H-

Patient End Results (455)*

          Longevity (25)

               Life of patient(s) saved (8)

                   Case reports of a rare and usually fatal
fungal infection and suggested treatment were used by physician
to choose treatment (IV miconazole) for a patient with a brain
abscess due to this fungal infection.  Patient has survived for
two years, but would have received the wrong treatment and almost
certainly would have died if this treatment had not been located. 
(035002)

                   Immediate information describing anaphylactic
and cardiogenic shock, and the recommendation that treatment
focus on the anaphylaxis as opposed to the cardiac problems,
provided physician with a treatment plan for a patient who had
taken a certain homeopathic remedy for poison ivy who was in
extreme shock and difficult to resuscitate.  Patient survived,
contrary to physician's expectations, and is doing fine. 
(039602)

               Length of life increased (17)

                   Information describing prognoses, treatments,
and medical centers performing treatments for advanced metastatic
ovarian cancer was provided by researcher to a physician with a
friend with this condition who had been treated with surgery
and radiation.  Physician located a center performing treatment
and patient participated in a clinical trial; patient is still
alive.  (048902)      









*Number in parentheses are the numbers of incidents classified in
each category


                   Information indicating that lymphoblastic
lymphoma, which is a rare cancer which acts more like a leukemia
than a lymphoma, should be treated aggressively provided
physician with information so that patient was treated with round
of CHOP followed by a round of another chemotherapy which will
increase the 5-year survival rate to 40-50% instead of 5-10% with
less aggressive chemotherapy regimens.  (040201)

          Abnormalities (107)

               Abnormality or disease prevented (10)

                   Information indicating that a giant cell
tumor of the foot required amputation only if biopsy showed
malignant changes in the tumors, that metastasis is unlikely, and
that biopsy and osteotomy (removal of tumor and bone) instead of
amputation are recommended, was responsible for physician
performing a biopsy and osteotomy on a patient with a history of
this condition and previous tumor removal.  The biopsy was
negative, the patient's foot was saved, and she is doing well. 
(T00801)

                   Information indicating that DIC (disseminated
intravascular coagulation) after orthopedic surgery can be
prevented by performing prothrombin (PT) and partial
prothrombin-plastin (PTT) time tests every two days starting
before, during, and after surgery prevented a patient from having
more serious postoperative complications because the probability
of DIC was detected sooner and morbidity prevented.  (T00802)

               Patient cured or completely recovered from
abnormality (37)

                   Information about unusual causes of
pancreatitis, including absence of indication that running could
be a cause, led physician to choose fasting therapy for
15-year-old patient who demonstrated pancreatitis while running
in a race.  Patient recovered completely and continued running,
and there was no reoccurrence.  (011401)
                   Information specifying the type of
cephalosporin that is effective for treating gram positive
pneumonitis enabled physician to replace ineffective treatment
with a different cephalosporin as recommended.  Patient recovered
completely.  (018801)

                   Information about ages of patients in a study
of acyclovir treatment for herpes zoster led physician to
conclude that a 30-year-old patient with this condition was too
young to benefit from acyclovir treatment.  Physician treated
patient with prednisone, and patient's herpes cleared up. (011403

               Patient improved or stabilized (but not cured) of
abnormality (34)

                   Absence of information about prior use of
clot dissolvers during pregnancy led physician to decide against
use of a clot dissolver (streptokinase) for a pregnant patient
with a thrombosis (patient had a history of Hodgkin's disease,
and thrombosis was related to a Hickman catheter in the right
subclavian artery).  Physician successfully relied on heparin
treatment instead.  Patient is full-term and prognosis is good.
(011202)  

                   Information about use of tests for
antiphospholipid antibody to diagnose hypercoagulability was used
by physician to test a patient who had a stroke at an
early age.  Tests were positive, and patient was anticoagulated
prophylactically to protect against future strokes.  Patient's
prognosis is fair. (010801)

                   Information about use of amantadine to treat
patient with AIDS who acquired neuroleptic malignant syndrome
after treatment with phenothiazine, was used by the physician and
the patient recovered from the neuroleptic malignant syndrome,
but still has AIDS.  (U17803) 
               No improvement of patient's abnormality (26)

                   Recommendations for use of azelaic acid for
treatment of acne were used by physician to guide treatment of
acne with this drug.  Physician does not believe treatment worked
and no longer prescribes it.  (016402)

                   Information about the location of an author
of papers on use of an experimental drug therapy that had been
used for low birth-height infants to stimulate growth was used by
a parent of a 9-year-old child with a height problem to contact
the researcher, who convinced the parent that the therapy would
be worth trying.  No change was noticed after a 6-month course of
therapy, and it was discontinued.  (048504)

                   Limited information obtained about seizures
and other neurological complications being associated with
flexeril overdose in rats, and absence of information about
pediatric overdose, resulted in physician's reservations about
stating that seizures and other complications found in a child
who had overdosed on flexeril were definitely caused by the
overdose, and left physician unable to specify an antidote. 
Patient was transferred to ICU, is still abnormal neurologically,
and requires mechanical ventilation. (T01301)

          Symptoms (15)

               Patient obtained partial or complete relief of
symptoms (9)

                   Information about a short-term, non-steroidal
treatment strategy for arthritis pain that would not exacerbate a
bleeding ulcer was used by physician to control patient's pain
until surgery for the ulcer was accomplished, thus avoiding
surgical complications, allowing surgery to occur sooner, and
getting patient on methotrexate as planned.  Patient is feeling
less pain, but prognosis is guarded.  (010901) 

                   Information about therapeutic value and side
effects of using an antidepressant (fluoxetine) for treatment of
an unusual movement problem in adults (myoclonus) was basis for
physician's trial of small doses of fluoxetine for myoclonus in a
pediatric patient.  Treatment was minimally successful but safe,
and physician is now using the treatment for an older child. 
(035403)

               No improvement of patient's symptoms (6)  
          
                   Information on the use of azelaic acid
(dicarboxylic acid) in the treatment of acne showed the physician
the dosage information and irritancy potential, which led him to
begin prescribing the medication.  He never prescribed it again,
because he did not think there was any improvement in the
patients' symptoms.  (016402)

                   Lack of helpful information on skin allergies
to white pigment led physician to be unable to improve the
allergic symptoms which his patient exhibited to a white pigment
which was part of a tattoo.  (031301)

Function (5)
     
               Role functioning of patient improved or protected
(2)

                   Information describing adverse effects of
propylthiouracil (PTU) treatment for hyperthyroidism, including
the fact that effects are not time or dose dependent, led
physician to decide not to grant waiver to woman on PTU with
hyperthyroidism who was seeking employment on a government
scientific vessel because she was still at risk for significant
adverse effects.  (031102)

