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Books helpful to patients with sexual and marital problems.

Providing patients with helpful and timely resource materials requires clinicians to be familiar with an ever-changing and over-whelmingly large body of information. To assist clinicians in the task of assembling current useful materials, we surveyed members of the Society for Sex Therapy and Research by mail and an electronic listserve. The survey forms requested respondents to list books, videotapes, and Internet sites that they recommended to their patients with specific sexual/marital problems. Fifty-two of 216 surveys were returned for a response rate of 24%. Responses were included if they were cited at least three times. Each citation was verified for accuracy and developed into an acceptable journal-quality reference. Frequency counts for responses were calculated, and a bibliography was developed.

Communication↗

Hereditary cancer syndrome: Part 1.--Clinical and educational issues.

PURPOSE/OBJECTIVES: To review current information on the biology and characteristics of hereditary cancer syndromes (HCS), and to identify families with HCS, various methods to communicate the diagnosis to families, and associated considerations for clinical practice and education. DATA SOURCES: Published articles and book chapters. DATA SYNTHESIS: HCS, which accounts for approximately 5%-10% of all malignancies, is characterized by diagnosis of the same malignancy in multiple family members, an earlier age of onset than expected, an increased frequency of bilateral cancers in paired organs, and the presence of premalignant syndromes. CONCLUSIONS: Identifying families with HCS and referring them to screening programs are necessary to reduce morbidity and mortality in these families. Many clinical, educational, and research issues are emerging. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be aware of HCS in order to identify families with HCS and refer them to screening programs. Information about HCS needs to be incorporated into basic, graduate, and continuing education nursing programs to increase awareness of HCS. Further nursing research is needed to better understand the best way to communicate the diagnosis to families, identify the psychosocial needs of individuals from these families, and facilitate cancer prevention and detection measures in these families.

Disease Susceptibility↗

The contributions of the Second Auxiliary Surgical Group to military surgery during World War II with special reference to thoracic surgery.

The outstanding scientific and surgical accomplishments of the Second Auxiliary Surgical Group in the Mediterranean Theater of Operations and the 7th Army in World War II were not exceeded by any other group in the United States Army Medical Corps. In the final 921-page report to the Surgeon General with 550 tables, 8801 severely wounded casualties out of a total of 22,000 treated were reviewed. In addition, the major portion of three books on war surgery and over 60 scientific articles were written by this group. The contributions in thoracic surgery that focused attention on physiologic principles and limited the indications for thoracotomy have stood the test of time. The author made the original description of the reaction of the lung to severe trauma of the brain, abdomen, and extremities by the development of "the wet lung of trauma" (RDS), while his introduction of a hand-operated, intermittent positive pressure oxygen respirator to treat the advanced form of this syndrome (pulmonary edema) ushered in a new form of treatment. Long-term, follow-up studies by the author confirm the validity of the physiologic approach to the treatment of thoracic trauma.

Europe↗

Anastomosis of Riolan revisited: the meandering mesenteric artery.

The eponym anastomosis of Riolan suggests that Jean Riolan (1580-1657), a famous 17th century French anatomist, was the first to describe this mesenteric arterial connection between the superior and inferior mesenteric arteries. Riolan was a strong defender of traditional Galenic doctrine in medicine and proved a vigorous opponent of the new concept of the circulation of blood as exposed by William Harvey (1578-1657). As confirmed by examining his anatomy book published in 1649, it is unlikely that Riolan would have conceived an arterial collateral pathway in the mesocolon. He probably had observed vascular arcades running along the inner border of the colon. It was not until 1743 that Albrecht von Haller (1708-1777) gave a detailed description of the anatomy of the mesenteric arteries, referring to the arterial collateral connection between the superior and inferior mesenteric arteries as the Arcus Riolani in honor of an old master of anatomy.

Collateral Circulation↗

Evolution of the management of depression in Spain from the psychiatrist's perspective. A comparative analysis: 1997 vs 1982.

