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Application of molecular biology in veterinary parasitology.

The number of applications of molecular biology in veterinary parasitology is increasing rapidly. The techniques used with eukaryotic cells are generally applicable to the study of parasites and their hosts. The polymerase chain reaction is particularly important for identification and diagnosis of parasites, as well as for many other applications. With species and type specific probes or primers, sensitivities and specificities unheard of with conventional techniques can be achieved. The accumulation of more information on the DNA sequences of parasites will reveal many more unique sequences which can be used for identification, diagnosis, molecular epidemiology, vaccine development and for studying the evolutionary biology and the physiology of parasites and the host-parasite relationship. Similarly, the completion of genome projects on host organisms will greatly assist efforts to select for hosts that are genetically resistant to parasite infection. The study of the molecular biology of antiparasitic drug receptors, potential targets for chemotherapy, and the molecular genetics of drug resistance will allow molecular screens to be used with combinatorial chemistry in the search for new antiparasitic drugs, improvements to existing chemotherapeutic families and better diagnosis and monitoring of drug resistance. While there is a proliferation of molecular biology techniques, the availability of simple kits and of automated techniques and services for sequencing, library construction and oligonucleotide synthesis and other procedures is making it easier for non-specialists to apply many of the common techniques of molecular biology. Molecular biology and the benefits from its application are relevant for veterinary parasitologists in developing countries as well as developed countries and we should introduce aspects of molecular biology to the teaching and training of veterinary parasitologists.

Animals↗

[Xenon anesthesia: from myth to reality].

OBJECTIVE: To analyze the current knowledge concerning xenon anaesthesia. DATA SOURCES: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files. STUDY SELECTION: All categories of articles on this topic have been selected. DATA EXTRACTION: Articles have been analysed for history, biophysics, pharmacology, toxicity and environmental effects and using prospect. DATA SYNTHESIS: The noble gas xenon has anaesthetic properties that have been recognized 50 years ago. Xenon is receiving renewed interest because it has many characteristics of an ideal anaesthetic. In addition to its lack of effects on cardiovascular system, xenon has a low solubility enabling faster induction of and emergence from anaesthesia than with other inhalational agents. Nevertheless, at present, the cost and arety of xenon limit its widespread use in clinical practice. The developement of closed rebreathing system that allowed recycling of xenon and therefore reducing its waste has led to a recent interest in this gas. Reducing its cost will help xenon to find its place among anaesthetic agents. An European multicentric clinical trial under submission will contribute to the discussion of the opportunity for xenon introduction in anaesthesia.

Anesthesia, Inhalation↗

[Malignant hyperthermia: new developments in diagnosis and clinical management].

OBJECTIVE: To analyse the current knowledge concerning anaesthetic malignant hyperthermia. DATA SOURCES: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files. DATA SYNTHESIS: Knowledge to possess, about the diagnosis and treatment of the acute hyperthermia crises and about "safe-anaesthesia" for malignant hyperthermia susceptible patients, are explained. The pathophysiology chapter give information about the calcium's transport and the defect existing in MH. Molecular genetics of MH find linkage to the region encoding the RyR1. The profile of hyperthermia episodes has changed over time due to the endtidal carbon dioxide-monitoring. Clinical aspects of MH are exposed. The treatment of the acute hyperthermia crises consist mainly to stop all triggering agents instantly and infuse dantrolene sodium. The gold standard for the diagnosis of malignant hyperthermia susceptibility relies on the in vitro contracture test (halothane and caffeine). Associated to genetic studies, it could lead to an non-invasive screening of the MH susceptibility. A protocol for "safe-anaesthesia" is proposed. Some syndromes with features similar to those of MH should be known (central core disease and exertionnal rhabdomyolysis).

Anesthesia↗

[Anesthesia ventilators].

OBJECTIVE: To review anaesthesia ventilators in current use in France by categories of ventilators. DATA SOURCES: References were obtained from computerized bibliographic search. (Medline), recent review articles, the library of the service and personal files. DATA SYNTHESIS: Anaesthesia ventilators can be allocated into three groups, depending on whether they readminister expired gases or not or allow both modalities. Contemporary ventilators provide either constant volume ventilation, or constant pressure ventilation, with or without a pressure plateau. Ventilators readministering expired gases after CO2 absorption, or closed circuit ventilators, are either of a double- or a single-circuit design. Double-circuit ventilators, or pneumatical bag or bellows squeezers, or bag-in-bottle or bellows-in-bottle (or box) ventilators, consist of a primary, or driving circuit (bottle or box) and a secondary or patient circuit (including a bag or a bellows or membrane chambers). Bellows-in-bottle ventilators have either standing bellows ascending at expiration, or hanging bellows, descending at expiration. Ascending bellows require a positive pressure of about 2 cmH2O throughout exhalation to allow the bellows to refill. The expired gas volume is a valuable indicator for leak and disconnection. Descending bellows generate a slight negative pressure during exhalation. In case of leak or disconnection they aspirate ambient air and cannot act therefore as an indicator for integrity of the circuit and the patient connection. Closed circuit ventilators with a single-circuit (patient circuit) include a insufflating device consisting either in a bellows or a cylinder with a piston, operated by a electric or pneumatic motor. As the hanging bellows of the double circuit ventilators, they generate a slight negative pressure during exhalation and aspirate ambient air in case of leak or disconnection. Ventilators not designed for the readministration of expired gases, or open circuit ventilators, are generally stand-alone mechanical ventilators modified to allow the administration of inhalational anaesthetic agents.

