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PubMed2004

Plasmapheresis treatment in Guillain-Barré syndrome: potential benefit over IVIg in patients with axonal involvement.

Response to therapeutic plasma exchange (TPE) was evaluated in patients diagnosed with Guillain-Barré Syndrome (GBS). Our aim was to assess response to TPE in patients who had failed treatment with intravenous immune globulin (IVIg). We conducted a retrospective chart review of 10 patients with the diagnosis of Guillain-Barré Syndrome who required TPE. Patients were identified by reviewing data from log books for TPE at The University of Connecticut Health Center, Farmington CT, USA. Patients who had failed IVIg treatment prior to being referred for TPE were also identified. Eight out of 10 patients treated with TPE showed improvement in their neurological exam. Four patients had axonal involvement on electromyelogram (EMG). Three patients were referred for TPE after failing IVIg treatment. All three of these had axonal involvement on EMG. Three of the four patients with axonal involvement demonstrated improvement with TPE. TPE may be a superior treatment option as compared to IVIg in patients with GBS and EMG findings of axonal involvement.

Axons↗
PubMed1996

Prospective regional study of planned home births. Home Birth Study Steering Group.

OBJECTIVE: To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners. DESIGN: Follow up study with anonymised postal questionnaires. SETTING: Northern Regional Health Authority area. SUBJECTS: The 256 women resident in the Northern region who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on all other women delivering a baby outside hospital in 1993. MAIN OUTCOME MEASURES: Rate of and reason for transferred care; maternal, midwifery, and general practitioner views; perinatal outcome. RESULTS: Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. CONCLUSIONS: Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of the midwife and general practitioner.

Attitude of Health Personnel↗
PubMed1990

[Occupational satire in Bernardino Ramazzini's 'De Morbis Artificum Diatriba'].

The classic work on occupational medicine, Ramazzini's 'De morbis artificum diatriba' (1700), is viewed from the perspective of literary history. The rhetorical term "diatribe" refers to the ancient traditions of Roman satire and Cynic moral philosophy. The literary model for Ramazzini's compendium is found in books of trade (Ständebücher) of the 16th and 17th century, in which the occupations of the time are characterized and satirized according to their individual vices. These literary traditions allow one to read Ramazzini's 'Diatriba' as a critical satire of social relations. In the course of interpreting selected chapters, it will become clear that the occupational illnesses of the working people, besides standing in a causal relationship to the moral illnesses of the privileged, are emblems and allegorical expressions of the Baroque view of life.

History, 18th Century↗
PubMed1986

Standards for academic visual science libraries. Association of Visual Science Librarians.

These standards are a revised and updated version of the Guidelines and Standards for Visual Science Libraries Serving Optometric Institutions, a paper first issued by the Association of Visual Science Librarians (AVSL) in 1976. Their purpose is to provide minimum standards as an aid to accreditation bodies and to institutions initiating library service. In this revision, the Standards and Guidelines have been separated physically so that current information can be updated more frequently and easily. The Standards are a qualitative statement about the minimum levels of staff, collections, and services that should be expected from visual science libraries; the Guidelines contain suggested lists of journals and other quantitative data subject to frequent change. The Guidelines are available separately from the AVSL.

Architecture↗
PubMed1999

Psychiatric resources: a core list for the small psychiatric hospital library.

There is a dearth of core lists for the mental health librarian and materials must be selected from several sources. This list is described as "basic," but it does provide a core collection of books, journals and Web sites which can be used by mental health librarians to build or evaluate collections. "Classics" not contained in this list should also be included in library collections as well as a comprehensive handbook, Tasman's Psychiatry, to which mental health practitioners can refer for a quick answer to a question. Most importantly, the library collection should reflect the purposes and philosophy of the medical staff and institution it supports.

Books↗
PubMed2005

First trimester maternal blood rheology and pregnancy induced hypertension.

This study evaluates the relationship between the first trimester assessment of maternal rheology and the subsequent development of pregnancy induced hypertension. This is a prospective observational study based in the Glasgow Royal Maternity Hospital, Scotland. From an original population of 744 consecutive antenatal attendees a total of 579 women were booked at less than 14 weeks' gestation. The main study group is a further subset comprising 251 primigravid women booking with a singleton pregnancy without essential hypertension. Previously published data from a group of non-pregnant women of similar age drawn from the same local community was used for external comparison. Blood samples were collected at the booking visit, from which fibrinogen, red cell aggregation, haematocrit and plasma, whole blood, relative and corrected viscosities were recorded. Information was obtained from the case notes in retrospect starting approximately 1 year after the first patients had first been recruited into the trial. The overall outcome of the pregnancies was noted with particular reference to pregnancy induced hypertension (PIH), birth weight, antepartum haemorrhage, pre-term labour, perinatal death, condition at delivery and neonatal complication. Our results show PIH is associated with a significantly raised mean blood viscosity and fibrinogen at time of booking. All significance disappears after adjustment for smoking, diastolic blood pressure and age. Viscosity is, however, only marginally non-significant (p = 0.07). In conclusion, blood rheology, in particular blood viscosity and fibrinogen, may play a predictive role in the development of pregnancy-induced hypertension. When combined with measurement of smoking and diastolic blood pressure at booking, these measurements could be used to calculate a risk score for the development of PIH, allowing targeting of antenatal care. Further data is required.

