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PubMed2005

The Internet for pathologists: a simple schema for evaluating pathology-related Web sites and a catalog of sites useful for practicing pathologists.

CONTEXT: With the increasing popularity of the Internet as a primary medical information source, it is critical for pathologists to be able to use and evaluate both general medical- and pathology-related Web sites. Several published models for evaluating Web sites prove cumbersome to use and often involve computer- or statistic-based algorithms. OBJECTIVES: To develop a simple group of scoring criteria to objectively evaluate medical Web sites and provide a list of the highest-scoring pathology-related sites that will be useful to the practicing pathologist. DESIGN: Using 11 commonly used Internet search engines, the top 50 "hits" retrieved from the search term websites for pathologists were scored using 5 criteria, including accuracy, ease of navigation, relevance, updates, and completeness. A possible 6 to 12 points per area were awarded, and the total score was summated. RESULTS: Scores obtained ranged from 12 to 21. Thirty-five Web sites, all scoring 15 or higher based on these criteria, were listed as most useful. CONCLUSION: A simple, easy-to-use, 5-category scoring system can prove useful in evaluating pathology- and medical-related Web sites.

Evaluation Studies as Topic↗
PubMed2001

Chloroplast and mitochondrial proteases in Arabidopsis. A proposed nomenclature.

The identity and scope of chloroplast and mitochondrial proteases in higher plants has only started to become apparent in recent years. Biochemical and molecular studies suggested the existence of Clp, FtsH, and DegP proteases in chloroplasts, and a Lon protease in mitochondria, although currently the full extent of their role in organellar biogenesis and function remains poorly understood. Rapidly accumulating DNA sequence data, especially from Arabidopsis, has revealed that these proteolytic enzymes are found in plant cells in multiple isomeric forms. As a consequence, a systematic approach was taken to catalog all these isomers, to predict their intracellular location and putative processing sites, and to propose a standard nomenclature to avoid confusion and facilitate scientific communication. For the Clp protease most of the ClpP isomers are found in chloroplasts, whereas one is mitochondrial. Of the ATPase subunits, the one ClpD and two ClpC isomers are located in chloroplasts, whereas both ClpX isomers are present in mitochondria. Isomers of the Lon protease are predicted in both compartments, as are the different forms of FtsH protease. DegP, the least characterized protease in plant cells, has the most number of isomers and they are predicted to localize in several cell compartments. These predictions, along with the proposed nomenclature, will serve as a framework for future studies of all four families of proteases and their individual isomers.

Arabidopsis↗
PubMed1998

[Analysis of medical catalog terms using the MAOUSSC model: application to Gyncecology-Obstetrics].

BACKGROUND: The Model of Assistance and Orientation of a User within a System of Coding (MAOUSSC) used to describe activity in human medicine was used to analyse French medical nomenclature in Gynecology and Obstetrics. METHODS: French medical nomenclature for gynecology and obstetrics was translated with the multiaxial model (MAOUSSC) to allow critical analysis. RESULTS: All the 119 medical acts in the French nomenclature involving the female genital tract and obstetrics could be translated with the model. 24% of the acts were imprecise, ambiguous or implicit: the nature of the procedure was not explicit in 7 cases, the surgical route was not given in 86 and the surgical instrumentation not named in 75. Activities involving numerous medical specialties and ambulatory activity can be described with the MOUSSC model. CONCLUSION: The MAOUSSC model is still in the experimental stage. It is however easy to implement, has a high potential for describing various medical acts and is suitable for the description of gynecological and obstetrical activity both in terms of economical and medical efficacy.

Computer Simulation↗
PubMed2007

Reporting adverse events in randomized controlled trials.