                   Absence of information about treatment of
dermatitis caused by fiberglass exposure led physician to
prescribe symptomatic treatment for patients with occupational
exposure.  Treatment initially worked but poor compliance, plus
constant exposure at work, led to relapses.  (016403)

          Role functioning of family improved or protected (3)
     
                   Information describing the increase in stress
to the parents caused by not being with their child, who is in
intensive care, and no increase in the incidence of infection in
neonatal intensive care when there was sibling visitation, led
nursing staff to increase parent and initiate sibling visitation
in neonatal ICU which improved the family's attitude toward the
child's illness  (U09101)
     
    Case reports suggesting that the main reason to perform
surgery for single-suture cranial stenosis in an infant is for
cosmetic reasons, helped the physician to counsel the parents,
although he could not give them a clear answer on the future
shape of the child's head.  Physician advised the parents to take
pictures, and if the child's appearance changes, then he will
perform the surgery. At the present time he looks fine. (U02803)

Process outcomes (303)

               Patient or family knowledge, attitudes, and
behavior (50)

                    Anxiety of patient and family relieved (13)

                        Information about an experimental drug
for migraine headaches was provided by physician to M.D./patient
with severe migraines who had heard of it, and helped reassure
her that new treatments were being developed.  (Patient decided
not to pursue the experimental treatment because it was offered
only at a distant medical center.)  (040202)

                        Information on the death rates and
complication rates from angiography during surgery for an
angiofibroma of the nasal pharynx, which is a rare, bloody tumor
that appears in teenaged boys, allowed physician to reassure the
patient's mother that it was likely her son would survive the
surgery and, in fact, the tumor was removed without leaving a
large facial scar.  (065402)
          
          Patient or family understanding of condition or health
risk enhanced (26)
          
                        Recent information about the key
pathological differences between acquired vs. familial
hemochromatosis and about likelihood that other family
members could have the familial type was used by pathologist to
make a definitive diagnosis of familial hemochromatosis for a
patient he had seen at autopsy and to provide information
to physician for the patient's family.  Family physician did
genetic counseling with the family and is now performing
biochemical screening on family members to look for serologic
indicators that precede the condition.  (031802)

              Information relating a type of birth defect
(chromosome deletion) to mild mental retardation was used by
physician to counsel parents of a child with this defect
about the mental retardation and the need to enroll the child in
an infant stimulation program as soon as possible.  (Parents did
not return to physician for follow-up and outcome is not known.) 
(015001)

    Basic information on non-Hodgkins lymphoma, including
reviews which described the disease, how it differs from
Hodgkins, its treatment and prognosis, was used by the physician
to explain the lump in her neck, by using the abstracts as a
brochure which could answer her questions.  (P12403)

          Patient/family involvement in treatment decision
enhanced (7)
          
                        Absence of information on the usefulness
of alpha-feto protein testing in pregnancy to detect fetal
abnormalities led the physician to call a colleague to get the
information so that the physician could tell his patient what her
options were and the predictive value of the test (negative test
tells which conditions can be excluded) and she could decide
whether or not she wanted to have the test done.  (I)  (034802)
          
                        Information that suggested that
colchicine may be effective for reducing progress of cirrhosis in
some end-stage patients, but is still optional and not a major
loss if not used, led physician to inform his patient about his
findings and the patient is deciding if he wants to have the
treatment or not.  (030301)

          Adherence to treatment recommendations enhanced (4)

                        General information about
hepato-cellular carcinoma in children, including lack of
relationship between the illness and hepatitis C, was used by
physician in a small town in a remote area to educate parents of
child with this condition before the child was sent to a major
medical center for chemotherapy and surgery, and to help them
properly care for the patient when he returned home.  (Patient is
doing well.) (041701)

                        Information about the lack of treatment
options besides dietary control for hyperlipidemia in children,
except for liver replacement in advanced cases, enabled physician
to counsel the father of a child with this illness about the
seriousness of the problem and to urge him to have the child
followed carefully, which the father has been doing.  (041702)

          Health care (236)

                    Unnecessary treatments or procedures avoided,
minimized, or reduced (40)  
     
                   Absence of information about treatment of
hepato-renal syndrome led physician to elect to forego all
measures except to continue supportive therapy for patient. 
Patient's liver did not improve and patient eventually died. 
(011101)
     
    Information that suggested that NMR is not better than
catheterization of the pancreatic duct in the early detection of
pancreatic cancer prevented patient in South America from having
to come to the U.S. to have NMR of the pancreatic duct performed. 
The catheterization was performed in South America and the
patient had chronic pancreatitis, not a tumor.  (063502)

    Information that fish oil should not be used by diabetics to
lower cholesterol, because the oil has negative effects on the
diabetic's condition, enabled the physician to tell his
colleague, who is a diabetic, to avoid using fish oil to lower
his cholesterol, which he did. (053902)
     
               Risks or side effects of treatment avoided,
minimized, or reduced (31)   


                        Information about the range of opinions
concerning monitoring for liver damage with methotrexate therapy
was used by physician to formulate monitoring strategies for
patients on methotrexate therapy for rheumatoid arthritis and to
educate patients about the need for monitoring.  (011102)  

                        Information about contraindications for
gamma globulin treatment due to long-term potential for
crossmatch problems in surgery were used by physician to stop
gamma globulin treatment for patient with recurring respiratory
infections who was receiving it unnecessarily for a low IGa
condition.  (Patient will receive specific treatment for her
infections.)  (010401)

                        Information on the use of carotid
ultrasonography to measure bloodflow through the carotid artery,
was used by the physician to recommend that his patient have this
procedure performed, rather than the more risky, painful, and
expensive arteriogram, to assess whether the patient had an
internal carotid aneurysm.  The patient had the test performed
and did not have an aneurysm.  (034901)


                    Duration or frequency of hospitalization
minimized or reduced without loss of medical benefit (5)

                        Information indicating range of duration
of abnormal cerebral spinal fluid values (for Group B Strep
Latex) for a child recovering from Group B Streptococcus
meningitis led physician with patient who showed abnormal values
after 4 weeks of antibiotic therapy to decide that these values
were not unusual for this point in the treatment and to discharge
the patient earlier than anticipated.  (Patient is doing well and
seems to be developmentally normal.)  (T03501)

                        Information indicating that sclerosing
(injection of an irritant into the pleural cavity to create scar
tissue) is a useful treatment for recurrent pneumothorax, and
estimates of potential for success, led resident and colleagues
to perform sclerosing procedure on hospitalized pediatric patient
who was on long-term mechanical ventilation due to this
condition.  Patient went home after the procedure, and received
procedure again 2 weeks later, after a pneumothorax episode. 
(Resident believes that patient has returned home.)  (T07001)
          
