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PubMed2005

Lessons without limit: how free-choice learning is transforming science and technology education.

Societies are becoming nations of lifelong learners supported by a vast infrastructure of learning organizations. The centers of this learning revolution are not schools, but a network of organizations and media (museums, libraries, television, books, and increasingly the Internet) supporting the public's ever-growing demand for free-choice learning - learning guided by a person's needs and interests. Science learning is an important part of this revolution. Traditional boundaries and roles distinguishing groups of science educators and institutions are disappearing. To not understand and embrace these changes will impede our ability to enhance science learning worldwide.

Education↗
PubMed1982

The role of the medical librarian in the use of a MeSH-indexed computerized test question bank.

The University of Missouri-Kansas City School of Medicine utilizes a full-time medical librarian in a non-conventional position as indexer-bibliographer for its computerized Item Library. The responsibilities of the librarian are to edit, index, and reference items for inclusion in the data base; maintain the currency of the Item Library; search the collection; and construct examinations, including a comprehensive quarterly examination, required of all students in this six-year school. Early research in computer-assisted test construction suggested the need for a comprehensive, standard approach to the classification of item content. A professional medical librarian using MeSH descriptors satisfies this need. In existence since 1973, the Item Library is now composed of over 12,000 multiple-choice questions in the basic sciences and clinical medicine. All questions are indexed with up to fifteen MeSH descriptors and referenced to literature sources. The items may be retrieved using any single MeSH term or combination of terms. The collection is available at all times on terminals, and students are encouraged to make use of it for self study. Selected examinations are made available to other institutions by arrangement. Experience has proven both the value of this resource for self study and student evaluation, and the necessity of establishing and continuing the librarian's role.

Abstracting and Indexing↗
PubMed2000

Vaccines for preventing malaria.

BACKGROUND: Despite continued efforts to control the disease, malaria remains a major health problem in many regions of the world, especially sub-Saharan Africa, and new ways to control or eradicate the disease are urgently needed. Two types of vaccine, SPf66 vaccine against the asexual stages, and NANP vaccines against the sporozoite stages of the Plasmodium parasite, have been tested in randomised clinical trials in endemic areas. OBJECTIVES: To assess the effects of malaria vaccines. SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles were searched. Organisations and researchers in the field were contacted. SELECTION CRITERIA: Randomised trials comparing vaccines against Plasmodium falciparum, P. vivax, P. malariae or P. ovale, and placebo. DATA COLLECTION AND ANALYSIS: Two independent reviewers assessed trial quality and conducted data extraction. MAIN RESULTS: Thirteen efficacy trials involving about 7700 people were included. There were nine trials of the Spf66 vaccine and four trials of the NANP vaccines. There was large heterogeneity between trials when investigating the effect of SPf66 in reducing incidence of the first attack of P. falciparum malaria. When trials were subcategorised by location, there was no evidence for effect of SPf66 in reducing incidence of P. falciparum in four African trials conducted in children under 5 years of age (Peto odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.81 to 1.14). In five trials outside Africa with participants aged 2 years to adult, there was a reduction in incidence by SPf66 vaccine (Peto OR = 0.77, 95% CI 0.67 to 0.88, fixed effects model). Significant heterogeneity remained between trials conducted outside Africa. Using a random effects model for these five trials, the OR was 0.74 (95% CI 0.54 to 1.01). In five trials, there was no evidence for effect of the SPf66 vaccine on the incidence of the first attack of P. vivax malaria (OR 1.01, 95% CI 0.87 to 1.17). Trials to date have not indicated any severe adverse effects of SPf66 vaccine. In three trials of NANP-based vaccines, there was no evidence for protection by these vaccines against P. falciparum malaria (OR 1.12, 95% CI 0.64 to 1.93). REVIEWER'S CONCLUSIONS: There is no evidence for protection by SPf66 vaccines against P. falciparum in Africa. There is a modest reduction in attacks of P. falciparum malaria following vaccination with SPf66 in other regions. Further research with SPf66 vaccines in South America may be justified. Trials to date have not been of sufficient size to evaluate the effect of malaria vaccines on mortality or on severe malaria requiring admission to hospital. There was not enough evidence to evaluate the use of NANP vaccines.