PURPOSE: How randomized controlled trial results are reported may minimize concerns and detection of adverse side effects. We aimed to describe the methods of reporting adverse events in these published trials. METHODS: Five frequently cited journals were investigated: Annals of Internal Medicine, British Medical Journal, JAMA, The Lancet, and the New England Journal of Medicine. For each journal, all randomized controlled trials conducted on the use of a medication were selected from January 2000 through June 2003. All issues of each journal were reviewed manually. Information retrieved included any mention of adverse events in the abstract, methods, results, or discussion section of the article; or inclusion of adverse events data in tables or figures. We also cataloged whether there was a separate subheading in the results section for reporting adverse events. Reports of trials that referred to methods described in a previous report were excluded. RESULTS: There were 521 eligible articles. Explicit mention of adverse events was in 328 (63%) of abstracts (range 47-66%), 380 (73%) of methods (range 51-81%), 464 (89%) of results (range 80-95%), and 250 (48%) of tables (range 31-49%). There was a separate subheading for adverse events in 240 (46%) (range 22-64%) of the eligible articles. CONCLUSION: There is variation among authors and journals as to the location of reporting adverse events and the means by which it is done. Authors and editors should include specific information on adverse events when reporting the results of randomized controlled trials. It would be ideal if there was more consistency among authors and journals as to how these adverse events are described.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Status of activator methods chiropractic technique, theory, and practice.

OBJECTIVE: To provide an historical overview, description, synthesis, and critique of the Activator Adjusting Instrument (AAI) and Activator Methods Chiropractic Technique of clinical assessment. METHODS: Online resources were searched including Index to Chiropractic Literature, EBSCO Online, MANTIS, CHIROLARS, CINAHL, eJournals, Ovid, MDConsult, Lane Catalog, SU Catalog, and Pubmed. Relevant peer-reviewed studies, commentaries, and reviews were selected. Studies fell into 2 major content areas: instrument adjusting and the analysis system for therapy application. Studies were categorized by research content type: biomechanical, neurophysiological, and clinical. Each study was reviewed in terms of contribution to knowledge and critiqued with regard to quality. DISCUSSION: More than 100 studies related to the AAI and the technique were found, including studies on the instrument's mechanical effects, and a few studies on clinical efficacy. With regard to the analysis, there is evidence for good reliability on prone leg-length assessment, but to date, there is only 1 study evaluating the Activator Methods Chiropractic Technique analysis. CONCLUSION: A body of basic science and clinical research has been generated on the AAI since its first peer-reviewed publication in 1986. The Activator analysis may be a clinically useful tool, but its ultimate scientific validation requires testing using sophisticated research models in the areas of neurophysiology, biomechanics, and statistical analysis.

Clinical Trials as Topic↗
PubMed1999

Genome-wide bioinformatic and molecular analysis of introns in Saccharomyces cerevisiae.

Introns have typically been discovered in an ad hoc fashion: introns are found as a gene is characterized for other reasons. As complete eukaryotic genome sequences become available, better methods for predicting RNA processing signals in raw sequence will be necessary in order to discover genes and predict their expression. Here we present a catalog of 228 yeast introns, arrived at through a combination of bioinformatic and molecular analysis. Introns annotated in the Saccharomyces Genome Database (SGD) were evaluated, questionable introns were removed after failing a test for splicing in vivo, and known introns absent from the SGD annotation were added. A novel branchpoint sequence, AAUUAAC, was identified within an annotated intron that lacks a six-of-seven match to the highly conserved branchpoint consensus UACUAAC. Analysis of the database corroborates many conclusions about pre-mRNA substrate requirements for splicing derived from experimental studies, but indicates that splicing in yeast may not be as rigidly determined by splice-site conservation as had previously been thought. Using this database and a molecular technique that directly displays the lariat intron products of spliced transcripts (intron display), we suggest that the current set of 228 introns is still not complete, and that additional intron-containing genes remain to be discovered in yeast. The database can be accessed at http://www.cse.ucsc.edu/research/compbi o/yeast_introns.html.