               Patient received different and more accurate
diagnosis than otherwise would have been obtained (49)

                        Information indicating a high
false-negative rate for a diagnostic test, and suggesting a more
helpful test, was used by physician to aid in correctly
diagnosing common duct disease (gallstone lodged in the common
duct) in a patient with severe abdominal pain and previous
cholecystectomy.  (Subsequent surgery indicated that stone had
already detached and the condition cleared by itself.)  (011404)

                        Information about all possible causes of
upper lobe bullous condition, including the fact that it is seen
in IV drug abusers, was provided by physician to a clinician with
a patient with this condition to aid in diagnosis, and also aided
physician in diagnosing his own patients who present with this
condition.  (029101) 
     
                        Information linking thyroid deficiencies
to depression was used by physician to test depressed patients
for thyroid disorders, with the result that three times as many
of his patients have been diagnosed with thyroid disorders. 
Appropriate patients are now treated for both depression and
thyroid disorders.  (010403)
     
               Patient received different and better treatment or
treatment recommendation than otherwise would have been obtained
(75)
     
                        Absence of concrete information on the
treatments that statistically yield the best results did not give
the physician the support he needed to second-guess what the
oncologists might tell him regarding the treatment of his patient
with endocervical adenocarcinoma.  They went ahead with surgery
followed by radiation and the patient is doing well.  (I) 
(062903)
     
                        Information that indicated that copper
deficiency is signaled by a decrease in neutrophils, followed by
sideroblastic anemia, and only occurs when zinc is given over
long periods of time, convinced a clinical pharmacist that a
critically-ill patient, who was receiving intravenous zinc for
wound healing, was not in danger of developing a copper
deficiency (there is a reciprocal relationship between the two),
and is receiving better care because they now know what to look
for.  (074701)

                        Lack of information about the side
effects of a drug, thymopentin, which a patient with colon cancer
was considering taking, did not give the physician the
information needed to determine if this was a better treatment
than the more traditional modalities; instead he called the
manufacturer, who gave him little information because it was
still investigational.  (063503)

               Patient received referral to appropriate
specialist or treatment center (35)

                        Provided information to endocrinologist
on relationship between diagnosis of adrenal masses and size when
they are found (P10503)

                        Location of a specific reference
summarizing classification, treatment, and prognosis of polypoid
melanomas enabled pathologist presented with a skin specimen
labeled "wart" that he subsequently determined to be a polypoid
melanoma to present this information to the surgeon who had
removed the skin, in order to familiarize him with treatment. 
(Physician is not aware of how the information was used by
the surgeon.)  (034001)

                        Absence of information about therapies
for advanced metastasized bladder cancer led physician to move
patient with this condition from oncology service to a tertiary
care center that was better suited to care for him.  (014401)

                    Patients received care where they otherwise
would have received none (1)

                        Absence of information on
non-psychiatric aspects of medical care for the homeless, which
arose from a discussion a pharmacy administrator had regarding
improper utilization of emergency rooms by the homeless, led his
department to develop a program at a local shelter.  Pharmacists
go to the shelter weekly to work with the medical staff to
educate the homeless on the appropriate ways to take their
medications.  They are providing medical care to patients who
otherwise would be receiving none. (T02601) 
               Cost of care, insurance, and reimbursement (17) 

                    Cost of care minimized or reduced without
loss of medical benefit (4)

                        Comparison of side effects of the
different beta agonists and their utility in managing premature
labor led physicians to establish a treatment protocolthat
employed a less expensive drug. (P10703)

                        Information on the use of inhaled
bronchodilator treatments for emergency room treatment of
children with pediatric asthma resulted in thephysician changing
his practice from prescribing epinephrine injections and
aminophylline drips, which would take 4-6 hours in the emergency
room, to giving them inhalation treatments in the ER and at home,
which is less traumatic for the child and results in less time in
the emergency room.  (U14401)

                    Insurance benefits and reimbursement obtained
appropriately (13)

                         Patient's status with insurer decided
appropriately (5)

                             Information indicating that while
remissions of a type of end-stage renal disease
(membrano-proliferative glomerulonephritis) do occur rarely,
they usually end in recurrence of the disease, was used by
physician to justify unwillingness to comply with patient's
mother's request that physician inform the patient's insurer that
patient in remission is cured.  (Patient is currently in
remission but long-term prognosis is not good.)  (040203)

                             Information about a technique for
diagnosing cirrhosis was used by physician to do a more thorough
analysis of liver enzymes for a patient who claimed that he was
being wrongfully labeled as an alcoholic by his insurance
company. Physician had test done but has not yet seen the lab
report.  He believes the patient is honest, and that when it is
proven that he is not an alcoholic, he will be spared a doubling
of his insurance premiums.  (034903)

                         Reimbursement of patient and/or family
for worker's compensation decided appropriately (4)

                             Information on neurologic injuries
and the deterioration that can result, allowed a rural physician
to understand the nature of his patient's neurologic impairment
resulting from a skull fracture he sustained after falling off a
truck several years before.  The physician was able to present
the information to the judge at the Workman's Compensation
hearing to refute the insurance company's contention that the
patient died from heart failure.  The widow received the pension. 
(010802)

                             Articles documenting loss of
pulmonary function after a stroke, led physician to counsel his
patient that his pulmonary problems were a result of the stroke
not related to his work and to give similar testimony in
litigation his patient was pursuing against his employer. 
(013603)

                         Problems or delays for patient in
securing insurance reimbursement avoided (3)

                             General information about a rare
cranial disease in children (Kronau's disease) aided company
physician in preparing the company's insurance claims processors
for timely approval of the treatment plan for a child with this
condition who was about to undergo surgery and home care.  After
surgery, patient's family was very pleased with the company's
supportive attitude.  (034904)

                             Information indicating that there
is a connection between acute myocardial infarction and exercise
or emotional stress was used by physician to support family's
worker's compensation claim that cardiac patient's fatal heart
attack was caused by his being forced to change a tire on the
road; case was settled favorably to family out of court. 
(T05801)

                         Reimbursement of provider for unaccepted
treatment prevented (1)

                             Information on the official
position of the American Academy of Allergy concerning Candida
hypersensitivity syndrome allowed insurance company to deny claim
for treatment (and presumably encouraged patient to seek further
for appropriate diagnosis and treatment.)  (P11203)

Research End Results (267)

          New knowledge produced (16)

               Theory developed or refined (6)

    Information on the role of oxidative reactions in the
process of differentiation in development was used by
investigator to help interpret his own data and formulate a
theory of the role of oxidative reactions in this process;
investigator published an article on this topic based on his
research.  (028702)