Adult↗
PubMed2006

The facial skin lesions "see and treat" clinic: A prospective study.

Facial lesions are commonly referred to ear, nose and throat surgeons. Almost all are amenable to excision under local anaesthetic as a day case. However, in the UK, there is still a significant delay between referral by the general practitioner (GP) and final surgery. To address this delay, a one stop see and treat consultant led clinic was set up in the community. The aim of this study was to assess the impact of the one stop clinic on waiting times and to ascertain the satisfaction of patients with the treatment they received in this clinic. Patients with facial skin lesions were referred by the GPs to the ENT department in the usual manner. The referral letters were screened by two consultants, the appointments were booked by telephone and the patients were seen and treated in a single visit. The clinics were held in a minor surgery unit of a centrally located GP practice. Patients were seen, assessed and if the facial lesion was considered amenable to excision under local anaesthetic, the patient was consented and the procedures carried out immediately. The clinic was audited over a 1 year period. Waiting times were compared before and after the start of the project. Patients were asked to fill in a questionnaire immediately after surgery. The attendance rate was 96%. The waiting time was reduced from 121 to 47 days. Patients rated the clinic experience as excellent (88%) or good (12%) indicating a very high satisfaction rate. During the study period, 160 lesions were excised of which 22% were malignant. Patients with malignant lesions did not show any sign of recurrence at a follow up of 9 months, except in one case with basal cell carcinoma. This was operated on and removed completely. Our project shows that the aims of reducing waiting times and improving patient care were achieved with this community model of a one stop facial lesions clinic. This clinic is now an integral part of the service provided by the ear, nose and throat department at Ipswich hospital, UK.

Ambulatory Care Facilities↗
PubMed2001

The decade 1989-1998 in Spanish psychology: an analysis of research in basic psychological processes, history of psychology, and other related topics.

This article presents a review of research published by Spanish Faculty from the area of basic psychology in the decade 1989-1998. It provides information about research on basic psychological processes commonly studied under the labels of experimental and cognitive psychology, plus a number of topics from other research areas, including some applied psychology issues. The review analyzes the work of 241 faculty members from 27 different Spanish universities, as reflected in 1,882 published papers, book chapters, and books. The analyses carried out in this report include a description of the main research trends found in each area, with some representative references of the published materials, and statistics showing the distribution of this research work in various relevant publications (both Spanish and foreign), with figures that reveal the impact of this work both at a national and international scale.

Bibliometrics↗
PubMed1976

Psychiatric treatment in jail: an experiment in health-care delivery.

The author discusses the source of referral, psychiatric diagnosis, and treatment of 539 inmates who were referred for psychiatric treatment in two metropolitan jails. Almost one-third of the patients were evaluated within 24 hours of their being booked into jail. Manifestly disordered and violent behavior accounted for 50 per cent of the referrals; almost half the patients were diagnosed as schizophrenic or manic. The author emphasizes the importance of a close working relationship with the custody staff to facilitate identifying inmates who need psychiatric treatment.

Delivery of Health Care↗
PubMed2004

Decision making and referral prior to abortion: a qualitative study of women's experiences.

BACKGROUND: Despite abortion being one of the most common gynaecological procedures performed in the UK, significant regional variation exists in access to services. OBJECTIVE: This study explores women's experience of referral for abortion in three inner London boroughs to determine if services met their expectations. METHOD: In-depth interviews conducted with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy. The data were subjected to qualitative analysis. RESULTS: Most women had made a decision to proceed with abortion before approaching the health service, and expected non-judgmental support, information and prompt referral. We found variations in the extent to which these expectations were met. Delays in referral occurred when health professionals either required women to have more thinking time, referred them elsewhere for pregnancy testing or avoided discussing abortion. This was further compounded by difficulties in making appointments via the centralised telephone booking service. The brief counselling session offered to most women by the abortion providers, although helpful to some women, was viewed as unnecessary and intrusive by others. CONCLUSIONS: Most women seeking an abortion prefer not to discuss their decision but expect information and prompt referral. Delays in referral cause distress and later abortions and should be avoided. High-quality counselling should be targeted at those in need.

Abortion, Induced↗
PubMed2004

[Breastfeeding and early childhood caries: a critical review].

