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What's the basis for treating infections your way? Quality assessment of review articles on the treatment of urinary and respiratory tract infections in older people.

OBJECTIVE: To assess the quality of readily available review articles on urinary and respiratory tract infections in older people. METHODS: Data sources were articles identified by MEDLINE search (1988-1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles. RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 +/- 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one-quarter of these clinical trials actually comprised primarily an older population. CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence-based practice guidelines, are needed.

Geriatrics↗

Living in space: results from Biosphere 2's initial closure, an early testbed for closed ecological systems on Mars.

The following summary of results from the first 2-year closure experiment (September 26, 1991 to September 26, 1993) in Biosphere 2 is excerpted from a chapter written by William Dempster and myself for a book, Strategies for Mars, edited by Carol Stoker and Carter Emmart of NASA Ames Research Center. The book will be published later this year by Krieger Publishers. It brings together a number of the most striking initial results, including food production and nutrition; ecosystem changes; oxygen and carbon dioxide dynamics; and the human role and response to living in a small, recycling life support system. The references cited are useful as a guide to currently available articles in journals. Hopefully, the next year will see a proliferation of papers presenting more data from the first 2 years of Biosphere 2's operation. There was a wealth of data collected during the closure and by teams of researchers who had access to the facility during the 5-month transition period following the departure of the first crew and the commencement of the second closure experiment in March, 1994.

Agriculture↗

[The hospital perspective: disease management and integrated health care].

Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

Disease Management↗

[Research on achievement on pulsology in Yi bian (Medical bank stone) by He Mengyao].

Yi bian (Medical Bank Stone) was the representative works of He Mengyao, a doctor of the Qing dynasty. There were detailed introduction about pulse in the fifth volume, pulse feeling, including its sites, figures, movements, paused conditions, corresponding with four seasons and five organs, stomach - qi of pulse and pulse conditions referring to various diseases with examples and reasons. Not only was it written in an easy and fluent style reasonably and colorfully, but also the words were arranged clearly and beautifully.

Books↗

Management of day-surgery patients with cataract attending a peripheral ophthalmic clinic.

PURPOSE: To compare two organisational models of management for patients with cataract referred to a peripheral ophthalmic clinic who underwent day-surgery at a main eye hospital. METHOD: Patients were randomised into two groups. The experimental group (n = 25) received pre-operative assessment by a trained ophthalmic nurse at the peripheral clinic immediately following diagnosis of cataract and diary-booking for surgery. The control group (n = 24) received a separate appointment for pre-operative assessment at the main hospital. For all patients, the first review appointment (3 or 5 days post-operatively) and all subsequent review was at the peripheral clinic. Outcome measures included: visual acuity, subjective visual function (VF-14), anxiety and depression (HADS), semi-structured interviews to ascertain patient satisfaction, and a cost-benefit analysis. RESULTS: There were no significant differences at any time between the experimental and control groups with respect to visual acuity, subjective visual function or anxiety and depression. The experimental model was found to be more cost-effective and provided a less fragmented means of care delivery. The majority of patients in both groups expressed satisfaction with their care but, overall, the experimental model was preferred. CONCLUSIONS: Nurse-led pre-operative assessment of patients with cataract at a peripheral ophthalmic clinic is safe, cost-effective and is preferred by patients.

Aged↗

The second offspring of General Process Learning Theory: Overt behavior as the ambassador of the mind.

Wasserman suggested in a recent book review that the study of intervening cognitive processes represents a current focus of interest in animal learning and that this has led to a revitalization of comparative psychology. An examination of the volume reviewed suggests that he may have overstated the case. Most of the authors to whom he refers expressed dissatisfaction with traditional stimulus-response associationism but few argued for the extreme (information processing) sort of cognitive approach described by Wasserman.

Journal Article↗

Robert Graves and neurology: a bicentenary tribute.

Armand Trousseau of Paris praised The Clinical Lectures of Robert James Graves (1796-1853). The Dublin physician's book never left Trousseau's study; he valued particularly 'the lectures which treat of paralysis'. These, he said, 'contain a complete doctrine', enlarging concepts introduced by Whytt and Procháska. Gowers (1902) and Kinnier Wilson (1954) credited Graves with an early account of peripheral neuritis; more recently Lawrence C. McHenry (1969) referred to him as the first to recognise that disease processes may affect the peripheral nerves. This and other contributions of Robert Graves to neurology are discussed against the contemporary framework appropriate to the bicentenary year.

History, 19th Century↗

Improving access to computer-based library and drug information services in patient-care areas.

A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.

Computer Communication Networks↗

A poisonous plant file in TOXLINE.

A file has been added to TOXLINE on the subject of the toxicology of poisonous plants. It contains 2508 records, each of which comprises the full reference, key words, Chemical Abstracts Service Registry Number and abstract when available. A controlled vocabulary was constructed for the indexing and can be obtained from the National Technical Information Service. Searches can be made for several different data elements including authors; year; significant textwords of the title or abstract; journal or book; document type such as review or case report; geographic place at the level of continent, nation and state/province; plant species at the level of family, genus and species; plant parts involved; animal species affected including humans; type of harmful effects including major signs and lesions and chemicals.

