Wüsteria

The last two decades have seen considerable efforts directed towards making Electronic Health Records interoperable through improvements in medical ontologies, terminologies and coding systems. Unfortunately, these efforts have been hampered by a number of influential ideas inherited from the work of Eugen Wüster, the father of terminology standardization and the founder of ISO TC 37. We here survey Wüster’s ideas – which see terminology work as being focused on the classification of concepts in people’s minds – and we argue that they serve still as the basis for a series of influential confusions. We argue further that an ontology based unambiguously, not on concepts, but on the classification of entities in reality can, by removing these confusions, make a vital contribution to ensuring the interoperability of coding systems and healthcare records in the future

Chronic urticaria: What diagnostic evaluation is best?

A detailed history and 6-week trial of an H1 antihistamine are the best diagnostic evaluations for chronic urticaria. More extensive diagnostic work-up adds little, unless the patient's history specifically indicates a need for further evaluation (strength of recommendation: B, inconsistent or limited-quality evidence)

Narrative Skills in 4-Year-Olds With Normal, Impaired, and Late-Developing Language

Two groups of children who were slow in expressive language development (SELD) at age 2 and a matched group of toddlers with normal language were re-evaluated at age 4. Assessment included measures of productive syntactic skills in spontaneous speech and narrative abilities in a standard story retelling task. Four-year-olds who continued to perform below the normal range in sentence structure production scored significantly lower than their normally speaking peers on all measures of narrative skill. Children who were slow to begin talking at age 2 but who, by age 4, had moved into the normal range in basic sentence structure production showed no statistically significant differences, in terms of several of the measures of narrative ability, from either normally speaking 4-year-olds or from the group with persistent delay. The implications of these findings for the management of early language delay and its relation to school learning disability are discussed

What is the most effective way to treat recurrent canker sores?

Amlexanox appears to be most effective overall. Amlexanox 5% paste reduces ulcer size, pain duration, and healing time (strength of recommendation [SOR]: A, multiple randomized controlled trials [RCTs]). Topical steroids may alleviate pain and decrease ulcer burden, defined as total number of ulcers over a measured time, usually 4 to 6 weeks (SOR: B, multiple small heterogenous RCTs). Chemical cautery agents also lessen pain (SOR: A, single RCTs on differing agents), and chlorhexidine mouthwashes may reduce overall ulcer burden (SOR: B, heterogeneous RCTs). The herbal preparation Eupatorium laevigatum alleviates pain and improves healing (SOR: B, single RCT). Oral vitamin B12 supplements and avoiding toothpastes containing sodium lauryl sulfate may prevent recurrent ulcers (SOR: B, small RCTs)

What is the best treatment for plant-induced contact dermatitis?

It's unclear which treatment is best, because there have been no head-to-head comparisons of treatments for Rhus (plant-induced) contact dermatitis. That said, topical high-potency steroids slightly improve pruritus and the appearance of the rash (strength of recommendation [SOR]: B, small cohort studies). Neither topical pimecrolimus (an immunomodulatory drug) nor jewelweed extract are helpful (SOR: B, 1 small randomized controlled trial [RCT]). Oral steroids improve symptoms in severe cases (SOR: C, expert opinion)

Ferning in amniotic fluid: Is it a useful indicator of ruptured membranes?

The presence of arborized crystals (ferning) in amniotic fluid is both sensitive (74%-100%) and specific (77%-100%) for diagnosing rupture of membranes in laboring women who report loss of fluid (strength of recommendation [SOR]: A, multiple prospective cohort studies). However, it is much less sensitive and specific for women with fluid loss who aren't in labor (SOR: B, 1 prospective cohort study). Gross contamination of amniotic fluid with blood or antiseptic solutions may decrease the diagnostic accuracy of ferning, whereas contamination with meconium doesn't (SOR: C, bench research)

Saying No to Say Yes: Mediating Student Technology Needs in Times of Crisis

This chapter details the mediating role embraced by the SSU Library in managing university-wide technology and learning challenges during an unanticipated pivot to remote instruction and is organized according to lessons learned. Responding to COVID disruptions in real time, we identified key areas where our expertise and relationships allowed us to advocate for and support students, while also saying no or limiting our participation in others. Limiting the services provided during a crisis to only those that fit within the core scope of our mission was a powerful tactic that libraries should exercise often and widely communicate. Rather than answering every call to service and overextending ourselves, libraries must embrace saying no and exercise transparency around decision-making. In doing so, libraries conserve energy and resources to deliver core services, thereby ensuring that primary services are thriving, robust, and able to withstand instabilities wrought by crises

Do asymptomatic adults need screening EKGs?

Although certain electrocardiogram (EKG) findings in asymptomatic adults are associated with increased mortality (strength of recommendation [SOR]: A, high-quality cohort studies), no randomized trials demonstrate that any intervention based on abnormal screening EKGs improves outcomes in this group of patients. Comparison to a baseline EKG has a minimal effect on emergency department (ED) management. (SOR: B, 2 prospective studies and one retrospective study)