                   Information on the pathophysiology whereby
left ventricular hypertrophy potentiates heart ischemia was used
by a researcher to provide support for his hypothesis to explain
their experimental findings; Investigator published an article on
this topic describing their research.  (T05201)

               Basic biomedical knowledge produced (6)

    Information describing differentiation caused by cAMP in
various cell systems, but an absence of information describing
differentiation caused by cGMP, led investigator to pursue
an initial finding of differentiation in a certain cell line
caused by cGMP; investigator has confirmed the finding with
further studies.  (Investigator has written up these results and
has also developed a grant proposal on the topic.)  (045802)

    Absence of information discussing an association between two
neurological diseases and expression of the ras oncogene led
investigator to conclude that his discovery of this association
in patients with these diseases was a new finding; investigator
presented the results at a professional meeting.  (046901)

               Understanding of medical history or medical ethics
enhanced (4)

    Information discussing clinicians' attitudes about the
benefits of high-technology developments in  cardiology, such as
mechanical hearts and artificial prostheses, were used by student
to compare these attitudes with those of medical historians who
are concerned with the attendant ethical and financial problems;
student will discuss the conflicts between these attitudes in a
dissertation.  (048901)

                   Additional information which the physician
researcher had not heard about before, on physicians who are also
writers (fiction or poetry) resulted in the citations being used
in the bibliography of a book on this topic, for which the
respondent was looking for a publisher.  (042101)


          New biological products developed (1)

              Information on the gene sequence of ovalbumin (egg
white) was used by a researcher to clone the gene into a plasmid
and transform plants to produce ovalbumin with the ultimate goal
of making these more nutritious plants commercially available. 
(046602)

          Process Outcomes (250)

               New research area identified (53)

                    Evidence of importance of research problem
obtained (10)

                        Information describing a research
finding on the role of calcium in induction of cell death by
radiation confirmed the importance of this same research
observation by an investigator, and led investigator to pursue
research to identify calcium-dependent factors involved in cell
death, because the initial research to confirm their existence
has already been done.  (056803)

                        Information obtained on the causes of
reticulocytosis confirmed for the immunologist researcher that he
had all the most up-to-date information, and could begin to
investigate why 40% of the patients taking a drug in a clinical
trial by his drug company exhibited this side effect.  (051702)

                    Evidence of lack of importance of research
problem obtained (3)

                        Absence of information showing the
beneficial effects of systemic retinoids in the treatment of
psoriatic arthritis, led the physician researcher to make
the decision not to pursue the project to develop other drugs in
this group, because there was not enough positive indication in
was worth pursuing.  (P10603)

                        Lack of specific studies addressing the
question of why the rate of heart disease in France is so much
lower than in other Western countries, when their cholesterol
levels were so high, resu lted in the physician researcher
dropping plans for the study because he found nothing exciting to
explain the phenomenon except possibly the French might be
underdiagnosing heart disease.  (034302)

                    Need for further research determined (33)

    Information describing increased mortality from heart attack
in people with bundle-branch block, combined with the absence of
information about the effect of thrombolytic therapy on heart
attack in people with this condition, led investigator to begin a
retrospective study of the effect of thrombolytic therapy on
heart attack in people with bundle-branch block.  (000501)

    Information describing eating disorders (such as anorexia)
in Asians outside of China, but an absence of information about
eating disorders in China, led investigator to design surveys in
Chinese to take along on a trip to China, with the goal of
initiating a study of eating disorders in China.  (017902)
               
         Lack of qualitative information on parents' adjustment
to home apnea monitoring convinced the nursing graduate student
that there was good rationale for her conducting a study to
measure parents' adjustment to having the monitoring device in
their home with an infant at risk for sudden infant death
syndrome (SIDS) and if she went on for a Ph.D., would develop the
measurement tool.  (U11002)
               
Need for preliminary research determined (7)
               
                        Lack of basic information on resources
utilized in normal deliveries including labor nursing hours,
supplies, drugs used, etc. to develop an assumed profile, led
physician to conclude that there was a real need for preliminary
research to get a good profile; the project is on-hold for the
time being.  (T01501)

                        Lack of any careful examination of the
connection between lung diseases and aortic aneurysm, led
physician to design and implement the project himself.  He
believes the results will have an impact on health care delivery. 
(063101)

               Appropriate research design formulated (16)

                   Information describing studies of primary
cilia in vestibular cells was used by investigator to help design
experiments to investigate primary cilia in another cell type
(cartilage cells) for incorporation into a grant proposal; grant
was funded and work has begun.  (012001)

    Information describing general aspects of the existing
health care systems in Central America, including numbers and
types of facilities and extent of health insurance coverage,
was used by investigators to design proposal to study how
external funds provided to Central American nations for health
care services are used; proposal was written and funded. (052606)

               Methodological impediment to research progress
removed (45)

                    New research methodology developed (1)

    Descriptions of a method (seriolactin chromatography) for
separating carbohydrates from proteins provided investigator who
was making no progress using other techniques with a method for
defining the carbohydrates attached to a protein
(androgen-binding protein) being studied without damaging the
protein.  (049302)

                    Existing research methodology adopted (23)

    Information describing methods for use of an antibody to
stain a brain peptide (corticotropin releasing factor), including
the animal species (rat) with which the antibody had been used in
previous experimentation, was used by investigator to choose rats
for initial experimentation with the antibody and to help design
experimental methodology, and allowed investigator to begin
immediately with experimentation instead of waiting for a
personal response from investigator who supplied him the
antibody.  (Initial outcome from experimentation has not been
successful, due to unknown reasons.)  (013301)

    Information describing the effects of passive smoking on
children (including an association with cancer as children get
older), and use of cotinine levels to measure smoke exposure, was
used by investigator to prepare talk on effects of passive
smoking and to design a study of baseline cotinine values in
children.  (033404)

    Information describing techniques for in vitro
phosphorylation of proteins by cAMP-dependant protein kinase was
used by investigator as the basis for the methodology for his
study of these proteins, instead of using a more standard method;
grant proposal was written and is being revised for resubmission. 
(045801)

                    Existing research methodology applied to
novel problem (15)

    Information describing use of a cytobrush in Pap smear
screening was used by investigator to modify protocol for study
of cytobrush use in Pap smear screening; study was completed and
results were written up.  (034501) 

    Inability to retrieve a specific recent citation describing
the reaction of a particular polyclonal antibody to a particular
protein and the sequence of that protein led to the investigator
calling the author of that paper; investigator used this
information to design experiments to react the antibody to
another protein he had recently purified; experiments were not
successful, and showed that the two proteins were not related. 
(I) (051003)

                    Access to materials obtained (6) 

