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[Computers in a center for cardiac stimulation].

The authors describe a computer system with details of the hard ware and filing organisation. The sophistication and originality of the programme makes it a multipurpose tool base on a condensed dictionary. Its uses may be summarised under three headings: --The upkeep of medical case notes, a very successful application, resulting in improved safety in the long term follow-up of pacemaker patients. Statistical analysis of multiple parameters in larger series of patients is possible, a task which could not be carried out without a computer. --The system has the advantage of providing secretarial help in the booking of follow-up appointments, automatic print-out of follow-up reports and letters to the referring physician. This leads to better efficiency in correspondence. --The third advantage is the stocking and treatment of numeric data on a wide range of materials, leading to the creation of its own data bank. The programme as described has been adopted for cardiology and, in particular, cardiac pacing. It could, however, be applied in all fields of medicine, especially those using other materials (valvular prostheses, orthopedic appliances, etc).

Adult↗

[Evaluation of using statistical methods in selected national medical journals].

The paper covers the performed evaluation of frequency with which the statistical methods were applied in analyzed works having been published in six selected, national medical journals in the years 1988-1992. For analysis the following journals were chosen, namely: Klinika Oczna, Medycyna Pracy, Pediatria Polska, Polski Tygodnik Lekarski, Roczniki Państwowego Zakładu Higieny, Zdrowie Publiczne. Appropriate number of works up to the average in the remaining medical journals was randomly selected from respective volumes of Pol. Tyg. Lek. The studies did not include works wherein the statistical analysis was not implemented, which referred both to national and international publications. That exemption was also extended to review papers, casuistic ones, reviews of books, handbooks, monographies, reports from scientific congresses, as well as papers on historical topics. The number of works was defined in each volume. Next, analysis was performed to establish the mode of finding out a suitable sample in respective studies, differentiating two categories: random and target selections. Attention was also paid to the presence of control sample in the individual works. In the analysis attention was also focussed on the existence of sample characteristics, setting up three categories: complete, partial and lacking. In evaluating the analyzed works an effort was made to present the results of studies in tables and figures (Tab. 1, 3). Analysis was accomplished with regard to the rate of employing statistical methods in analyzed works in relevant volumes of six selected, national medical journals for the years 1988-1992, simultaneously determining the number of works, in which no statistical methods were used. Concurrently the frequency of applying the individual statistical methods was analyzed in the scrutinized works. Prominence was given to fundamental statistical methods in the field of descriptive statistics (measures of position, measures of dispersion) as well as most important methods of mathematical statistics such as parametric tests of significance, analysis of variance (in single and dual classifications). non-parametric tests of significance, correlation and regression. The works, in which use was made of either multiple correlation or multiple regression or else more complex methods of studying the relationship for two or more numbers of variables, were incorporated into the works whose statistical methods were constituted by correlation and regression as well as other methods, e.g. statistical methods being used in epidemiology (coefficients of incidence and morbidity, standardization of coefficients, survival tables) factor analysis conducted by Jacobi-Hotellng's method, taxonomic methods and others. On the basis of the performed studies it has been established that the frequency of employing statistical methods in the six selected national, medical journals in the years 1988-1992 was 61.1-66.0% of the analyzed works (Tab. 3), and they generally were almost similar to the frequency provided in English language medical journals. On a whole, no significant differences were disclosed in the frequency of applied statistical methods (Tab. 4) as well as in frequency of random tests (Tab. 3) in the analyzed works, appearing in the medical journals in respective years 1988-1992. The most frequently used statistical methods in analyzed works for 1988-1992 were the measures of position 44.2-55.6% and measures of dispersion 32.5-38.5% as well as parametric tests of significance 26.3-33.1% of the works analyzed (Tab. 4). For the purpose of increasing the frequency and reliability of the used statistical methods, the didactics should be widened in the field of biostatistics at medical studies and postgraduation training designed for physicians and scientific-didactic workers.

Case-Control Studies↗

On the circumstances of the publication of the 1855 edition of "Roshia Gyuto Zensho" (Russian Vaccination Book).