Anesthesia, Closed-Circuit↗

[Anesthesia in the HIV positive or AIDS patient].

OBJECTIVE: To analyze the current anaesthetic management of HIV/AIDS patients. DATA SOURCES: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service, personal files. STUDY SELECTION: Original articles, reviews, cases reports, letters to the editor in French and English were analyzed and selected. DATA EXTRACTION: Current data on HIV infection, perioperative clinical and biological symptoms, arguments for choice of the type of anaesthesia, risks of transmitting HIV to health care workers and protective measures were extracted. DATA SYNTHESIS: Twenty per cent of HIV-positive patients require surgery during their illness. Anaesthesia and surgery decrease cell mediated immunity and modify the activity of immune mediators. These changes are more pronounced under general anaesthesia compared to regional anaesthesia. They are transient and not clinically significant. Poor information is available concerning the perioperative management of HIV-positive patients and the effects of anesthesia on their immune status. Preoperative evaluation focuses on the following three important data: patient's status, surgery, and anaesthesia. In patients in good clinical conditions who comply with treatment, the anesthetist assesses the effects of the antiretroviral treatment and the risk of interactions between anaesthetic and antiretroviral agents. Etomidate, atracurium, cisatracurium, remifentanil and desflurane are not dependent on hepatic metabolism by the cytochrome P450 system. In patients in bad clinical conditions or in patients who do not comply with treatment, attention focuses on cardiovascular, pulmonary, neurologic and nutritional status. The specific antiretroviral treatment is not discontinued in the perioperative period, as far as compatible with the type of surgery and associated dysfunction of the digestive tract. Regional anaesthesia offers the benefits of not interfering with the immune system and antiretroviral agents. However, the viral infection can be enhanced by regional anaesthesia due to the cofactors' effect of local anaesthetic agents in cerebrospinal fluid. Homologous blood transfusion is not recommended as it increases postoperative infection and viral activation. Erythropoietin can be of benefit in selected cases. In the future, supportive immunotherapy will probably be the main tool for perioperative management of HIV and AIDS patients.

Acquired Immunodeficiency Syndrome↗

Information in primary health care.

The results of two recently completed studies, one in the Trent Region and the other in the Anglia and Oxford Region, of the information-related behaviour of general medical practitioners (GPs) and of information activities within the general practices illustrating the information seeking behaviour of GPs, their generation of information, and communication within, to and from the practice. GPs stated that there is a need for more information to enable practices to function within the changing NHS environment. The increasing emphasis on evidence-based medicine also creates the need for appropriate information sources. The Trent study resulted in guidelines for best information practice, especially the need for each practice to have an information strategy. The Anglia and Oxford Study examined the role which the library and information services could play in supporting primary health care.

Communication↗

Teaching evidence-based medicine to medical students.

Given the proliferation of published studies and clinical updates, knowing how to use the literature effectively and efficiently is a necessary skill. Many medical schools in the United States are requiring courses in evidence-based medicine (EBM) in an effort to teach medical students how to distinguish high- from low-quality studies, how to interpret results from systematic reviews, and how to recognize flaws in study design or in methodology. The Department of Public Health of the Weill Medical College of Cornell University, in collaboration with the Information Service of the Library, initiated a required EBM course in the first year of medical school. This four-week comprehensive course in the concepts and techniques of EBM focused on methods, study design and statistical analysis in assigned articles as well as on instruction in database-searching techniques. This report reviews the process of implementing such a course and factors needed to ensure the realization of its objectives.

Curriculum↗

Cost-effectiveness of complementary therapies in the United kingdom-a systematic review.

OBJECTIVES: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. DATA SOURCES: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005. REVIEW METHODS: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. RESULTS: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than pound10 000. The complementary therapy represented an additional health care cost in five of the six studies. CONCLUSIONS: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment. Estimates of the incremental cost of achieving improvements in quality of life compare favorably with other treatments approved for use in the National Health Service. Because the specific efficacy of the complementary therapies for these indications remains uncertain, and the studies did not include sham controls, the estimates obtained may represent the cost-effectiveness non-specific effects associated with the complementary therapies.

Journal Article↗

Phytophthora functional genomics database (PFGD): functional genomics of phytophthora-plant interactions.