Information Systems↗

Efficacy in treatment of subclinical cervical HPV infection without intraepithelial neoplasia: systematic review.

CONTEXT: The treatment of the subclinical Human papillomavirus (HPV) infection of the uterine cervix is controversial. OBJECTIVE: To assess the efficacy of any therapy for subclinical HPV infection of the cervix without intraepithelial neoplasia, via a search in the medical literature. METHOD: We performed a systematic review with a comprehensive reference search in Medline, LILACS, Excerpta Medica, AIDSLINE, Popline, Cochrane Library and other authors' reference lists to identify experimental studies of therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. In order to identify unpublished studies, we also contacted experts in the area, clinical trial registries, pharmaceutical industries, government and research institutions. We also searched on the Internet and in the book-of-abstracts of some medical conferences. The studies identified were masked and selected by inclusion criteria to help ascertain their internal validity. The data about regression or progression of HPV infection were extracted from the studies included. RESULTS: We identified 67 studies related to the treatment of subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. Only five clinical trials matched the inclusion criteria and none demonstrated significant differences between the experimental group and the control group concerning regression of HPV infection (with or without CIN I) or progression to higher grades of CIN. CONCLUSION: The evidence we found in the medical literature regarding the efficacy of any therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix was unsatisfactory.

Clinical Trials as Topic↗

[Concept analysis of endotracheal suctioning (ETS)].

PURPOSE: Concept analysis was performed on the behavioral concept of endotracheal suctioning (ETS), to identify the goal, to develop a standardized clinical protocol, to identify the antecedents and consequences, and to differentiate the improper use of ETS. METHOD: Walker & Avant's concept analysis was employed using clinical guidelines, books and review articles in which the procedures of ETS were written in detail and published in Pubmed within the last 20 years. RESULT: The macro-goal of ETS was to remove accumulated respiratory secretions. Three defining attributes of ETS were identified; catheter, suctioning and asepsis. Each attribute involved empirical referents, such as the size and depth of the catheter, the suction pressure, duration and method for suctioning. The antecedents of ETS were identical to the clinical evidences for the need of ETS such as the nursing assessment data. The consequences of ETS serve as an evaluation criteria on the effects of ETS based on the goal of ETS. CONCLUSION: The concept analysis of ETS demonstrates an example of considering a specific nursing protocol of ETS as a behavioral concept, applying concept analysis to it to identify it's key behavioral components as defining attributes and empirical referents and then developing and applying the standard ETS protocol.

Humans↗

[The crazy king].

The English king Georg III (1738-1820) was a dutiful sovereign, a loving family man, a good rider and sportsman, temperate in drink and food, refusing the orgies of his contemporaries. He patronized science and was a dedicated collector of book and pictures. In spite of his healthy living he four times after the age of 50 suffered from periods of illness, causing political crises. His symptoms were confusion, pains and discoloured urine. Each time he completely recovered after 3-4 months. These enigmatic fits have now been diagnosed as porphyria. Reference is given to the outstanding research by Swedish scientists regarding this disease.

Famous Persons↗

[Problems of implementing integration management at company level in small and medium-sized enterprises].

UNLABELLED: At company level responsibility increases for the employment of workers with health-related problems or disabilities, but realisation in small and medium-sized enterprises (SME) is lacking. Therefore a model is developed based on theory and a survey. SITUATION: Minimum requirements for "betriebliches Eingliederungsmanagement" (integration management at company level) according to section 84 (2) SGB IX Book 9 of the German Social Code, the main products of the international movement "disability management", a description of roles for realisation and the main sources of employers' support are described. Although external supporting of SMEs is unquestioned, it is expensive and retards own initiative and own activity counting solely on this. HYPOTHESIS: Only by developing a minimum of SME's awareness, acceptance and competence, this will open up to (currently suboptimal) external support. SURVEY: Goal is identifying SME managers' attitudes, activities, proposals and expectations referring integration management at company level to derive concepts of SME's support. 13 interviews are analysed by qualitative content analysis identifying the following barriers: information deficit, absence of priority, limited possibilities for transitional work, cost, partially limited workers' self-responsibility, illness as a "tabes" subject. Possibilities overcoming these barriers are delineated. On that basis a model is presented: pragmatically for realisation, a company contact person with minimum competence, uniform external support, institutional partners' integration and quality assurance according to disability management. OUTLOOK: Interlocking SME world and social insurance world means first to support SME's awareness, acceptance and competence, second to create for SME a central contact in the "rehabilitation jungle" and third to develop SME-suitable premiums according to section 84 (3) SGB IX, Book 9 of the German social code.