The main problem of depression is not only the high prevalence of the disorder but also its serious consequences on the patient's quality of life and the associated social costs in terms of health care resource utilization and productivity losses. In recent years, there has been a considerable improvement in the knowledge of depression from the pathogenic, clinical and therapeutic perspectives. The present study analyzes whether such advances are reflected in a positive evolution of the treatment of depression in Spain. To this effect we have contrasted the results of two socio-sanitary studies published in this country: the White Book editions of 1982 and 1997 (WB82 and WB97, respectively). From the methodological perspective, the physician selection criteria employed were very uniform (structured questionnaires delivered to 128 (WB82) and 300 (WB97) randomly selected psychiatrists). The origin of patients consulting for specialized care has varied over this 15-year period. In effect, WB82 patients were essentially referred by friends (87.5%) and from the primary care setting (44.5%), whereas in the WB97 study referral from primary care predominated (50.1%), followed by the patient's personal decision (24.8%). In turn, 40.7% and 51.7% of the psychiatrists in WB97 respectively considered the diagnostic and therapeutic means available in primary care to be insufficient. The priorities for improving patient quality of life, as reflected by both editions of the study, were the training of primary care physicians and the adequate provision of means in the mental health care centers. On the other hand, fewer problems for establishing a correct diagnosis were referred in the 1997 edition of the study (28.7%) than in 1982 (48.4%). In this sense, the main problem reported in WB82 was the lack of specialized training, whereas the masking of depression by some other disease process or symptoms was the main problem in WB97 (67.6% vs 21.1% according to WB82). The main symptoms upon which the diagnosis of depression are based do not seem to have evolved much in the past 15 years. The most frequently cited manifestations were a worsening of mood, loss of interest and leisure capacity, sleep alterations and diminished vitality. A comparative analysis of the therapeutic resources used was not possible, for prior to 1982 the only drugs available to physicians were the classical tricyclic agents and some MAO inhibitors; the selective serotonin reuptake inhibitors (SSRIs) - possibly the greatest advance in the treatment of depression in these 15 years - had not yet been introduced. Nevertheless, it should be pointed out that 98% of the psychiatrists consulted in WB97 considered pharmacologic treatment to be the most widely adopted form of management once depression has been diagnosed.

Antidepressive Agents↗

The orifice revisited: women in gynaecological texts.

A content analysis was carried out on obstetric and gynaecological textbooks recommended for medical students at four Australian universities. The texts were read for a hidden curriculum of sexist ideology. This study is a partial replication of a study carried out by Scully and Bart in the United States eighteen years ago. The findings of Scully and Bart demonstrated that obstetric and gynaecological texts contained outdated and erroneous views about women's sexuality and portrayed women in stereotyped roles. It was anticipated that institutionalized changes may have occurred since the time that Scully and Bart carried out their research and the texts would reflect this accordingly; particularly with the effect of the women's health movement which has been expressing dissatisfaction with the health care system. The findings of this research show that sexist ideology still pervades the obstetric and gynaecological texts, though to a lesser extent than eighteen years ago. There are some differences from what Scully and Bart discovered, but major similarities were found. The main difference between the results of this study and the findings of Scully and Bart, is that the majority of texts analysed here did not contain outdated and incorrect information about women's sexual response. For example, none of the texts refer to vaginal orgasm as the 'mature' response for women. The main similarity is that women's sexuality is still depicted with a heterosexual perspective, with marriage and mothering the 'natural' aspirations of all women.

Books↗

Cytogenetics in acute myeloid leukaemia.

A wealth of literature spanning 20 years describing cytogenetic abnormalities in acute myeloid leukaemia (AML) already exists. It ranges from single case reports of unusual abnormalities to large multicentre studies of hundreds of cases. A landmark publication was the Fourth International Workshop on Chromosomes in Acute Leukaemia which established a base line for diagnosis, prognosis and frequency of chromosome abnormalities in AML. Two large sources of information are a book, 'The Chromosomes in Human Cancer and Leukemia' and a catalogue of chromosome abnormalities, which aims to list all chromosome abnormalities described in the scientific and medical literature from 1973, when the widespread use of banding techniques, enabled the precise definition of the chromosome breakpoints. In this review the common cytogenetic abnormalities seen in AML with reference to associations with the French-American-British (FAB) classification, their possible prognostic significance and their associated molecular biology are summarized.

Acute Disease↗

Self reported alcohol intake in pregnancy: comparison between four methods.