Adult↗
PubMed2000

Piracetam for acute ischaemic stroke.

BACKGROUND: Piracetam has neuroprotective and antithrombotic effects which may help to reduce death and disability in people with acute stroke. OBJECTIVES: The objective of this review was to assess the effects of piracetam in acute presumed ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Review Group trials register, Medline (from 1965), Embase (from 1980), BIDIS ISI (from 1981). We also contacted manufacturers and handsearched 15 journals. SELECTION CRITERIA: Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within approximately 48 hours of stroke onset. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data and assessed trial quality and this was checked by the other two reviewers. Study authors were contacted for missing information. MAIN RESULTS: Three trials involving 1002 people were included, with one trial contributing 97% of the data. Participants' ages ranged from 40 to 85, and both sexes were equally represented. Piracetam was associated with a statistically non significant increase in death (31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependency or proportion of patients dead or dependent. Adverse effects were not reported. REVIEWER'S CONCLUSIONS: There is some suggestion of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. Piracetam does not appear to reduce dependency for stroke patients.

Brain Ischemia↗
PubMed2006

Community animal health services for improving household wealth and health status of low income farmers.

BACKGROUND: Community animal health services in low-income countries aim to improve the health of animals and directly improve the wealth and health or livelihood of their owners. These services have been promoted by aid organizations since the 1970s. OBJECTIVES: To summarize reliable research of community animal health services on indicators for household wealth and health. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (July 2005), CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE (1966 to July 2002), AGRIS (1975 to July 2005), Science Citation Index (2000 to July 2005), STN SIGLE database (1976 to 2002), and AGRICOLA (19 July 2005). We contacted relevant researchers and organizations, and also checked the reference lists of articles. SELECTION CRITERIA: Randomized controlled trials and controlled before-and-after studies comparing community animal health services with no community animal health services or with an alternative animal health service. DATA COLLECTION AND ANALYSIS: We independently assessed studies for inclusion in the review. MAIN RESULTS: No studies met the inclusion criteria. AUTHORS' CONCLUSIONS: Well-designed randomized controlled trials or controlled before-and-after studies that use standard pragmatic outcomes are needed to evaluate the positive results reported by observational studies.

Animal Husbandry↗
PubMed2004

Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block.

BACKGROUND: Dual chamber pacing or single chamber atrial pacing ('physiologic' pacing) is believed to have an advantage over single chamber ventricular pacing in that it resembles cardiac physiology more closely by maintaining atrioventricular (AV) synchrony and dominance of the sinus node, which in turn may reduce cardiovascular morbidity and mortality thus contributing to patient survival and quality of life. However, a significant proportion of pacemakers currently implanted are single chamber ventricular pacemakers. OBJECTIVES: The objective of this review was to assess the short- and long-term clinical effectiveness of dual chamber pacemakers compared to single chamber ventricular pacemakers in adults with AV block, sick sinus syndrome or both. An additional objective was to assess separately any potential differences in effectiveness between dual chamber pacing and single chamber atrial pacing. The clinical effectiveness of single chamber atrial pacing versus single chamber ventricular pacing was not examined. SEARCH STRATEGY: The Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2002), MEDLINE (1966 to 2002), EMBASE (1980 to 2002) and the Science Citation Index (1980 to 2002) were searched on 19th August 2002. Citation lists and web sites were checked and researchers in the field contacted. SELECTION CRITERIA: Parallel group or crossover randomised controlled trials of at least 48 hours duration comparing dual chamber pacing and single chamber ventricular pacing, and investigating cardiovascular morbidity, mortality, patient related quality of life, exercise capacity and complication rates. DATA COLLECTION AND ANALYSIS: Data was extracted onto pre-piloted data extraction forms. Quality assessment was undertaken using a checklist, with a sub-sample of quality data independently extracted by a second reviewer. Where appropriate data was available, meta-analysis was performed. Where meta-analysis was not possible, the number of studies showing a positive, neutral or negative direction of effect and statistical significance were simply counted. MAIN RESULTS: Five parallel and 26 crossover randomised controlled trials were identified. The quality of reporting was found to be poor. Pooled data from parallel studies shows a statistically non-significant preference for physiologic pacing (primarily dual chamber pacing) for the prevention of stroke, heart failure and mortality, and a statistically significant beneficial effect regarding the prevention of atrial fibrillation (odds ratio (OR) 0.79, 95% CI 0.68 to 0.93). Both parallel and crossover studies favour dual chamber pacing with regard to pacemaker syndrome (parallel: Peto OR 0.11, 95% CI 0.08 to 0.14; crossover: standardised mean difference (SMD) -0.74, 95% CI - 0.95 to -0.52). Pooled data from crossover studies shows a statistically significant trend towards dual chamber pacing being more favourable in terms of exercise capacity (SMD -0.24, 95% CI -0.03 to -0.45). No individual studies reported a significantly more favourable outcome with single chamber ventricular pacing. REVIEWERS' CONCLUSIONS: This review shows a trend towards greater effectiveness with dual chamber pacing compared to single chamber ventricular pacing, which supports the current British Pacing and Electrophysiology Group's Guidelines regarding atrioventricular block. Additional randomised controlled trial evidence from ongoing trials in this area will further inform the debate.

