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A guide to the understanding and use of tricyclic antidepressants in the overall management of fibromyalgia and other chronic pain syndromes.

The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. Data sources include MEDLINE searches in English, relevant reference books and textbooks, my personal database and library, as well as personal clinical experience. I discuss these data with regard to the pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with the use of tricyclic antidepressants. Additional information is given on drug selection and dosage titration. Much emphasis is placed on the fact that while tricyclic antidepressants play a major role in the management of fibromyalgia and other chronic pain syndromes, lifestyle alterations (eg. physical reconditioning and exercise), as well as behavior modification, are also vital to a successful outcome in management.

Amitriptyline↗

Development of an International Directory of Reference Methods and Reference Materials.

Laboratorians have a need for a resource document that includes citations for definitive methods, reference methods and materials, and related information. In preparation for the IFCC meeting on Reference Materials and Reference Measurement Systems in Laboratory Medicine held in Geneva in October 1994, a Working Group recommended that such a sourcebook be made internationally available and that it meet the criteria embodied in Working Group recommendations. It was proposed that this sourcebook be based on the Sourcebook of Reference Methods, Materials, and Related Information for the Clinical Laboratory: Proposed Guideline, NCCLS Publication NRSCL 12-P. This paper contains the Working Group recommendations, an NCCLS proposal presented in Geneva for preparation of an international sourcebook, a summary of the discussions and meeting Steering Group request from Geneva, and the NCCLS responses to the Steering Group request.

Chemistry, Clinical↗

[Quality assurance in transfusion medicine: organization of a quality assurance system exemplified by the Heidelberg University Blood Bank].

The 'Pharmabetriebsverordnung' requires a quality assurance system for the manufacturing of blood products. The quality assurance system of the university blood bank at Heidelberg is founded on the components 'quality of structure', 'quality of process' and 'quality of result'. The internal quality standard, based on national law and national/international guidelines, is specified in written form for every aspect of structure, process and result by standard operating procedures (SOPs). The SOPs are the basis for the quality system manual and the laboratory reference books. The quality assurance system integrates a programme for carrying out internal quality audits as well as a concept for updating SOPs at regular intervals.

Blood Banks↗

Vocabulary for use in measurement procedures and description of reference materials in laboratory medicine.

The preparation of written records of measurement procedures and descriptions of reference materials requires order, scientific and practical expertise, exactness, and completeness. Realizing the importance of adequate documentation in science, practice, and industrial development, the European Committee for Standardization (CEN) has drafted two European Standards on the two subjects, presenting the structure and contents of such documents. The standards, however, do not provide guidance to the proper use of quantities, units, equations, numerical values, and terminology. Laboratory workers writing procedures and descriptions of materials have various educational backgrounds, so that it may be difficult to achieve harmonization of presentation and language. The present text provides an overview of structure of such documents (with reference to the CEN standards), some principles of quantities and units, a common vocabulary (based on authoritative international standards and recommendations), 144 named and defined concepts, and an extensive bibliography.

Chemistry, Clinical↗

Obituary

Sheila Willmott, (1921-1998)CAB International and the Editor, Assistant Editor and Editorial Board of the Journal of Helminthology wish to express their deepest sympathy to the family and friends of Sheila Willmott who died on 8 May 1998 after a very short illness. Sheila served as Editor of the Journal of Helminthology from 1980 to 1986.Dr Lotfi Khalil, formerly Deputy Director of the International Institute of Parasitology at St Albans, worked closely with Sheila and has written the following tribute.John W. Lewis, EditorSheila Willmott was a leading contributor to the dissemination of parasitic information before the development of computerization and information technology. She was born on 8 June, 1921, in London, and was educated at Tollington High School for Girls, Chelsea Polytechnic and University College, London. She did her PhD at the London School of Hygiene and Tropical Medicine under the supervision of Professor John Buckley, the subject of her thesis being the study of amphistome digeneans. Her studies were interrupted as a result of the Second World War when she was 'drafted' as a Rodent Instructor at the Ministry of Agriculture, Fisheries and Food. After completing her PhD, she was appointed Assistant Lecturer in Zoology at the University College of South Wales and Monmouthshire, Cardiff. In 1951, Professor R.T. Leiper, the Director of the Bureau of Agricultural Parasitology (Helminthology) recruited her as a Scientific Information Officer. She was appointed Assistant Director of the Bureau in 1954, and Director in 1961, where she stayed until her retirement in 1980.During her period as Director of the Bureau, which was sited in the White House in the centre of St Albans, she maintained and improved the high quality of Helminthological Abstracts and, in 1976, accepted the extra burden of starting and producing Protozoological Abstracts. In 1979, she initiated and edited a primary journal, Systematic Parasitology, devoted to papers on the taxonomy and systematics of parasites, published by Junk. The activities of the Bureau were greatly expanded and she initiated the taxonomic laboratories to provide a worldwide service for the identification of animal helminths and plant-parasitic nematodes and to undertake taxonomic research. A vast helminth reference collection was started, and the Bureau became a recognized centre for the deposition of type specimens. The library of the Bureau accumulated an enormous number of reference books, journals and reprints, and provided a photocopying service supplying, at short notice, copies of papers and publications. A number of books and other publications, including the CIH Keys to the Nematode Parasites of Vertebrates, were produced and edited by her and others. She also persuaded the Natural Environment Research Council to finance the Fisheries Helminthology Unit which she established at the Bureau in 1960, where it remained until it was transferred to Plymouth as part of the Institute for Marine Environmental Research. The Bureau's name and status were changed to the Commonwealth Institute of Helminthology, Commonwealth Institute of Parasitology and, finally, the International Institute of Parasitology.As Director, she travelled extensively and visited Commonwealth and other countries, where she gave a number of seminars on information services and the work of the Institute and the Commonwealth Agricultural Bureaux (CAB) as a whole. She encouraged contact with Eastern Europe and visited Poland, Czechoslovakia, Hungary, Bulgaria and the USSR. She initiated the system of exchange publications with these countries, and this resulted in the exposure of the literature from these countries to other research workers when abstracts of these papers appeared in Helminthological Abstracts in English. Her links with Eastern Europe resulted in her editing three volumes of taxonomic monographs produced in English by Czech and Russian scientists. (ABSTRACT TRUNCATED)