The Phytophthora Functional Genomics Database (PFGD; http://www.pfgd.org), developed by the National Center for Genome Resources in collaboration with The Ohio State University-Ohio Agricultural Research and Development Center (OSU-OARDC), is a publicly accessible information resource for Phytophthora-plant interaction research. PFGD contains transcript, genomic, gene expression and functional assay data for Phytophthora infestans, which causes late blight of potato, and Phytophthora sojae, which affects soybeans. Automated analyses are performed on all sequence data, including consensus sequences derived from clustered and assembled expressed sequence tags. The PFGD search filter interface allows intuitive navigation of transcript and genomic data organized by library and derived queries using modifiers, annotation keywords or sequence names. BLAST services are provided for libraries built from the transcript and genomic sequences. Transcript data visualization tools include Quality Screening, Multiple Sequence Alignment and Features and Annotations viewers. A genomic browser that supports comparative analysis via novel dynamic functional annotation comparisons is also provided. PFGD is integrated with the Solanaceae Genomics Database (SolGD; http://www.solgd.org) to help provide insight into the mechanisms of infection and resistance, specifically as they relate to the genus Phytophthora pathogens and their plant hosts.

Algal Proteins↗

QuickDOC: an interlibrary loan department in a microcomputer.

Interlibrary loan (ILL) is a critical service in most libraries and one that may consume much staff time. QuickDOC, a software program written by a medical librarian, has been designed to expedite and organize the process of requesting loans, keeping records, and preparing reports on ILL activity. The software communicates with DOCLINE, the automated ILL and referral system of the National Library of Medicine (NLM), and simplifies the management of all borrowing and lending, regardless of how requests are transmitted. QuickDOC's creator is very responsive to suggestions from users and continues to enhance the capabilities of this excellent software package.

Data Display↗

EVINCE: The value of information in developing nursing knowledge and competence.

The aims of the EVINCE research project included examination of the impact of information on the clinical knowledge and practice of nurses, midwives and health visitors. EVINCE (Establishing the Value of Information to Nursing Continuing Education) was funded by the British Library R&D Department for 1 year, from 1 November 1995 to 31 October 1996. The methods employed (based on those used in the Value project) included a critical incident type study to establish patterns of information need and use among a random sample of nursing professionals. The nature of the impact of information obtained on present and future competencies was assessed from a survey of the searches and requests presented to library and information services. Nurses, midwives and health visitors did value the information (96% of respondents agreed that there was, or would be an effect on future practice through enhanced competence in one or more areas). The impact findings can be used to guide a more precise assessment of information needs.

Clinical Competence↗

Electronic reserves: copyright and permissions.

Electronic reserves present a new service option for libraries to provide needed materials during hours that the library is not open and to user groups located some distance from library collections. Possible changes to current copyright law and publishers permissions policies have delayed the development of electronic reserves in many libraries. This paper reviews the current state of electronic reserves materials in the publishing and library communities and presents the results of a survey of publishers to determine permissions policies for electronic materials. Issues of concern to both libraries and publishers are discussed.

Computer Communication Networks↗

A health/patient education database for family practice.

Using pilot project funding from the W. K. Kellogg Foundation, the American Academy of Family Physicians Foundation (AAFP/F) developed a program by which health/patient education print materials were reviewed. Favorably reviewed materials were entered into a database accessible through the AAFP/F's Huffington Library. The review service and resulting database were designed to help the busy clinician identify scientifically accurate, reliable materials for use in patient education. The review process developed for the project is described, as is the database and its use by family physicians. Research findings from the pilot project are discussed, some of which assisted in planning the self-supporting second phase of the program.

Databases, Bibliographic↗

The U.S. National Library of Medicine: a worldwide nursing resource.

The National Library of Medicine, the world's largest library of the health sciences, will celebrate this year the 150th anniversary of its founding. The Library's material and its information services may be used by nurses and other health professional and health science students throughout the world.

Abstracting and Indexing↗

The health information environment: a view of organizational and professional needs and priorities.

Inspired by Platform for Change: The Educational Policy Statement of the Medical Library Association, this paper discusses the institutional changes, new delivery modes and services, learning and development, leadership, and strategies needed for health sciences librarians to prosper in the changing medical information environment. To fulfill their potential, librarians must articulate and act upon a vision that involves them more fully in the work of faculty, researchers, and medical practitioners.

Curriculum↗

Outreach services: issues and challenges.

Tompkins-McCaw Library of Virginia Commonwealth University has planned and implemented four one-year outreach service projects during the past two years. These projects were funded by the National Library of Medicine and the National Network of Libraries of Medicine Southeastern/Atlantic Region. The projects focus on information access for public health nurses, HIV/AIDS information access, and circuit librarian services in rural Southern Virginia. This article documents issues and challenges which have been identified from these projects and suggests ways to resolve them.

Academic Medical Centers↗

The medical librarian's views.

A library should review carefully the complex implications before undertaking to be a Regional Medical Library. Eight important considerations are examined: Possible conflict of interest between local, defined clientele and larger regional clientele; Indirect costs, especially as they relate to administrative and management time; Possible abuse of unlimited cost-free copy service; Region-wide participation in planning efforts; The hazard of depressing the quality of the rank and file of local libraries; Balance between private and public support--the risk of diminished dues support for library extension services; Complexities of territory definition; and Defining the proper recipient (the "qualified individual") of regional library service. Recognition of the problems should not be interpreted as a lack of appreciation of the great opportunity which the regional program affords.

Libraries, Medical↗