Computational Biology↗
PubMedDate not supplied

Addressing the issue of cataloging and making accessible chiropractic literature: Part II. Pilot software development program.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty, and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A solution to those problems of accessing, obtaining, and storing article citations from the chiropractic literature come from a pilot computerized program developed for use on the Los Angeles College of Chiropractic (LACC) campus. The Chiropractic Literature Archive and Search Program (CLASP) is dedicated to chiropractic literature. It provides rapid access to the literature and directs the user to one of the participating chiropractic campuses where the article can be found. Because of its ease of operation, the program is a useful tool for nearly all areas of chiropractic, ranging from education and research to clinical patient management. The program would be inexpensive to fully implement, and the hardware needed is minimal. Important protocols have been developed for database input, use and maintenance. Testing of this program on the LACC campus reveals that such a program is capable of making citations of the chiropractic literature available within days of their publication.

Abstracting and Indexing↗
PubMed1999

Developing a register for randomized controlled trials in prosthodontics: results of a search from prosthodontic journals published in the United States.

STATEMENT OF PROBLEM: Treatment decisions are often made despite absence of evidence from well-conducted clinical trials. Conclusions about treatment efficacy derived from nonexperimental approaches often overestimate treatment effect. Randomized controlled trials (RCTs) provide the most reliable basis for evaluating effectiveness of treatment interventions. PURPOSE: This study attempted to identify and catalog RCTs in prosthodontic journals published in the United States as an initial step in creating a register of clinical trials that would be a resource in setting up systemic overviews of prosthodontic literature. METHODS: The International Journal of Prosthodontics, The Journal of Prosthetic Dentistry, and The Journal of Prosthodontics published between 1988 and 1997 were searched manually to identify clinical trials. Clinical trials had to meet the following criteria for inclusion in the register: the trial must involve human subjects, must include at least 2 treatment groups, and treatment group allocation must be randomized. RESULTS: A total of 3,631 articles in 196 journal issues were screened. Sixty-two articles (1.7%) met the minimum criteria for inclusion in the RCT register. CONCLUSION: Given the lack of randomized controlled trials in prosthodontic journals, a concerted effort by the organized prosthodontic community should be made to screen national and international journals and contribute to the development of a register of randomized controlled trials relevant to prosthodontics.

Dental Research↗
PubMed1998

Bioinformatics: searching the Net.

During the past 30 years, there has been an explosion in the volume of published medical information. As this volume has increased, so has the need for efficient methods for searching the data. MEDLINE, the primary medical database, is currently limited to abstracts of the medical literature. MEDLINE searches use AND/OR/NOT logical searching for keywords that have been assigned to each article and for textwords included in article abstracts. Recently, the complete text of some scientific journals, including figures and tables, has become accessible electronically. Keyword and textword searches can provide an overwhelming number of results. Search engines that use phrase searching, or searches that limit the number of words between two finds, improve the precision of search engines. The development of the Internet as a vehicle for worldwide communication, and the emergence of the World Wide Web (WWW) as a common vehicle for communication have made instantaneous access to much of the entire body of medical information an exciting possibility. There is more than one way to search the WWW for information. At the present time, two broad strategies have emerged for cataloging the WWW: directories and search engines. These allow more efficient searching of the WWW. Directories catalog WWW information by creating categories and subcategories of information and then publishing pointers to information within the category listings. Directories are analogous to yellow pages of the phone book. Search engines make no attempt to categorize information. They automatically scour the WWW looking for words and then automatically create an index of those words. When a specific search engine is used, its index is searched for a particular word. Usually, search engines are nonspecific and produce voluminous results. Use of AND/OR/NOT and "near" and "adjacent" search refinements greatly improve the results of a search. Search engines that limit their scope to specific sites, and metasearch sites that use multiple search engines optimized for specific types of searches have recently emerged. The distinctions between search engines and directory searches have blurred. Eventually, conceptual searching in which the computer searches for related ideas, without having to be given all the related keywords, may become a reality. This will free the user from having to learn specific rules about searching, allowing energies to be focused on results of the search, not the search itself.

Computational Biology↗
PubMed1998

Medication errors analysis is an opportunity to improve practice.