Journal Article↗

Formalising and acquiring model-based hypertext in medicine: an integrative approach.

Combining a knowledge acquisition methodology with a powerful data model we present an approach to the acquisition, maintenance and browsing of scientific medical hypertext. The hypergraph-based data model supports the consistent treatment of cyclic data structures, the nesting of complex object and provides an elegant way of path declaration to represent time-dependent medical processes or large hypertext tours. It encourages a stepwise schema design and therefore supports a spiral-shaped acquisition process. We formally define view mechanisms on the basis of a rule-based query and modification language. The views enable a context-sensitive presentation of medical knowledge according to the informational needs of the physician. Our approach has been applied to the implementation of an authoring and tutoring environment for a computer-based hypermedia reference book for cerebrovascular diseases (NeuroN). During the acquisition process the expressive power and flexibility of the representational formats have been evaluated.

Artificial Intelligence↗

Comparative evaluation of drug interaction publications--1976.

The usefulness of several reference books in the retriveal and application of drug interaction information was evaluated. Each publication was evaluated as to whether it included information that would be necessary to determine if a suspected interaction was actually occurring. Twenty drug combinations which may interact were studied. In addition, the general format and features of each publication were reviewed. The American Pharmaceutical Association's Evaluations of Drug Interactions and Hansten's Drug Interactions were reviewed favorably on all points. Stockley's Drug Interactions and their Mechanisms was considered nearly as complete and certainly as authoritative. Cohen's Drug Interactions: A Handbook for Clinical Use, Gant's Drug Interaction Index: A Survey of Drug Interactions and Hartshorn's Handbook of Drug Interactions, were deemed useful as an added check if an interaction suspected clinically was not included in any of the former group.

Drug Information Services↗

Has general practitioner computing made a difference to patient care? A systematic review of published reports.

OBJECTIVE: To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN: Systematic review of world reports from 1984 to 1994. SETTING: The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. SUBJECTS: 30 papers met the inclusion criteria and were included for detailed review. INTERVENTIONS: A validated scheme for assessing methodological adequacy was used to score each paper. MAIN OUTCOME MEASURES: Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. RESULTS: Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and "medical" content of consultations increased at the expense of a reduction in patient initiated and "social" content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). CONCLUSIONS: Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations.

Ambulatory Care Information Systems↗

Patient dosimetry activities in the United States: the nationwide evaluation of X-ray trends (NEXT) and tissue dose handbooks.

In the United States the Food and Drug Administration (FDA) in collaboration with the Conference of Radiation Control Program Directors (CRCPD) and state and local government agencies surveys clinical facilities about X-ray system air kerma and ancillary data related to patient dosimetry for a variety of diagnostic X-ray examinations. The survey program is known as the Nationwide Evaluation of X-ray Trends (NEXT). The survey utilizes reference patient-equivalent phantoms in the collection of comprehensive technical information. With knowledge of the skin-entrance air kerma, specific tissue doses can be calculated. An overview of NEXT and previously published FDA tissue dose handbooks for diagnostic X-ray examinations is presented.

Child↗