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Medical Sciences	75%

Selected Abstracts

A review of paroxysmal sympathetic hyperactivity after acquired brain injury

ANNALS OF NEUROLOGY, Issue 2 2010
Iain Perkes BMedSc
Severe excessive autonomic overactivity occurs in a subgroup of people surviving acquired brain injury, the majority of whom show paroxysmal sympathetic and motor overactivity. Delayed recognition of paroxysmal sympathetic hyperactivity (PSH) after brain injury may increase morbidity and long-term disability. Despite its significant clinical impact, the scientific literature on this syndrome is confusing; there is no consensus on nomenclature, etiological information for diagnoses preceding the condition is poorly understood, and the evidence base underpinning our knowledge of the pathophysiology and management strategies is largely anecdotal. This systematic literature review identified 2 separate categories of paroxysmal autonomic overactivity, 1 characterized by relatively pure sympathetic overactivity and another group of disorders with mixed parasympathetic/sympathetic features. The PSH group comprised 349 reported cases, with 79.4% resulting from traumatic brain injury (TBI), 9.7% from hypoxia, and 5.4% from cerebrovascular accident. Although TBI is the dominant causative etiology, there was some suggestion that the true incidence of the condition is highest following cerebral hypoxia. In total, 31 different terms were identified for the condition. Although the most common term in the literature was dysautonomia, the consistency of sympathetic clinical features suggests that a more specific term should be used. The findings of this review suggest that PSH be adopted as a more clinically relevant and appropriate term. The review highlights major problems regarding conceptual definitions, diagnostic criteria, and nomenclature. Consensus on these issues is recommended as an essential basis for further research in the area. ANN NEUROL 2010;68:126,135 [source]

Short- and long-range dispersal of medfly, Ceratitis capitata (Dipt., Tephritidae), and its invasive potential

JOURNAL OF APPLIED ENTOMOLOGY, Issue 8 2007
A. Meats
Abstract:, Data were obtained from mark recapture trials pertaining to the dispersal of medfly, Ceratitis capitata (Dipt., Tephritidae), over both short (10,160 m) and very long distances (0.5,9.5 km) within the surveillance trapping array in Adelaide, Australia. They could be related to previously reported data sets by expressing the capture rates of each set in common terms that corrected for differences in recapture rate resulting from type of trap, season or climate. The mean capture rate at each distance from the point of release in each data set was expressed as a percentage of the real or inferred rate of that set at a distance of 100 m. The resulting distribution of dispersal distances conformed to both an inverse power model and a modified Cauchy model regardless of whether the present and previous data were combined or not. The modified Cauchy model inferred that the median distance flown was extremely short and 90% of flies displaced only 400,700 m despite the fact that a consistent trend in declining catch rates was obtained up to 9.5 km. The spread of invading propagules in quarantined zones in the first generation is likely to be limited by a decline to non-viable density within 1 km or less of the incursion point and the spread of larger infestations could be limited by the longevity of the dispersers. The results also have significance to the ability of surveillance trapping arrays to detect infestations and also to methods of distributing insects for the ,sterile insect technique'. [source]

Sources of knowledge in clinical practice in postgraduate medical students and faculty members: a conceptual map

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2007
Reza Yousefi-Nooraie MD
Abstract Objectives, To determine the most important knowledge sources that can influence clinical practice and to cluster them in conceptual groups based on their relative importance. Methods, Faculty members, fellows and residents of a large teaching tertiary care hospital were asked to rate the importance of different resources in their daily clinical practice and their understanding of some common terms from evidence-based medicine. The knowledge sources were distributed in a two-dimensional map using multidimensional scaling and hierarchical cluster analysis. Results, A total of 250 of 320 recruited hospital staff returned the questionnaires. The most important resources in daily practice were English journals, text books and literature searching for faculty members, experience, text books and English journals for fellows and text books, experience and peers for residents. Regional journals were the least important resources for all study groups. About 62.7% of residents did not know the meaning of ,number needed to treat', 36.8%,confidence interval', 54.9%,confounding factor' and 44.6%,meta-analysis'. The percentages for faculty members were 41.3%, 37%, 42.2% and 39.1%. The knowledge sources were placed in four clusters in a point map derived from the multidimensional scaling process. Conclusion, The dominance of the traditional information resources and experience-based medicine debate which is the consequence of traditional approaches to medical education may be one of the considerable barriers to the dissemination of evidence-based medicine in developing countries. The evidence-based clinical practice guidelines could be used as a useful passive-predigested source for busy clinicians to make informed decisions. A considerable Western bias may undermine the local research in developing world. [source]

Practical pharmacovigilance analysis strategies

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2003
A. Lawrence Gould
Abstract Purpose To compare two recently proposed Bayesian methods for quantitative pharmacovigilance with respect to assumptions and results, and to describe some practical strategies for their use. Methods The two methods were expressed in common terms to simplify identifying similarities and differences, some extensions to both methods were provided, and the empirical Bayes method was applied to accumulated experience on a new antihypertensive drug to elucidate the pattern of adverse-event reporting. Both methods use the logarithm of the proportional risk ratio as the basic metric for association. Results The two methods provide similar numerical results for frequently reported events, but not necessarily when few events are reported. Using a lower 5% quantile of the posterior distribution gives some assurance that potential signals are unlikely to be noise. The calculations indicated that most potential adverse event,drug associations that were well-recognized after 6 years of use could be identified within the first year, that most of the associations identified in the first year persisted over time. Other insights into the pattern of event reporting were also noted. Conclusion Both methods can provide useful early signals of potential drug,event associations that subsequently can be the focus of detailed evaluation by skilled clinicians and epidemiologists. Copyright © 2002 John Wiley & Sons, Ltd. [source]