STUDY OBJECTIVE: To assess the agreement between four different measures of alcohol intake in pregnancy. DESIGN AND SETTING: Danish speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were contacted at their first visit at approximately 15-16 weeks gestation from October to December 1998. The women were interviewed about current average alcohol intake and intake within the previous week, and subsequently filled in a two week diary on alcohol intake. When booking for delivery at the end of the first trimester the women were also asked to complete a questionnaire including a one item question on current average alcohol intake. PARTICIPANTS: Participants were 441 pregnant women. MAIN RESULTS: Per cent agreement +/- 1 category ranged between 73 and 82. Mean (SD) intake ranged between 1.09 (1.35) drinks/week for diaries, and 0.69 (0.85) for questionnaires. Mean differences between methods were all close to zero. Three of the four measures yielded comparable distributions of average alcohol intake, but reports of intake within the past seven days seemed to be an inappropriate measure of average intake, yielding three times as many abstainers as expected when combining the methods. CONCLUSIONS: When assessing the distribution of alcohol intake in pregnancy or when studying adverse pregnancy outcomes that are probably caused mainly by sustained exposure it seems that for pregnant women with low to moderate alcohol intake diaries or an average measure from interviews or a simple one item questionnaire may be applied. A measure of intake for the previous week seems to be a relevant measure only when studying adverse pregnancy outcomes that are most probably caused by binge-like exposure.

Adult↗

Bibliometric analysis of the American Journal of Veterinary Research to produce a list of core veterinary medicine journals.

OBJECTIVE: Bibliometric techniques were used to analyze the citation patterns of researchers publishing in the American Journal of Veterinary Research (AJVR). METHODS: The more than 25,000 bibliographic references appearing in the AJVR from 2001 to 2003 were examined for material type, date of publication, and frequency of journals cited. Journal titles were ranked in decreasing order of productivity to create a core list of journals most frequently used by veterinary medical researchers. RESULTS: The majority of items cited were journals (88.8%), followed by books (9.8%) and gray literature (2.1%). Current sources of information were favored; 65% of the journals and 77% of the books were published in 1990 or later. Dividing the cited articles into 3 even zones revealed that 24 journals produced 7,361 cited articles in the first zone. One hundred thirty-nine journals were responsible for 7,414 cited articles in zone 2, and 1,409 journals produced 7,422 cited articles in zone 3. CONCLUSIONS: A core collection of veterinary medicine journals would include 49 veterinary medicine journals from zones 1 and 2. Libraries supporting a veterinary curriculum or veterinary research should also include veterinary medical journals from Zone 3, as well as provide access to journals in non-veterinary subjects such as biochemistry, virology, orthopedics, and surgery and a selection of general science and medical journals.

Animals↗

Obstetricians' attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in caesarean section.

Over 10% of current births in all countries of the world are delivered by caesarean section. Single-dose ampicillin or cefazolin administered after cord clamping has been proven to be effective for the prevention of post-caesarean infections as indicated in many randomised trials and reviews in the Cochrane Library. This study aimed to determine three determinants of behavioural intention using the theory of planned behaviour: attitudes, subjective norms, and perceived controls. Intentions were examined for five aspects of the use of antibiotic prophylaxis, namely whether or not antibiotics were used, used in all caesarean sections, after rather than before cord clamping, whether ampicillin/cefazolin or broader-spectrum antibiotics were used, and whether single or multiple doses were given. Fifty obstetricians selected from university, regional, and general hospitals in southern Thailand, were surveyed using a questionnaire and in-depth interview. Their intentions to use a single dose and to use in all cases were low, and this was related to negative attitudes and reference groups who did not approve of the single dose. The negative attitude was based on scepticism concerning the applicability of well-equipped trials from the developed world and fear of consequences of post-caesarean infections. Norms carried over from residency training had more long-term influence in their practice than newer information from books or journals. Perceived external controls on their practice were less predictive of intentions. Intentions were only partly predictive of behaviour. Changing attitudes, introducing evidence-based information into residency training and strengthening control systems in the hospital are essential to improve intentions.

Adult↗

There are many Mediterranean diets.

Interest in Mediterranean diet began 30 years ago, when Ancel Keys published the results of the famous Seven Countries Study, Since 1945, almost 1.3 million people have come to Australia from Mediterranean countries as new settlers. There are 18 countries with coasts on the Mediterranean sea: Spain, southern France, Italy, Malta, Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Egypt, Libya, Malta, Tunisia, Algeria and Morocco. This study from which this report derives aims to investigate the influence of the food habits of immigrants from Mediterranean countries on Australian food intake. Here we look at the 'traditional' food habits of the above Mediterranean countries as told by 102 people we interviewed in Sydney, who came from 18 Mediterranean countries to Sydney. Most of the informants were women, their age ranged from 35 to 55 years. The interview was open-ended and held in the informant's home. It usually lasted around 1 1/2 hours. The interview had three parts. Personal information was obtained, questions relating to the food habits of these people back in their original Mediterranean countries and how their food intake and habits have changed in Australia were also asked. From the interviews, we have obtained a broad picture of 'traditional' food habits in different Mediterranean countries. The interview data was checked with books of recipes for the different countries. While there were similarities between the countries, there are also important differences in the food habits of the Mediterranean countries. Neighbouring countries' food habits are closer than those on opposite sides of the Mediterranean Sea. We suggest that these food habits can be put into four groups. The data here refer to food habits in Mediterranean countries 20 or 30 years ago, as they were recovering from the Second World War. There is no single ideal Mediterranean diet. Nutritionists who use the concept should qualify the individual country and the time in history of their model Mediterranean diet.