OBJECTIVE: To find scientific evidence that can prove or refute the assumption that nocturnal and on demand breastfeeding are associated with caries in infants and preschool children. SOURCES OF DATA: MEDLINE, Lilacs, and SciELO articles were searched, as well as important internet sites, technical books and consensus publications of national and international organisms. The following keywords were used: "early childhood caries", "dental caries", "dental decay" and "breastfeeding". References cited in the articles selected were also included. SUMMARY OF THE FINDINGS: Studies associating caries with breastfeeding invariably observe factors associated with how this disease develops, letting aside those associated with breastfeeding. Many of these factors act as confusing variables because in the same way as they interfere in breastfeeding, they also influence the development of caries. Besides, current studies have already demonstrated the cariogenic potential of some types of aliments given to children against the non-cariogenic potential of the human milk. CONCLUSIONS: There is no scientific evidence proving that human milk can be associated with the development of caries. This is a complex relation to be established, as it is often blurred by too many variables.

Breast Feeding↗
PubMed1992

An epidemiologic study of neural tube defects: Delta County, Michigan, 1969-1988.

We determined the incidence of neural tube defects (anencephaly, spina bifida, hydrocephalus) in a rural county in the Upper Peninsula of Michigan because several local physicians perceived that the incidence in this area might be high. To assure that all neural tube defects that occurred were noted, data for the study were collected from hospital birth-log books, patient records of all neural tube defect births, all stillbirth records, and from records of babies transferred to other regional hospitals. A reference group consisting of 10% of all nonneural tube defect births during the 20 years of the study was selected at random and used to make comparisons to the case group. During the twenty-year period 1969-1988, the incidence of neural tube defects (NTDs) was found to be 2.09 per 1000 total births. The incidence of anencephaly was 1.05/1000; of spina bifida, 0.56/1000; and for hydrocephalus, 0.48/1000. Seasonal variations by month of conception were noted for anencephaly and spina bifida, confirming previous findings in the literature. Study results showed that between 1972 and 1976 there was a cluster of NTDs, but the NTD incidence was not statistically different from what might be expected over a twenty-year period. The incidence of NTDs in Delta County was found to be normal for this part of North America. The results of this study indicate that physicians should be cautious when attempting to interpret rare events, which often occur in clusters, leaving the impression that their incidence is excessive.

Adult↗
PubMed1970

The Indiana Biomedical Information Program.

In 1966, the Indiana University School of Medicine Library became part of a statewide teletype network. Biomedical personnel throughout Indiana may use the resources of the Library by requesting either specific books and articles or bibliographic searches through local public libraries which relay the requests to the School of Medicine Library. All transactions except reference questions receive twenty-four-hour service. The popularity of such a facility is indicated by the fact that 472 identified borrowers used it during the twenty-five months between its inception and December 31, 1968. Over half of the borrowers have used it repeatedly, and as many as 358 transactions have occurred in a single month. The largest group of borrowers consists of practicing physicians. It is felt that the enthusiastic response to the service justifies its continuation and expansion.

Indiana↗
PubMed1995

Pope John XXI, ophthalmologist.

Pope John XXI was an ophthalmologist before becoming Pope. He was born in Lisbon and trained at University of Paris and was part of the early medical school faculty in Siena. He became physician for Pope Gregory X and shifted to church duties. He rose quickly in the ranks of the Catholic church and was elected Pope in 1276 AD. His term was short. He died when construction in the Papal Palace at Viterbo, collapsed on him. His text book is in two parts with introductions to the eye followed by descriptions of diseases with their mostly medical treatments. He concludes with a section about his own wonderful waters. The work survived and a copy was even found amongst Michelangelo's papers. Unfortunately the book turns out to be a plagiarism of two earlier text books. His most notable achievement supposedly was discovering that glaucoma was a disease with a hard eye. It turns out that this section is referring only to a suppurative external disease with indurated lids called sclerophthalmia.

Catholicism↗
PubMed1986

Learning statistical methods.

Since at least 1951 anesthesia journals have called for a more rigorous application of statistical methods in research reports. This appeal for statistical excellence actually applies to the researcher, to the clinician journal reader, and to the editor. Thirty five years ago the obligations of these three groups was made clear in an unsigned editorial in Anesthesiology; there is now a widespread consensus on these responsibilities. The researcher must create valid science. The clinician reader must bring sufficient intellectual skills to understand a journal article; using these skills the reader must critique the research report to judge its applicability to his patients. The editor must decline manuscripts showing poor or absent application of the scientific method, experimental design, and statistical analysis. Though the editors continue to exhort further improvements, even a casual perusal of their journals demonstrates a tremendous improvement in the handling of numeric data over the last four decades. With the increasing sophistication of statistical methods in journals, the reader must continue to expand his statistical understanding. In this short review, a few highlights of statistical methods useful either in planning and accomplishing a research project or in reading a research report will be discussed; these include the planning of a study design, data collection, data analysis, and interpretation of the research. Comments about using these concepts to better understand a research article will be included. Also included will be an annotated reading list for further study and reference. Mathematical formulas have been avoided as much as possible. Actual use of statistics requires use of equations which can be found in the books of the reading list.