Cardiac Pacing, Artificial↗
PubMed2006

D-penicillamine for primary sclerosing cholangitis.

BACKGROUND: Primary sclerosing cholangitis is a cholestatic disease. D-penicillamine is suggested as a treatment option due to its copper reducing and immunomodulatory potential. OBJECTIVES: To evaluate the beneficial and harmful effects of D-penicillamine for patients with primary sclerosing cholangitis. SEARCH STRATEGY: Eligible trials were identified through searches of The Cochrane Hepato-Biliary Group Controlled Trials Register (August 2005), The Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 3, 2005), MEDLINE (1950 to August 2005), EMBASE (1980 to August 2005), Science Citation Index EXPANDED (1945 to August 2005), and reference lists of relevant articles. Authors of trials and pharmaceutical companies known to produce D-penicillamine were also contacted. SELECTION CRITERIA: Randomised clinical trials comparing D-penicillamine in any dose, duration, and route of administration versus placebo, no intervention, or other intervention(s). Trials were included irrespective of publication status, year of publication, language, or blinding. DATA COLLECTION AND ANALYSIS: Both authors selected the trials, extracted data, and evaluated the methodological quality of the trials with respect to the generation of allocation sequence, allocation concealment, blinding, and follow-up. The results were reported by intention-to-treat analysis. The outcomes were presented as relative risk (RR) or weighted mean difference (WMD), both with 95% confidence intervals (CI). MAIN RESULTS: One randomised trial was identified and included in the review. It was of low methodological quality. The trial compared D-penicillamine versus placebo in 70 patients with primary sclerosing cholangitis. Compared with placebo, D-penicillamine therapy had no significant effect on mortality (RR 1.14, 95% CI 0.49 to 2.64), liver transplantation (RR 1.11, 95% CI 0.39 to 3.17), hepatic histologic progression (RR 1.17, 95% CI 0.79 to 1.74), or cholangiographic deterioration (RR 0.87, 95% CI 0.43 to 1.79). D-penicillamine led to a significant improvement in the serum aspartate aminotransferase (WMD -23.00 U/L; 95% CI -30.66 to -15.34), but not in serum bilirubin level (WMD 0.40 mg/L; 95% CI -0.19 to 0.99) and serum alkaline phosphatases activity (WMD 44.00 U/L; 95% CI -37.89 to 125.89). There were significantly more adverse events in patients receiving D-penicillamine (P = 0.013). AUTHORS' CONCLUSIONS: There is not sufficient evidence to support or refute the use of D-penicillamine for patients with primary sclerosing cholangitis. We do not recommend the use of D-penicillamine for patients with primary sclerosing cholangitis outside randomised trials.