Adult↗

Physicians' perceptions of and approaches to woman abuse. Does certification in family medicine make a difference?

OBJECTIVE: To discover whether family physicians who go through residency training and The College of Family Physicians of Canada's (CFPC) certification process are more responsive than other physicians to woman abuse, whether they perceive and approach such abuse more appropriately, and whether they seek out more education on the subject. DESIGN: A national survey using a pretested 43-item mailed questionnaire to examine perceptions of and approaches to detection and management of woman abuse. SETTING: Canadian family and general practice. PARTICIPANTS: A cross-sectional sample of 1574 family physicians and general practitioners, of whom 963 (61%) volunteers responded. MAIN OUTCOME MEASURES: Demographic variables, perceptions of abuse, methods of diagnosing and managing woman abuse. RESULTS: Most respondents agreed they could not diagnose and treat woman abuse effectively, regardless of certification status. They indicated they were detecting only 33% of cases. Certificants of CFPC, in particular residency-trained certificants, were more likely to think that they should be diagnosing woman abuse than noncertificants; they were also more likely to help victims by referring them to specialists and other agencies. Certificants were also more likely to think they should be treating these patients themselves, and that they were not adequately trained to do so. Although most respondents thought they needed more education, certificants were more likely to know of relevant courses, to have attended such courses, and to have read books or articles on the topic. CONCLUSIONS: Being a certificant is not associated with perceived skills in diagnosing and treating woman abuse, but is associated with an increased awareness of the problem. Certificants know that education on woman abuse is available.

Adult↗

National Confidential Enquiry into counselling for genetic disorders by non-geneticists: general recommendations and specific standards for improving care.

OBJECTIVES: To assess genetic counselling by non-geneticists and to improve clinical practice. DESIGN: National retrospective review of casenotes. SETTING: Antenatal, paediatric, medical, and surgical units. SAMPLE: 1293 genetic events were identified, involving potentially avoidable cases of Down's syndrome, neural tube defect, cystic fibrosis, beta thalassaemia major and late onset medullary carcinoma of the thyroid (multiple endocrine neoplasia). Notes were available for review in 888 (69%) of these cases. OUTCOMES: Documented counselling, offers of relevant genetic screening and prenatal diagnosis. RESULTS: Clinical audit was frustrated by poor quality hospital records lacking evidence of counselling. Non-geneticist clinicians concentrate on the management of disease, and may overlook the need for counselling and recording data which patients will later need for decisions about reproduction or disease prevention. Counselling, screening and prenatal diagnosis were sometimes impossible because of late booking in pregnancy, or because of delayed diagnosis of an earlier affected child with cystic fibrosis. There are marked regional inequalities of access to genetic services, particularly for minority ethnic groups with increased risks of thalassaemia. Although patients were selected for this enquiry because they had known high risks of genetic disorders, on average less than half were referred to medical geneticists. General recommendations relevant for improvement of care for patients and families with medical genetic needs and those specific for each disorder are given. CONCLUSIONS: Assessment of the quality of genetic care becomes increasingly important as genetic counselling spreads beyond the narrow confines of specialist genetic services. Even though the events studied in this enquiry largely occurred between 1991 and 1995, there is little reason to believe that clinicians in general have become markedly better trained in medical genetics. The General Medical Council and Medical Royal Colleges should urgently consider the need for a national policy for improving undergraduate and postgraduate medical, nursing and midwifery education in genetics. Commissioners of clinical services should require that genetic management be at least as well-documented as surgical operations, drug records and informed consent, perhaps by using a nationally agreed pro-forma for prenatal diagnosis. Regular audit of counselling provided by non-geneticists is necessary to confirm that clinical improvements are occurring and standards are being met. The Confidential Enquiry provides data for a systematic approach to clinical governance of genetics in all specialities. This sets the scene for multi-speciality NHS genetic services capable of giving patients greater consistency both in access and in quality.

Clinical Competence↗

Aromatic drugs in Unani medicine with special reference to Kitabul-Mia-Lil-Masihi.