There is a report that the 1850 edition of "Roshia Gyuto Zensho" (Russian Vaccination Book) translated by Sajuro Baba and edited by Sen-an Riko is not extant and that the 1855 edition of the book is the first edition. The author found an important document entitled "Shichu-Torishimari Zokuruishu - Shoseki-no-bu" at the National Diet Library, which includes several official records describing the publication circumstances of "Roshia Gyuto-Zensho" issued in 1856. This document has scarcely been referred to by medical historians before. It reads as follows: "Ihachi Subaraya, the publisher, asked the magistrate of Edo to permit him to publish and sell two volumes of the translated vaccination book entitled "Roshia Gyuto Zensho" in 1856. The magistrate consulted the members of astronomy division of the Tokugawa Shogunate concerning its possible publication and gave finally a sanction to the publisher after careful consideration. There is a description in the records which shows that two volumes of the 1850 edition were submitted for check, indicating that the 1855 edition is the second and the 1850 edition is the first edition. Behind the situation regarding the granting of permission to the publisher by the Shougunate, there would have been the fact that Sajuro Baba, the translator of the book, was one of the founders of the division of astronomy of the Shogunate.

History, 19th Century↗

On the ability to provide evaluative comments: further explorations of children's narrative competencies.

This study investigated the changing functions of evaluative devices in children's narratives. The evaluative devices included (a) references to 'frames of mind', particularly to emotions, (b) character speech, (c) 'hedges', (d) negative qualifiers, and (e) causal connectors. Narratives were elicited from a 24-picture story book. The subjects were three groups of native English-speaking Americans (12 per group): five- and nine-year-old children and college undergraduate students. A quantitative comparison revealed that (i) adults used evaluative devices three times as often as five-year-olds, and two-and-a-half times as often as the nine-year-old children; (ii) adults used significantly more references to 'frames of mind' and 'hedges' than the children; and (iii) whereas five-year-olds used each evaluative type equally often, nine-year-olds and adults used references to 'frames of mind' significantly more than the other four evaluation types. A second analysis, focusing specifically on the discourse functions of references to 'frames of mind' revealed that, early on, this particular device is used to express a local evaluative perspective on particular events, while with increasing age it is used to signal the hierarchial organization of the story events. These findings are discussed with regard to two non-linguistic developmental achievements, the formation of event schemas and the formation of a theory of mind.

Adult↗

[The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit].

OBJECTIVES: To compare the efficacy of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain referred to a rehabilitation department. METHODS: An alternate-month design was used for 142 patients with subacute or chronic low back pain who were hospitalized for treatment. Seventy-two patients received written standardized information about back pain (the "back book") and usual physical therapy (intervention group), and 70 received usual physical therapy only along with nonstandardized oral information (control group). The main outcome measure was disability (measured on the Quebec back-pain disability scale), and secondary outcome measures were pain intensity (measured on a visual analog scale), fear-avoidance beliefs (measured on the Fear-Avoidance Beliefs Questionnaire [FABQ] Physical component), and knowledge of the relation of back pain to physical activity assessed at baseline, just before discharge from the hospital and 3 months after discharge. Satisfaction related to the information received was assessed on the day of discharge. RESULTS: Receiving the "back book" had a significant impact on disability at 3 months, from 48.40+/-14.55 to 34.57+/-18.42 in the intervention group and from 52.17+/-16.88 to 42.40+/-14.95 in the control group (p=0.03). Receipt of the book also had a significant impact on patients' knowledge and satisfaction about information but a nonsignificant effect on fear-avoidance beliefs. CONCLUSIONS: Providing an information booklet about back pain to patients with subacute and chronic low back pain referred to a rehabilitation unit contributes to reduced disability in these patients.

Adult↗

Bisphosphonates for osteoporosis in people with cystic fibrosis.