Cholangitis, Sclerosing↗
PubMed2006

Bicyclol for chronic hepatitis B.

BACKGROUND: Bicyclol is a novel synthetic 'anti-hepatitis' drug, used in China for chronic hepatitis B. Until now, systematic reviews of bicyclol therapy have not been performed. OBJECTIVES: To study the benefits and harms of bicyclol for patients with chronic hepatitis B. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2005), The Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 2, 2005), MEDLINE (1950 to July 2005), EMBASE (1980 to July 2005), Science Citation Index Expanded (1945 to July 2005), The Chinese Biomedical Database (1994 to August 2005), VIP Chinese Science and Technique Journals Database (1994 to August 2005), and China National Infrastructure (CNKI)(1994 to August 2005). We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: Randomised clinical trials with bicyclol versus no intervention, placebo, or other interventions were included, irrespective of blinding, publication status, or language. DATA COLLECTION AND ANALYSIS: The primary outcome measures were mortality (total and liver-related) and liver-related morbidity (eg, cirrhosis and carcinoma). Secondary outcome measures were viral response and liver histology. MAIN RESULTS: The search identified one randomised clinical trial comparing bicyclol with bifendate (biphenyldicarboxylate) for patients with hepatitis B. The follow-up was three months. There was no evidence that bicyclol was superior to bifendate for loss of HBeAg (RR 1.38, 95% CI 0.95 to 2.00), seroconversion of HBeAg to HBeAb (RR 1.44, 95% CI 0.90 to 2.29), loss of HBV DNA (RR 1.19, 95%CI 0.93 to 1.53), or number of patients with normalised alanine aminotransferase and aspartate aminotransferase activity (RR 0.88, 95% CI 0.70 to 1.11 and RR 0.97, 95% CI 0.79 to 1.20, respectively). AUTHORS' CONCLUSIONS: Only one randomised clinical trial has examined the potential benefit of bicyclol for patients with chronic hepatitis B. This small, short-term trial found no evidence to support or refute its use. Large, randomised double-blind clinical trials with long-term follow-up are needed to examine the possible benefits and harms associated with bicyclol. Bicyclol can only be recommended for use in randomised trials.

Biphenyl Compounds↗
PubMed2006

Platform synthesis: A useful strategy for rapid and systematic generation of molecular diversity.

Emergence of library-based approaches have changed the way of developing new functional molecules in materials science and pharmaceutical science. Therefore, reliable methods for rapid and systematic generation of functional molecules are highly called for in this field. We herein describe our concept of "platform synthesis" as a useful strategy for generating molecular diversity. This simple yet powerful strategy realizes the synthesis of a number of interesting multifunctional molecules, such as multisubstituted olefins, in a programmable and diversity-oriented format. As well as applications to the synthesis of pharmaceutically important molecules, such as tamoxifen and CDP840, applications to materials science, which have led to the discovery of interesting fluorescent materials and properties, are also described.

Journal Article↗
PubMed2004

A new synthetic method for controlled polymerization using a microfluidic system.

While many parallel synthesis methods developed by the pharmaceutical and life science communities are being applied to polymer synthesis, there remains a need to construct "libraries" of polymeric materials that explore a wider range of polymer structures with accuracy, flexibility, and rapid, often small, changes. We report the use of microfluidics to create an environment for continuous controlled radical polymerization. Varying either the flow rate or the relative concentrations of reactants (i.e., stoichiometry) controls the molecular properties of the products. Molecular variables, here molecular weight, can then be varied continuously. Well-defined materials with narrow molecular weight distributions are produced inside the microfluidic reactor and are available for processing, such as further mixing, deposition, or coating on surfaces. Preliminary kinetic data appear to agree well with literature values reported for larger-scale reactions.

Journal Article↗
PubMed1998

Managed care: US research evidence and its lessons for the NHS.