Persons with Disabilities↗

[The Spanish writer Cervantes and the painter Murillo as references of the Spanish childhood in the golden age].

Till the date all critiziens and curators of the Spanish painter Bartolomé Esteban Murillo (1617-1682) have not found papers written before relating his provocative scenes of childhood. It was said they were fantastic ideas of the painter. The author begining with the basket (or esportilla) on the Velázquez picture Old woman friyng eggs, done a careful study of the Miguel de Cervantes (1547-1616) books. In these way he found phrases written before the Murillo childhood pictures, included those with a clair sexual context.

Child↗

An evaluation of a cancer counselling service.

The CancerBACUP London Counselling Service offered short-term face-to-face counselling to self-referred cancer patients and their relatives and friends, provided by experienced supervised counsellors working within a humanistic theoretical framework. This study aimed to identify its clients' characteristics, use of the service, extent of perceived benefits and satisfaction with the service. Sociodemographic data were collected in Data Sheets from all 384 clients who booked an appointment over 18 months; they were predominantly female, < 50 years old and from non-manual social classes. Significantly more people in those classes and in the 30-59 age group attended three or more sessions. Three hundred and nine clients who attended at least once were sent an Evaluation Form; 142 responded. The probability of the Evaluation Forms' return was greater for those who had completed more sessions; the great majority of respondents felt that they had benefited, and were satisfied with the service. This study, notwithstanding its limitations, shows that a short course of counselling may be perceived by clients to be helpful; it also raises other issues of value to those involved in cancer services and/or counselling provision.

Adult↗

[The life of medical historian Miki Sakae, and the "history of Korean medicine and of diseases in Korea"].

Miki Sakae was a Medical historian, who is well known for his studies of Korean medicine. He authored the renowned trilogy which dealt with subjects of Korean medicine and diseases, namely the "History of Korean Medicine and of Diseases in Korea", "Bibliography of Korean Medical Books", and "The Chronological Table of Medical Events in Korea"), during the Japanese Occupation period. He was born in 1903 in Osaka, Japan, and graduated from the Kyushu College of Medicine. In 1928 he was assigned to the Gyeongseong Imperial University's College of Medicine as a professor, and also served as Chief of the Suweon Provincial Hospital while he was staying in Korea. During the 18-year period of his stay, he widely collected medical books of Korea and also thoroughly studied them. He returned to Japan in 1944 due to the illness of his father, but continued his studies of Korean medicine, and in 1955 published the "History of Korean Medicine and of Diseases in Korea" for the first time. Following such accomplishment, "Bibliography of Korean Medical Books" was published in 1956, the next year, and finally "The Chronological Table of Medical Events in Korea" was published a few decades later, in 1985. Since the 1950s, aside of continuing to study and author the history of Korean medicine, he had also engaged himself in a joint effort associated with the members of the Medical History Association of Japan (which also included the alumni of the Kyushu College of Medicine) in a group study of Huseya Soteki, the first Japanese Experimental Physiologist. He also attempted at establishing an academic branch which could be referred to as Experimental Historical Studies of Medicine, by recreating the experiments of Huseya Soteki with his own son. Later he also expanded his interest and studies to the medical history of the world and also the area of Medical Ethics. But his ultimate interest and passion were always targeted at the Medicine of Korea, and the one consistent position he maintained during his entire life regarding the Korean medicine, was that 'One can only talk about the medicine of China and Japan when he or she is well versed in the medicine of Korea'. And his lifetime achievement, "History of Korean Medicine and of Diseases in Korea" was authored upon the basis established by such conviction and philosophy. First, in this book the perspective of Cultural Transmission, which considers the flow of cultural qualities and assets to be ordinarily flowing from highly developed regions to less developed ones, was firmly maintained. He argued that the medicine of China had to pass through the Korean peninsula to reach Japan. Second, he suggested that studies of medicine and diseases could only be fully and thoroughly understood when it is approached not only from the perspective devised by medical historical studies but also from perspectives devised for general and total historical examination of human life events. And third, he argued that all historical studies should be based upon proofs and evidences, and the 'development' factor of a particular type of studies or practices should be measured by whether that study or practice has reached or accomplished the level of Western modern science. Demonstrating such conviction, out of Korean traditional medical practices he particularly examined the medical procedures of treating tumors or regulations and procedures developed for forensic medicine, which he considered superior to or at least at the same level with Western medicine. In his final years he was forced to battle cancer, but he refused to be hospitalized. Instead, he exhibited his firm belief that medicine and medical practices which believe in the ultimate power of human body and soul are what the practitioners should pursue in order to acquire the very core of medicine. He died in 1992, at home, surrounded by his family. He is known to have always uttered that one of the most celebrated Medical books of Korea, the "Dongeui Bogam" authored by Heo Jun, was a true example of a book containing 'Medicine Based upon Human Body and Soul'. A huge portrait of Heo Jun is reported to have been hung at the living room of his house all the time.

Historiography↗