                        Identification of the source of new
compounds that were purified from the fatty acid of the organism
pseudomonas aeroginosa, which inhibited acetyl-CoA synthetase,
allowed the researchers to contact the authors to acquire a
sample of the compound.  Without the information be could not
have conducted his experiments because he needed a blocker of
acetyl-CoA synthetase in order to show his effect was the result
of transport not metabolism.  (052401)

    Identification of too much information made it difficult for
the researcher to identify the appropriate benzodiazepine which
he could use to block TRH receptors in the pituitary but do not
enter the brain.  (T01202)

               Interpretation of results clarified (7)

    Information describing negative clinical trials of therapies
for cystic fibrosis for which there are an average of 14 patients
in a study led investigator to suggest that these studies may not
have the statistical power to support such negative conclusions
due to the small number of subjects; investigator has written a
paper evaluating negative clinical trials.  (033401)

    Information describing a reaction undergone by guanine
methyl sulfate that blocks in vitro DNA synthesis was used by
investigator to explain his own problems synthesizing DNA by
treating cells with dimethyl sulfate; investigator was greatly
relieved to find support in the literature for his experimental
results and his student who is writing his thesis on this topic
will cite this paper.  (056601)

               Relationship of ongoing research to other/previous
research clarified (42)

    Case reports of problems with polyethylene as a
total-joint-replacement material were used by investigator to
document own research on the topic, and led investigator to begin
another study to continue to look for a better prosthetic joint
material.  (045401)

    Data indicating that phenobarbital does not block long-term
potentiation (LTP) in the hippocampus in animal studies was basis
for investigator's conclusion that his drug currently under
investigation, which does block LTP, is therefore different
pharmacologically from phenobarbital; investigator was therefore
spared the necessity of proving this experimentally and could
proceed to other, more productive, experimentation.  (054001)

    Absence of information about scales used in nursing research
to assess wound healing led investigator to continue search for
this information, with help from a colleague; information was
eventually retrieved, and used by investigator to develop a scale
to assess the depth of a wound and to write a paper about this
scale.  (I)  (057302)
     
          Scientific communication prepared (46)

                    Research findings submitted for publication
(24)

    Information describing the use of a drunkmeter to measure
body water in humans was used by investigator to design study to
measure body composition of paraplegics as it relates to their
nutritional requirements; research was completed successfully and
5 or 6 papers were written documenting the results.  (034402)

    General background information describing research on the
influence of non-steroidal anti-inflammatory drugs on blood
pressure control, and a few articles specifically describing
randomized prospective trials, were used by investigator to
provide background for a paper documenting results of his
research on the topic.  (034801)
         Information on isolation of the fungus which causes
blastomycosis from beaver dam or fishing hut, was used by the
veterinarian as background information when he submitted his
paper documenting the results of his research on a new
experimental drug for the treatment of the pneumonia caused by
this fungus.  (071503)

                    Bibliographical source documented (22)

    Citation and abstract of a particular journal article on the
effect of estrogen on glucocorticoid receptor synthesis in the
pituitary was used by investigator to prepare for poster
presentation of her own research, and to cite the article in the
introduction to her presentation.  (016001)

    A couple of additional references that showed aging
correlated to changes in cardiac function were used in physician
researcher's paper describing his research on the relationship
of aging with changes in renal function correlated with changes
in cardiac function.  (T00602)

    Citations for approximately 400 articles on the topic of
ethical dilemmas and newborns were used by doctoral student to
present a comprehensive bibliography to his dissertation
committee in support of the viability of his planned historical
dissertation on the topic; the plan was approved and student has
begun research.  (048401)

               Research support obtained (36)

                    Application for research support strengthened
(25)

                        Information describing the expression of
glycoprotein T-200 during differentiation of cells was used by
investigator to support and strengthen research plan in grant
proposal.  (013803)
    Information describing previous studies of a cytoskeletal
protein in liver tumor cell lines was used by investigator to
document assertions in a grant proposal; grant proposal was
submitted.  (Funding is pending.)  (041601)

    General information about factors affecting human fetal
growth retardation was used by investigator to provide background
for grant proposal in a new area of research; proposal was
submitted.  (Funding status is unknown.)  (047701)

                    Application/review process facilitated (6)

    Information describing research by a specific author (who
was on the study section committee to review a proposal submitted
by this investigator) was used by investigator to improve methods
of glycoprotein analysis, and also reassured investigator that he
had submitted his proposal to the appropriate study section. 
(013802)

    Information on various methodologic approaches that could be
used in the study of the control of fatty acid utilization by
tissues and whether it is a biologically regulated process,
and the feasibility of each approach, was used by a member of the
metabolism study section, and his colleagues, to review the grant
applications in an area which he would otherwise not be well
versed.  (74202)

                    Regulatory approval received (5)

    An article describing a clinical study in which [new drug]
was used for cancer treatment with reasonable safety was used by
FDA regulator as basis for judgment that clinical trials of this
drug for breast cancer (a new application) would be relatively
safe; regulator granted approval to investigators who wished to
begin trials of the drug.  (049901) 
    Absence of any studies which were not contained in the
application for approval to conduct a clinical trial of a new
drug for breast cancer, convinced the physician working for
the FDA that there were no selective omissions of negative
studies, and the application was approved.  (049902)

               Appropriate participants secured for research
project or conference (5)

                   Information on the research interests and
prior collaborations of a neuroscientist, allowed a researcher to
decide whether he wanted to collaborate with the individual
before he spoke with him to see if his work was useful to his
laboratory and to give him an awareness of his prior research. 
(074402)

    Information on the latest references and research interests
of suggested speakers, allowed physician researcher to review
their work in light of the profile of the planned symposium on
hypertension, and to invite them to participate.  (024401)

Teaching End Results (249)

          Direct instruction (classroom, wards, grand rounds,
lectures) (172)

               Students, residents, or local medical colleagues
gained better understanding of topics in basic biomedical
sciences (12)

                   Inability to locate a specific article about
elevation in cyclic AMP in neuroblastoma cells led investigator
to ask a colleague to supply him with this article that was too
recent to be indexed in MEDLINE; investigator used this reference
in writing a literature review on the effects of prostaglandins
and beta-agonists on elevating cyclic AMP in neuroblastoma cell
lines.  (I) (030602)

    Information from review articles on the six subclasses of
colony stimulating factors, which affect cell proliferation, was
used by an animal science researcher to present a lecture of a
group of graduate students in animal science, and provided a
source of new information for both the instructor and the
students.  (013903)

               Students, residents, local medical colleagues, or
other health personnel gained better understanding of clinical
care (106)

                    Gained understanding of particular disease or
condition (pathophysiology, diagnosis, natural history,
prognosis) (42)

                        General information on multiple myeloma
was used by physician to supplement resident's talk on the
disease, particularly the history of use of antimony compounds
compared to modern treatments; staff gained a more complete
understanding of the illness.  (P12404)