BACKGROUND: Osteoporosis is a disorder of bone mineralization that can lead to reduced bone mineral density and an increased risk for fractures. It is found in about one third of adults with cystic fibrosis. Bisphosphonates have been shown to increase bone mineral density and decrease the risk of new fractures in post-menopausal women and in patients receiving long-term oral corticosteroids. OBJECTIVES: To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, study withdrawals, and survival in people with cystic fibrosis. SEARCH STRATEGY: Relevant trials were identified in the Cochrane Cystic Fibrosis and Genetic Disorders Review Group specialised register of controlled trials by the centre co-ordinator. This register comprises references identified from comprehensive electronic database searches, handsearching of relevant journals and of conference proceedings. Additional sources such as abstract books for osteoporosis conferences were hand-searched by the authors. The most recent search(es) were conducted in February 2001. SELECTION CRITERIA: Randomised controlled trials of at least six months duration that studied the use of bisphosphonates in adults with cystic fibrosis were considered for inclusion. Outcomes included one of the following: fractures, bone mineral density, quality of life, adverse events, study withdrawals, or survival. DATA COLLECTION AND ANALYSIS: Information on study design, participants, interventions, and outcomes was abstracted from included studies. Two independent reviewers abstracted the information. Authors were contacted to obtain missing data. MAIN RESULTS: Two trials were identified in the trials search. Both trials with a total of 65 participants were included in this review. One study examined patients without lung transplants while the other study included only patients who had received a lung transplant. The intervention in both trials was pamidronate administered intravenously every three months. In patients who had not received a lung transplant, bone mineral density at axial sites was increased after six months of treatment in the treatment group compared to the control group (lumbar spine WMD [for % change BMD] = 5.8 [95% CI 4.63 to 6.97], hip WMD = 3.00 [95% CI 1.99 to 4.01]). There was a small decrease in forearm bone mineral density in patients treated with pamidronate versus controls (distal forearm WMD = -1.70 [95% CI -2.46 to -0.94]). Bone pain was the most common adverse event occurring in 11/15 participants not using corticosteroids (RR = 24.40, 95% CI 1.57 to 381.48). There was no difference in survival (RR = 1.00, 95% CI 0.83 to 1.20), although this may be due to short follow-up and small sample size. In patients who had received a lung transplant, the number of new fractures did not change with the use of pamidronate (non-vertebral RR = 3.38 [95% CI 0.39 to 29.29], vertebral RR = 0.56 [95% CI 0.17 to 1.89]). Bone mineral density at axial sites was increased after two years of treatment in the treatment group compared to the control group (lumbar spine WMD [for % change in BMD] = 6.20 [95% CI 4.28 to 8.12], femur WMD = 7.90 [95% CI 5.78 to 10.03]). REVIEWER'S CONCLUSIONS: Intravenous pamidronate increases bone mineral density at axial sites in people with cystic fibrosis, although it can cause severe bone pain in patients not receiving corticosteroids. Additional studies in larger populations are needed to determine the effect on fracture rate and survival.

Bone Density↗

Preconception care in international settings.

OBJECTIVES: This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. METHODS: Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations. RESULTS: Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and recommendations related to preconceptional health promotion exist worldwide and comprise a readily identifiable component of historic and modern initiatives pertaining to women's health, reproductive freedom, and child survival. CONCLUSIONS: The integration of preconception care services within a larger maternal and child health continuum of care is well aligned with a prevention-based approach to enhancing global health.

Child Health Services↗

Accuracy of references in four pediatric nursing journals.

Inaccurate references hinder retrieval of documents, may prevent researchers from examining all of the work by an author, and may result in authors not getting credit for their work. This study determines the number and types of errors in references in four widely read pediatric nursing journals. Of the 190 references examined, 79 of them contained an error, for an overall error rate of 41.6%. Major errors, which prevent the rapid retrieval of information, occurred in 28.9% of the references. Minor errors occurred at half the rate (13.7%) of major errors. Errors in the titles of articles, chapters, and books were the most common type of mistake followed by errors in authors' names.

Bibliographies as Topic↗

[Max Scheler and Kurt Schneider. Scientific influence and personal relationship].

Two years after Kurt Schneider had finalised his thesis qualifying him as a lecturer at Cologne University, he completed his doctorate dissertation in philosophy, also at Cologne University. His advisor was Max Scheler. Schneider published the results of his researches in a short monograph. It appears that at this time Scheler's phenomenology began to influence psychiatry. However, Kurt Schneider made only passing references to Max Scheler in this regard. Nevertheless, Scheler's influence on Schneider remained noticeable even in his most famous book "Clinical Psychopathology". Years after their academic contacts, Scheler, on several occasions, asked Schneider's advice concerning his psychically disturbed son Wolfgang. Schneider's diagnosis amounted to a case of a severely psychopathic personality. He informed Max Scheler on this and, subsequently, Wolfgang Scheler was interdicted, i.e. legally incapacitated.

Germany↗

Specific dermatoses of pregnancy: an evidence-based systematic review.

