection, but uncertainty might persist as to whether transmission had occurred during a short incarceration or before it. If the actual transmission rate was 10%, as recently documented, then such a study would have more adequate statistical power. A definitive study of 3000 prisoners for 10 weeks would expect to detect about six seroconversions, even with conservative estimates of injection frequency and transmission rate. Adequate design and power of these studies is important because of the complacency that could result from false-negative findings. We suggest six risk-factor themes that studies should document.

Adult↗
PubMed2005

A summary of important documents in the field of research ethics.

Today's researchers are obligated to conduct their studies ethically. However, it often seems a daunting task to become familiar with the important ethical codes required to do so. The purpose of this article is to examine the content of those ethical documents most relevant to the biomedical researcher. Documents examined include the Nuremberg Code, the Declaration of Helsinki, Henry Beecher's landmark paper, the Belmont Report, the U.S. Common Rule, the Guideline for Good Clinical Practice, and the National Bioethics Advisory Commission's report on research protections for the mentally ill.

Advance Directives↗
PubMed1995

A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: parasomnia with continuing danger as a noninsane automatism?

A case of childhood-onset somnambulism is reported in which a 43-year-old man presented with repeated sleep-related injuries incurred during violent nocturnal activity, which included frenzied running, throwing punches and wielding knives. He had also driven an automobile a long distance during a presumed somnambulistic state. His wife had been repeatedly injured, and she felt that her life was threatened by his nocturnal violence 2-3 times yearly. Polysomnography (PSG) documented multiple episodes of complex and violent behaviors arising exclusively from stage 3/4 sleep, thus confirming the diagnosis of somnambulism. Other causes of sleep-related violence were excluded. The patient responded promptly to treatment with bedtime clonazepam, and benefit was maintained at 5-year follow-up. Although this strictly clinical case did not have any legal repercussions, it does carry forensic implications, particularly when placed in the context of the published medical literature on PSG-documented parasomnias (somnambulism, rapid eye movement sleep behavior disorder) containing explicit examples of recurrent violence, at times life-threatening, directed toward the bed partner and others. Thus, a new medical-legal concept is proposed, consisting of "parasomnia with continuing danger" as a noninsane automatism. Treatment guidelines, within the context of forensic medicine, are presented.

Adult↗