                        Information indicating that gallbladder
disease may predispose to heart attack, but not vice versa, was
used by physician to determine that a patient with a heart attack
and right upper abdominal quadrant pain did not also have
gallbladder disease, to direct treatment accordingly, and to
instruct students; students learned about the reflex relationship
between the gallbladder and the heart.  Patient eventually
recovered.  (T03702)  

                        Absence of information describing
clinical studies, as opposed to animal studies, of proxisomal
disorders in children and adults hampered physician's ability to
prepare grand rounds presentation on a patient with proxisomal
disorder and also to choose treatment for the patient; physician
will reattempt search using "human" as a limiter.  (I)  (036401)

                    Gained understanding of (new) diagnostic
procedure (e.g. indications, procedures for performing,
interpretation of results) (13)

                        Information about use of ultrasound for
diagnosing carotid artery disease was provided by physician in
talk on a new radiologic technique (carotid Doppler ultrasound)
such that physicians in clinic gained an understanding about use
of the technique for diagnosis.  (038301)

    Information on the high accuracy rate for needle biopsy of
carcinoma cells of the prostate, using the size of the nucleolus
as a diagnostic criterion, allowed the pathologist to prepare and
present his talk to the city-wide cytology group so they gained
additional knowledge regarding cytology of prostate carcinoma. 
(036102)
 
                    Gained understanding of management of a
particular disease or condition (e.g. use of certain therapies,
overall care of the patient, risks involved in management) (9)

                        Small amount of information published
since 1983 about use of 6-mercapto-purine and azothyoprin for
Crohn's colitis and ulcerative colitis demonstrated to physician
that the most important research on the topic was done in the
1960s and 1970s, and that little new research was done in the
1980s; physician used this information to present a lecture;
medical students gained an understanding of the topic.
(P10402)

    Information on the different categories of mothers'
reactions to an unexpected caesarian birth, and the role of
success or failure on breast feeding in dealing with the
negative feelings, resulted in the nurse being able to provide
childbirth educators with specific techniques to identify those
women who need assistance and what interventions to employ. 
(U14502)

                    Gained understanding of (new) therapeutic
procedure (e.g. indications, dosage, efficacy, risks) (19)

                        Article illustrating malpositioning of
various types of catheter tips was used by physician for
teaching; residents learned to read films to identify
malpositioning and learned about potential complications of
malpositioning; article also served as a permanent reference for
these residents for future use in training and practice. (029102)

                        Inability to retrieve citations for all
of the new cooperative studies on use of Levine or peritovenous
shunts in treatment of ascites of which physician was aware
resulted in physician directly contacting investigators who had
performed a particular study; physician used data obtained, plus
other data obtained through the search, to deliver lecture;
members of journal club gained an understanding of the topic. (I)
(P10403)

                    Gained understanding of specific issues in
health care delivery (organization of services, role of
providers, role of patient and family) (17) 

                        Information obtained on group therapy
for families of children with cancer, allowed a social worker to
gain an understanding about families where children have cancer
and could speak to a class for clinical social workers. (T04502)

                        Information obtained on how other
institutions and physicians are confronting the situation of how
to determine brain death, was used by physician to make residents
more aware of the issues.  (038803)

                    Gained understanding of specific issues in
disease prevention (6)

                        Information about the chronic effects of
indoor air pollution on children allowed the physician to gain an
understanding about these effects and resulted in his being
offered a position.  (067902)
    Information on the methods of transmission of Clostridium
difficile infections in a hospital setting, led infection control
monitor to create more stringent controls on staff cleanliness,
through more staff education.  There were no more outbreaks since
the changes. (U11302)

               Students, residents, physicians, or other health
care personnel gained ability to access biomedical literature
(42)

                    Gained appreciation of value of on-line
medical information service for clinical care or research (12)

                        Retrieval of a collection of recent
citations about cardiac assist devices in animals was used by
physician to help graduate student develop a bibliography for her
master's thesis on this topic.  (P10805)

                        Retrieval of a series of articles on a
blood coagulation problem due to protein C deficiency, provided
the resident with an opportunity to see how quickly he could gain
access to information on an unusual clinical problem using an
on-line database.  (070001)

                    Gained better access to current literature in
their specialty (9)

                        Collection of all citations in MEDLINE
for the past three years from 6 major journals were downloaded
into a microcomputer by physician for use by medical department;
residents in department use this database regularly as a
reference.  (P10806)

                        A retrieval of all information on
surfactant and its associated proteins, led physician gain a
better perspective on surfactant research and will now have an
ongoing literature search updated monthly, to keep current in
this area. (U13901) 
                    Gained better access to broad-based
bibliographic information (11)

                        Large number of publications on the
national impact of ritodrine tocolysis (drug therapy for
inhibiting premature labor) allowed the physician to prepare a
report documenting the number of articles written on this topic
per year over the past fifteen years, to support the increasing
interest in ritodrine therapy over this period.  (T05501)

                        Information from 40-50 articles on lead
poisoning and trauma, allowed physician to have a more complete
information base with which to discuss his patients, in his
chapter in a book on lead intoxication from retained missiles
such as bullet fragments.  (T03001)

                    Gained better access to biographical
information (10)
                        Identifications of the complete
bibliography for a visiting dignitary led the researcher to
download all the citations and distribute the bibliography to
everyone in the department before he gave the lecture.  (052601)

    Identification of some new papers on photactivable labelling
by a researcher in France, allowed the molecular cell biologist
to keep up-to-date on the research interests of this individual. 
(025203)

               Lay public gained understanding of health issues
(12)

                    Gained understanding of use and possible
risks of particular medical therapies (4)

                        Absence of information on specific
treatment for fire ant bites led the physician to inform [youth
organization], who requested the information, that there is no
specific remedy for fire ant bites other than treating the
symptoms.  (T05802) 
    Information on the increased incidence of falls in older
people who are taking benzodiazapines, was included in the
medical writer's consumer book on prescription drugs in
older people.  (055301)

                    Gained understanding of the positive outcomes
or risks of particular health habits and behaviors (6)

                        Information describing incidence of use
of smokeless tobacco in adolescents and health implications aided
rural dentist who was a student in a public health program in
preparing a paper on the topic, and led him to design a survey of
use in middle schools and high schools, to deliver information on
the topic to medical societies, health departments, and schools,
and to counsel patients more vigorously against use of smokeless
tobacco.  (043001)  

    Information that a high fat diet is correlated with an
increased incidence of breast cancer, and that vitamin A and E
supplements decrease the risk of cancer, was used by the
physician in community talks and the nutritionist used the
information to counsel patients, who have already had breast
cancer; some patients have followed through and changed their
dietary habits.  (U19702)