Biometry↗
PubMed2004

[Phantom sensations and peripheral induced neglect following implantation of total hip prosthesis].

OBJECTIVES: O. Sacks describes in his book "A leg to stand on" the inability to move his leg for along period after rupture of the tendon of m. quadriceps. He refers the history of similar cases, especially of a woman with a hip fracture. He discusses this as a result of disruption of proprioception (peripheral induced neglect). The aim of this investigation is to answer the question how frequently this symptom may be found in patients with hip fracture and/or arthrosis perioperativly after implantation of a total prosthesis. METHODS: we examined 106 patients aged 70.35 +/- 10.01 years (36-male 67.54 +/- 9.74 years and 69 female 71.9 +/- 9.9 years) who underwent an implantation of a hip prosthesis - antero-lateral access Watson-Jones - (right side n = 61, left n = 44) because of arthrosis (n = 81) or a hip fracture (n = 18) on postoperative day 1./2. and 10. - 14. Besides exact neurologic examination, we particularly asked for changed perception of the operated leg. RESULTS: by neurological examination we found only rarely signs of peripheral nerve lesion as a complication of implantation of hip prosthesis (1 femoral nerve lesion, 1 ischiadicus nerve lesion). 14 patients reported a changed perception at the first examination: 5 patients felt their operated leg shorter or longer, 4 patients described their leg changed in a strange manner (like a block of wood or lead), 2 patients felt their leg changed, but could not tell how. At follow-up examination there was no patient with a changed perception of the operated leg. CONCLUSIONS: at first examination only a small number of patients report a changed perception of the operated leg. Early mobilization of the operated leg may be the cause of quick normalization of perception. The peripherally induced neglect, described by O. Sacks, was possibly caused by decrease of cortical representation because of immobilization, but not by disrupted proprioception.

Aged↗
PubMed2001

A study of neonatal BCG immunization within an acute hospital trust.

BACKGROUND: Tuberculosis is a re-emerging problem in the United Kingdom. BCG immunization administered in the neonatal period is protective. National guidelines and locally published standards identify infants for whom BCG immunization is recommended. The study aimed to calculate the rate of identification of infants 'at risk' by parental ethnic group and/or family history of tuberculosis, to determine subsequent immunization uptake, and to describe characteristics associated with missed BCG immunization. METHODS: A retrospective audit was conducted. Demographic data were collected from a computer database of antenatal booking data, for 2043 pregnancies delivering between 1 October 1998 and 30 April 1999. A cohort of infants 'at risk' was defined, and infants referred for BCG immunization were identified. A manual search of immunization records determined immunization uptake. RESULTS: A cohort of 247 (12 per cent pregnancies) was 'at risk'. Fifty-five per cent of the cohort 'at risk' was correctly identified and 42 per cent correctly identified and immunized. The largest subgroup of the cohort, 48 per cent, was Caucasian and at risk because of a positive family history of tuberculosis. Family history of tuberculosis was the most important risk factor, and was missed in 86 per cent of cases. CONCLUSIONS: Despite the local publication of established guidelines, 58 per cent of infants 'at risk' failed to be immunized. Family history of tuberculosis was more important than parental ethnic group in predicting risk for the cohort, and was missed in the majority of cases. Appropriate guidelines alone do not guarantee good practice. Guidelines should be introduced in conjunction with regular audit to ensure effective implementation.

Attitude to Health↗
PubMed1987

Impairment, time out of school, and time off from work after burns.

Objective measurement of impairment after burns is important to patients, physicians, lawyers, and insurance companies. Even so, we could not find any references in the English literature describing how to objectively rate the physical impairment of burn survivors. The American Medical Association (AMA) has published the book Guides to Evaluation of Permanent Impairment, which is commonly used by surgeons to rate injuries. We decided to use this document to rate the impairment of burn patients. We studied patients who were treated at the University of Washington Burn Center during the years 1981, 1982, and 1983; survived the injury; were hospitalized 5 or more days or were skin grafted; and were followed until their condition was fixed (usually 12 months). This group included 325 patients. The mean age was 28.2 years and the mean total body surface area burned (TBSA) was 11.6 percent. We measured whole-man impairment (WMI) as described by the Guides to the Evaluation of Permanent Impairment. The mean whole-man impairment was 7.7 percent. In addition, we recorded time off from work and out of school after burns. The average time off from work was 12.7 weeks, and the average time out of school was 8.5 weeks. We conclude that the AMA publication can be used to rate burn patients and that the whole-man impairment of burn survivors is quite low if amputation, loss of range of motion, and nerve damage can be prevented.

Absenteeism↗