The United States Pharmacopeia (USP) Medication Errors Reporting (MER) Program collected and cataloged 2,213 reports between October 1991 and November 1996. Medication errors occur in all health care facilities, involve health care practitioners from all disciplines, and involve drugs from all categories, including neuromuscular blocking agents (38 out of 2,213). This class of drugs is discussed as an example of the program, and we trust will serve the reader as an educational guide about medication errors that occur with drugs in any class. When used inappropriately, they represent a higher morbidity and mortality than many other drug classes analyzed. Reports indicate various causes for the errors, such as similar-appearing products, and include suggestions by practitioners to prevent recurrence of the error. The USP Advisory Panel on Medication Errors has developed recommendations for facilities that are intended to prevent errors with neuromuscular blocking agents (NMB). The USP Medication Errors Reporting Program is presented in cooperation with the Institute for Safe Medication Practices (ISMP).

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Injuries among world-class professional beach volleyball players. The Fédération Internationale de Volleyball beach volleyball injury study.

BACKGROUND: Very little is known about the injury characteristics of beach volleyball. PURPOSE: To describe the incidence and pattern of injuries among professional male and female beach volleyball players. STUDY DESIGN: Cohort study--retrospective injury recall and prospective registration. METHODS: Injuries occurring over a 7.5-week interval of the summer season were retrospectively registered by interviewing 178 of the 188 participating players (95%) in the 2001 Beach Volleyball World Championships. Injuries were also cataloged prospectively during five of the tournaments held during this interval. RESULTS: Fifty-four acute injuries was recorded, of which 23 (43%) resulted in 1 or more days of missed practice or competition. The incidence of acute time-loss injuries was estimated to be 3.1 per 1000 competition hours and 0.8 per 1000 training hours. Knee (30%), ankle (17%), and finger injuries (17%) accounted for more than half of all acute time-loss injuries. In addition, 67 players reported 79 overuse injuries for which they received medical attention during the study period. The three most common overuse conditions were low back pain (19%), knee pain (12%), and shoulder problems (10%). Similar results were observed in the prospective portion of the study. CONCLUSIONS: The rate of acute time-loss injuries in beach volleyball is considerably lower than that in most other team sports, but overuse injuries affecting the low back, knees, and shoulder represent a significant source of disability and impaired performance for professional beach volleyball players.

Acute Disease↗
PubMed2006

Cataloging the relationships between proteins: a review of interaction databases.

By organizing and making widely accessible the increasing amounts of data from high-throughput analyses, protein interaction databases have become an integral resource for the biological community in relating sequence data with higher-order function. To provide a sense of the use and applicability of these databases, we describe each of the major comprehensive interaction databases as well as some of the more specialized ones. Content description, search/browse functionalities, and data presentation are discussed. A succinct explanation of database contents helps the user quickly identify whether the database contains applicable information to their research interest. Broad levels of search/browse functions as well as descriptions/examples allow users to quickly find and access pertinent data. At this point, clear presentation of search results as well as the primary content is necessary. Many databases display information graphically or divided into smaller digestible parts over a number of tabbed/linked pages. In addition, cross-linking between the databases promotes interconnectivity of the data and is an added layer of relational data for the user. Overall, although these protein interaction databases are under continual improvement, their current state shows that much time and effort has gone into organizing and presenting these large sets of data-describing protein interactions.

Database Management Systems↗
PubMed2004

Comparison of cytochrome P450 (CYP) genes from the mouse and human genomes, including nomenclature recommendations for genes, pseudogenes and alternative-splice variants.

OBJECTIVES: Completion of both the mouse and human genome sequences in the private and public sectors has prompted comparison between the two species at multiple levels. This review summarizes the cytochrome P450 (CYP) gene superfamily. For the first time, we have the ability to compare complete sets of CYP genes from two mammals. Use of the mouse as a model mammal, and as a surrogate for human biology, assumes reasonable similarity between the two. It is therefore of interest to catalog the genetic similarities and differences, and to clarify the limits of extrapolation from mouse to human. METHODS: Data-mining methods have been used to find all the mouse and human CYP sequences; this includes 102 putatively functional genes and 88 pseudogenes in the mouse, and 57 putatively functional genes and 58 pseudogenes in the human. Comparison is made between all these genes, especially the seven main CYP gene clusters. RESULTS AND CONCLUSIONS: The seven CYP clusters are greatly expanded in the mouse with 72 functional genes versus only 27 in the human, while many pseudogenes are present; presumably this phenomenon will be seen in many other gene superfamily clusters. Complete identification of all pseudogene sequences is likely to be clinically important, because some of these highly similar exons can interfere with PCR-based genotyping assays. A naming procedure for each of four categories of CYP pseudogenes is proposed, and we encourage various gene nomenclature committees to consider seriously the adoption and application of this pseudogene nomenclature system.