                    Gained understanding of other general health
issues (2)

                        Information on definitions of the value
of humor in medicine and the names of critical workers in the
field, allowed the physician to network with the individuals to
access the latest information and prepare his talk for the public
on the emotional aspects of cancer, laughter, and medicine. 
(U19403)

    Information on children of the survivors of the Holocaust
was used by the psychologist to prepare his talk for a consumer
group.  (024502)
 
          Professional writing (textbooks, non-research articles,
case reports) (74)

               Wide professional audience gained better
understanding of clinical care 
                    Gained understanding of particular disease or
condition (pathophysiology, diagnosis, natural history,
prognosis) (25)

                        Information about Merkel cell tumors of
the skin and their immunohistochemistry was used by physician to
document a case study of this life-threatening condition seen in
one of his patients.  (028701)

                   Information about the natural course of
B-cell lymphoma of the skin, diagnosis, and treatment was used by
physician to document a case study of this rare and
life-threatening condition seen in one of his patients.  (028703)

    Lack of information citing titles of books on food
allergies, led physician to ask medical librarian to search
CATLINE, in order to get the titles, to settle an argument
between the physician (author), book sponsor, and publisher, on
what the title of his book should be, so that the book could be
published and provide new information on food intolerance in
infants.  (070601)
 
                    Gained understanding of (new) diagnostic
procedure (e.g. indications, procedures for performing,
interpretation of results) (13)

                        Inability to locate articles
specifically describing test results in children with cochlear
implants (search yielded many articles on other types of auditory
prostheses) led physician to use another method to locate
articles on this topic; physician wrote a paper on the topic. 
(I) (030803)         
    Information on new staining techniques used in diagnostic
cytochemistry of acute leukemia were used by the pathologist in
his book on the subject.  (063302)

                    Gained understanding of management of a
particular disease or condition (e.g. use of certain therapies,
overall care of the patient, risks involved in management) (6)

                        Information on lymphocyte
pathophysiology and its role in kidney and heart transplant
rejection allowed a nephrotologist to prepare the manuscript
and present his talk to a national seminar updating physicians on
the management of transplanted organs.  This was a very hot topic
because certain of these lymphocytes are transferred during
transplantation and react causing rejection graft vs. host
disease.  (T07801)

    Lack of information on the use of certain medications, such
as nitroglycerin, to dilate blood vessels during microsurgery,
resulted in surgery preparing a paper on his experience
using these medications as an aid in repairing the vessels during
microsurgery, such as reattachment of severed fingers.  (U06201)

d.   Gained understanding of (new) therapeutic procedure (e.g.
indications, dosage, efficacy, risks) (20)              
               
    Information on drugs which are toxic to the kidneys,
including the startling information to the physician that
indomethacin is toxic to the kidney of the fetus, was used as
part of a review article on drugs that are toxic to the kidney. 
(058502)

    Original source which said that gastric freezing was good,
and a later one which stated that it was terrible, provided both
points of view in a review article on gastric freezing, which
was a technique to stop gastric bleeding, but was abandoned
because by the end of a year the patients bled again.  (077901)

    A series of articles on sclerosing agents, duration of
wrapping, and wrapping techniques, helped physician prepare a
paper and a talk to a national audience on his experience with
scleral therapy for varicose veins.  (U00501)

e.   Gained understanding of specific issues in health care
delivery (organization of services, role of providers, role of
patient and family( (3)

                        Studies of attitudes and beliefs toward
aging and the elderly on the part of society in general, the aged
themselves, and health care providers were used by investigator
to prepare a literature review of the topic.  (013402)

    Information on individual DRG's and how they impact on the
hospital as far as remuneration, possible impact on care, and
death rates and readmission rates in nursing homes were used by
physician to write a 10-page summary and 300-citation
bibliography on the quality of care in the Peer Review
Organization which formed the basis of his testimony before a
congressional committee.  (063001)

               Wide professional audience gained access to
clinical observations and case reports   (7)

    Information which indicated that while Cogentin has been
reported to be helpful in the treatment of neuroleptic malignant
syndrome, there is not true drug therapy for the condition and if
the neuroleptic drug is withdrawn, the patients get better,
contradicted the physician's experience where treatment with
Cogentin caused dramatic improvement in the patient, which she
reported in a case report.  (U08801)

    Lack of substantial reports of patients who visit a doctor
for lower back pain, and in the course of the workup are found to
test positive for AIDS, resulted in the orthopedic surgeon
writing up a case report of such a patient so that other spine
surgeons would be made aware that AIDS is a possibility in
patients with back pain.  (T07901)
 
          Physician's own understanding  (3)

              Information obtained on a monthly basis on CPR and
emergency cardiac care led the physician to increase his
understanding of the newest trends in the area, such as new
treatment or education modalities, which he can use in a variety
of his professional activities. (U00701)

    Information on Forcious Erikson ocularomnis, was used by
ophthalmologist to keep himself current on the subject, since he
was nine months behind in reading Current Contents.  (36403)

Administrative End Results (102)

          Physician's own practice (27)

               Physician altered care for specific condition (20)

                    New protocol/standards adopted by physician
(14) 

                        Information which discussed the rates of
positive needle localizations for malignancy based on the results
of mammography showed the physician where he should change his
practice in terms of reading mammograms and determining the
indications for performing a needle biopsy.  Instead of biopsying
when there were three calcifications, the literature suggested
biopsying if the patient has five or more.  He also found that
his positive for malignancy rates after biopsy were in line with
the national average.  (P12102)

    Information on a newly marketed bronchodilator for the
treatment of childhood asthma resulted in the physician changing
the way he manages his patients.  He now uses agents which are
more selective for bronchodilation, rather than the more general
drug he was taught to use as an intern.  (T01801)
                    New equipment/technology adopted by physician
(6)  

    Information on the test results, testing protocols, and
reliability and validity of the various machines to perform
isokinetic testing, led physical therapist to purchase and
utilize two pieces of the this equipment, one for testing backs
and another for lower extremities. (T05301)

    Lack of information on the utility of newer blood counting
machines, especially with respect to mean platelet volume, led
physician to delay making a decision on whether to purchase one
of the new machines.  (I) (P30402)

               Appropriate future employment pursued (6)

                   Identification of an article by another
investigator on using biochemical methods to study neuronal
development in a journal that the researcher did not normally
read (he was a biochemist, not a cell biologist), led the
researcher to find out more about that investigator's work, and
interview with him for a fellowship position.  The researcher
liked the approaches used in that laboratory and made the
decision to accept a position.  (051002)

    Identification of several groups that were doing work in
neurobiology with some interface with the immune system, a topic
relevant to the research interests of a
rheumatologist/immunologist, led him to talk with other experts
about their opinions of the different laboratory and enabled him
to make a decision on the laboratory where he would spend his
sabbatical.  (068802)