OBJECTIVES: To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques; namely, financial incentives, utilisation management and review, physician profiling and disease management. METHODS: Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library. For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward. For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature; however, more current results were required (1990 forward). RESULTS: We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity). The strength of the evidence varied by dimension. It was strongest for utilisation and quality. In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. As for specific techniques, we identified 19 articles for review, but limitations of these studies prevented our drawing any definite conclusions about techniques' effectiveness. This is an important, if somewhat negative, conclusion. CONCLUSIONS: Applying US evidence is complicated by an irrelevant comparator and a higher baseline of utilisation. Managed care brought Americans the familiar NHS practices of population-based health care and resource management through gatekeeping; hence, changes due to UK adoption of managed care techniques may be modest. US evidence should be used to generate hypotheses, not to predict UK behaviour.

Disease Management↗
PubMedDate not supplied

Use of cultural themes in promoting health among Southeast Asian refugees.

PURPOSE: Vietnamese, Cambodian, and Hmong refugee populations in the United States face serious physical and psychosocial health issues. Literature on these populations is largely descriptive of illnesses and of cultural beliefs or behavior patterns related to illness. There is minimal literature linking beliefs and behaviors to the underlying cultural themes. The purpose of this paper was to search the literature for cultural themes from which culturally relevant health promotion strategies could be designed. SEARCH METHODS: Literature was reviewed from the fields of health, social, and political science, history, and Southeast Asian folklore. Search methods included review of 147 writings from library and MEDLINE search and 123 interviews with refugees and key professionals in the field. This manuscript includes 106 selections as well as content from 93 interviews. FINDINGS AND CONCLUSIONS: From the literature emerged two cultural themes common to these population, kinship solidarity and the search for equilibrium. The use of these cultural themes as carriers of health messages is suggested. Examples of ways to link the message with the cultural theme are presented, including the use of folklore, recognition of cultural illnesses, and use of cultural knowledge in addressing new situations such as inner city urban survival. Cultural themes are a means of conveying health messages addressing such issues as transition in family structure, depression, and substance abuse.

Asian↗
PubMed1990

Selected list of books and journals in allied health sciences.

This list of 453 books and 74 journals is intended as a selection guide to be used in a library supporting allied health educational programs or allied health personnel in either an academic or health care setting. Because of the impossibility of covering the large number and wide variety of allied health professions and occupations, the recommended publications are focused primarily on the twenty-six educational programs accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, plus physical therapy, dental allied health, medical secretarial, and nutrition programs. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Items suggested for initial purchase (179 books and 29 journals) are indicated by asterisks. To purchase the entire collection of books and journals (1990 subscriptions) would require an expenditure of about $21,650. The cost of only the asterisked items totals $9,250.

Allied Health Personnel↗
PubMed1988

Selected list of books and journals in allied health sciences.

This list of 435 books and 76 journals is intended as a selection guide to be used in a library supporting allied health educational programs and/or health personnel in either an academic or health care setting. Because of the impossibility pf covering the large number and wide variety of allied health professions and occupations, the recommended publications are focused primarily on the twenty-six educational programs accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, plus physical therapy, dental allied health, nutrition, and medical secretarial programs. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Items suggested for initial purchase (176 books and 29 journals) are indicated by asterisks. To purchase the entire collection of books and journals (1988 subscriptions) would require an expenditure of about $19,000. The cost of only the asterisked items totals $7,900.

Bibliographies as Topic↗
PubMed1986

Selected list of books and journals in the allied health sciences.

This list of 450 books and 69 journals is intended as a selection guide to be used in a library supporting allied health educational programs and/or allied health personnel in either an academic or health care setting. Because of the impossibility of covering the large number and wide variety of allied health professions and occupations, the recommended publications are focused mainly on the twenty-three educational programs accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, plus physical therapy, dental allied health, and medical secretarial programs. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Items suggested for initial purchase (157 books and 27 journals) are indicated by asterisks. To purchase the entire collection of books and journals (1986 subscriptions) would require an expenditure of about $16,700. The cost of only the asterisked items totals $6,700.

Bibliographies as Topic↗