Alternative Splicing↗
PubMed1997

[Evaluation of the usefulness of vitamin/mineral preparations as dietary supplements].

The purpose of this work was to evaluate the vitamin/mineral preparations available on Polish market in 1995 in relation to their usefulness as dietary supplements. On the basic of the information in compendia, scientific papers, booklets, leaflets etc. the catalog of products containing vitamins and/or minerals was prepared. Complete data on composition, designation and other descriptors of 274 products were included. For further 28 preparations no full data were available. More than 53% of preparations were produced in Poland. Out of 274 preparations, 50% contained a single nutrient, while 20.1% contained 2-5 nutrients, 14.6%--from 6 to 10 nutrients, 13.1%--from 11 to 20 and only 2%--from 21 to 30 nutrients. Most of the products were intended for adults (165 preparations), adolescents (154 preparations) and children (132 preparations). Only 16 products were designed for pregnant and lactating women. Some of the preparations were intended for more than one population group with different dosage recommended by the producer. The amounts of nutrients in a single unit (pill, tablet etc.) of each product as well as percentage of recommended daily intake were estimated. Generally, these amounts were higher in products containing single nutrient than in multivitamin/mineral preparations. Out of 274 products included into the catalog, 132 met criteria established for dietary supplements in Poland (i.e. the amount of nutrients in supplements should not exceed 150% RDA). Among them in 25 preparations the amounts of nutrients in a unit of product were in agreement with a definition of supplements but daily doses recommended by the producers were much higher than 150% of RDA. For 33 products the amounts of nutrients in single units were very low, therefore to obtain a dose significant for dietary supplementation, one should take several units per day, usually the maximal dose recommended by producer. For 74 preparations the amounts of nutrients in single units as well as in daily doses recommended by the producer met criteria for supplements. Lack of complete and clear information on the label of vitamin/mineral preparations as well as lack of data on percentage of RDA covered by nutrients in the unit of product are the most important difficulties in choosing for dietary supplementation. The knowledge of composition of preparations containing various nutrients is necessary for nutritionist who want to assess the intake and nutritional status of some individuals as well as for their counselling work.

Adolescent↗
PubMed2003

The phase III trial in the era of targeted therapy: unraveling the "go or no go" decision.

PURPOSE: To review characteristics of contemporary phase III oncology trials and create an explicit framework to help clinical researchers prioritize novel therapies for phase III testing. METHODS: We searched the MEDLINE and EMBASE databases for all reviews of phase III trials; cataloged all phase III trials in two national clinical trial databases; and reviewed approval criteria of recently approved oncology drugs from public data provided by the US Food and Drug Administration. Industry data not available elsewhere in the medical literature were obtained from a sourcebook published by a large contract research organization. RESULTS: Phase III oncology trials are the most expensive and time-consuming aspect of the drug development process. The results of these trials continue to exert the greatest influence on the treatment decision of oncologists and remain pivotal to the granting of drug approval. Making optimal decisions about which agents to advance to phase III testing may decrease the overall cost of cancer drug development and limit the number of patients exposed to ineffective drugs. A conceptual decision model for prioritizing novel therapies for phase III testing is presented. CONCLUSION: Cancer drug development has become more complex and expensive, whereas overall clinical progress remains slow. The transition from phase II to phase III requires a strategic decision that is based on new considerations. A greater investment in phase I and II drug trials may be required to provide the information necessary for phase III planning.

Antineoplastic Agents↗
PubMed1998

Providing patients with written medication information.