OBJECTIVE: We conducted an evidence-based systematic analysis of the literature on specific dermatoses of pregnancy. STUDY DESIGN: The bibliographic databases MEDLINE and EMBASE were screened for studies and reports in all languages about herpes gestationis, pruritic urticarial papules and plaques of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy from January 1962 to January 2002. As main index terms, including analogs and derivatives, we used the names of specific dermatoses of pregnancy. Intrahepatic cholestasis of pregnancy, not a primary dermatosis, was included herein because this disorder is associated with pregnancy and its secondary skin manifestations must be differentiated from specific dermatoses of pregnancy. Other sources were abstract books of symposia and congresses, theses, textbooks, monographs, reviews, editorials, letters to the editor, free or rapid communications, and the reference lists from all the articles that were retrieved. All articles selected for inclusion in this review were evaluated critically with regard to their impact factor and evidence-based contribution to this field, as measured by their citation index and impact factor of the journal in which they were published. Approximately 39% of articles met the selection criteria. RESULTS: The clinical features and prognosis of the specific dermatoses of pregnancy have been delineated through a number of retrospective and cohort studies. The molecular biologic and immunogenetic properties of herpes gestationis, pruritic urticarial papules and plaques of pregnancy, and intrahepatic cholestasis of pregnancy have been further clarified. A meta-analysis in this review reveals a higher prevalence of multiple gestation pregnancy (11.7%) among patients with pruritic urticarial papules and plaques of pregnancy. Several investigations have unraveled the fetal complications in intrahepatic cholestasis of pregnancy and herpes gestationis. New treatment modalities in intrahepatic cholestasis of pregnancy (cholestyramine, ursodeoxycholic acid) and herpes gestationis (cyclosporin, intravenous immunoglobulin, and tetracyclines postpartum) have shown promise and warrant further evaluation. CONCLUSION: During the past few decades, a significant amount of new data has provided new insights into the classification, pathogenesis, treatment, prognosis, and fetal risks that are associated with the specific dermatoses of pregnancy.

Cholestasis, Intrahepatic↗

Viral encephalitis: a review of diagnostic methods and guidelines for management.

Viral encephalitis is a medical emergency. The spectrum of brain involvement and the prognosis are dependent mainly on the specific pathogen and the immunological state of the host. Although specific therapy is limited to only several viral agents, correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury in survivors. We searched MEDLINE (National Library of Medicine) for relevant literature from 1966 to May 2004. Review articles and book chapters were also included. Recommendations are based on this literature based on our judgment of the relevance of the references to the subject. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. Diagnosis should be based on medical history, examination followed by analysis of cerebrospinal fluid for protein and glucose contents, cellular analysis and identification of the pathogen by polymerase chain reaction (PCR) amplification (recommendation level A) and serology (recommendation level B). Neuroimaging, preferably by magnetic resonance imaging, is an essential aspect of evaluation (recommendation level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be obtained at the shortest span of time it should be delayed only in the presence of strict contraindications. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. All encephalitis cases must be hospitalized with an access to intensive care units. Supportive therapy is an important basis of management. Specific, evidence-based, anti-viral therapy, acyclovir, is available for herpes encephalitis (recommendation level A). Acyclovir might also be effective for varicella-zoster virus encephalitis, gancyclovir and foscarnet for cytomegalovirus encephalitis and pleconaril for enterovirus encephalitis (IV class of evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective and their use is controversial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.

Central Nervous System↗

A comprehensive bibliography database using a microcomputer.

A system was implemented using a commercial database management program and a microcomputer for computerising references from journals and other sources. In addition to the citation, the user can enter the address of the institution where the study was carried out, a description of the article and of the work, key words, and an abstract. References are added, edited, searched for, displayed on screen, typed on paper, or sent to a text file, using selection criteria entered by the user. When a search is performed the printout will include the abstract of each paper, similar to that obtained from larger bibliographic services. The computer also writes requests for reprints. This program now holds over 30 000 references and has been in use for over three years. Such a system is beneficial for personal study, for writing books, articles, and theses, and for use by institutions, departments, and small libraries.

Bibliographies as Topic↗

Outcomes of universal antenatal screening for haemoglobinopathies.