This is an established fact since time immemorial that, the aroma plays a vital role in the human beings and even in animals. The aromatic plants and aromatic chemicals contained in them has also significance in our day to day living. Process of distillation as adopted and described by Unani physicians confirms the claim that, they were aware of the importance of aromatic drugs and perfumes. There is a vast literature scattered in existing Unani medical books, which shows their intelligential towards the knowledge of herbal drugs including aromatic plants. 'Kitabul-Mia-Lil-Masihi is a book on Unani medicine. Its 17th Chapter consists of aromatic drugs exclusively. The drugs have been classified and presented here under different headings.

Aromatherapy↗

The Charles procedure: misquoted and misunderstood since 1950.

The Charles procedure, named for Sir Richard Henry Havelock Charles, is an eponym for a surgical treatment of leg lymphedema. Sir Havelock led a fascinating life, with his travels taking him to India, the Afghan territories, and the Court of King George V of England. At the turn of this century, Sir Havelock published material describing a series of 140 consecutive patients treated successfully for scrotal lymphedema. In a book chapter published a decade later, entitled "Elephantiasis Scroti," Sir Havelock briefly described the treatment of leg lymphedema but did not document a single successful case report. The name of Sir Havelock Charles was absent from the literature until 1950, when Sir Archibald McIndoe attributed the treatment of leg lymphedema with radical excision and skin grafting to Sir Havelock. References to Charles for the treatment of leg lymphedema have proliferated since that time.

England↗

Urgent in-patient coronary angiography: a comparison of centres with and without cardiac catheter facilities.

OBJECTIVES: To review the referral of patients to a tertiary centre for urgent angiography and to determine if there are differences in invasive treatment strategies for patients with acute coronary syndrome (ACS). METHODS: There were 2 parts to the study, a retrospective part over 3.5 years from a computerised cardiac laboratory booking data base and a prospective part over 3 months. RESULTS: There were 1190 urgent in-patient angiograms performed with 499 (42%) admitted initially to the tertiary centre while the remaining 691 (58%) were admitted to district general hospitals (DGH), with no on-site access to a cardiac laboratory, and subsequently transferred to the tertiary centre. Once referred, DGH patients waited longer for their angiogram (2.7 +/- 3.2 vs 2.0 +/- 2.8 days, p < 0.0001). Interestingly, DGH patients appear to spend an average of 4 days in hospital prior to referral for angiography. DGH patients were more likely to have a higher Thrombosis in Myocardial Infarction (TIMI) risk score at presentation and following angiography were more likely to have coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) and less likely to have angiographically normal arteries. CONCLUSIONS: Our findings are consistent with previous studies demonstrating that access to coronary angiography varies considerably between hospitals. However, we have demonstrated that patients in DGHs wait on average 4 days before referral for coronary angiography suggesting that there may be triage based on initial responses to medical therapy. Further research is needed to determine whether this has a direct effect on outcomes.

Aged↗

Mechanization of library procedures in the medium-sized medical library. 8. Computer applications in hospital departmental libraries.

To test the hypothesis that a standard library system could be designed for hospital departmental libraries, a system was developed and partially tested for four departmental libraries in the Washington University School of Medicine and Associated Hospitals. The system from determination of needs through design and evaluation, is described. The system was limited by specific constraints to control of the monograph collection. Products of control include catalog cards, accessions list, new book list, location list, fund list, missing book list, and discard book list. Sample data form and pages from a procedure manual are given, and conversion from a manual to an automated system is outlined. The question of standardization of library records and procedures is discussed, with indications of the way in which modular design, as utilized in this system, could contribute to greater flexibility in design of future systems. Reference is made to anticipating needs for organizing departmental libraries in developing regional medical library programs and to exploring the role of the departmental library in a medical library network.

Computers↗

Analyses of monoclonal antibodies reacting with porcine CD5: results from the Second International Swine CD Workshop.

Among the 57 monoclonal antibodies analyzed within the T-cell group, three mAbs fell within cluster T13 including the CD5a standard b53b7 (No. 174). The two new mAbs 1H6/8 (No. 058) and BB6-9G12 (No. 166) both precipitated 55 and 60 kDa proteins that were of similar molecular weights as the standard. Staining patterns on the various cell types were similar. Both new antibodies inhibited the binding of the CD5a reference mAbs b53b7 to peripheral lymphocytes. These mAbs, therefore both react with the CD5a epitope bringing the number of anti-porcine CD5 mAbs to eight, all of which appear to recognize the same epitope.

Animals↗