OBJECTIVE: To review the literature and provide recommendations for the development and dissemination of written medication information to patients and their care providers. DATA SOURCES: A MEDLINE search (1966-1997) of the English-language literature was performed to identify articles pertaining to the development or use of written medication information. A search of the Internet was conducted by using Yahoo as the guide and "medication information" as the search term. Additional resources were obtained through texts, bibliographies, and catalogs from medical publishers. DATA EXTRACTION: Reports documenting the creation and use of written medication information systems were reviewed, as well as studies of readability and reading skills assessment. Examples of materials available for purchase by laypeople and healthcare providers were also examined. DATA SYNTHESIS: Current statistics support the widespread availability of written medication information for patients and care providers. The goal set forth by the Food and Drug Administration of having 75% of patients receive written information by the year 2000 appears achievable. However, there are still many issues to address. Content is not standardized, and materials are frequently written at reading levels higher than that of the average patient. The development and use of resources requiring only minimal reading skills and an increase in the availability of materials written in Spanish are needed. CONCLUSIONS: Written medication information provides a useful addition to counseling by healthcare professionals. A wide variety of prepared materials is available, as well as resources for those interested in developing tools for a specific patient, population, or setting. Healthcare professionals should be aware of the limitations of some resources. Content and readability must be appropriate for the intended audience for these tools to serve a useful role in patient education.

Counseling↗
PubMedDate not supplied

Expert clinical rules automate steps in delivering evidence-based care in the electronic health record.

A working framework is presented for interdisciplinary professionals for designing, building, and evaluating clinical decision support rules (expert rules) within the electronic health record. The working framework outlines the key workflow processes for eight health system organizations for selecting, designing, building, activating, and evaluating rules. In preparation, an interdisciplinary team selected expert rules for their organizations. A physician, a nurse, and/or pharmacy informatics specialists led the team for each organization. The team chose from a catalog of expert rules that were supported by regulatory or clinical evidence. The design process ensured that each expert rule followed evidence-based guidelines and was programmed to automate steps in planning and delivering patient care. Expert rules were prioritized when improving the safety and quality of care. Finally, clinical decision support rules were evaluated for abilities to improve the consistency and currency of assessments and follow-through on patient findings from these assessments. The informatics specialists from each of the health system organizations also participated in a health system oversight group to construct the key processes for this beginning framework. The group refined the processes for the selection, design, construction, activation, and evaluation of expert rules over the past 3 years. These steps offered direction to subsequent clinic and hospital organizations in a similar situation. This case study identified four key considerations when implementing and evaluating the clinical decision support expert rules within care delivery. In summary, the processes for decision support expert rules required rigorous development and change control processes to support operation.

Decision Making, Organizational↗
PubMed2001

Catalog of 46 single-nucleotide polymorphisms (SNPs) in the microsomal glutathione S-transferase 1 (MGST1) gene.

A major goal in our laboratory is to understand the role of common genetic variations among individual patients as regards susceptibility to common diseases and differences in therapeutic efficacy and/or side effects of drugs. As an addition to the high-density SNP (single-nucleotide polymorphism) maps of 12 glutathione S-transferase and related genes reported earlier, we provide here an SNP map of the microsomal glutathione S-transferase 1 (MGST1) gene. Among 48 healthy Japanese volunteers examined. we identified a total of 46 SNPs at this locus, 36 of which had not been reported before: 4 in the promoter region, 34 in introns, 3 in the 3' untranslated region, and 5 in the 3' flanking region. No SNP was found in 5'untranslated or coding regions. The ratio of transition to transversion was approximately 1.2:1. Among the 13 insertion-deletion polymorphisms was a 2-bp deletion in the coding region of MGST1 in DNA from one of the volunteers, which resulted in a frame-shift mutation. Since the gene product encoded by this mutant allele would lack the C-terminal half including the MAPEG (membrane-associated proteins in eicosanoid and glutathione metabolism) domain, MGST1 activity is likely to be reduced in the carrier's cells. The SNP map presented here adds to the archive of tools for studying complex genetic diseases, population migration patterns, and a variety of pharmacogenetic possibilities.

3' Untranslated Regions↗