OBJECTIVE: To evaluate universal antenatal screening for haemoglobinopathies. SETTING: District general hospital serving a London borough with 45% ethnic minorities. METHODS: Retrospective cohort study of 1444 women referred in 1688 pregnancies and 95 tertiary referrals during 101 pregnancies. RESULTS: Unselected women at risk for sickle cell disease booked 2.7 weeks (95% confidence interval (CI) 0.14 to 5.1) later in gestation than those at risk for beta thalassaemia were less likely to attend counselling (83% v 93%, relative risk (RR) 0.89; 95% CI 0.85 to 0.94), their partners were less likely to be tested (77% v 95%, RR 0.81; 0.77 to 0.83), and they were less likely to accept prenatal diagnosis (22% v 90%, RR 0.37; 0.24 to 0.57). Over 99% of tertiary referrals attended counselling and had their partners tested. There were no significant differences in acceptance of prenatal diagnosis between those at risk of sickle cell disease and beta thalassaemia (55% v 67%). Unselected women at risk of sickle cell disease were significantly less likely to have their partner tested or to accept prenatal diagnosis than tertiary referrals, but not those at risk of beta thalassaemia. 80% of beta thalassaemia and 16% of SS births were prevented. CONCLUSIONS: Uptake of prenatal diagnosis among unselected women at risk of beta thalassaemia is similar to that reported by tertiary centres. It is considerably lower for sickle cell disease but could increase considerably if screening occurred earlier in gestation. Acceptance of counselling is universally high, suggesting that informed choices are made, and indicating a need to measure these outcomes for cost effectiveness studies.

Abortion, Induced↗

Facial anthropometry in cleft patients: a historical appraisal.

OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.

Anthropometry↗

[Pica, a strange symptom unveiled even in "Don Quixote"].

Pica, the compulsive eating of non edible substances, is known by the medical profession for centuries. In the novel by Miguel de Cervantes "Adventures of the famous knight Don Quixote de la Mancha'', there is a history in which "women that by caprice eat soil, plaster coal and other disgusting substances'' are mentioned. This description configures the clinical diagnosis of pica. This fact has not attracted the attention of the critics of Cervantes' novel, up to now. This unequivocal reference of pica suggests that iron deficiency anemia, caused by chronic hemorrhages in adults, was frequent in 1605, when the book was first published.

Anemia, Iron-Deficiency↗

[Historical flashes on prostatic symptoms and urinary retention].

OBJECTIVES: To perform a chronological search about symptoms of bladder outlet obstruction of prostatic origin and some of its treatments. METHODS/RESULTS: Over the years we have been collecting data about the topic from books and journals; we present them in such a way that they can be consulted chronologically. From more than 100 references we have selected the 60 most relevant to our judgment. CONCLUSIONS: Many ideas about the syndrome and the way to solve it have arisen, which vary from one time to another. For most urologists, the main operative complication has always been bleeding, leading to the development of a great number of techniques to avoid it. Infection, the other great complication, prompted that initially surgical maneuvers were performed very fastly and with the small incisions. In addition, big drainages were necessary.

Equipment Design↗

The influence of Cervantes on the future creator of psychoanalysis.

Our work is intended to recreate the origins of the 'future creator of psychoanalysis'. Cervantes had a decisive influence on Freud. Don Quixote occupied a central place during a period which we consider to be crucial in the creation of psychoanalysis; we refer to the summer of 1883 during which Freud confessed to Martha that he had become more interested in this book than in brain anatomy. In this work, Cervantes delves in-depth into problems which he had set out in The Colloquy of the Dogs, read by Freud in his adolescence when he was learning Spanish and which confronted some of the great psychoanalytic themes such as reality-fantasy, language, instinct and reason, traumatic situations, 'family romance', etc. These themes appear in a psychoanalytically structured dialogue in which one of the dogs, Berganza, tells his life story (in the form of catharsis) to the other dog, Cipión, with whom Freud identified himself. Basically, it is the psychotherapeutic model that Freud used with his own hysterical patients. Another dialogue which was essential for Freud was that of Don Quixote and Sancho Panza, due to the following major reasons (as well as others): For the clear discrimination between reality and fantasy as well as their interplay. Because madness is presented as a complex phenomenon, but intelligible in terms of human motives. For the penetrating description of the transition in Don Quixote from mania to depression. Because at that moment of his life, Freud himself was living through a personal conflict between his dreams of carrying out some scientific feat and the demands of attending to his mundane necessities.

Austria↗