               Physician's personal business endeavors did not
benefit (1)

                   Absence of information on implants of
anabolic steroids for weight gain in cattle, led the veterinarian
to continue to use the recommendations of the feed lot operators
in his cattle-raising business.  (I)  (043403)


          Hospital (66)

               Personnel matters successfully resolved (2)

    Bibliography of publications by a physician who was an
applicant for an attending position at a hospital was provided by
research assistant to the person who would by interviewing the
candidate.  (049401)

    Retrieval of the bibliography of an associate, which
contained only one case report in the past 20 years rather than
the extensive bibliography which he claimed to have, resulted in
a re-evaluation of his honesty.  (P11202)

               Hospital adopted or altered protocol/standards of
care for specific condition (40)

    Recent national mortality statistics referencing
birthweights and death rates at different gestational ages were
used by investigator to compare with similar statistics from his
own hospital for the purpose of publication and for analysis and
potential revision of the hospital's standards for ultrasound
identification of growth-retarded fetuses.  (011203)

    Information from a wide variety of journals on the causes of
urinary tract infections led physician to develop a questionnaire
to administer to his female patients who have urinary tract
infections which addresses all sources of the infection.  This
has improved the physician's ability to track and prevent urinary
infections in his patients.  (066602)

    Lack of specific information on the safety and efficacy of
using sodium bromide in the treatment of seizures in pediatric
patients made it more difficult for the Pharmacy and Therapeutics
committee to approve its addition to the formulary.  Ultimately
its use was approved, but only in restricted cases.  (044001)

               Hospital continued to use existing
protocol/standards of care for specific condition while
maintaining quality of care (17)

    Information describing animal studies of use of LHRH analogs
for management of uterine fibroids, but an absence of human
studies advanced enough to provide a standard of care on this
issue, led physician on a clinic committee to decide that LHRH
analogs are not yet a viable option for management of uterine
fibroids.  Committee eliminated LHRH as a possible alternative to
surgery in its guidelines.  (019402)

                   Lack of information on proper dosages of
heparin to prevent deep vein thrombosis, led physician and his
colleagues to continue to use their existing protocol, since they
had no evidence to prove that it would be helpful to change to a
new prevention protocol.  Physician did not believe they had a
higher incidence of deep vein thrombosis with their current
protocol.  (I) (T07701)

               Hospital set up new facility/service (7)

                   Broad-based information on demographics,
financial operations, and models of children's hospitals
convinced the hospital administrator to support the arguments put
forth by the pediatricians of the need for a separate children's
hospital. (U09502)

    Articles chronicling the prevalence of substance abuse among
the chronically mentally ill and treatment models which have been
used resulted in a mental health agency quickly setting up a
program to accommodate schizophrenics and other chronically
mentally ill who have substance abuse as their main problem. 
(U04801)

          Other institution or organization (9)

               Personnel matters successfully resolved (1)

                   Identification of a large number of recent
articles by a researcher in a subject area medical school was
interested in including on their faculty convinced a chairman of
the search committee to invite this previously unknown researcher
to present a seminar and discuss one of the department's job
openings.  (048501)


               Government program policy established or revised
(8)

                   Absence of new information concerning
community health effects of disposal of solid wastes from
hospitals reassured county health department employee that his
research on the topic was exhaustive.  County employee informed
state health department that proposed new state regulations to
treat medical wastes as hazardous wastes were excessive and would
place unnecessary burden on hospitals.  State altered proposed
regulations and labeled hospital wastes special wastes instead of
hazardous wastes. (T04801)

              Absence of new information on screening for and
identification of children with dyslexia assured
physician-administrator of a public school district that the
district did not need to change its current procedures. Physician
developed a policy that put school district into compliance with
latest state law without changing the screening method itself. 
(T00201)

Legal End Results (22)

          Patient or physician effects (8) 

               Patient protected from adverse decision (2)

    Information on the complications of thoracic outlet syndrome
and its surgical management was used by a surgeon to provide
testimony to support a patient's claim of lack of attention to
detail by another surgeon who had operated on the patient, an
operation which resulted in injury to the ulnar nerve and partial
paralysis.  (U11903)

    Lack of information on the causes of spinal cord infarction
after surgery did not provide the neurologist with enough
information to counsel the patient's lawyer in a case involving a
patient who developed paraplegia following abdominal surgery in
the retroperitoneal area.  (I) (021103)


               Physician protected from unwarranted legal action
or adverse decision (6)

    Identification of articles from surgical journals on the use
of actuarial statistics in medicine will allow  psychiatrist to
refine his approach to courtroom testimony in that when he is
asked to make a prediction, he will make a more considered and
elaborate response.  (063803)

    Information that indicated that in 1977 there were published
articles that indicated that cryosurgery was appropriate as a
treatment for basal cell carcinoma, allowed the physician to pass
the information along to the attorney defending a physician
against malpractice who used this procedure on a patient with the
condition in 1977.  (019602)

          Legal process (14)

               Time and expense of questionable suit avoided (12)

    Information indicating that Stoddard's solvent and similar
solvents were linked to hepatic cancer in rats, but that there
was no documented link to hepatic cancer in humans, was used by
epidemiologist to counsel family of patient who had died from
liver cancer that occupational exposure to the solvent was
probably not the cause of his illness, and that there was not a
reasonable justification for them to take legal action to
pressure the company to change the work environment or to sue the
company for damages.  Family was very reassured by this. 
(T03701)

    Information that suggested that occasionally congenital hip
problems are not picked up until the child begins to walk, even
though they had routine testing at birth, allowed a physician to
pass the information on to child's mother's lawyer to give him
the background to build a defense that there were no grounds for
a suit on the basis of neglect simply because the hip problem was
not found until the child started to learn to walk.  The case was
dropped. (062902)


               Offenders tried on appropriate grounds (1)

    Information that indicated that the entire concept of the
"shaken baby syndrome" was based on one article, and that there
was no scientific basis for the premise, convinced forensic
pathologist that it should stop being used as a defense for
defendants in child abuse cases (i.e., the lawyer tells the jury
that the client-parent just "shook" the child, when in fact the
parent probably threw the child).  (T04301)

               Illegal business closed (1)

                   Physician was asked to prepare a written
accusation for the state medical licensure board regarding a
business that advertised a high colonic (washing out the
colon) as a cure for colon cancer, diverticulitis, and colitis. 
Failure to obtain information on "colon hydrotherapy" meant that
physician could not include information on any recognized
detrimental effects of the colonic washouts, but the business was
closed for practicing medicine without a license.  (I) (U14902)

Outcome unknown or not yet determinable (56)